DEVELOPMENT OF MODERN MEDICINE 211 Pflanzen" (II, 277-310), a paper on the "Etiology of Anthrax" by a German district physician in Wollstein, Robert Koch (Fig. 105), which is memorable in our literature as the starting point of a new method of research into the causation of infectious diseases. Koch demonstrated the constant presence of germs in the blood of animals dying from the disease. Years before, those organisms had been seen by Pollender and Davaine, but the epoch-making advance of Koch was to grow those organisms in a pure culture outside the body, and to produce the disease artificially by inoculating animals with the cultures. Koch is really our medical Galileo, who, by means of a new technique, pure cultures and isolated staining,-introduced us to a new world. In 1878, followed his study on the "Etiology of Wound Infections," in which he was able to demonstrate conclusively the association of micro-organisms with the disease. (Fig. 106.) Upon those two memorable researches made by a country doctor rests the modern science of bacteriology. The next great advance was the discovery by Pasteur of the possibility of so attenuating, or weakening, the poison that an animal inoculated had a slight attack, recovered and was then protected against the disease. More than eighty years had passed since on May 14, 1796, Jenner had vaccinated a child with cowpox and proved that a slight attack of one disease protected the body from a disease of an allied nature. An occasion equally famous in the history of medicine was a day in 1881, when Pasteur determined that a flock of sheep vaccinated with the attenuated virus of anthrax remained well, when every one of the unvaccinated infected from the same material had died. Meanwhile, from Pasteur's researches on fermentation and spontaneous generation, a transformation had been initiated in the practice of surgery, which, it is not too much to say, has proved one of the greatest boons ever conferred upon humanity. It had long been recognized that, now and again, a wound healed without the formation of pus, that is, without suppuration, but both spontaneous and operative wounds were almost invariably associated with that process; and, moreover, they frequently became putrid, as it was then called,infected, as we should say, the general system became involved and the patient died of blood poisoning. So common was this, particularly in old, ill-equipped hospitals, that many surgeons feared to operate, and the general mortality in all surgical cases was very high. Believing that it was from outside that the germs came which caused the decomposition of wounds, just as from the atmosphere the sugar solution got the germs which caused the fermentation, a young surgeon in Glasgow, Joseph Lister, applied the principles of Pasteur's experiments to their treatment. From Lister's original paper* I quote the following: "Turning now to the question how the atmosphere produces decomposition of organic substances, we find that a flood of light has been thrown upon this most important subject by the philosophic researches of M. Pasteur, who has demonstrated by thoroughly convincing evidence that it is not to its oxygen or to any of its gaseous *Lancet, March 16, 1867. [Cf. Camac: Epoch-making Contributions, etc., 1909, p. 7.—Ed.] constituents that the air owes this property, but to minute particles suspended in it, which are the germs of various low forms of life, long since revealed by the microscope, and regarded as merely accidental concomitants of putrescence, but now shown by Pasteur to be its essential cause, resolving the complex organic compounds into substances of simpler chemical constitution, just as the yeast-plant converts sugar into alcohol and carbonic acid." From these beginnings modern surgery took its rise, and the whole subject of wound infection, not only in relation to surgical diseases, but to child-bed fever, forms now one of the most brilliant chapters in the history of preventive medicine. With the new technique and experimental methods, the discovery of the specific germs of many of the more important acute infections followed each other with bewildering rapidity: typhoid fever, diphtheria, cholera, tetanus, plague, pneumonia, gonorrhoea and, most important of all, tuberculosis. It is not too much to say that the demonstration by Koch of the "bacillus tuberculosis" (1882) is, in its far-reaching results, one of the most momentous discoveries ever made. ness. Of almost equal value have been the researches upon the protozoan forms of animal life, as causes of disease. As early as 1873, spirilla were demonstrated in relapsing fever. Laveran proved the association of hæmatozoa with malaria in 1880. In the same year, Griffith Evans discovered trypanosomes in a disease of horses and cattle in India, and the same type of parasite was found in the sleeping sickAmœbæ were demonstrated in one form of dysentery, and in other tropical diseases protozoa were discovered, so that we were really prepared for the announcement in 1905, by Schaudinn, of the discovery of a protozoan parasite in syphilis. Just fifty years had passed since Pasteur had sent in his paper on "Lactic Acid Fermentation" to the Lille Scientific Society-half a century in which more had been done to determine the true nature of disease than in all the time that had passed since Hippocrates. Celsus makes the oft-quoted remark that to determine the cause of a disease often leads to the remedy,* and it is the possibility of removing the cause that gives such importance to the new researches on disease. * "Et causæ quoque estimatio sæpe morbum solvit," Celsus, Lib. I, Prefatio.—Ed. |