A question of the future is in mind



One last question remains to be examined. The syphilis which so resolutely took hold of the human race, and which has too much of it faithfully accompanied since then, is it destined to be extinguished one day?

Astruc observes, that the fire Saint-Antoine or evil of the ardents of the middle ages has disappeared for several centuries; that the English suet is only a memory; he therefore expresses the hope that syphilis will retire in its turn: “what,” he adds, “may not be a vain conjecture .” He cites, in fact, a host of testimonies which tend to prove that this disease has been gradually softening for a long time; and his personal experience gave him confirmation of this fact. He then enumerates the reasons which predict the progress of this attenuation, although he is careful not to indicate, even approximately, the date which will mark this eventuality more or less distant.

Fracastor, faithful to her purely arbitrary hypothesis of the very long-term intermittences of the appearance of syphilis, prefers to believe that the moment will come when she will separate herself from the reigning diseases, and be reborn after a long series of centuries.

“Namque iterum cum fata dabunt labentibus annis
Tempus erit, cum night atra sopita jacebit
»Interitu data. Mox iterum, post sæcula longa,
Illa eadem exurget, Aurasque revet coelumque,
Atque iterum ventura illam mirabitur ætas . ”
This forecast is not for Fracastor a poetic fiction, since it reproduces it, a few years later, in another writing:

” Hic idem morbus (Gallicus) interacts and extinguishes; mox etiam and nepotibus nostris rursus visendus renascetur, quemadmodum and præteritis ætatibus visum to majoribus nostris fuisse credendum est . ”

How Fracastor, so close to the epidemic explosion, and witness of the ravages that spread terror everywhere, hazarded a prophecy in favor of which he could not have alleged any serious reason?

Fernel, who has studied the new disease so well, is less optimistic because he does not have to defend a preconceived opinion. His only hope is in the clemency of God; but the affection with which he deplores fury, scarcely enables him to count on a persevering amendment, when he sees it unceasingly re-drenching itself at its source, and maintaining its vigor in the unbridled demoralisation of man:

” Hanc luem ,” he says, ” Nisi Deus optimus maximus, sua clementia, ipse extinguet, aut effrenatam hominum libidinem temperet, nunquam extinctam iri, sed fore humano generi comitem, and immortalem crediderim .”

It is certain that God alone knows the secret of the future. However, if the novelty of syphilis became an absolute truth, would this fact not contain, by analogy, the probability of its future disappearance?

To say that syphilis has not existed at all times is to acknowledge that it has not always found the conditions indispensable for its development. It is quite permissible to suppose that this set of refractory circumstances will be able to be reproduced one day, and syphilis would return to the darkness from which it had emerged at another time, without it being possible to determine its cause.

Trousseau, comparing the current pox that of the XV th century, is struck by the huge difference finds. In the early days, its ravages were frightening. Gradually its violence diminishes, one would have said that succeeding generations had partly used the energetic action of the virulent cause. It is rare today that the affected individuals of constitutional syphilis, have symptoms of a true severity .

Trousseau recognizes that the means of treatment, due to the progress of art, which was caught unawares in principle, have become more rational and more powerful; but he is also convinced that this reason alone does not fully explain the benignity of modern syphilitic accidents. The most probable cause seems to him to be in the degeneration of the virus .

That is my opinion too. If syphilis was more serious than it is today, it was because it was closer to its origin, and in a way, in the whole of the world. vigor of his youth. It has weakened as it ages, and it has obeyed this general law, which seems to condemn the contagious principles to the gradual loss of their activity. If smallpox and vaccinia have furnished us with the most striking examples, it is because they are the diseases whose art has multiplied indefinitely the transmissions for a prophylactic purpose. But the observations that gave the idea of ​​reviving the energy of viruses by taking them back to their source, abound in practice; and they have been experimentally verified for many other contagious diseases after successive transplants. , until the time of its complete extinction. I admit, however, that after having put aside the dogmatic question, this forecast is somewhat like what is called a dream of a good man.

If syphilis followed a regularly continuous decrease, one could glimpse, in the distance, its last term. But as long as one frequents special asylums, open to his victims, one finds, with regret, certain pictures whose hideous composition awakens the saddest memories of the past. Art, having become so skilful and so rich in heroic resources, is reduced again to remain an impotent spectator of horrible mutilations which have no other solution than death. Whence it follows, that there might be so many motives for fearing that at a given moment, and by an ignored impulse, the great epidemic might recover from its ashes, generalising again its first ravages.

It must be remarked, however, that the present syphilis differs essentially from the other plagues of which I write the history, by this capital circumstance that man will be very powerful against it, when he has taken the firm resolution to defend himself.

