that popular medicine was in all ages at least fifty years behind
scientific medicine. He had himself discovered the principles of
cellular pathology nearly half a century before his death, yet he
declared that the popular mind still believed in the old doctrines of
humoral pathology,--that is, that the conditions of health and
disease depended on the constitution of the fluids of the body (the
blood, the bile, the mucus, and so forth), and had not generally
accepted modern advances in medical knowledge of the underlying basis
of disease in the solid tissues. There is no doubt that many
old-fashioned notions long since discredited by physicians are still
very generally accepted by the popular mind, and even the intelligent
classes sometimes harbour convictions with regard to the good or evil
effects of habits {89} of life, diet, and the operation of drugs of
various kinds that are entirely contrary to present-day medical
knowledge.
It is extremely important, then, that the clergyman or charitable
visitor, in giving views on medical matters, which are sure to have
much more weight than he perhaps attributes to them himself, should be
careful not to make statements for which he has not good authority in
modern medical science. It is very easy, in a matter of this kind, to
state principles that are not the result of education, properly so
called, but are gleaned from early false impressions obtained one
knows not how or where, entirely without definite consciousness as to
their real origin. The physician himself finds that he is compelled to
be careful of this same tendency to put too much stress on traditions
with regard to health which he imbibed before he began to study
medicine. It is perhaps not so surprising, then, to hear physicians
complain often that clergymen instead of being a help are sometimes a
hindrance to the enforcement of modern hygienic rules, because they
still cling to old-fogy notions of hygiene and sanitation retained
from a defective early training. Owing to the influence that the
clergyman is sure to exert, this becomes an extremely important
matter. Great harm may be done and the physician discredited, almost
without a realisation, on the part of the clergyman, that he is
interfering in another's department. Sympathetic coordination of
clerical and medical efforts would accomplish much good that is now
unfortunately left undone.
There is no doubt that for the important crusade against tuberculosis,
for instance, the aid of the clergyman will accomplish much for the
reduction of the death rate from this disease. What is needed at the
present moment is a universal conviction that tuberculosis is not an
hereditary but a communicable disease. This does not mean that it is
virulently contagious and that as a result sufferers from tuberculosis
must at once be segregated from other members of the family and from
the community generally; but it does mean that careful precautions
must be taken with regard to the disposal of sputum, with the
enforcement of the most exacting cleanliness on the part of
consumptives themselves. {90} It also means that the person suffering
from the disease should not sleep with those as yet unaffected, nor be
allowed to live in very close contact, especially with children or
susceptible individuals.
The persuasion that tuberculosis is not hereditary will do much to
encourage patients suffering from the disease to feel that they are
not hopelessly doomed. At the present time it is not unusual to find
patients so discouraged, when told that they have tuberculosis, that
it is almost impossible to secure a favourable reaction to any mode of
treatment. They have seen members of families die one after another,
or they have heard stories of the inevitable way in which consumption
wiped families out of existence, and they give up hope and become
quite cast down. Needless to say, while in this condition any
treatment is practically hopeless. On the other hand, the conviction
that tuberculosis is only an infectious disease, quite curable in the
majority of cases if taken in time, is of itself a most important aid
in the treatment of the disease, since courage and faith are the
principal requirements for successfully combating the affection.
We have had any number of newly invented remedies for consumption in
the last twenty-five years. Scarcely a year has passed in which some
new form of treatment, often eventually proved to be the resuggestion
of an old therapeutic method, has not been heralded as a positive cure
for consumption. In every case the first patients treated by the
discoverer of the new remedy have rapidly improved under his care. In
the hands of others, however, such results have not been obtained, or
only for a very short time at the beginning of the treatment. After a
time the new remedy failed in its inventor's hands. The true reason
for the improvement was then seen to be, not the remedy suggested, but
the favourable influence on the mind of consumptives produced by the
faith of the inventor in his remedy, and their reaction to this
powerful suggestion when they were put under proper conditions of an
abundance of fresh air and a plentiful diet.
This shows, too, the reasonableness of the modern treatment of
consumption, which consists not in the giving of {91} drugs, but in
securing for the patient a plenty of fresh air for many hours a day
and the encouragement to consume a liberal amount of nutritious food.
