CHAPTER IV Let me say to the younger men in connection with deriving (Part 3)

is the matter with Kansas?" and yet we find on reference to the table relating to ten thousand fee-splitting circulars (quoted elsewhere) that Kansas holds its head up fairly well. Our conclusion would be that legislators in other fee-splitting states have just as little regard for the regular medical profession. We must continually remember that man as yet is only semi-domesti- cated, and the wilder the medical profession in any state, the wilder the legislators of that same state. Both sets of men t from about the same social stratum originally, and grad- ing relates to state social standards on the whole. The few men in the medical profession or in the legislature whose standards are high may have more difficult work, but at the same time a more elevated life joy which will serve in a compensatory way 1 i 192 TO-MORROW'S TOPICS for their troubles. Natural aristocrats belong to a privil^ed class in the best meaning of that expression. The League for Medical Freedom has pushed forward the Christian Scientists as their best cards before the legislature, the moneyed patent medicine interests remaining out of sight, but furnishing the sinews. The League people knew that legislators would recognize their sordid motives, unless they chose representatives with a great deal of shrewdness. Chris- tian Scientists representing an over-cultivated social element so largely, are really very influential. All of these people have large amounts of money for securing legislation which will be favorable to their interests. On one occasion when I had been sent to Albany to address a legislative committee, the train arrived about midnight. The two best hotels were full. A gentlemanly appearing man who stood near me at the desk and who had arrived on the same train suggested that we might find quarters at another hotel of which he knew. That was full. We journeyed about together and finally brought up at a hotel in Troy about two o'clock in the morning. There was only one room and one bed at that hotel. We decided to share the quarters. In the morning after an enjoyable breakfast together we made our way toward Albany, and found that we were both bound for the Capitol. My chance acquaint- ance told me that he was going there to speak for Christian Science. I told him that I was going there to speak against it, but that we would have dinner together afterward if he would meet me at the hotel. Sectarianism in medicine is fortunately not recognized by the United States Government, or by any other great government, and is recognized by the states only in proportion to the influ- ence which is brought to bear upon venal or careless legislative committees. Eventually the states will act like the central TO-MORROW'S TOPICS 193 government in recognizing only one standard group of quali- fied physicians. There will be freedom for any man to study the beliefs of various sects and call himself anything he pleases. No harm will be done so long as he has first qualified himself in the essentials of a certain standard education. It is interesting to observe the way in which states are fooled by sectarians while the central government keeps its head. Medical sectarians and faddists have gained much legal recognition in many states. This may sometimes have been due to ignorance rather than criminality on the part of legis- lators. The reason why I believe it was sometimes due to ignorance is because it is nearly impossible for laymen to exercise good judgment in matters requiring technical educa- tion for their comprehension. One cannot realize what influences are brought to bear for furthering selfish ends or unwise ends, unless he has been in a position for observation. My father was governor of one of the states, and all medical matters which were brought before him were given to me for consideration. He was a most conscientious man, just, wise, large minded, and bound to do what he thought was right in the face of all opposition, and even against my counsel in some cases. The trouble which I had in placing matters in a clear light for him showed how difficult it must be for a man in power in any state to know what is best for the interests of the medical profession and for the greater interests of society. At a hearing on the osteopaths' claim for recognition at Albany, one of the speakers seemed to make a great impression upon the committee by saying that osteopaths would be driven out of the state, if they could not be licensed. Before me in the audience sat one of the leaders of the osteopaths who had driven several people out of the state. One of my friends in the profession who was present had kept notes relating to 194 TO-MORROW'S TOPICS some of the cases of his own which had been under the care of this particular osteopath. One was a case of epilepsy which had previously been under a fair degree of control. The patient died very quickly with intense exacerbation of attadcs after the beginning of treatment upon his ''displaced bone." Another case was one of progressive paralysis agitans. The patient quickly left the state when subjected to violent manipu- lation. Another case was one of cancer of the breast subjected to manipulation and rapidly carried to a hopeless stage which drove the patient out of the state. Another case was one of hip-joint disease carried to the point of requiring excision which could have been avoided by regular treatment. The patient left the state. Another case was an acute appendicitis from which the patient was allowed to die without operation after having peritonitis stirred up by the violent movements of the osteopath in attempting to "empty the appendix." All of these people who were "driven out of the state" had formerly belonged in the clientele of just one physician imtil