At least for an infallible attenuation, we can rely on the incessant progress of public and private hygiene, and on the day-to-day vigilance of the medical police.

M. Ricord, whose assertion is a serious argument, attributes to the use of the speculum a great improvement in the health of prostitutes. Thus, according to Parent-Duchatelet, we met, in 1800, a sick girl out of nine; since 1834, only one out of sixty has been encountered .

Such a result is very encouraging. Since it depends only on the more widespread use of a simple local diagnostic instrument, it may be supposed that new improvements will gradually reduce the vast field of syphilis. But it will always be necessary to count with the irresistible drive of a passion, whose reign does not seem to be coming to an end yet.

The doctrine of great new epidemics is summed up in the history of cholera. The principles on which it is based, find their most striking confirmation. We see them, so to speak, at work in one of their most formidable applications. All the doubts that might have been preserved about the authenticity and the interpretation of the documents I have collected fall before the irresistible eloquence of this great pathological event.

The English suet has been extinguished after its lightning storms, and three hundred years separate us from it. Syphilis, which, by a fatal derogation from the general law, had followed it so closely, has not deserted, it is true, its new domain; but it did not renew this memorable overflow which marked a sad day if the end of the XV th century. Since then, the archives of the great popular plagues have remained closed. Cholera has reopened them to write this dark page, which inflicts such a cruel denial on the over-ambitious promises of our civilization.

It does not enter happily into the plan of this study, to review, the innumerable swarm of hypotheses which revolve around this question always new. The most ingenious have remained on the surface; and certainly, it is not the facts, this indispensable substratum, which have missed these fancies. In the scientific order, and medicine is no exception, the creators of theories gladly take this convenient sentence as an epigraph: Se non e vero, bene trovato; which is to say that when we do not discover the truth, we must be satisfied with its parody. To proclaim any cause, fictitious or real, occult or ostensible, to assign it to the order of the phenomena whose reason is sought, and to conclude boldly that this cause is capable of producing the effects which it is intended to explain. the process which avails itself of the authority of Descartes, and which one is sure to bring to a successful end, when one has wit, and a certain faculty of invention.

We see another example in these tests of parasitism, applied to the epidemic of our century; but I declare that it is impossible for me to share the expansive jubilation which overflows into the writings of the patrons of this hypothesis.

It is not today that one seeks in the regions of the invisible, the animated germ of diseases. I can quote a curious sample.

The library of the Faculty of Medicine of Montpellier possesses an immense collection, designated under the title of Mixtures , and composed of 354 volumes, which contain nearly 9,000 pieces, among which there is a large number which it would be impossible to obtain today. Volume 71 (Exhibit 7) contains a memoir titled: An English Physician’s System on the Cause of All Disease Species, with the Surprising Patterns of the Different Species of Small Insects Visible by the Medium a good one microscope in the blood and in the urine of the various patients, and even of all those who must become so, collected by MACD Paris, MDCCXXVI .

The anonymous author of this writing will not be denied the merit of having preceded, in this way, the micrographers of our time. The text is illustrated with 91 figures on wood, representing as many species of animalcules that are supposed to cause diseases. ( Migrainiste , white and red flower , dartrifiant , rougeoliste , vérolique , small vérolique , ragifiant , érysipéliste , écrouelliste , épilepsique , apoplectic, etc.) The author greatly extols the excellence of the microscope which he has used for his observations, and I have no difficulty in believing it, when I see with what aplomb he recounts this journey to the land of chimeras. I must admit, however, that among the fantastic beings whose image he exhibits, the sarcopter of scabies , as described and drawn by the moderns , is recognized by enormous magnification . Note, by the way, that this text and the accompanying plate, date from 1726.

At that time, it would be said, neither the true methods of exploration nor the sophisticated instruments that serve them. I will not disturb this satisfaction of self-esteem; but I will never admit these reluctances of the microscope, which gives for certain what it undertakes to discover, and addresses the imagination, when it can not strike the eyes.

I am therefore waiting for the cholerigenic principle, microphyte or microzoic, to take on a real existence, such as the achorion of ringworm and the acarus of scabies. Above all, I wait until we have determined with certainty the pathogenic relation which would link the cause to the effect, the antecedent to the consequent. In the meantime, I will allow myself to speak of cholera as of other great epidemics, whose true cause has not emerged from the darkness which, in the series of ages, their birth certificate. Let contemporary science deepen this mystery with courage. But until finally it is possible to repeat the historical exclamation of Archimedes, we will have time to apply to the study of the cosmopolitan plague, the rational elements of which we can dispose. We will not forget that I am not writing a monograph which would overburden the medical literature unnecessarily. I just try to clarify one point in the history of the great epidemic, without exceeding the defined limits of my program .