Most of the much advertised remedies for consumption are really
harmful rather than beneficent. Many of them are ordinary cough
mixtures containing considerable opium, which lessens the cough, it is
true, but also lessens the appetite and locks up the bowels. Besides,
the cough is nature's method of removing material from the lungs which
has become disintegrated, and if allowed to remain will certainly
bring about the spread of the infection in the pulmonary tissues.
Cough is a natural protective reaction to be encouraged, and is not in
itself a source of evil needing to be suppressed. If cough is
bothering the patient so much at night as to cause loss of sleep, then
it is necessary to make a choice between two evils and somewhat to
suppress the cough, even though it involves certain other
inconvenience to the patient. All these so-called consumption cures
contain materials that are almost sure to disturb the appetite and
upset the stomach. The fate of a consumptive patient absolutely
depends on his stomach; just as little, then, of medicine must be
employed as possible. This will indicate the necessity for clergymen
rather advising against than in favour of these proprietary medicines
which have been definitely known to do so much harm in recent years.
Many a patient delays an appeal to medical aid so long, as the result
of trusting to such medicines, that a curable case of consumption
becomes incurable, or else develops to such a condition as to require
years of treatment on the fresh-air, abundant-food plan, where months
would have sufficed before.
A very interesting phase of social medicine is the ease and confidence
displayed by people, often of more than ordinary intelligence, in
recommending various proprietary medicines of which they know nothing
except the fact that someone says he, or more often she, was cured of
something or other by their use. A chance remark like this to a
sufferer becomes a high recommendation. The hardest problem the doctor
has before him is to find out what is really the matter with his
patients. Not infrequently people having apparently the same set of
symptoms are suffering from quite different {92} ailments. A symptom
like a sore throat, for instance, may very well be due to any one of
at least a half-dozen of causes, most of which require their own
peculiar treatment. When the affection under consideration is as
indefinite as a tired feeling, or indigestion, or some one of the many
ailments included under the term biliousness or kidney trouble, from
which people are supposed to suffer, then the diagnosis problem
becomes by far the most serious question in the case, and is often
very difficult. The trained physician prudently hesitates, but the
inexpert in medicine steps in and quite volubly announces what the
ailment is in his opinion, and what will probably do it good. A little
knowledge is indeed a dangerous thing in medical matters. If it be
remembered that there is a very general impression among medical men
now, as the result of recent acquisitions of scientific information
with regard to the origin, pathological basis, and course of disease,
that very probably more harm than good has been done by the
administration of medicines in the past, not only the futility of lay
(or clerical) prescribing will be manifest, but also somewhat of the
amount of harm that may be done.
It is often a matter for painful surprise, then, to find that
clergymen and members of religious communities allow their names to be
used in the recommendation of remedies of whose composition they know
nothing, for a disease of which they know less, if possible. This evil
becomes especially poignant when the columns of our reputable
religious press are allowed to be used for the purpose of exploiting
the public in these matters. The remedies most often recommended are
the so-called tonics. These are best represented by the sarsaparillas,
and by various cures for catarrh, indigestion, and kindred indefinite
ills, of which there are a great many on the market. These are not
secret remedies, since their composition is well known by those of the
medical profession who care to secure the information. Some six years
ago an analysis of most of them was made by the Massachusetts State
Board of Health. [Footnote 1]
[Footnote 1: 28th Annual Report Mass. Board of Health; food and drug
inspection, 1897.]
The principal active agent in all of these remedies was {93} found
to be alcohol. In most of them it exists in a proportion about equal
to that in which it is supposed to occur in ordinary whiskey. Some of
them are even stronger in alcoholic contents than the whiskey usually
sold in our large cities. This matter has seemed so important that we
give the official figures of the Board of Health.
TABLE
From the Report of the Massachusetts Board of Health
_Tonics and Bitters_
The following were examined for the purpose of ascertaining the
percentage of alcohol in each. Some of them have been recommended as
temperance drinks!
Per cent, of Alcohol (by volume).
