Out of the caves and into the light?
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

Click here to read
The Truth About Vaccines

An anxious mother brings her infant daughter to the doctor’s office. Neither the baby nor mother slept well the night before. The baby was extremely fussy. She did not nurse well, and her mother thought she felt warm. The baby seemed uncomfortable and swatted at her ears a lot.

The mother tells her story to the doctor. The doctor then examines the baby carefully. He tells the mother he has made a diagnosis (it is the one the mother suspected), and he proceeds to discuss his plan for treatment. The mother agrees. Then the doctor reaches into his drawer, takes out a scalpel, and makes two small cuts in the baby’s gums.

This is not a scene from a horror movie. This is a description of a typical visit to a pediatrician’s office in 1904. The diagnosis that both mother and doctor were concerned about was teething. In 1904, and for several hundred years prior to the beginning of the 20th century, medical science regarded teething as a dangerous disease. In fact, many death certificates during this era would list teething as a cause of infant death. The "state of the art" in treatment of teething involved "releasing" the baby’s teeth, typically by cutting the gums. The theory went that the danger of teething could be reduced this way. Articles from this period describe infants whose gums were cut as often as twice per day.

Historical memory is long. In 2004, although it is no longer considered a cause of death, teething is blamed for infant fevers, rashes, and diarrhea in addition to fussiness, sleeplessness, and apparent mouth discomfort. To test this proposition, a recent study published in a pediatric journal studied the relationship between teething and all of the symptoms traditionally thought to be caused by teething. The conclusion of the study was that only two symptoms were associated with teething: drooling and teeth (so far, I’ve been unable to convince any mother, including the mother of my own children, that these findings are true).

Nevertheless, no mother today would submit her baby to gum cutting. We might say that, compared to the practice of medicine today, doctors at the turn of the last century were veritable cave dwellers who walked hunched over, dragging their knuckles on the floor. At best we might observe that we simply know more today than they did then. Indeed modern medicine offers cures for diseases that would have killed us one hundred years ago. And it is unquestionably true that technology has transformed the practice of medicine into a discipline that would be unrecognizable to doctors in 1904.

But doctors in 1904 did not see themselves as knuckle-dragging cave dwellers – Quite the opposite. By the late 1800’s hospitals had been transformed from places where a person went to die to places where a person went to be cured. By 1904 all doctors understood that microbes, not evil humors, caused infections. And surgery was performed with anesthesia, under sterile conditions. By 1904, doctors believed they knew everything, or nearly everything, that there was to know about the human body and the diseases that afflicted it. To the early 20th century practitioner, the real cave dwellers lived one hundred years earlier, when bloodletting was the only therapy available for most diseases.

If the mother in our example story had brought her infant to the doctor today, she would probably suspect that the infant had an ear infection. She might hope that the doctor would prescribe an antibiotic for her daughter. For the doctor’s part, when he listens to her story and then sees a little redness in the baby’s eardrums, he too might believe she has an ear infection and might prescribe an antibiotic.

Antibiotics are a lot like scalpels. At the proper times, and in the proper hands, they can do much good. Since the introduction of sulfa-based antibiotics in the 1930’s, millions of lives have been saved. Millions more have been cured of non-fatal bacterial infections as well. But antibiotics, like scalpels, can do, and have done, much harm as well. At the dawn of the 21st century, we face a severe public health crisis that has been caused (at least in part) by the overuse of antibiotics. Stated simply, the germs are becoming immune to most antibiotics. We are running short of new drugs to treat previously treatable bacterial infections.

The crisis has become so severe that many doctors are choosing to hold off treating patients with antibiotics, unless the doctor is certain that the infection is bacterial and if so, if the doctor determines he can treat the infection without antibiotics.

The oldest principle of the practice of medicine is primum non nocere – First, do no harm. There are risks as well as benefits associated with everything that a doctor does in connection with treating patients. When a doctor decides to start treating a patient, one of the first thoughts that enters his mind (or should enter his mind) is "Am I doing more harm than good?" Sometimes the best decision is to leave the prescription pad in the drawer.

In my office, when I see mothers and babies who haven’t slept the night before, and the baby is fussy, hasn’t nursed well, and has been swatting at her ears, I think about the pediatrician from 1904 with his scalpel. Then I imagine a pediatrician in 2104 looking back at me with my prescription pad, and I wonder: What will he think of me, and the way I practice medicine? Will he say I lived in a cave, walking hunched over, dragging my knuckles on the floor?