CHAPTER IV Let me say to the younger men in connection with deriving (Part 6)

worthless and dangerous. The proprietor has become opulent and enjoys all of the luxuries afforded by great weahh. My friend, Dr. McM., who lives in the same city, is a man of the very highest scientific attainments, famous for his charming social quali- ties, and he has occupied the highest place of honor in the gift of the -American Medical Association. He has saved the lives of hundreds of people, has given comfort and happiness to thousands, has furnished inspiration as an ideal character for a host of young men — and older — yet he has to be careful about expenditures, and is not free to give largely to the cause of science in money endowment. His income does not compare favorably with that of a man who is reported upon investiga- tion to be deceiving and injuring the people for selfish pur- poses. The difference is due to a condition brought about through what man calls his higher intelligence. One of my old college friends who is in the patent medicine business with a really useful line of household remedies, tells me that he receives a great many photographs from people, to- gether with testimonials, asking to have both published in the newspapers. Men who enjoy the personal notoriety of A TO-MORROW'S TOPICS 219 having their pictures and names in the papers would testify that a medicine for the troubles of women had cured them of illness obtained from that source. My friend says we need not suspect that testimonials are written up in the office of a company, because all of the patent medicine men receive more than they can use. He and I are fond of sitting together before the open fireplace and discussing phases of human nature, while watching the cheery red flame of an apple limb making its way through a squirrel hole, the licking bluish light of hickory confidently gaining headway about a solid log, and the combustive flame of sassafras making great ado before settling down to an even yellow blaze. With com- forting pipes, in our easy chairs, we go over experiences together. He tells of the inner secrets of the patent medicine business, while I amuse him with quotations extending from Moliere to Bernard Shaw in their bearing upon real doctors. If the best of doctors are the best of all men because of their opportunities, and if the worst of doctors are the worst of all men because of their opportunities, we shall always have both sorts because the public is not clear about the difference. It cannot distinguish between patent medicines which are really useful household remedies and patent medicines which create drug habits and cause endless misery. One of my friends, who obtained patent rights for evaporat- ing milk in such a way as to make a dry granulated prepara- tion, told me that he tried for years to obtain ten cents per pound for this article, which cost him four cents per pound to make. Offering it upon its merits for food value, he made no progress. Another concern added a common drug, and advertised the mixture as a cure for all sorts of nervous break- down, dyspepsia and neurasthenia. This firm immediately ob- tained a great sale for the preparation, at a price of more than three dollars per pound. Testimonials poured in from I 1 TO-MORROW'S TOPICS some of the most famous men in the country, attesting to its value. Various newspapers and magazines now carry the advertisement, for which hundreds of thousands of dollars are expended annually. The facts in a case of this sort are so well known "in the trade" that it is a never ceasing wonder, even among manufacturers of "proprietaries," that the facts do not become generally known. They are not secret in the "trade," but are discussed freely. This is an example not only of the way in which people like to be deceived, but it shows the value of advertising. A preparation of this particular sort actually secures one common drug effect and it serves as pretty fair food at its real value of less than ten cents per pound. It advances education greatly because the enormous amounts expended for advertising allow the magazines to obtain larger circulation, and to spread their information about politics, poetry and police. Many of the proprietary articles which are placed upon the market for physicians are extremely valuable, but there is always competition between commercial houses. I f one men- tions any such article when publishing a paper or addressing a medical society, he is promptly beset by rival manufacturers. They send to him representatives who have a reputation for being good talkers. Reference to proprietary articles when published by a physician is apt to be seized upon for advertis- ing purposes and thousands of copies are sent out, but not in the plain form which would appeal to physicians. It is almost impossible for the manufacturers to avoid making use of display type, attractive covers, and all that sort of thing, which appeal to people in the commercial world, but which arc extremely obnoxious to members of the medical profession, who do not care to be impressed by anything excepting a simple fact presented in the simplest way. Further than that it is generally believed in commercial circles at least, if not I TO-MORROW'S TOPICS 221 in professional circles, that a physician has been given a quid pro quo for bringing forward a proprietary preparation, and this idea reduces him at once to a commercial level in the minds of readers of his article. On one occasion when it was difficult to avoid referring to a proprietary article of value, I was shortly afterward offered several thousand dollars' worth of stock in a rival concern if I would state over my signature that their preparation was the best. Their confidential man offered to go one better over any proposition "that had been made to me by the confidential