TRANSCRIBER’S NOTES:
—Obvious print and punctuation errors were corrected.
—Subscripts have been rendered as a_{b}
[Illustration: JOHN A. MILLER, M. D.]
FEMINA,
A WORK FOR EVERY WOMAN
ILLUSTRATED.
A perfect woman, nobly plann’d,
To warn, to comfort and command;
And yet a spirit still, and bright,
With something of an angel light.
—_Wordsworth._
BY
JOHN A. MILLER, M. D.
GRADUATE MEDICAL DEPARTMENT UNIVERSITY OF CALIFORNIA, ALSO HOLDING
CREDENTIALS FROM THE UNIVERSITIES OF BERLIN AND
HEIDELBERG, GERMANY.
SAN FRANCISCO,
THE FEMINA COMPANY,
1893.
ENTERED ACCORDING TO ACT OF CONGRESS, IN THE YEAR 1893
BY JOHN A. MILLER,
IN THE OFFICE OF THE LIBRARIAN OF CONGRESS,
AT WASHINGTON, D. C.
TO
THE LATE
DR. CARL SCHROEDER,
PROFESSOR OF DISEASES OF WOMEN
IN THE FREDERICK WILLIAM UNIVERSITY, BERLIN
MY TEACHER AND FRIEND.
[Illustration]
PREFATORY NOTE.
The publication of this volume was suggested by the astonishing
ignorance displayed and the antiquated ideas entertained upon questions
of health and disease by most persons with whom I came in professional
contact, even by those who were accomplished in other subjects of a
scholastic and scientific nature. The practical importance of the
subject naturally led me to the consideration of diseases that are
essentially inflammatory, for over seventy-five per cent of all
diseases of women are of an inflammatory nature. In this respect the
book differs from other works on similar subjects.
In discussing this class of diseases I have aimed to present a treatise
simple in style, and easily understood by the casual reader. While I
have endeavored to impart strictly scientific information, I have tried
to impart it in familiar language, avoiding the use of technical terms
as far as possible, and carefully defining them when their use became
indispensable.
JOHN A. MILLER, M.D.
No. 1137 Geary Street, San Francisco, Cal.
[Illustration]
BY THE SAME AUTHOR.
MEDICAL EDUCATION IN THE UNITED STATES AND AN OUTLINE OF THE GERMAN
SYSTEM. Essay read before the Alumni Association of the Medical
Department of the University of California, March, 1886.
EROSIONS OF THE VAGINAL PORTION OF THE CERVIX, OR ULCERATION OF THE
SAME PART. _Pacific Medical and Surgical Journal_, January, 1887.
RETROVERSIO-FLEXIO AND A NEW INSTRUMENT FOR THE REPOSITION OF THE
UTERUS. _American Journal of Obstetrics and Diseases of Women and
Children_, February, 1887.
UTERINE HEMORRHAGE AND LIGATION OF THE UTERINE VESSELS AS A
THERAPEUTIC EXPEDIENT. _The New York Medical Record_, September, 1889.
PHLEGMASIA ALBA DOLENS, OR MILK LEG; ITS PATHOLOGY AND TREATMENT
BY MEANS OF COLD WATER COMPRESSES AND ICE BAGS. _Pacific Medical
Journal_, June, 1891.
CONTENTS.
CHAPTER I.
THE REASON WHY 15
CHAPTER II.
DELUSIONS AS TO THE CURATIVE VALUE OF DRUGS 36
CHAPTER III.
WHAT IS MIND CURE? 46
CHAPTER IV.
GENERAL CAUSES OF UTERINE AND PELVIC DISEASES OF WOMEN 61
CHAPTER V.
UNCLEANLINESS AS A CAUSE OF DISEASES IN WOMEN 76
CHAPTER VI.
MARITAL EXCESSES AND PREVENTION OF CONCEPTION 87
CHAPTER VII.
CRIMINAL ABORTION OR FETICIDE 101
CHAPTER VIII.
ANATOMY OF THE FEMALE ORGANS 119
CHAPTER IX.
MENSTRUATION AND MENSTRUAL DISORDERS 126
CHAPTER X.
HISTOLOGY OF INFLAMMATION 145
CHAPTER XI.
URETHRITIS AND NEURALGIA OF THE URETHRA 150
CHAPTER XII.
INFLAMMATION, CATARRH, AND OTHER DISORDERS OF THE BLADDER 157
CHAPTER XIII.
ACUTE AND CHRONIC INFLAMMATION OF THE VAGINA 172
CHAPTER XIV.
HYGIENIC MEASURES FOR CATARRHAL DISEASES OF THE FEMALE ORGANS 182
CHAPTER XV.
