The antiseptic failure: How the historical tension between inhibition and destruction created the antibiotic resistance crisis

“ Sterilization is the absolute destruction of all organic life, whether infectious or not; it is therefore more than disinfection, which destroys the germs of infection alone.
A Disinfectant is an agent which destroys germs of infection.
A Germicide is the same; an agent destroying germs.
An Insecticide is an agent capable of destroying insects; it is not necessarily a disinfectant, nor is a disinfectant necessarily an insecticide.
An Antiseptic is a substance which inhibits and stops the growth of the bacteria of putrefaction and decomposition. ”

“ In the arts, any substance which arrests fermentation and decay; in medicine, any agent which arrests the development and growth of micro-organisms. A germicide is a substance or agency which destroys these micro-organisms. ”

“ All cleansing operations and antiseptic processes are instituted with the sole idea of preventing the entrance of germs into the wound, either from the hands of the operator, the dressings, instruments, or the skin of the patient.
Antiseptics are chemical substances which have the power of killing germs outright, or so checking their growth that the cells in the blood can easily cope with them. The antiseptics that are mentioned in these notes are carbolic acid, chinosol, permanganate of potash, and boric acid. ”

“ PREFERRED ANTISEPTICS ANTISEPTIC SOLUTIONS
These are solutions used for the destruction of and to arrest the progress of microörganisms that have found their way into wounds—the cause of sepsis, as exhibited by fever, suppuration, and putrefaction. These preparations are called antiseptics and are used to render parts aseptic. They vary much in their destructive power, effect on tissue, and toxic properties. ”

“ The ideal treatment of any parasitic disease would be to administer drugs which have a specific destructive influence upon the parasites, but spare their host, i.e., the cells of the animal body. But no substance of such virtue is known to us. All so-called antiseptics, i.e., chemicals arresting bacterial life, injure the body as much as if not more than the bacteria. For the latter of all living beings are characterized by their resistance to poisons. ”

“ The ideal treatment, however, of bacterial disease is to put into the blood a substance, like an antiseptic, which will kill the bacteria or neutralize their toxines, but which will not injure the tissues with which it is brought in contact. ”

“ It might be easy enough for a doctor to make a patient swallow some antiseptic solution, like carbolic acid or corrosive sublimate or nitrate of silver, for the purpose of getting rid of certain undesirable bacteria in the intestines, but it does not need a doctor to know that for a patient to swallow such active poisons as these would not merely kill the harmful bacteria and the good ones as well, but probably the patient himself. ”

“ But while some surgeons were thus ceasing to apply the antiseptic spray to the wound during operation, others were pouring mild carbolic lotion, or a very weak solution of corrosive sublimate (an extremely potent germicide) over the freshly-cut surfaces. These measures were in turn given up, to the advantage of the patient; for it was hardly to be expected that a chemical agent which was strong enough to destroy or render inert septic micro-organisms in and about a wound would fail to injure exposed and living tissues. ”

“ In some cases the knowledge obtained has led to a control of the attack or of the poisonous action of the parasite. Antiseptic surgery, by defeating the poisonous parasite, has saved not only thousands upon thousands of lives, but has removed an incalculable amount of pain. Control is slowly being obtained in regard to several others among these deadly microbes in various ways, most wonderful of which is the development, under man's control, of serums containing anti-toxins appropriate to each disease, which have to be injected into the blood as the means of either cure or protection. ”

“ The last transition in this model, the third, is the one that we are entering now. It is characterized by the continued prominence of chronic, non-infectious disease now augmented by the re-emergence of infectious diseases. Many of these infections were once thought to be under control but are now antibiotic resistant, while a number of “new” diseases are also rapidly emerging. The existence of pathogens that are resistant to multiple antibiotics, some of which are virtually untreatable, portends the possibility that we are living in the dusk of the antibiotic era. ”

“ Antibiotics save millions of lives each year in the United States and around the world. The rise of antibiotic-resistant bacteria, however, represents a serious threat to public health and the economy. ”

“ Crucially, when the heterogeneous traits involved are drug tolerance and virulence, then unfortunate clinical consequences may arise from the peculiar confluence of two facts—that expression of virulence proteins is expensive enough to slow cellular growth and that slow cellular growth helps bacteria to weather the presence of antibiotics. ”