they left him and were treated by the one osteopath who sat before us in the audience, — and who did not wish to be driven out of the state himself. The lawyer who was engaged by the osteopaths for presen- tation of their case at Albany one year happened to be a dear old friend of mine. He had become deeply impressed with the idea of their not being treated fairly, and went into their cause with good faith. One day he came into the office and said: "Now, Tut, I want to have you come up to dinner to my house to-morrow, and meet three or four of the leading oosteopaths personally. You don't know what they are really like— good fellows and all that sort of thing." My reply was, "No. I cannot in justice to my profession go up to dinner with you and the osteopaths, but I will run up later and have a talk with all of you." This I did« taking along a segment TO-MORROW'S TOPICS 19S of a spinal column and rib articulations of a lamb. On arriv- ing at the house my proposition was that one of his clients show us how he moved bones, and if the test proved satisfac- tory to the mind of a lawyer we would then have a conference upon any other question. His clients not only refused to make the test, but the experience so impressed this lawyer that he dropped their case.. My friend was an unusually astute lawyer and had been offered a nomination by his colleagues for the Supreme Court bench. If a man of his type did not drop the osteopaths until after actually witnessing an object lesson relating to fraudulent procedure, we may readily under- stand how easily the average layman may be deceived. On one occasion when describing the people who had been "driven out of the State" by certain osteopaths, one of their lawyers arose menacingly and asked if I knew that what I was saying was actionable. Another one of their advisors immediately called the imprudent one to his seat. (Flexner reports not wanted in court. ) The osteopaths make a pretence of superior anatomical knowledge in the presence of laymen, and claim that members of the medical profession are not such expert anatomists as they. The laity cannot know that since the days of Ambroise Pare anatomy has been fundamental mathe- matics for the regular profession. Many thousands of books and monographs on the subject are to be found in the libraries. Amongst all this mass of serious scientific literature there is not one book on anatomy by an osteopath. These people would not dare to print most of what they say to the public and what the public really believes. Any layman who will take the trouble to step into the meat market and have one look at the spinal column and ribs of a lamb may be trusted thereafter to use plain sense about this question of moving bones. Face an osteopath with a real bone and joint and he quickly runs away from the hot pair of tongs. The osteopaths had to raise their I9^ TOMORROW'S TOPICS edocatioaal stuidards^ At first some of their sdiools adver- r^icd dtat after a six wedcs* coarse of stixfy any derk could stand OQ a social level with r^obr physicians and make a larger average income. This was no doubt pretty nearly true. The ettect. however, was to load up the ranks of osteopaths with such a swarm of uneducated men that for their own prv>tectioQ ther were obliged to raise educational standards. An osteopath whose famihr is at present under my care tells me that he has very litde work, yet he is a man who is naturally ver>^ clever, speaking several languages and interesting in various sorts v>f conversation. He took up the subject because of failure in another occupation. Kam\ hands were doing to them what ostec^ths had been dv^iuj: to the n^;ular medical profession. After raising standards there was no longer opportunity for the small derk tv^ stand on a sodal le'd with good physidans and be called **IV</' In order to supply that need for the public, chirv^practic came into the fidd and began to advertise as osteopathy had done pre*iously. Wlien this new method of practice lias beo>me overloaded with homy-handed tons of soil cvx^HHlog men, and remnant stocks of bankrupt intellect, the letter class of chiropractors will raise their standards, and their schools will require more and more of the educa- tion belonging to the regular profession, finally joining its ranks. Meanwhile the public is cheerfully standing the cv^nsequences, and it will continue to do so for every new medical fad which captures the imagination with its pretence. Not only the present-day faddist but others that will arrive to-morrow, will attract people who believe they can afford to pay for something new. During something over thirty years of medical practice I have observed the beginning and estab- lishment of half a dozen great new movements of advance, and at the same time have watched the development of an TO-MORROW'S TOPICS 197 equal number of medical fads. Steps of the former were as follows: (i) A valuable movement began from the laboratory. (2) Its exponents were at first assailed by honest men, actuated from the basis of safe tradition. (3) Facts were gradually taken under consideration and weighed. (4) Advanced position was established through recognition by the laity of practical end results. Fads developed as follows: (i) Some irresponsible indi- vidual with a delusion spoke in terms of mystery and convic- tion. (2) Others of the same type of mind joined to form a nucleus. (3) Unoccupied but restless people seeking to place their minds somewhere, following instincts of variation, joined forces with the faddists. This group included many people of high social position. (4) A fad including people of high social position attracted business and professional men, very much as when a gull finds a school of herrings, actions of the first gull attract a whole flock of them. Architects, artists, brokers, insurance