METRITIS OR INFLAMMATION OF THE WOMB 196
CHAPTER XVI.
CHRONIC METRITIS OR CHRONIC INFLAMMATION OF THE WOMB 203
CHAPTER XVII.
ENDOMETRITIS OR CATARRHAL INFLAMMATION OF THE WOMB 209
CHAPTER XVIII.
THE NATURAL POSITION OF THE UTERUS AND HOW IT IS SUPPORTED 226
CHAPTER XIX.
PROLAPSUS OR FALLING OF THE WOMB 231
CHAPTER XX.
VERSIONS AND FLEXIONS OF THE WOMB 240
CHAPTER XXI.
DISEASES OF THE FALLOPIAN TUBES 258
CHAPTER XXII.
DISEASES OF THE OVARIES 263
CHAPTER XXIII.
PERIMETRITIS AND PELVIC PERITONITIS 275
CHAPTER XXIV.
PELVIC CELLULITIS OR PARAMETRITIS 285
CHAPTER XXV.
ELECTRICITY AS A REMEDY 294
CHAPTER XXVI.
SIGNS AND SYMPTOMS OF PREGNANCY 305
CHAPTER XXVII.
PRECAUTIONS AND SUGGESTIONS TO PREGNANT WOMEN 315
CHAPTER XXVIII.
WHILE IN CHILD BED 328
CHAPTER XXIX.
DISEASES PECULIAR TO CHILDREN 341
CHAPTER XXX.
DISEASES PECULIAR TO CHILDREN—CONTINUED 356
CHAPTER XXXI.
EMERGENCY TREATMENT IN SUDDEN ACCIDENTS 377
CHAPTER XXXII.
SOMETHING ABOUT DIET 392
CHAPTER I.
THE REASON WHY.
I see a large field of usefulness which has not been covered by
competent authorities. I propose, therefore, to offer a plain, simple
statement of the most common causes of physical suffering in women,
and a simple and reliable method of home or domestic treatment, to be
carried out by the patients themselves, which, in the great majority of
cases, is easily applied.
The first nine years of my professional life was an untiring and
incessant devotion to the arduous demands of a large family practice,
after which I decided to go to Europe, and there prosecute such studies
in two German universities as my experience as a practitioner had fully
convinced me to be of the greatest practical and scientific importance;
hence, I offer no excuse or apology for aught I may say on a subject
with which I have taken especial pains to familiarize myself. Having in
a measure established my identity, I am more fully prepared to proceed
in a more congenial way.
In the realm of thought there is no monopoly, and it is, after all, at
the bar of public opinion that a final judgment must decide the merits
of my course.
The question is not what to teach, but whom to teach. This may seem, at
first sight, an easy matter to determine, but a more careful inquiry
will show the complexity.
The platform of a medical college is considered by some the only
legitimate place from which a medical man may impart his knowledge,
but here the opportunity is limited, notwithstanding the abnormally
great number of these institutions. This, however, is not the only
reason. Medical colleges are becoming so numerous, that they should
be discouraged by all honest and high-minded medical men, because in
this country they are private institutions, with very few exceptions,
and subserve sinister purposes, in furthering the interests of their
promoters either as advertising schemes or money-making institutions,
or both.
Of course they are incorporated under State laws, which make them
_quasi_-public institutions, but the State exercises no authority over
them, and their self-constituted professors conduct them to suit their
own private ends. They are not limited by law, nor is a _required
course_ for their students imperative, so that the public have no
guarantee of the fitness or competency of their graduates. There is,
also, an unhealthy rivalry among our colleges for students, improper
material is taken in, and correspondingly poor material is turned out;
this in turn causes a rivalry among their graduates in making spoil of
the sick.
Every self-respecting and competent medical man has an utter contempt
for these doctor mills. This will never be different in this country
until we follow the plan of European governments, and make medical
colleges State institutions, and their professors officers of the
State, with liberal salaries.
The medical press has a comparatively limited opportunity for imparting
information to the public, unless the editor of the secular press
happens to make a quotation.
The exclusiveness that has characterized the learned professions
generally, and the medical profession particularly, is rapidly passing
away. Only half a century ago, the medical lectures in Germany were
mostly delivered in the Latin language, and, while we now often suffer,
in listening to medical lectures in _bad_ English, the latter may
still be the lesser evil. In fact, so great is the deference to public
opinion in favor of diffusing knowledge that medical faculties court
popular favor by delivering a course of lectures on medical subjects,
and consider these the best-drawing card of the institution.