“ They usually died because they "ate to keep up their strength." Most of these deaths were unnecessary, caused by ignorance and poor nursing care. For example, standard medical treatment for typhoid fever used to consist of spoon-fed milk--sure to kill all but the strongest constitution. Even without the assistance of massive doses of vitamin C, if people would but fast away infections they could cure themselves of almost all of them with little danger, without the side effects of antibiotics or creating mutated antibiotic-resistant strains of bacteria. ”

“ Antibiotics fight bacterial infections, like strep throat, whooping cough and symptomatic bladder infections. But they don't fight viruses—like common colds, flu, or most sore throats and sinus infections. Ask if you have a bacterial infection.
2 What are the risks? Antibiotics can cause diarrhea, vomiting, and more. They can also lead to "antibiotic resistance"—if you use antibiotics when you don't need them, they may not work when you do need them. ”

“ In addition to considering evolutionary factors in the emergence of disease, we will incorporate the spread of drug resistance and explore the implications of globalization in expanding the threat posed by some diseases. We also discuss how the epidemiological model allows us to examine the recent rise of certain classes of disease, such as the frequency of allergies and autoimmune diseases, in high-income countries. Finally, we discuss the ways in which increased attention from epidemiologists may clarify and improve the model. ”

“ In this article, we hope to have made it clear how the epidemiological transition model can prove useful to epidemiologists. It provides a means through which findings on individual diseases in disparate populations can be synthesized into a framework that facilitates understanding and intervention. As globalization speeds the appearance of new infections and the spread of old ones, and as degenerative diseases increasingly mingle with antimicrobial resistant pathogens in the same population, this model may help make sense of an increasingly complex disease-scape. ”

“ Just at present progress in serum therapy appears to be at a standstill, though vaccines are giving good results in many instances not believed possible a few years ago. As a consequence workers in all parts of the world are giving more and more attention to the search for specific chemical substances, which will destroy invading parasites and not injure the host (chemotherapy) . Nevertheless, in the study of immunity very much of value in the treatment and prevention of disease has been learned. Also much knowledge which is of the greatest use in other lines has been accumulated. ”

“ Soap has, owing to its alkalinity, disinfectant as well as cleansing action. A temperature of 55°-75° C. greatly aids its action. Antiseptic soaps possess no special value as germicides, but carbolic soap is a useful insecticide.
Lime in a one-tenth per cent. solution destroys typhoid and cholera microbes.
Mercuric Chloride (HgCl2, corrosive sublimate) was found by Koch to destroy anthrax bacilli in a dilution of 1 in 20,000. Others have obtained less favourable results, but it is certainly a powerful germicide. ”

“ Disinfecting agents and antiseptics, whether carbolic acid, salicylic acid, or iron, are of no service when administered internally only, unless the seat and cause of the septic infection be attended to previously. Under the local employment of antiseptics, as described, or by simply washing out with water or salt water, most cases recover; without them, death will result. ”

“ In the modern aseptic operating room germicides and antiseptics do not play so important a part as they formerly did. This is largely due to the fact that heat is used wherever possible in the preparation of sutures, ligatures, dressings and instruments, and to the farther fact that in uninfected tissues no antiseptic solutions are employed. It must also be remembered that the germicidal agents possess the disadvantage of exercising a more or less destructive action on the body cells, and consequently their use is not warranted in clean wounds. ”

“ I am fully of the opinion that chemical antiseptics would be needless if absolute freedom from germs was easily obtained. When I know that even such an enthusiast as I myself is continually liable to forget or neglect some step in this direction, I feel that the additional security of chemical antisepsis is of great value. It is difficult to convince the majority of physicians, and even ourselves, that to touch a finger to a door knob, to an assistant's clothing, or to one's own body, may vitiate the entire operation by introducing one or two microbic germs into the wound. ”

“ Until the last quarter of a century there was a large addition to the death rate each year from the blood poisoning following operations and injuries making open wounds. It was not until the discovery of the germs which cause septic poisoning that deaths from these causes could be checked. The use of antiseptics, such as carbolic acid, alcohol, and various other preparations, the boiling of all surgical instruments, and the boiling or baking of all articles used in the treatment of open wounds and sores has reduced the death rate at least one-half. ”