It was in 1817, about the month of May or August, that cholera broke out in Jessore, a city located in the Ganges delta, 120 kilometers from Calcutta. As soon as he appeared, he struck everything around him, the natives and the foreigners. The mortality that followed was appalling and worthy of the great historical epidemics. After having overflowed into Asia, he rushed from east to west, across Syria, Persia, and Arabia. Five years after its first explosion, that is to say in 1822, Europe was threatened by Astrakhan and the Mediterranean. It is only after several years that he enters Poland and Russia, Austria, Holland. In 1831, he invaded England where Magendie and Delpech go, each on his side, make their first observations and prepare to receive it. The following year, he enters France from where he spreads in Spain, in Portugal, in Algeria, in Italy. It is soon to America and the archipelago of Oceania, and it can be said that in 1840 it ruled both the five parts of the world. Seventeen years after his first invasion, the plague returns to us from the depths of Hindustan. Paris was struck in 1849, from spring to autumn. In 1850 he was seen again in California, Algeria, Hungary. We know that in 1853, our capital still struggled against its attacks. In 1865, a new invasion, remarkable for the slowness of its march and its long duration.

The rights of cholera as a great epidemic, are revealed at first sight by the darkness of its cause. All the hypotheses which have defied the ardent imagination of physicians, seem destined to prove that the nosogenic influences of the common order are incapable of producing it. I can prove it, from now on, by a single example relating to the presumed action of the atmospheric temperature. In India and Bengal, it has ravaged by 30 degrees of heat . The thermometer marked 30 degrees below zero as it devastated Russia. Ab uno disce omnes.

In the course of this book I have had many opportunities to verify the general law, which seems to connect the great epidemics to the combined influence of cosmic and moral disturbances. These antecedents have been faithful to the cholera epidemic.

Great meteorological upheavals have been observed for nearly a century, and at the same time the world witnessed this unprecedented revolution, which carried off feudal society, and replaced it with a new order whose evolution takes place before our eyes, without being able to predict the stopping point.

The influence attributed to this competition of nosogenic conditions is doubtless inexplicable. But we must not tire of seeing the coincidence, which once again meets the teachings of history and the logical forecasts of science.

As this aetiology, rather presupposed than demonstrated, raises perhaps to the rank of causes, simple successions, and that it does not conclude to a practice, the field remains open to the analytical searches, which strive to penetrate more deeply into the constitution of phenomena, and to reach the nature of the disease, by the way of its next cause. Dr. Marchal (of Calvi) has seized upon a theory which has won many votes, and he has appropriated it, in my opinion, by the form with which he has clothed it. He thinks that the specific cause of cholera resides exclusively in the malarious miasma raised to its highest power.

This opinion, presented and defended with a talent which I am pleased to recognize, is to me only a hypothesis like so many others, the verification of which is still remote, if it is ever permitted.

What is the modification that the malaria miasma has had to undergo in order to rise to that state which is called its highest power ? Is it, as Mr. Marchal seems to believe, an increase in concentration and intensity? But a quantitative mutation can not explain the original specificity of the disease attributed to it, and the nosological distance which distances it from the natural group of swampy affections. Is it the nature of the miasma that has changed? Nothing is easier than to imagine molecular alterations which transform the intimate constitution of bodies, and make, for example, a food repairman, a deadly poison. It is much less easy to give the material proof; and in this case it will be admitted that this mysterious chemistry keeps its secret well.

What I know, no doubt, because the daily facts tell me, is that preparations of cinchona triumph wonderfully fevers pernicious, whose termination would be, without their help, promptly and infallibly fatal, while they always fail against cholera affection. Some essays, undertaken as by way of acquit, have dispelled all illusion. It goes without saying that cholera is not confounded with those Mali Moris fevers or comitata of Torti, who accidentally borrow the main features. These observations are frequent in Algeria and in our southern zone. During the autumn of 1765, Leroy saw the third cholera epidemic reign in Montpellier. Against this special form of the intermittent mode, cinchona is all-powerful and has no substitute.

My confrere of Paris confesses that “the miasm producing cholera is not known materially; it is imperceptible and elusive. But, he adds, it says to the reason of its effects, and that is enough . ”

I accept this language; I am not one of those who believe only in the testimony of the senses. In medicine, as in all orders of human knowledge, the eyes of the mind are often more clairvoyant than those of the body. I must, however, give up following M. Marchal when, forcing the analogy, he claims that this miasm is alive like ferments, since it is multiplying. I have so many clarifications to ask, that I think it prudent not to venture into a path whose outcome I do not know.

China Rifampicin