"Best" Tonic 7.6
Carter's Physical Extract 22.0
Hooker's Wigwam Tonic 20.7
Hoofland's German Tonic 29.3
Hop Tonic 7.0
Howe's Arabian Tonic, "not a rum drink" 13.2
Jackson's Golden Seal Tonic 19.6
Liebig Company's Coca Beef Tonic 23.2
Mensman's Peptonized Beef Tonic 16.5
Parker's Tonic, "purely vegetable," "recommended for inebriates" 41.6
Schenck's Sea Weed Tonic, "entirely harmless" 19.5
Atwood's Quinine Tonic Bitters 29.2
L. T. Atwood's Jaundice Bitters 22.3
Moses Atwood's Jaundice Bitters 17. 1
Baxter's Mandrake Bitters 16.5
Boker's Stomach Bitters 42.6
Brown's Iron Bitters 19.7
Burdock Blood Bitters 25.2
Carter's Scotch Bitters 17.6
Colton's Bitters 27.1
Copp's White Mountain Bitters, "not an alcoholic beverage" 6.0
Drake's Plantation Bitters 33.2
Flint's Quaker Bitters 21.4
Goodhue's Bitters 16.1
Greene's Nervura 17.2
{94}
Hartshorn's Bitters 22.2
Hoofland's German Bitters, "entirely vegetable and free from
alcoholic stimulant" 25.6
Hop Bitters 12.0
Hostetter's Stomach Bitters 44.3
Kaufmann's Sulphur Bitters, "contains no alcohol." As
a matter of fact, it contains 20.5 per cent, of alcohol
and no sulphur 20.5
Kingsley's Iron Tonic 14.9
Langley's Bitters 18.1
Liverpool's Mexican Tonic Bitters 22.4
Paine's Celery Compound 21.0
Pierce's Indian Restorative Bitters 6.1
Puritana 22.0
Porter's Stomach Bitters 27.9
Pulmonine 16.0
Rush's Bitters 35.0
Richardson's Concentrated Sherry Wine Bitters 47.5
Secor's Cinchona Bitters 13.1
Shonyo's German Bitters 21.5
Job Sweet's Strengthening Bitters 29.0
Thurston's Old Continental Bitters 11.4
Walker's Vinegar Bitters, "contains no spirit" 6.1
Warner's Safe Tonic Bitters 35.7
Warren's Bilious Bitters 21.5
Wheeler's Tonic Sherry Wine Bitters 18.8
Wheat Bitters 13.6
Faith Whitcomb's Nerve Bitters 20.3
Dr. Williams' Vegetable Jaundice Bitters 18.5
Whiskol, "a non-intoxicating stimulant, whiskey without its sting" 28.2
Colden's Liquid Beef Tonic,
"recommended for treatment of the alcoholic habit" 26.5
Ayer's Sarsaparilla 26.2
Thayer's Compound Extract of Sarsaparilla 21.5
Hood's Sarsaparilla 18.8
Allen's Sarsaparilla 13.5
Dana's Sarsaparilla 13.5
Brown's Sarsaparilla 13.5
Corbett's Shaker Sarsaparilla 8.8
Radway's Resolvent 7.9
The dose recommended upon the labels of the foregoing preparations
varies from a teaspoonful to a wineglassful, and the frequency also
varies from one to four times a day, "increased as needed."
Many so-called tonics not on this list are also known to contain
alcohol, {95} though not as yet officially analysed so as to give
exact figures. Most of the cure-alls for women's ills contain
alcohol in noteworthy amounts, this being in fact usually the only
active ingredient in them.
As the analyst of the State Board of Health of Massachusetts is a
thoroughly competent chemist, and as these figures have now been
before the public for over five years without any contradiction on the
part of the manufacturers of these remedies, though it is evident how
undesirable the truth of the matter is from an advertising standpoint,
there can no longer be any question as to the authoritativeness of the
proportions of the alcohol in the remedies as given.
