The crisis of the external cure: Antibiotic resistance and the challenge to the medical paradigm

“ 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. ”

“ The disinfection of the sick-room and the antiseptic methods which go far toward the creation of modern surgery all depend upon chemical products whose long list increases year by year. Crude drugs are now replaced by active principles discovered in the laboratory—morphine, quinine, and the like—and instead of the bulky, nauseous draughts of olden time, the invalid is given tasteless capsules of gelatin or compressed tablets of uniform strength and more accurately graded power. ”

“ DRUG abuses have become so grave that at last the medical profession is compelled to correct them. The public should learn clearly our mutual positions in the proper and improper use of drugs, which are chemical substances found useful or necessary to combat the effects of disease. ”

“ Sickness, as well as health, according to one of the prevailing theories, depends upon chemical causes, viz., on the presence and predominance of various complex substances generated in the juices and tissues of the body by unknown processes, in which bacteria may sometimes play an important part. According to another theory, the living animal cells are engaged in a continual struggle against intruding micro-organisms. ”

“ I wish especially to emphasize the simplicity of the modern scientific conception of disease as a disturbed condition of a complex cellular mechanism, because it is largely due to a failure to comprehend this that the shadows of the middle ages actually still lie dark over certain of the popular conceptions of medicine, and seriously retard the speedy fruition of many of its new discoveries. ”

“ The disease is, in fact, the resultant of the reaction of the one upon the other of the two factors, the microbe and the organism. According to the felicitous comparison of Prof. Bouchard, the organism is a strong place, the microbe is its assailant, and the struggle between them is the infectious disease. The condition of the organic estate which the microbe endeavors to seize is therefore important. If the person is in general good health, he will offer a vigorous resistance to the microbes. ”

“ Dictatorships usually exist primarily because of the internal power distribution in the home country. The population and society are too weak to cause the dictatorship serious problems, wealth and power are concentrated in too few hands. Although dictatorships may benefit from or be somewhat weakened by international actions, their continuation is dependent primarily on internal factors.
International pressures can be very useful, however, when they are supporting a powerful internal resistance movement. ”

“ When one wants to bring down a dictatorship most effectively and with the least cost then one has four immediate tasks:
One must strengthen the oppressed population themselves in their determination, self-confidence, and resistance skills; One must strengthen the independent social groups and institutions of the oppressed people; One must create a powerful internal resistance force; and One must develop a wise grand strategic plan for liberation and implement it skillfully.
A liberation struggle is a time for self-reliance and internal strengthening of the struggle group. ”

“ Cellular pathology with its wonderful revelation of the anatomical seat of disease and bacteriology, with its still more wonderful revelation of the external cause of disease, so dazzled the eye and the mind that we forgot that the sensitive animal body behind the attacking microbe had its changes, too, its changes in body chemistry that could not be stated in terms of cells and bacteria. The pendulum is swinging back now to a consideration of the constitution of the body on which the microbe or poison acts, its resistance or immunity, its anaphylaxis or allergie. ”

“ Inventive persons have from time to time thought that they had secured a sure cure, if not an unfailing prophylactic; and, at the present time, since the discoveries of Koch, all sorts of parasiticides are being used to kill the germ of the disease. ”

“ Surgery is applied anatomy; antisepsis is applied bacteriology; pharmacology is applied chemistry; with instruments of precision, wonderful progress is made in the interpretation of experience. There is nothing in the history of science more suggestive than the simultaneous lights thrown on bacteria and microbes from many quarters at once. ”

“ The time may come when science will give us some tuberculin, or serum, or antitoxin, or antiseptic, that will kill the tubercle bacillus in its hidden lair, act its poisonous products, or reinforce the phagocytes in their attacks on it, but meanwhile sanatorial treatment gives expectations of recovery greater than those of any other kind of treatment that is known to us, and it seems to me inexpedient to say anything which may discourage the benevolent from putting it within reach of the poor and needy, or hinder the poor and needy, stricken with tuberculosis, from taking advantage of it. ”