Information that is not sensational nor untruthful cannot fail to do
incalculable good to the class for whom it is intended, namely, our
wives, mothers, daughters, and sisters, so that they may avoid errors,
that entail suffering and disease; information that will teach them how
to cure themselves of the commoner and simpler ailments, and thus avoid
running to the doctor, who cannot always afford to tell them the truth.
Some would not if they could.
The Darwinian theory is of wider application than to mere animal or
plant life; it extends itself to the overcrowded professions, and the
increasing “struggle for existence” in the ranks of the profession
makes men dishonest and greedy for any opportunity to raise a fee, so
that patients are being treated for diseases which are created for them
by the cunning and dishonesty of their doctors.
A little common sense and a knowledge of the elementary principles of
disease would be the best protection against these deceptions; but,
as a rule, sick persons are inclined to throw aside all good sense,
and give themselves up entirely to their feelings or to their doctor.
This is a very wrong thing to do, and opens the door for all manner of
impositions.
The general practitioner of thoughtful and studious habits finds that,
in the course of years, a diversified reading on the different diseases
which in the routine of his work he is called upon to treat makes him a
generally well-informed man, but not a thoroughly exact man, either in
theory or in the details of his treatment.
Fifty to sixty years ago the entire field of medicine was comparatively
so small that it was easier for a brilliant mind then, to comprehend
all that was believed to be known, than it is for the same quality of
mind to understand any of the subdivisions of medicine to-day.
Those were the days of doctrines and rules. Little that was absolutely
correct or true was then known about disease, otherwise such absurd
theories as the “_dynamization_ or _spirit-like_” influence, causing
disease on the one hand, or that the “great source” of chronic
diseases was _psora_, or itch, on the other, as Hahnemann would have
them believe, could never have gotten a foothold.
These are the days of scientific deductions from microscopical
and physiological research, in laboratories connected with great
universities, and the result is, that any of the specialties or
subdivisions of medicine is as large and interesting a field as the
entire area was some time ago. It thus happens, that some thoughtful
persons, after years of general practice, drift almost involuntarily
into some one department of medical art and science. To this they
become gradually wedded, and in it they grow in knowledge and
experience far beyond their previous anticipations. What they read on
the subject is better understood, and new ideas are constantly formed,
which enlarge the scope of their knowledge. In this manner the writer
drifted into the domain of diseases peculiar to women, which was as
unhappy on the one hand, as it is interesting on the other, for the
phrase “_diseases of women_” has fallen into disrepute because every
superficial practitioner professes to know all about them, and it often
is but another name for criminal abortion.
But for all that, there is a legitimate and scientific specialty of
women’s diseases. The time-serving specialist must be exposed in every
department of medical science. Whether the pretender is labeled, a
professor in a college, or labels himself through glaring newspaper
advertisements, one is just as much a catch-penny as the other.
The object of educating the laity cannot be reasonably confined to
a few medical truths, but the perversion of the truth must also be
understood, so that the false can be detected. It is necessary to
point out the dangers and frauds which are the unhealthy outgrowths or
excrescences of established truths, and there must be no veneering of
the wicked and sinful with ambiguous phrases to shield the guilty; the
truthful and innocent require no apologist.
The honest observer can pursue no middle way in a work to which he
has devoted the best years of a studious life, and hence he may seem
radical in his opinions. While policy often dictates a conservative
course, that which conscience and reason dictate to be true is prompted
by loftier motives, namely, to subserve the highest purpose of moral
integrity.
It has often been said that this is a mechanical age. How true is this
even in the furtherance of science! How true is this of the science
of astronomy, which was revolutionized by the construction of good
telescopes! Mechanical genius has perfected a lens for Mount Hamilton
thirty-six inches in diameter, and one is now in course of construction
for Mount Wilson, in Southern California, which is to measure forty
inches. Through these means scientists hope to decipher the complexion
of remote planets.
Microscopic lenses have been equally perfected, and, by means of
achromatic condensers and immersion lenses, great magnifying power can
be obtained with perfect distinctness. That this mechanical spirit
of the age should also have obtained a foothold in medical art and
science, is but natural. Surgical and other mechanical methods have
entered so boldly into the field of diseases of women that the writer
feels constrained to sound a note of alarm. Great strides have been
made in a more perfected technique in abdominal operations, and, by
favorable recoveries from grave and severe operations, the field
of surgical usefulness became enlarged, but this has degenerated
into a license for notoriety and personal aggrandizement of not
over-scrupulous and selfish surgeons who are over-anxious to operate so
as to be able to boast of the great number of their capital operations,
or laparotomies.
I was enthusiastic in abdominal and pelvic surgery, but not until I
entered the field as a specialist in this department of medicine did
I see and hear of daily abuses and misuses of this branch of surgery.