It is rather sad to think of mothers giving these remedies to their
children, hopeful of the good they may accomplish, when, as a matter
of fact, it would be so much simpler and just the same in the end, to
give them, instead of a tablespoonful of the favourite sarsaparilla,
whatever it might be, a tablespoonful of dilute whiskey. As was noted
in the volumes on the _Physiological Aspects of the Liquor Problem_
published recently by a sub-committee of the Committee of Fifty for
the investigation of the liquor problem, not a few prominent total
abstinence advocates have put themselves on record as recommending
these remedies, though there can be no possible doubt of the great
harm likely to arise from their use. There are many physicians who
feel sure that some of the alcoholic habits in women, whose origin it
has been hard to account for, were really contracted during this
secret "tippling" process under the form of a tonic remedy. Everyone
knows that any tonic, in order to be effective, has to be gradually
increased, so it is not surprising that in many cases physicians have
heard of patients taking six to ten tablespoonfuls of some tonic
remedy every day. This would be the equivalent, in some cases, of from
three to five ounces of whiskey--a rather liberal allowance even for a
confirmed whiskey drinker.
As noted by the Massachusetts Board of Health, the dose recommended
upon the labels varies considerably, but practically all agree in
suggesting that the amount of the remedy taken shall be increased as
needed. A simple presentation of this subject will surely be
sufficient to arouse clergymen {96} to a proper sense of their duty in
this matter. Senators, judges of Supreme Courts, Congressmen, and even
university professors and teachers may be so benefited by dilute
whiskey, taken early and often, as to be tempted to furnish
testimonials for them (for a due consideration usually), but clergymen
should at least know something of the consequences of their act before
committing themselves.
An almost precisely similar state of affairs obtains with regard to
another class of favourite popular remedies. A number of so-called
blood-purifying remedies have been recommended at various times, and
here, as in other things, it is surprising to find how many
intelligent people lend themselves to the exploitation of the public
in the interests of the proprietary vender, who cares only to sell,
and cares very little what effect his remedies may produce. Most of
the sarsaparillas are said to be blood purifiers. It is surprising
what vogue this word "sarsaparilla" has obtained. A little more than
half a century ago a German chemist and pharmacist announced that the
sarsaparilla plant contained certain principles that could be
extracted by boiling, and that form excellent remedies for atonic and
anaemic conditions. This announcement was received by the medical
profession very kindly, and immediate tests as to the efficacy of the
new remedy were made. As a result of these tests, within a few years
the inefficacy of sarsaparilla became very clear. It is almost
entirely without effect upon the human system. In the meantime,
however, the word "sarsaparilla" was one to conjure with for the
popular mind, and the sarsaparilla remedies began to be manufactured.
Millions have been made on them and out of the public. The only active
agent as regards tonic qualities which they contain is, as we have
said, alcohol. Most of them however, contain at least one other
well-known drug likely to be at least as harmful as alcohol. This is
iodide of potash. Very few of the so-called sarsaparillas are without
a notable proportion of this strong mineral salt, as the Massachusetts
Board of Health said.
"With but few exceptions they contain a considerable percentage of a
very active and powerful remedy, the iodide of potassium. The sale of
such an article in unlimited {97} quantities by druggists, grocers,
and others is censurable. More than this, the method of its sale is
dishonest, since the unwary purchaser is led to believe that he is
purchasing a harmless vegetable remedy, namely, sarsaparilla.
"It may be seriously questioned whether the blood of persons who take
iodide of potassium continuously is not decidedly impoverished,
instead of being purified, as is claimed by the manufacturers. It is
not uncommon to find persons who have used continuously six, eight, or
ten pint bottles of one of these preparations.
"Unlike sarsaparilla, the iodide of potassium is classed among poisons
by nearly every writer upon toxicology."
Practically all the proprietary remedies have their most potent
principle in the supposed mystery of their composition. As a matter of
fact, all are simple prescriptions, well known to physicians, and
owing their successful treatment of many ills much more to the
printer's ink used to secure their sale than to any pharmaceutical
ingredient which they contain. No important remedy has ever been put
on the market by advertising methods. Exposure of the charlatanry of
such methods will not, however, cause an interruption of their sale.
