Price of Progress

The great Sir William Osler was gloomy about congenital heart disease. "[It has] only a limited clinical interest, as nothing can be done to remedy the defect or even to relieve the symptoms." As for pneumonia: "[It] can neither be aborted nor cut short by any known means . . ." Thus read the 1892 edition of Osler's Principles and Practices of Medicine.

Today, any well-read medical student can make vast corrections in Sir William's first edition, but man is still heir to numberless ills, and new problems come with new cures. Doctors' textbooks, observed Canadian Pathologist William Boyd at sessions of the International College of Surgeons last week, "do not tend to become smaller."

Syndromes for Comas. Every advance in therapy has its price, noted Dr. Boyd. "Since the discovery of insulin, the picture of diabetes has altered. The patient no longer dies of diabetic coma; he is spared to develop arteriosclerosis with diabetic gangrene, or the Kimmelstiel-Wilson renal lesion with the nephrotic syndrome and hypertension. If the diabetic is a child, he will live to be an adult and develop miliary retinal aneurisms and diabetic retinopathy [i.e., diseases of the circulatory system affecting the extremities, kidney and eye]."

"The patient suffering from pain can be treated with barbiturates, but he may pay a heavy price by dying of agranulocytosis [i.e., too few white corpuscles] . . . Blood transfusions have saved countless lives, but a patient who might have recovered without transfusions may die of hemoglobinuric nephrosis and anuria [i.e., kidney disease], no matter how carefully the blood may have been grouped and matched."

Sea of Carcinogens. Rare indeed, said Dr. Boyd, are the sicknesses that actually vanish, and there are more than enough new troubles to take their place. Among the industrial diseases, "beryllium granuloma and pneumonitis [i.e., diseases of lungs, skin, lymph nodes and liver, caused by exposure to beryllium fumes or dust] are new . . . because fluorescent bulbs with their beryllium content are new. Betanaphthylamine carcinoma of the bladder had to await the development of the aniline dye industry [i.e., cancer of the bladder caused by exposure to toxic chemicals] ... In fact, it may be said that we swim in a sea of carcinogens [cancer-causing substances]. Changes in habits and diet expose us to new perils. Excessive use of tobacco, so-called refinements of food which result in the loss of essential elements, the increased stress of modern living and the increased age of the general population are apt to have their counterpart in new disease pictures."

The complications of medical advance are enough to give the medical man a few special syndromes of his own. But Dr. Boyd seems to think a doctor can still hold his own--provided he has "the outlook of a biochemist, as well as that of an anatomist, physiologist and pathologist."

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