“ A second error of the uric acid advocates, flowing from their first error of naming the poison, is to pour their acids and alkalies into the blood with the childlike faith that, like good children, the acids and alkalies will go in there and do just what they were told to do, neutralize the uric acid, and get out. They assume that the chemistry of the acids and alkalies is as simple inside of the body as it is outside of it and that the blood is simply a passive mixture of chemicals. ”

“ 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. ”

“ When, however the elements of this mechanism, such as time study, functional foremanship etc., are used without being accompanied by the true philosophy of management, the results are in many cases disastrous. And, unfortunately, even when men who are thoroughly in sympathy with the principles of scientific management undertake to change too rapidly from the old type to the new, without heeding the warnings of those who have had years of experience in making this change, they frequently meet with serious troubles, and sometimes with strikes, followed by failure. ”

“ Hence, a partial failure of the inner man to meet the successive changes that are going on about him, means incomplete life or disease, and a complete failure of a similar adjustment signifies death. The transmission and the development of characters known as inheritance are made clear by the hypothesis of pangenesis, which, therefore, with your permission, let me give: "Every unit or cell of the body throws off gemmules or undeveloped atoms, which are transmitted to the offspring of both sexes, and are multiplied by self-division. ”

“ But when the vital resistance of the tissues is reduced, on the one hand, by wasting sickness, profuse discharges, etc., or, on the other hand, the vital activity of the invading parasitic organism is increased, the balance of power rests with the infinitesimal but potent micrococcus. ”

“ Having a firm belief in the proverb that "an ounce of prevention is worth a pound of cure," the author has endeavored, in the succeeding pages, to point out a series of hygienic rules which, if applied to the nursling, can hardly fail to maintain good health, give vigor to the frame, and so lessen susceptibility to disease. ”

“ The principal causes which diminish resistance to infection are: wet and cold, fatigue, insufficient or unsuitable food, vitiated atmosphere, insufficient sleep and rest, worry, and excesses of all kinds. The mechanism by which these varying conditions lower our immunity must receive our attention, for they are of the greatest importance in preventive medicine. It is a matter of common observation that exposure to wet and cold or sudden changes of temperature, overwork, worry, stale air, poor food, etc., make us more liable to contract certain diseases. ”

“ In fact, the case is always one where the whole organism is more or less under the spell of the mental distress, and consequently has a minimum of recuperative forces at command. Even almost every physical function is apt to be so lowered and perverted that, in turn, they may contribute to the disease of mind and to the resistance to be overcome. In fact, the case is one of "sickness all through"; and the remedy and management must be based upon this comprehensive vision, or failure will almost inevitably result. ”

“ And although new drugs always find new votaries, and many of them have great value, the absolute usefulness of all mere remedial measures is at the present time looked upon as very slight compared with the shielding influence which the physician exercises in placing his patient under the most favorable circumstances for Nature to effect her cure. ”

“ Although it usually originates within the chest, it sometimes finds its primary origin in the throat, and in a large percentage of cases the throat affection forms a complication of tuberculosis of the lungs. In spite of the numerous remedies which have been advocated for the cure of this disease, it must be admitted that our chief reliance is in proper nourishment and climatic effects, and that hygiene is the sheet-anchor which will eventually rescue us from this terrible foe of the human race. ”

“ The presence of toxins in an organ of secondary elimination is frequently the cause of infection. Sinuses and lungs, inflamed by secondary eliminations, are attacked by viruses or bacteria; infectious diseases of the skin result from pushing toxins out of the skin. More generalized infections also result from toxemia; in this case the immune system has become compromised and the body is overwhelmed by an organism that it normally should be able to resist easily. The wise cure of infections is not to use antibiotics to suppress the bacteria while simultaneously whipping the immune system ”