man" of the concern whose article I had mentioned. When a proprietary article of great value has become established and has been approved by the Council of Pharmacy of the American Medi- cal Association, one need not be so carefully on guard. Ask any manufacturer if he would approve of your advertising the good product of a rival house and the situation will be clear. "Nostrums and Quackery," published by the Journal of the American Medical Association, may be obtained through any book dealer, and will furnish about as much dramatic reading as any other literature extant. There is opportunity right now in this imexplored field for the dramatist. With this book at hand he might prepare for the stage a telling play which would really serve the public better than white slave literature, which leads thousands into immoral lives of temporary ease by showing how it is done. The harm done by self -prescribing on the part of the laity is incalculable, even for such a standard sort of real disease as "malaria," and with such a standard drug as quinine, which is bought in some places in the South in grocery stores. Quin- ine, like any other drug, is a poison unless properly used. In this country there are at least three species of sporozoan parasites that have been classified as producing different types 2 TO-MORROW'S TOPICS of malaria. These parasites are introduced into the blood of healthy men through the probosces of three species of anopheline mosquitoes which have previously bitten patients suffering from different kinds of malarial fever. Each malarial microbe which has been introduced into a man through the agency of a mosquito pierces a red blood corpuscle, in which it lives and grows like a grub snugly curled up in a chestnut, feeding upon the hemoglobin of the blood corpuscle. All of the malaria microbes of one "infection family" have the habit of producing their spores at about the same hour. Chill, fever, and sweating are caused by a toxin which is liberated in the patient's blood on the day of segmentation of these parasites. Their poison is eliminated by the patient's emunctories in the course of a few hours and he then feels fairly well again. Another brood of parasites comes to maturity on its appointed day and spore forming with its consequent effects upon the patient follows. If the patient has been infected by several broods of one species of protozoan the spore dates may overlap and the fever becomes continuous. The same thing may happen when quinine interferes with the spore formation of one brood. Plasmodium viz-ax pro- duces its spores every other day, and causes tertian fever; Plasmodium malarii forms spores every three days, and causes quartan fever; Plasmodium praccox sporulates irregularly, and causes pernicious malaria. Quinine when skilfully used in different ways for meeting the conditions brought about by these different parasites is commonly curative, but sometimes harmful even when employed by the very best authorities. Further than that, poisonous doses of quinine are often given by physicians on mistaken diagnosis in febrile diseases which prove not to be malarial at all. The quinine itself may result in the production of congestion of the alimentary canal, depression of the cerebral and spinal centres, depression of I TO-MORROW'S TOPICS 223 the vasomotor centres, and secondary interference with the heart's action. It may cause cerebral congestion, defects of vision, permanent deafness, delirium, stupor, and certain hemo- lytic effects classified as special forms of pernicious fever and malarial cachexia. The improper use of quinine may also cause the appearance of numerous sexual forms of the malarial parasite instead of the common asexual forms, and when this occurs the patient is in a condition favoring an endless number of relapses. Further than that, it makes him a menace to the commimity, because mosquitoes which bite him are trans- ferring the parasites to other good folks in the neighborhood. A case of malarial fever which may be cured by proper administration of quinine at one stage of the existence of a Plasmodium may, on the other hand, be converted into one that is practically continuous and incurable. In cases in which quinine has been used carelessly and the parasites have become immime against its influence they seem to become at the same time particularly susceptible to the influence of arsenic, so that a single injection of salvarsan will some- times destroy them at once completely. Quinine at all times has a tendency to lessen the oxygenating power of the blood and it then retards the reconstruction of cells which have been injured. It has almost a paralyzing effect upon phagocytosis, because it combines oxygen more firmly with hemoglobin and consequently lessens the general ability of the patient to repair damage that has been done by any sort of microbe. If so much damage can be done in a class of diseases which we know pretty well about, and with a drug which we know pretty well about, little imagination is required for appreciating the effect of self -prescribing in general on the part of the laity. Such a simple matter as the mere closing of an ordinary cut is a dangerous thing for a layman, as exemplified by the dis- 224 TO-MORROWS TOPICS tressing results which we obaer\e to follow the application of popular materials purchased at a drug store for that purpose. If we close a wound which is not aseptic, and if we do not maintain asepsis, a very small amount of retained serum be- comes a culture medium for bacteria in a few hours, and the toxin immediately sets up an inflammation which may be verj- dangerous, as often observed at our clinics. In any event, closure of the wound by a layman or by a doctor who does not understand the principles involved, will lead to loss of time in the healing process, if nothing