Long ago Barnum said that people wish to be humbugged, and there is no
doubt that they have been, are, and will be humbugged just to the
extent to which they lay themselves open to the alluring methods of
the advertiser. It does seem too bad, however, that the influence of
the clergymen and of religious as well as charitable visitors--an
influence acquired because of the confidential position they occupy
and the feeling of good faith their mode of life inspires--should be
abused for the encouragement and extension of what is manifestly a
great evil.
Alcohol and iodide of potash are not the only drugs likely to do harm
that are incorporated in proprietary medicines. Great complaints have
recently been made with regard to the spread of the cocaine habit in
this country. Not a few of the remedies that are supposed to give
immediate relief to colds in the head contain cocaine in dangerous
amounts; and there seems no doubt that in many cases the drug habit
for this substance has been acquired innocently and {98} unconsciously
at first by the use of such preparations. These are only the more
notable evils likely to result from the indiscriminate employment of
medicines of whose composition there is complete ignorance, and of
whose effect there can be only the judgment dependent upon the
subjective feelings of the patient. It must not be forgotten that the
patient's feelings are for the moment often favourably influenced by
some substance that may do no good to the ailment, though making the
patient less sensitive to any symptoms from which he was suffering;
but in the end doing positive harm, because of the contraction of the
alcohol or some drug habit, or because the suppression of symptoms may
be the very worst thing for the patients, since it allows the
underlying ailment to progress to a serious stage without forcing them
to have it treated _in radice_.
These are only a few examples that show very well the inadvisability
of recommending in any way medicines of which one does not know the
exact contents. The present writer has had one example of how utterly
disingenuous, though one feels much more like calling it rascally, the
manufacturers of so-called patent medicines or proprietary remedies
may be. One of the remedies widely advertised for the cure of
epilepsy, or fits, is announced always as containing no harmful drugs,
no bromide of potash. The manufacturer of the remedy was asked how he
could say any such thing, since it was very evident even to the taste
that the remedy contained bromides. "Oh," he said, "yes, it contains
sodium bromide, but not bromide of potash." Almost needless to say,
sodium bromide is at least as harmful as potassium bromide, and the
advertisement is entirely for purposes of deception.
The poor epileptics have been a source of revenue for quacks and
charlatans as long as history runs. At the present time one not
infrequently finds testimonials from convents, asylums, reformatories,
and the like, asserting the value of some particularly advertised
remedy for this disease. All these remedies contain bromides. The
treatment of epilepsy is now better understood by physicians and it is
generally recognised that the two things that epileptic {99} patients
need are outdoor air and as far as possible all freedom from
responsibility. Bromides will, for a time, control the number and
frequency of the attacks, but if used indiscriminately, and especially
if employed without any proper realisation of their possibilities for
harm, these salts are almost sure to make the condition of the patient
much worse than before, to bring on a state in which mental symptoms
predominate over physical, and in which the patient may go into
dementia, or some form of mental alienation. Especially is this true
with regard to epileptic children. Continuous dosing with drugs of any
kind is sure to do them harm rather than good. Care for their diet and
rest and the removal of all sources of disturbance of their digestive
tract is more important than any other method of treatment.
The poor children have to suffer many things from many people. People
hesitate, as a rule, to accept recommendations with regard to the
administration of drugs to their animals when the person who gives the
recommendation is known not to be an expert in the matter. Almost any
suggestion, however, with regard to the dosing of their children is
likely to be followed by loving but indiscreet mothers. It is well
known now, and in many cases is admitted, that the so-called soothing
syrups so often given to children contain opium in quite appreciable
quantities. Needless to say, nothing much worse than this could
possibly be given to children. The child soon becomes accustomed to
its daily dose of opium and craves the repetition of it. It will not
sleep without it, and as this adds to the sales of the remedy, this
special ingredient continues to put money in the pockets of the
manufacturers, but at the expense of the nervous stability of the
child, and lack of resisting power later in life. It would be hard to
say how many of the nervous wrecks so commonly met with in young
adults now are to be attributed to this unfortunate state of affairs
early in life; but undoubtedly this evil has had much to do with the
noticeable increase in the nervousness of our people. The more nervous
the heredity of the child, the more it must be guarded against such
mistaken methods of inducing sleep, or the result is sure to be
serious.
{100}