“ The means of passive and active defence are sometimes so closely associated that it is difficult to distinguish between them. Thus if a little diphtheritic sputum were coughed into a person’s eye, or some blood containing anthrax bacilli were to touch a raw spot upon the hand, the removal of microbes in either case by washing with simple water might be regarded as a means of passive defence, whilst washing them away with an antiseptic lotion might be regarded as active defence, because the antiseptic would tend not only to remove but to destroy the microbes. ”

“ The claims urged as to its germicidal power are indeed glittering. This “new chemical compound” is claimed to liberate formaldehyd in some new and peculiar condition which, while it has a soothing and tonic effect on the cells of the human tissues, can at the same time quickly kill any form of bacterial life.
“Dissolving readily, it releases its germicidal, antiseptic qualities, which impregnate the saliva and are carried naturally and easily around the mouth and in the deepest crevices of the throat—destroying the germs where they are causing the mischief. ”

“ Photographic reproduction (reduced) of an advertisement of the “originator” of Toxicide; it ran for many months in the program of a burlesque theater located in Ruckel’s neighborhood.
There is no evidence, however, that any effort has been made to demonstrate the presence of a “latent immunizing active principle” by scientific methods of modern immunology. The following claims for the use of Toxicide appear on the label:
“Acne, boils, carbuncles, furuncles and abscesses of the most virulent types usually begin to show improvement within 4 to 12 hours after beginning administration. ”

“ Glyco-Thymoline conflicts with Rule 1 of the Council on Pharmacy and Chemistry, which declares that no article shall be accepted for inclusion with New and Nonofficial Remedies unless its composition be furnished.
2. No matter which published formula be accepted as correct, it is at best a weak antiseptic. The antiseptic ingredients present cannot act as germicides in the strength in which they are used, or in the alkaline solution on the unique virtues of which the circular lays so much stress (“the one antiseptic solution based on the alkalinity and saline strength of normal blood”) . ”

“ The exploitation of such a preparation is deserving of strong censure. By such methods the firm places itself on the same plane as those nostrum venders, who advertise certain antiseptic sprays and gargles as cures for epidemic meningitis and diphtheria and thereby deprive credulous victims of the curative antitoxin treatment. Succus Alterans is not a new remedy on trial for its possibilities of improvement in therapeutics ”

“ An inefficient antiseptic is more than merely useless; it is a menace to public safety, in that it tends to lead to the neglect of rational and effective protective measures. It therefore seems advisable for the Council again to call the attention of physicians to the subject. Accordingly, three specimens of these products were purchased and examined in the Association’s Chemical Laboratory. ”

“ By the aid of these poisons the body is able to prevent the growth of the vast majority of bacteria which get into its tissues. Ordinary micro-organisms are killed at once, for these alexines act as antiseptics, and common bacteria can no more grow in the living body than they could in a solution containing other poisons Thus the body has a perfect protection against the majority of bacteria. ”

“ These resisting powers are in many cases entirely sufficient to prevent the bacteria from obtaining a foothold. If the invading host overcome the resisting powers, then they begin to multiply rapidly, and take possession of the body or some part of it. They continue to grow until either the individual dies or something occurs to check their growth. After the individual develops the renewed powers of checking their growth, recovery takes place, and the individual is then, because of these renewed powers of resistance, immune from a second attack of the disease for a variable length of time. ”

“ This production of antitoxin on the part of the infected body is a vital, protective mechanism of a chemical order; it is the chemical reply to a chemical insult. If the attacked body-cells can provide sufficient of this antitoxin to neutralize all the toxin made by the bacteria, the individual will not merely get well, but will remain immune from that particular infection for a long time, because, when once the body-cells begin making antitoxin they make a great deal more than is needed to neutralize all the toxin which the invaders have manufactured. ”

“ These soluble toxins affect, stimulate, the tissues of the victim, which, being living cells, react, and the expression of their reaction is the outpouring of a chemical something, appropriately called an antitoxin which, uniting with the bacterial toxin, neutralizes it and prevents it exercising its injurious powers. The infected organism thus works out its own chemical salvation by a vital, but no less chemical, response to the poison of the infection. ”

“ That an attack of certain diseases leaves the patient immune to that disease for a longer or shorter time has of course been known for centuries, but it is a modern discovery that a specific poison induces the body to produce a specific antidote which neutralizes it, and the detailed working out of this principle and the study of the means by which the immunity is brought about promise to lead us a long way towards the central problem of the nature and activities of life itself. ”