“ Twenty-five years' experience at the sick-bed and the dissecting-table, in the nursery and on the battlefield, have convinced me that, "with rare exceptions, the disorders of the human body, which have been treated after such an infinite variety of drug-systems, can be as well cured without any drugs at all" ↑ "Our system of therapeutics is so shaky" (vacillant) "that the soundness of the basis itself must be suspected." ”

“ Combined with political defiance during the phase of selective resistance, the growth of autonomous social, economic, cultural, and political institutions progressively expands the "democratic space" of the society and shrinks the control of the dictatorship. As the civil institutions of the society become stronger vis-à-vis the dictatorship, then, whatever the dictators may wish, the population is incrementally building an independent society outside of their control. ”

“ But they overlook the fact that the moral power of resistance decreases with each repetition of the dose, and that the time will come when only the practical impossibility of procuring their wonted tipple will enable them to keep their pledge of total abstinence. It is true that by the exercise of a constant self-restraint a person of great will-force may resist the progressive tendency of the poison-habit and confine himself for years to a single cigar or a single bottle of wine per day. ”

“ Tissues of the body vary greatly in their power to resist invading germs, so that the route by which germs enter influences the severity of their effects. Typhoid bacilli and the spirilla of Asiatic cholera when taken with food or water produce far more serious disturbances than when injected under the skin; infections from pus germs through an abrasion of the skin may result in a slight local disturbance, while the same amount introduced into a deeper wound might cause a fatal infection. Certain germs nourish in certain tissues only ”

“ Medical advice ought to be more frankly and constantly sought for the lesser infirmities of age than during middle life for reasons obvious. As the internal resistances lessen small disorders more readily throw the actions of the organism out of balance, and fatal results follow seemingly small causes. Another prerequisite is consistency and persistence in the measures employed. The balance of power in the old is not easily retained, and regained with far greater difficulty. ”

“ Nearly all are struck by the resistance of the Chinese to blood poisoning. From my note books I gather such expressions as "Blood poisoning very rare. More resistant than we are to septicæmia." "Relative immunity to pus-producing germs." "More resistant to gangrene than we are. Injuries which at home would cause serious gangrene do not do so here." "Peculiarly resistant to infection." "With badly gangrened wounds in the extremities show very little fever and quickly get well." "Women withstand septicæmia in maternity cases wonderfully well, recovering after the doctors have given them up." ”

“ The development of a nonviolent struggle capacity means that the dictatorship's capacity for violent repression no longer as easily produces intimidation and submission among the population. The population will have at its disposal powerful means to counter and at times block the exertion of the dictators' power. Further, the mobilization of popular power through political defiance will strengthen the independent institutions of the society. The experience of once exercising effective power is not quickly forgot. ”

“ By placing resistance capacity directly in the hands of the citizenry, newly liberated countries could avoid the need to establish a strong military capacity which could itself threaten democracy or require vast economic resources much needed for other purposes.
It must be remembered that some groups will ignore any constitutional provision in their aim to establish themselves as new dictators. Therefore, a permanent role will exist for the population to apply political defiance and noncooperation against would-be dictators and to preserve democratic structures, rights, and procedures. ”

“ The population experienced in the use of political defiance is less likely to be vulnerable to future dictatorships.
After liberation, familiarity with nonviolent struggle will provide ways to defend democracy, civil liberties, minority rights, and prerogatives of regional, state, and local governments and nongovernmental institutions. Such means also provide ways by which people and groups can express extreme dissent peacefully on issues seen as so important that opposition groups have sometimes resorted to terrorism or guerrilla warfare. ”

“ If the changes that we fear be thus irresistible, what remains but to acquiesce with silence, as in the other insurmountable distresses of humanity? It remains that we retard what we cannot repel, that we palliate what we cannot cure. Life may be lengthened by care, though death cannot be ultimately defeated: tongues, like governments, have a natural tendency to degeneration; we have long preserved our constitution, let us make some struggles for our language. ”