worse. Court plaster has killed thousands of people. A great deal of harm may be done by syndicate letter reports in the newspapers from correspondents who bring forward sensational medical news. A typical instance of this has occurred recently where a feature was made of the cancer cure said to have been discovered by a Doctor Odin of Paris, and published widely in this country. My enterprising friend Doctor Edwin Walker at once went to Paris in order to obtain first-hand knowledge for the benefit of his patients at home. He found Dr. Odin in newly furnished elegant apartments, to which he had recently moved, in one of the best neighbor- hoods; and with evidence of new prosperity from some source. He was found to be practically unknown in Paris, and was not connected with hospitals or other medical organizations to which responsible men belong. He had published nothing in French medical journals on the subject of the serum treatment of cancer, and had never done any work on lines of research or investigation so far as any of his colleagues knew. He did not have the manner and bearing of a man who was elated over making a great discovery of benefit to mankind, but was par- ticularly desirous of making a business arrangement which would allow him to obtain an income. Some cancer patients whom Dr. Walker examined in the office of Dr. Odin did not I A TO-MORROW'S TOPICS 225 seem to have received any benefit from treatment. The sad part of the visit was the observation of a great heap of letters from America in the doctor's private office from unfortunate sufferers, who in desperation were appealing to what appeared to be the cheapest sort of charlatan. This was all due to the enterprise of an enterprising newspaper correspondent who had sent a syndicate letter to the American newspaper press. It is somewhat risky for a physician to appear in the news- paper press on purely impersonal matters. A reporter for one of the best of our newspapers not long ago asked if I could state ways in which the poor could obtain medical services of high class. It seemed a perfectly legitimate subject for discussion. I gave him impersonal information, but in the kindness of his heart he added, without my knowledge, a line to the effect that all who were without funds were invited to come to my office. He could not see that this was a grave error, because we cannot ask for cases, even though the patients pay little or nothing at all. The result of this invitation, which I did not even suggest, — in fact carefully avoided suggesting in the interview, — was to subject me to the sort of criticism that would be natural and just unless one were given opportimity to make explanation. We must be more than particular. A doctor cannot afford even to be careless about allowing his name to be used, under present conditions, but the time may come to-morrow perhaps when some society like the New York Academy of Medicine will appoint certain representative men, who are given freedom to speak on various medical topics for the lay press. This would be of immense educational value for the people, if men could be selected who would have the finesse to leave out debatable and personal features when giving infor- mation. One reason why we cannot freely allow publicity of medical { 326 TO-MORROWS TOPICS subjects for the purpose of educating the people is because of a fundamental tendency on the part of the public to look for mystery and wonder in the field of healing. This trait is as characteristic of the human species as are the cartilages of selachians. It is undoubtedly founded upon a very deep in- stinctive desire for health ( self-preservation idea acting in accordance with this instinct). Reliance is quickly placed upon either superstition or knowledge, whichever one is most readily available. Superstition being handiest, people not only choose that by preference, but they allow imagination to magnify such right or wrong ideas as they may obtain. The fallibility of testimony concerning the wonders of healing may be ob- served through all history. In the letters of Saint Francis we find reference to nothing miraculous in his own work, yet there are many books in many languages describing him as a miracle worker. Saint Francis would have worked a real miracle had he persuaded people to accept his definition of a gentleman as "one who excuses every one but himself." One who is simply suspected of possessing mysterious knowl- edge, even though he make no such claim, is looked up to with interest and respect. The young man in a white jumper behind the soda water fountain of a drug store is called "Doc," and his advice is asked upon many questions, by people who would not notice him at all were he to wear a brown coat and stand three feet nearer to the centre of the shop. Knowledge of mysterious drugs is supposed to invade him as their odor pervades the atmosphere of the shop. When reporters for the daily press attend a meeting of bankers there are no scare heads next day relating to Federal reserve measures — the relation of national banks to reserve associations — the right to define the character of paper eligible for discount— rules against transferring or hypothecating shares of capital stock — the disposition of earnings — or other TO-MORROW'S TOPICS 227 questions of direct importance in finance. Let these same reporters attend a meeting of a medical society and they will be prone to make startling reports, introducing the feature of wonder, miracle, or mystery, and distorting the facts as pre- sented. I do not mean the reporter who reads this note, but the one whom he knows about. An3rthing so general as this tendency to look for wonder and miracle in healing must represent the working of some natural law, and it is presum- ably the response to a deeper feeling (self-preservation feelr ing) than