men, manufacturers, added them- selves to the throng through motives of personal profit. (S) The business men who had been attracted to the faddist group had a good deal of confidence in each other. (6) Suc- cessful men of business, interested in a fad, made it a subject of conversation at the home. Women then promulgated the ideas in cheerful conversation. We shall have endless movements like that of the gold cure for alcoholism. My own income has never been so large as that of a certain faddist whose books I came to know about seven years after he had graduated from his occupation as a driver of an express wagon. Perhaps someone will say, "Why ! All these peculiar sectarian practitioners are not really given a license to practice medicine. They are simply given a license to apply their methods in some sorts of cases !" Run- ning over in mind a rather long list of cases of various kinds, I igS TO-MORROWS TOPICS do not at the moment recall any sort of case that would not be claimed by faddists of one sort or another. If osteopathy could be freed from its fraudulent preten- sions and placed in proper hands, it would serve an useful purpose. It seems to have entered a field beyond that of Swedish movement and massage. Ross and Sherrington many years ago discovered that certain visceral irritations sent an afferent nerve impulse to definite segments of the spinal cord. from which efferent impulse was then sent out over the peri- pheral distribution of somatic sensory nerves. The next step in progress in this field was made by Head. He followed up the data of previous observers, and classified into definite groups the zones of cutaneous hyperesthesia which correspond to irritated viscera within the body. Neither Ross, Sher- rington, nor Head suggested any important application of this knowledge to practical therapeutics, although Head described the sedative effect of counter-irritation over the cutaneous zones belonging to various organs. The organs were relieved of some of their irritability by resources applied to the skin. For instance, a mustard plaster over the cutaneous zone for the stomach relieves certain forms of gastric disturbance. A hot-water bottle over the lumbar region is helpful in cases of congestion of pelvic viscera. In a paper published in the Journal of the American Medical Association for June, 191 1, I showed that peripheral trophic nerves are apparently in- fluenced quite as much as are peripheral sensory nerves, by irritation proceeding from the stomach. Practical application of the idea was made in a more careful suturing of the abdominal wall after gastric operations, and attention of the ifession was called to the nature of "unaccountable failure jOi union" of the abdominal wound after gastric operations. Furthermore, cases are recorded in which removal of some pressing upon the intercostal nerves has relieved TO-MORROW'S TOPICS 199 chronic gastric disturbance or intractable cough. For the most part, such scattered observations as have been made by members of the regular medical profession in relation to regional somatic response to visceral irritation, have not been classified and arranged in practical form for therapeutic appli- cation. It is reported that a spiritualistic dreamer, Dr. Still of Missouri, while partly asleep under a tree one day, became possessed of a fanciful thought that diseases were mostly caused by bones being out of place. He followed up the idea by making manipulation of various bones, particularly of the spinal column, and incidentally noted what appeared to him to be confirmation of his idea. This was the beginning of osteopathy. As a matter of fact, Dr. Still was really massag- ing the superficial areas of distribution of nerves which cor- responded to asthenic or irritated nerves of different viscera. In his ignorance he imagined that he could move various bones into place and "remove pressure from the nerves." Starting from the practical results of a system of massage which was based upon nonsense, a number of followers of Dr. Still began to develop a fanciful system. Imperfectly educated men who took up the subject were often quite honest in their belief that they were moving dislocated bones, but the more highly edu- cated had to become frauds in order to tell patients that they moved bones of the spinal column or ribs into place and kept them there. A peculiar phraseology was constructed by the osteopaths to fit the idea of moving bones, and this is nothing more than a jumble of words belonging to the type of mind of the Indian medicine man. In order to convince patients that bones were being moved into place some of the osteo- paths developed a trick belonging to the old-fashioned bone- setters, of snapping the second joint of the thumb in such a way that it gives a patient the impression of his own bone going into place. Later, when the X-ray began to be used for TO-MORROWS TOPICS photographing spinal columns and ribs, a very little trickery of the sort which is well known to photographers sufficed to give a mendacious representation of bones in place, after a previous photograph had pictured the common irregularities which belong to every one, and which, in fact, have no refer- ence whatsoever to disease. Almost every civilized individual has one hip a little higher than the other, one shoulder a bit higher than the other, and certain vertebrae a trifle out of natural alignment. The statement that these "dislocated bones" could be put in place by manipulation was fraudulent when not made by the ignorant. The idea of adjusting bones was promulgated by the osteopaths, because it served a purpose in allowing them to "catch cases." A reformed bone-setter who showed me how to snap the second joint of the thumb in order to give patients the impression that one of their own bones had gone into place told me that it was