SOME RECENT ADVANCES IN MEDICINE RALPH P. SMITH IN writing an article of this type, one is always somewhat fear­ ful of becoming over technical, and should I do so, I crave indulgence. Medicine has progressed considerably since the days of the old family practitioner, who relied mainly on the use of his eyes, ears and hands for diagnosis, and was somewhat scornful of the newer methods. However, many of the newer laboratory and mechanical aids make diagnosis infinitely more sure, and enable the physician to gauge the course of the illness more accurately and thus to give a more reasoned opinion. The contrast in bacteriology, which is a comparatively recent science, between the vague speculations of the ancient phil­ osophers, that there existed living organisms too small to be seen by the unaided human eye, and the present certainty of that science, is outstanding. Prior to the work of the Dutch microscopist, Anton Van Leuwenhoek, in the latter part of the 17th century, definite ocular evidence for such a belief did not exist. He was a skilled lens maker in Delft, who spent many years looking through his microscope at a great variety of natural objects (with industry. if without system), and chanced to come across the organisms now known as bacteria in stagnant water. In a letter in 1683 to the Royal Society, London, speaking of what he saw in some tartar from his teeth, he wrote: "I S!1W with wonder that my material contained many tiny animals which moved about in a most amusing fashion and were one thousand times smaller than the eye of a big louse" (thereby showing a familiarity with the latter animal which we do not have to the same extent at the present time!). But he had no inkling of their significance, and 200 years had to elapse before that was realised. Even in the 16th century, from as far back as the time of Aristotle, the statement that mice could be created by placing some old linen and cheese in a cupboard was believed in all seriousness, and, in spite of the earlier work of Ehrenberg, Naegeli and Spallanzani, spontaneous generation and fermenta- 22 THE DALHOUSIE REVIEW tion was not finally disproved until Pasteur's researches around the year 1860. It was almost entirely through the work of Pasteur that bacteria and their allies emerged from their re­ lative obscurity and took a conspicuous position in natural science, as a group of organisms whose activities were full of significance for all mankind. He placed the germ . theory of many diseases in man and animals on a sound basis. Lord Lister, whose own name is inseparably connected with the triumphs of antiseptic surgery, said in an address to Pasteur in 1892 at the latter's Jubilee celebration: Truly Lhere does not exist in the en tire world any individual to whom medical sciences owe more than they do to you. Your researches have thrown a powerful beam, which has enlightened the baleful darkness of surgery and has transformed the treat­ ment of wounds from a matter of uncertain and too often dis­ asterous empiricism into a scientific art of sure beneficence. Thanks to you, surgery has undergone a complete revolution, which has deprived it of its terrors and has extended without limits its efficacious power. But Lister's own work on the cause and prevention of wound putrefaction, by means of a spray of carbolic acid to kill off bacteria which might drop into a wound, led to the general adoption of the aseptic or germless technique to which the advance of modern surgery has been chiefly due. We are proud to possess a Lister Carbolic Spray in the small Historical In­ strument Museum of the Nova Scotia Medical Society, brought back to Nova Scotia by our own beloved surgeon, the late John Stewart, who served under Lister in Edinburgh, even though to our modern eyes it looks so much out of date. To give an example of the practical benefits of bacteri­ ology:-my readers have no doubt noticed that there has been recently a scare concerning the use of shaving brushes of Ja­ panese origin, wbicb are believed to have been contaminated by anthrax bacilli. Anthrax bacilli, first discovered by Robert Koch in 1876, have the power of forming what are called spores when exposed to air. This is a stage of hibernation by which the bacterium as it were curls itself up into its shell, and is able to resist deleterious or harmful external influences. It can live in this state for years, and then germinate afresh and cause infection when introduced into a suitable environment. As anthrax is a disease of cattle and sheep, the bacilli contam­ inate the hairs and hides, and unless these are properly sterilized (and this is done only by steam heat under