“ Now, as we have already seen from the experiments of Ogata, Kitasato, and others, the blood of an animal dead of anthrax is protective against anthrax, from which and the foregoing it appears that microbes produce by their growth in the tissues poisonous substances we term toxins, which have the power of producing in the blood and body cells substances inimical to themselves, named antitoxins, and so long as these latter substances remain in the tissues the body remains insusceptible to further attacks of the same disease. ”

“ Underneath all this storm and stress of the fever paroxysm, nature is quietly at work elaborating her antidote. In some marvelous fashion, which we do not even yet fully understand, the cells of the body are producing in ever-increasing quantities an anti-body, or antitoxin, which will unite with the toxin or poison produced by the hostile germs and render it entirely harmless. By a curious paradox of the process, it does not kill the germs themselves. It may not even stop their further multiplication. Indeed, it utilizes part of their products in the formation of the antitoxin ”

“ If the phagocytes and similar cells in the blood of a man or animal exposed to the poison produced by localised microbes (such as those of tetanus, diphtheria and septic growths) cannot produce enough antitoxin so as to quickly destroy the poison, we can, and do, nowadays, save his life, by injecting into his blood the required antitoxin, obtained from another animal which we have caused (by injection [Pg 248] of the toxin) to produce the antitoxin in excess. That is one sort of "immunity" or "resistance" which we can confer, and is largely in use at the present day—the "antitoxin" treatment. ”

“ In specific germ diseases a similar antitoxin forms, and in cases which recover it counteracts the toxin, while the germs are destroyed by the tissues. Antitoxins can be prepared by immunizing a large animal, such as a horse, by injecting gradually increasing doses of specific toxins into its subcutaneous tissue. In due time the horse is bled, the serum is filtered free of blood corpuscles, and then constitutes the antitoxic serum, which can be standardized to a certain potency. ”

“ From the study of the processes by which immunity is secured against the effects of bacterial action the serum and vaccine methods of treating certain infective diseases have been evolved. The _serum treatment_ is designed to furnish the patient with a sufficiency of antibodies to neutralise the infection. The anti-diphtheritic and the anti-tetanic act by neutralising the specific toxins of the disease--_antitoxic serums_; the anti-streptcoccic and the serum for anthrax act upon the bacteria--_anti-bacterial serums_. ”

“ Kennedy quickly drew from his pocket the vial which I had seen him place there in the laboratory early in the day. From the doctor's case he selected a hypodermic and coolly injected a generous dose of the stuff into her arm.
"What is it?" asked the doctor, as we all watched her face anxiously.
"The antitoxin to abrin," he replied. "I developed some of it at the same time that I was studying the poison. If an animal that is immune to a toxin is bled and the serum collected, the antitoxin in it may be injected into a healthy animal and render it immune. ”

“ There exist, therefore, different mechanisms for excluding poisons from the sensitive and reacting cells and among them are certain quantities of neutralizing, or antitoxic substances, normally contained in the blood. We know at least one such definite antitoxin, namely, the diphtheria antitoxin, which exists in minimal quantities in the blood of man and the horse.
The absence of numerical relation between the mechanism which destroys bacteria and neutralizes poisons sometimes works sad havoc for the body. ”

“ It is too early to know the ultimate results that may be expected from the use of the vaccines, but from personal observation, conversation with other workers, and numerous reports, most of which are incomplete, it seems reasonable to believe that for localized bacterial infections much may be accomplished. ”

“ It may sometimes occur that the poison secreted by a microbe will paralyze and kill the leucocyte, unless care has been taken, by inoculations of virus, at first attenuated and afterward gradually increasing in virulence, to create an immunity in the phagocyte, to make it refractory to the poison and capable of swallowing the toxic bacterium without suffering from it. ”

“ Fortunately an occurrence of this kind is rare, yet with a wide application of the Pasteurian inoculation the opportunities also are great, and with the free sale and distribution of the mitigated virus (anthrax “vaccine”) , the evil may grow indefinitely. The method departs from the ideal one, aimed at a final extinction of the disease, and accepts in place a mere temporary protection of the herd or flock, and though in this affection eradication cannot always be secured, every effort should be made to gain it and above all to prevent an encrease of the area of infection. ”

