A Frugal Physician Prescribes
Common Sense and Enthusiasm
Germs and Disease
spends almost all of its time attending, studying, testing,
manipulating, drugging, and operating on the human body. Devoting so
much time, energy and money is akin to worship. Clinics and hospitals
might not unjustly be called Churches of the Body. Physicians, then
The next layer of the medical dilemma seems to
be a somewhat similar reverence to the relatively hidden world of
germs. Oh, how we love to fear them. Bernard Dixon, in his book
entitled Powers Unseen, says, “Always, microbes lie in wait as
opportunists, ready to exploit any change in human behaviour or living
environment . . . Microbes, not macrobes, rule the world.”
we are not vanquished. There is hope. Real LIGHT at the end of a long
tunnel of experience. Limited and shortsighted though it be, modern
medical practice is slowly - very slowly - drawing us toward a
broader understanding of disease and healing. The passion of physicians
and researchers for microbes hints that doors will eventually open
toward real LIGHT on the subject of things that are now quite hidden
even from microscopes. In the meantime . . .
disease.” That idea is akin to the modern belief in evolution. While
there is some truth to both, there are large holes in each widely held
hypothesis. The whole story is still out on Germ Theory and Darwinian
Yes, I heard, “Germs cause disease.” Every child
knows this long-held, concise and supposed fact. Many learn it before
they go to school. The idea is driven into us day in and day out on TV,
in the newspapers, by friends and neighbors. We are impressed to gargle
Listerine, sanitize the bathroom, sterilize our dishes, take
antibiotics prophylactically, etc.
I had a significant problem
with that idea from early on in my medical training - even before
medical school. I remember sitting in my crude medical aid station in
the boondocks of Vietnam - not far from Cambodia - in 1968-69. I often
had time on my hands and spent many hours reading and trying to make
sense of the Merck Manual of Diagnosis and Therapy. It was a compact
book crammed with fine print and seemed to say that most every illness
or syndrome known to medicine could be caused by one microbe or another.
in many disciplines in the modern age, “Things are complicated.” And so
was and is disease and medical practice. There were lists and lists and
more lists of causative agents for this or that problem. And, germs
were almost always high among them.
After I completed college
with a degree in Medical Technology, I took my first and only job in
that field in hospital bacteriology. Ouch! I lasted just a few months
and went back to nursing until I arrived at medical school. While
working in the Bacteriology Deparment, we spent our time pursuing,
culturing and plating bacteria. Hoping to find something to treat with
the growing arsenal of antibiotics.
We not only tested human
beings for bacteria but regularly cultured inanimate objects as well.
Weekly, one of the three of us in the department had to go around the
hospital wards and swab the floors. That’s right we took large cotton
qtips, ran them across the footpaths of the hospital, and then stuck
the swabs in individual tubes of growth broth.
Before long we
made cultures on agar plates to see what kind of bacteria were
collecting on our floors. They might be potential sources of
contamination! At the time, carpets in hospitals were unthinkable
because they could become hosts for even more of the ubiquitous
Culturing the floor was practically the
same as taking a swab to the streets or yards in the vicinity. Anything
and everything there would certainly end up underfoot in the hospital.
We made our regular “floor reports,” but who cared? I suspect the
reports were filed for inspection purposes.
I quickly tired of
chasing bugs. That experience might well have given me a clue about
challenges and headaches I would have in coming years with the “germ
theory.” Germs have been in vogue and blamed for practically every bad
thing under the sun since the days of Pasteur and Koch. In many ways,
it seems that evil germs took over where miasms, humors, and spirits
left off in the Middle Ages.
Germs were one of several things
in my craw when I made an appointment during my second year to speak
with the dean of the medical school, Dr. Robert Tuttle. This was before
I started working on the wards and encountered Dr. Kirkendall. I
basically told Dean Tuttle that, “I don’t quite believe a lot of what
they are teaching us in the academic end of school. I am having trouble
swallowing all of it.”
I didn’t have quite the gumption to say
I didn’t believe in the prevailing germ theory because I knew Tuttle
had been professor of immunology and microbiology at Bowman-Gray School
of Medicine in North Carolina prior to becoming Dean at UTMSH.
listened gently without taking the slightest offense. Then, he talked
to the tune of, “Our job is to teach medicine as we now understand it.
It’s certainly far from perfect and changes frequently. Your job is to
learn what we teach you. When you graduate and are on your own you will
have some leeway on how you practice according to your own beliefs and
understandings. Just go out and do what is expected of you and do it
well. Your own time and opportunity will come soon enough.”
listened and tried for a time. But, my own ideas and mouth got in the
way soon enough. My ideas about germs were just some of the stumbling
blocks along the way. I know I was an exceptional case in med school.