pressure) they may SOME RECENT ADVANCES IN MEDICINE 23 induce the disease. Hence, shaving brushes made from such hairs, improperly sterilized, are a potential source of danger to everyone who uses a contaminated brush. The spores enter a nice cut and then grow, causing a local angry wound from where they spread to the blood stream and cause death. Un­ fortunately, no efficient antiserum has as yet been evolved, but early surgical excision yields many cures. We are passing through the season of pneumonia, a disease which takes more lives than any other disease, except heart disease and cancer. It causes an inflammation with consolida­ tion of the lung or lungs, and in over 95% of cases is due to a small lancet shaped bacterium occurring in pairs, the pneumococ­ cus, which is surrounded by a gelatinous envelope or capsule. The latter makes it more dangerous or virulent. Until recently only four types of pneumococci had been identified, but now we recognize 23 types. Neufeld discovered that each of these 33 types could be identified by mixing a drop of sputum, con­ taining pneumococci, from a case of pneumonia, wi Lh a drop of serum (which is the fluid part of the blood, separated from the blood cells) from a rabbit, previously injected with the same type. When mixed only with its own type serum, the cap­ sule swells up to 2 or 3 times its normal size, and thus allows one to identify it under the microscope. Within the last few months antisera have been elaborated for treatment against all of the types causing pneumonia, but they are of value only against the individual type of pneumococcus causing the di­ sease. Formerly we had antisera only for Types I and II, which were obtained from the horse by injecting it with pneum­ ococci of these types. Now we use not only the horse serum for,certain types, but also a similar serum made from rabbits. By use of these antisera the mortality of the disease has been reduced by more than 2 or 3 time:') , The serum acts by aiding the defences of the body, namely the white cells of the blood, which in turn destroy the pneumococci, if the outcome is favour­ able, and remove the inflammatory products which make the lung solid. The only drawback to the use of antisera is the necessity of great care in giving in case of a reaction; it requires to be given very slowly, and this is time consuming. Within Lhe past two years a new drug has been added to our armaments in the war against the pneumococcus. It is called sulphapyridine, M. & B. 693, and dagenan. The story of the drug really begins with that very famous German chemist and 24 THE DALHOUSIE REVIEW bacteriologist, Paul Ehrlich, who had a theory that certain chemicals would kill bacteria inside man without injuring or killing man himself. He experimented with hundreds of ar­ senical compounds until he finally stumbled on the famous 606, salvarsan,-which has been of invaluable aid in the cure of syphilis. Since then, research chemists and bacteriologists everywhere have been looking for something to destroy other disease producing organisms. About 4 or 5 years ago in Ger­ many, Gerhardt Domagk discovered certain chemical compon­ ents in a new dye substance, called sulphanilamide, and tested it for checking streptococcus infection (rolmd bacteria occurring in chains which cause tonsilitis, abscesses, erysipelas, scarlet fever, purperal or childbirth fever, etc.). Excellent results have been experienced by sulphanilamide treatment, and it has been tried on numerous other disease producing germs. In turn, pneumococci faced it. White mice, which are very sus­ ceptible to pneumococci, were injected with pneumococci and sulphanilamide, but died. Their deaths were slower than when pneumonia germs alone were injected, however, and in the Laboratories of May and Baker in Birmingham, England, research chemists strove to find a combination of the atoms in Domagk's drug which would protect. After many failures, Dr. Lionel Whitby, the pathologist who tested these drugs at Dudley Road Hospital, Birmingham, England, finally with preparation 693 was able to record success. The control mice, given pneumococci alone, all died, but those given "693" with enough pneumococci to kill 10,000 mice lived. But before the drug could be used on human beings, he had to discover whether the new M. and B. 693 (sulphapyridine or dagenan) was poisonous, and what was the lethal dose. To :find this out, Whitby gave tremendous quantities to his mice until it killed them. Can this drug kill human beings too? It can, just as salt, caffeine or alcohol, can kill when administer­ ed in staggering doses, but now a imitable dosage for human beings has been worked out.