“ In view of the rapid development of bacterial therapy, the possibility for harm that attends the use of bacterial vaccines and the skepticism among experienced clinicians as to the value of vaccines representing a combination of organisms, the Council has felt that it should scrutinize the claims for such agents with exceptional care and that there should be admitted to New and Non­official Remedies only those vaccine mixtures for which there is acceptable evidence to indicate that the use of the particular mixtures is rational. ”

“ It has become a tragedy."
This sentence was preceded by the statement that the soldiers in cantonments were being inoculated and dying from inoculations rather than disease. The sentence was the conclusion of the federation's argument against inoculation.
"This statement is going into the homes of the nation and creating anxiety almost indescribable," said Mr. Reavis. "What is meant by it is that the Government, by inoculating soldiers against typhoid and other diseases, is deliberately killing thousands of soldiers in cantonments. ”

“ And thus the high hopes and claims attached to the sero-therapy inocculation process, the injection into the blood of anti-toxins prepared with the serum of animals, have positively vanished.
Hundreds of thousands of human beings have perished in the course of this delusion; but countless numbers will have cause, yet in our day, to rejoice at the exposure of the stupid and unnatural theory, so long legally enforced, that the introduction into the human system of such poisonous substances could remove or overcome the natural consequences of constitutional disease. ”

“ As we have seen, a recovery from an attack of most germ diseases renders the individual for a time immune against a second attack. This applies less, however, to a recovery after the artificial inoculation with antitoxine than when the individual recovers without such aid. If the individual recovers quite independently of the artificial antitoxine, he does so in part because he has developed the antitoxines for counteracting the poison by his own powers. ”

“ But to kill them, while the underlying conditions for their reproduction remain unchanged, can, obviously, never effect a cure. So the great hopes that have attached to sero-therapy are doomed to disappointment, and the application of anti-toxins prepared from the serum of animals, are fated shortly to vanish in the wake of others of those strange temporary crazes which periodically obsess mankind for a while and pass away. ”

“ The physi­cians who revered him held that sickness could be cured using drugs and potions that came from outside the body, since they believed that's where disease originated. Now, of course, billion-dollar industries thrive by enhancing our ar­senal of antibiotics. ”

“ We know from sampling that no new disease has been introduced by either side in over ten years now. Against all the known ones, we have immunization techniques, anti-sera, antibiotics, and so on. I suppose you get your shots every six months like all the rest of us; we should all be very hard to infect now, and such infections as do take should run mild courses. ”

“ Control is slowly being obtained in regard to several others among these deadly microbes in various ways, most wonderful of which is the development, under man’s control, of serums containing antitoxins appropriate to each disease, which have to be injected into the blood as the means of either cure or protection. But why should we be content to wait long years, even centuries, for this control, when we can have it in a few years? If more men and abler [39] men were employed to study and experiment on this matter, we should soon make an end of all infectious disease. ”

“ Even though infectious diseases are uncommon in some countries (mainly developed countries) , the microorganisms that cause these diseases continue to spread. And in a globalized world, they can cross geographical boundaries and infect any unprotected person, so the anti-vaccination option, it doesn’t only affect the person who decides, but also affects his entire community.
Remember! The real or false information goes viral as fast as a microscopic infection, so get vaccinated against it and do some research to know the truthfulness of the sources. ”

“ To support research related to combating antimicrobial resistance and antibiotic resistant bacteria, including research into new treatments, diagnostics, and vaccines, research, in consultation with the Centers for Disease Control and Prevention, into stewardship, and the development of strategies, in coordination with the Biomedical Advanced Research and Development Authority under section 319L of the Public Health Service Act, to support commercialization of new antibiotics, not to exceed a total of $1,144,500,000, as follows: “ (I) For each of fiscal years 2022 through 2025, $100,000,000. ”

“ Now is the time for us to come together and develop a comprehensive biodefense plan that looks first at prevention to make sure we have the adequate intelligence, the appropriate research in terms of viruses, in terms of vaccines, and in terms of methods of early detection; second to look at preparedness, to make sure we are stockpiling the appropriate antibiotics, that we have a sufficient number of vaccines, which we simply do not have today but we are working very hard to get ”

“ The Federal Government will work domestically and internationally to detect, prevent, and control illness and death related to antibiotic-resistant infections by implementing measures that reduce the emergence and spread of antibiotic-resistant bacteria and help ensure the continued availability of effective therapeutics for the treatment of bacterial infections. ”