In many instances it degenerated into criminal malpractice. It will be
instructive information to cite a few cases which occurred under my
observation, and present the actual facts to the reader.
It was in the month of February, in the year 1888, that a business trip
to the southern part of the State forced an absence of several weeks
upon me. Some two months before this time I had been called to see a
young woman, who had then been sick for several months. She informed me
that she had been married nine years, and, not having had any children,
she concluded to see a noted specialist of female diseases. By this
physician she was told that her sterility was owing to a closure or
contraction of the mouth of the womb. This was obviously a wrong
diagnosis, and for these reasons: she had always menstruated regularly
and without pain, which excludes a constriction; and, secondly, no
physician can honestly call a woman sterile until he has examined her
husband, who, in the majority of instances, is the cause of his wife’s
sterility, because it is he who is sterile. This woman and the doctor
agreed, however, on a course of treatment, which was to forcibly open
or stretch the mouth and cervical canal of the womb. This by itself is
neither a dangerous nor a severe operation, if carefully performed, but
care in this case was evidently not exercised, because the young woman
was taken with severe inflammation, which caused a pelvic abscess.
I found her after two months of suffering. The discharge had become
extremely offensive, her body emaciated, and her strength exhausted.
I enlarged the opening of the abscess, placed a large drainage tube in
the cavity, through which it was washed out, by means of an antiseptic
solution of bichloride of mercury, 1 part to 2,000 parts of water, and,
by further giving her simple, nutritious food, she improved rapidly,
so that the day before I left the city she was at my office, and told
me that she felt as well as ever, although not thoroughly recovered. I
was absent two weeks, and a few days after my return I incidentally met
her husband, who told me that a week after I had left, his wife felt
unwell and called in one of her former doctors, who, by the way, rides
a hobbyhorse on surgery. This man found a few pimples on her body,
which can be found on almost any healthy person, these, he said, were
signs of blood poisoning from her abscess, and that an operation to
extirpate the abscess, with one or both of her ovaries, was of urgent
necessity to save her life from blood poisoning. The deceived woman was
of course frightened into giving her consent to the operation, which
was undertaken immediately, and, as luck would have it, she recovered;
but she might have easily died, which she undoubtedly would have done
had this _knife-man_ got her sooner, or before I had restored to her a
splendid physical condition, which withstood the unnecessary butchery
to which she was induced to submit.
Some doctors seem to have a perfect mania for cutting operations, just
as though the entire science and art of medicine were exhausted in
surgery alone. To assume this for an instant is manifestly ridiculous.
More lives are annually saved by a scientific application of other
methods of cure than the most elaborate and brilliant statistics of
surgery can approach. There is science and skill in selecting proper
medicines, in the employment of hygiene or the rules of health, in the
practice of obstetrics, and in a variety of other ways to demonstrate
the triumphs of the art of healing.
The rash and unnecessary resort to the knife has brought surgery into
general distrust, so that some patients would rather die, or wait until
they are almost dead, before they allow an operation to be performed on
them, in cases where surgery is, indeed, the only possible method of
cure.
A lady recently called at my office for a consultation. I found her
uterus and other pelvic organs in a perfectly healthy condition,
although she suffered pain there. This was due to neuralgia from a
generally exhausted and debilitated condition. I was not a little
surprised to learn, from her own lips, that she had been treated for
womb disease, and was about to undergo an operation for a tear in the
mouth of her womb. This was manifestly absurd, because no laceration
existed at all, and if there had it might not have been necessary,
because it is quite natural for women who have borne children to have
the scars of old lacerations on the mouths of their wombs, and they are
not any the worse for them.
It is important for mothers to know something about themselves and of
the common diseases to which they are liable, for then they will not
be so easily persuaded to permit the use of caustics, or the cutting,
stitching, or scraping of their wombs, which is quite likely to excite
complicated inflammations, more serious in their results than the
diseases for which these operations were performed. I know of what I
write, and there is no one who can successfully deny it.
Dr. William Goodell, who stands as high in the department of diseases
of women as any American, had an article in one of the medical journals
on “The Abuses of Uterine Treatment.” He says: “From a large experience
I humbly offer to the reader the following watchwords as broad helps to
diagnosis: 1. Always bear in mind what another has pithily said, that
‘woman has some organs outside of the pelvis.’ 2. Each neurotic case
will usually have a tale of fret or grief, of cark and care, of wear
and tear. 3. Scant or delayed or suppressed menstruation is far more
frequently the result of nerve exhaustion than of uterine disease. 4.
