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A hundred years ago: Future lines of treatment

The changes in medical and surgical treatment which have been made during the last thirty years have been enormous, so that it is difficult to realise the fact that a student at that time never saw a case of appendicitis operated upon; that stones were always cut out, and not crushed; that throat, nose and ear surgery was unknown; that the study of bacteriology had not commenced; that aseptic and antiseptic treatment was just beginning; that diphtheria was treated without antitoxins, with a fatality constantly appalling; that lung cases, including phthisis, were treated in ill-ventilated and hot rooms; that almost all abdominal operations were fatal; that alcohol was administered in large quantities for all acute cases, and ordered also in many chronic ones; and so one might go on with a wearisome tale. Many of us have had to almost relearn our profession.

Of course, all these great changes of treatment have been more or less gradual, but can be traced back to two or three great principles. The first, perhaps, that occurs to us, is Lister's great teaching, that pus is not only unnecessary, in all wounds, whether natural or artificial, but also is harmful, and often deadly in its effects. To all of us here it is almost incredible that we should have lived these nineteen centuries of the Christian era and not to have discovered this fact.

Moses wrote quite clearly about the power of heat to destroy disease; we applied this power in many ways to preserve our foods, but when it came to the presence of pus, we called it laudable! The second great advance was the promulgation of the Public Health Acts, which have been since amended and extended in many ways. To-day, the health of every town and village is more or less under the supervision of a special medical officer. The third important advance has been division of labour among medical men.

Among other great events, which have affected our treatment, is the study of bacteriology, with all its ramifications, by means of which the real causes of disease are ascertained; for, instead of calling all diseases by one of its leading signs or symptoms in the past, such as peritonitis, meningitis, pleuritis, we place a distinguishing adjective in front, as septic, tuberculous, pneumococcus, influenzal, etc., thereby placing the diagnosis on a scientific basis, and often following it by a correct treatment. Although we have not yet been able to trace the origin of all our diseases, yet we believe that a great and successful beginning has been made, which must sooner or later be followed by even greater advances.

Once more, and this will suffice for our present purpose, the teaching now, in many of our elementary and public schools, of the laws of health will, before long, have an enormous influence in affecting the well-being of our nation, and preventing many diseases which now come under our care. Whatever our private views may be as regards Mr. Birrell's late Education Bill, we must all feel that the people at large lost much by its rejection, in regard to those provisions in it, which put the teaching of the physical part of our nature on a proper footing.

Now coming to the present time, it may be asked, What are the lines of treatment that are particularly engaging our attention, and to what end are they leading?

Many things that I am going to say you may not agree with, still, they are worth thinking and pondering over.

First let me take the subject of Anaesthetics. Surely it ought to be an unnecessary risk, as well as an unscientific procedure, to render a person wholly insensible in order to operate on a small area of the body. It is well known that many of the fatalities in connection with general anaesthesia have occurred in most trivial local complaints.

Local anaesthesia is only at present in its infancy, but I have already read and seen enough to prophesy that, within ten years, all minor operations will be performed by means of its aid, and, where this method cannot be used, that some such method as that known as spinal anaesthesia will be adopted.

There must be some cases which will require the whole body to be made insensible for some reason or another; at the same time I believe and hope that it will not be the rule.

Now all this preventive teaching of medicine, which will increase more and more, is being brought about by ourselves for the destruction of ourselves.

It is one of the most extraordinary occurrences of the present day, that a great profession is digging its own grave. Yet to be honest we must dig it. But what is going to happen to us? A great deal has already happened. Our dispensing to a great extent is gone. For slight ailments our patients treat themselves, or their friends do it for them.

As medicine approximates more and more to the character of an exact science, its chief aim tends to change from the cure to the prevention of disease. In the defence of the public health, its most conspicuous triumphs have been won, and in that direction lies the hope of its future expansion.

It is certain that, when a knowledge of the general principles of physiology and of the laws of health is the common property of all men and women, the belief in futile remedies will cease, and quackery will die a natural death. Medicine will no longer be looked on as the art of curing disease, but as a science of preventing such of them as cannot be altogether abolished.

That such an existence of things as described above is far off, we must all admit, still we have only to compare the present with the past in order to see and appreciate what we have left behind, and what we enjoy to-day.

In that far-off time, to which I am referring, the physician will take the place that rightly belongs to him, as the most important functionary in an enlightened state.

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