My compatriots ate the traditional medical meal, chewed on it just a
bit, while relishing the flavor.
Most physicians as well as the
general public take it as established and irrefutable fact that germs
cause disease. The idea is pretty much Gospel and influences so much of
our behavior that to question it may seem sacrilegious. But, that
hasn’t held me back and won’t now.
“Germs do not cause disease,” I say. “They are a part of the picture, but neither the biggest nor most important.”
it,” you might say. Well, I can’t prove it any more than medical people
can prove the usual belief. Although they have lots of tests and
research to support their case. As for me, I ask that we try to use
some common sense as we take another look at this belief.
begin with, the world and our physical bodies are hosts to uncountable
numbers of bacteria, viruses, fungi and the like. (Germs in other
words.) Many of these are said to “cause disease.” But, a thoughtful
and economical physician might ask, “If these creatures are always with
us, around us, and in us, how is it that we are generally undiseased
and healthy appearing, and not overwhelmed by such microbial vermin?
Explain that, please.”
It is quite clear that microbes rarely
cause us harm, and more often than not are helpful to us because we
live in a state of comfortable coexistence with them. Actually, we have
many cooperative relationships with these microscopic creatures. We
give them a place to live and they help us synthesize vitamins, break
down foodstuffs, and eliminate waste products. Most of this action
occurs, but is not confined to, the confines of our large intestines.
also have functions that support the health of our skin and hair as
well. All of their helpful chores are likely not yet discovered.
Possibly because scientists have been pointing their lights in the
opposite direction, hunting for “those disease makers.”
their main tasks - as they fill an incredibly important niche in nature
- is to aid in decomposition of dead, morbid, necrotic material
wherever it may be found. Without the fulfillment of that function life
would be impossible.
A basic premise which medicine largely
ignores is that only when something goes wrong in our environment -
internal and external - do bacteria seem to cause us harm, or at least
make themselves more visible. Sometimes they just appear to cause harm
or we perceive that they do. Bacteria and viruses have become “the
usual suspects,” take the wrap for practically every human ill, and
come out looking like evil personified. Even though they are tiny, tiny
The influential 19th century chemist,
Claude Bernard, said, "The seeds of disease are everywhere to be found.
Whether they take root depends on the terrain on which they land." Thus
came the idea of the “terrain factor,” which gets too little attention
in medical circles and the society in general. And, it may be that
seeds are not the best analogy for germs as they are seen producing
disease. Too often it seems that microbes are “accessories after the
fact” in the crimes we call disease.
Many germs are
opportunistic like weeds. They say, “Weeds are a gardener’s best
critics.” They take over terrain which is not well tended. The real
problem in that case is not the weed, but the gardener.
like manner, in human disease the real problem is rarely a microbe but
the state of the affected individual and his/her environment. If we
take a look at some of the most common “contagious” diseases, past and
present, we will be able to understand the point of view of Claude
Bernard and others of his ilk.
Who is most likely to come down
with influenza? What people are at the top of the list to be given flu
vaccine every year? What groups of people are most likely to become
infected with West Nile Virus or SARS or Legionnaire’s Disease? Who is
most susceptible to E coli diarrhea? Looking back in time, who was most
likely to succumb to tuberculosis, leprosy, and even malaria and
The answer to all these questions is older,
debilitated, already diseased or injured people. Secondarily, it is the
malnourished, the stressed and anxious, the injured and maimed and
hopeless. The hale and hearty, vital and virile, active and energetic
need worry little about any of these contagious diseases unless
confined to the trenches and terrors of war, the filth and rot of
On the other side of the world, we see
contagion affecting poor, starving and often war-ravaged civilian
populations. In this case, many who become diseased are young but not
robust for simple lack of adequate food and proper hygiene, for living
in the dirt and being tormented by fear and trauma.
profession has taken credit for increased lifespan and greater
wellbeing in many populations because of vaccination and antibiotics.
But, real credit is largely due to improvements in sanitation and
hygiene, better food, and overall enhanced living conditions in most
parts of the world.
Despite the general rap and hype which is so
common, germs aren’t king of the mountain, barbarian invaders standing
at the gate waiting for opportune moments to kill. They are not
predators, but generally scavengers, feeders, members of the cleanup
We ought to give credit and blame where they are due.
Let’s not point the finger at the tiniest of creatures for problems
which we create.
The enemy is not a germ. The enemy is us. A Wise Doctor knows that and so should you.
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