Anteflexion of the womb, _per se_, is not a pathological condition. It
is so when associated with sterility or painful menstruation, and only
then does it need treatment. 5. An irritable bladder is more a nerve
symptom than a uterine one. 6. In a large number of cases of supposed
or actual uterine disease, which display marked gastric disturbance, if
the tongue be clean the essential disease will be found to be neurotic,
and it must be treated so. 7. Almost every supposed uterine case,
characterized by excess of sensibility and by lack of will-power,
is essentially a neurosis. 8. In the vast majority of cases in which
the woman takes to her bed, and stays there indefinitely, from some
supposed uterine lesion, she is bedridden from her brain and not from
her womb. I will go further, and assert that this will be the rule even
when the womb is displaced, or it is disordered by a lesion or disease,
that is not in itself exacting or dangerous to life. Finally, uterine
or womb symptoms are not _always_ present in cases of uterine disease,
nor, when present and even urgent, do they necessarily come from
uterine disease, for they may be merely nerve counterfeits of uterine
disease.”
There is not a physician of any extended experience in the land who,
if he be true to his better judgment, will not indorse every word of
Professor Goodell’s propositions. But the chances are they will never
accomplish the good for which they were intended if the mothers, wives,
and daughters are not permitted “a little peep” behind the curtain,
and learn for themselves. For those who are wealthy and have plenty
of money, doctoring may be a luxury or an amusement, but there the
line must be drawn for the benefit of the deserving poor, with whom
any treatment is a hardship. Stupidity of the masses is one of the
causes of the abuse of surgical treatments, for they always look upon
a surgical or bloody operation as one of the greatest achievements of
modern medical art. Then there is the cupidity of the professional
classes, who trade upon this popular error and delusion, and charge
correspondingly large fees, which, as a rule, are exorbitant,
particularly when the working classes are the sufferers.
A little cutting or stitching is much more quickly done, and the
patient may be dismissed as cured, or left under the impression “that
everything was done that could have been done,” than a conservative
medical or hygienic treatment, which involves more thought, labor, and
patience, qualities which are not as eagerly cultivated as the art to
wring out a good fee by a little surgery, with less labor and skill.
There is not only too much mischievous doctoring, but there is too much
of every kind, whether good, bad, or indifferent. The trouble is there
are too many in the ranks of the medical profession; and this is not
only true of this country, but is raising a cry of warning in Europe.
The struggle for existence is a natural law, and nature is immutable. I
do not mean to say, that it is a humane law, or that competition is a
virtue; in fact, I believe quite the reverse. But much that is natural
from a physical standpoint might not be so from a moral or spiritual
plane; thus the two natures are distinct.
It is reasonable to suppose that, if the natural crop of diseases falls
short of supplying the demands of those who hunger for an opportunity
to treat disease, and it lies within their power to create disease,
they will certainly do so. The deficiency must be supplied, or one of
two things must be done by the doctor: he must either starve, or go to
work at something else. This may be cruel logic, but I know that these
are the actual facts.
Now let me ask how many persons who have some sort of a diploma will be
self-sacrificing enough or sufficiently unselfish to prefer to starve
or honestly work for a living, if they can avoid either, by defrauding
someone out of a fee, for pretending to cure some manufactured
disease? It seems almost a waste of time to argue such a self-evident
proposition. I have known physicians of high standing who treated women
for womb diseases which never had a real existence, and surgeons of
large incomes to remove the female breast for a “supposed cancer;”
and, that being the case, what would you expect from a less fortunate
brother practitioner who is eking out a miserable existence?
How many a case of simple sore throat or tonsilitis is being paraded
as a case of diphtheria. Why, I know of doctors who built up their
reputations in that way. It is quite an easy matter, to call an
ordinary, simple case of bronchitis, pneumonia. Harmless swellings, no
matter of what sort, are treated and palmed off every day as cancers.
The quack cancer doctor is almost ubiquitous. Some would much rather
part with the village parson, or their regular old town doctor, than
to part with the cancer doctor. Diseases that are conjured up in the
minds of susceptible or hypochondriac persons have for them a real
existence, because if a person believes he has a certain disease, it
becomes a reality, as far as his own state of mind is concerned, and
as far as the treatment is concerned to him who created the delusion,
it is much more desirable than if the disease were real, because you
can cure an imaginary disease, which may be impossible when a real one
comes under treatment. This is another method of making a reputation
for extraordinary cures that really never occurred.
When I contemplated writing a book, which I hoped to make a _vade
mecum_ for those who felt interested in the subject, I felt that it
would be a duty which I should reluctantly perform, for it would be a
criticism on the status of the medical profession of this country. I
was convinced that whatever I said that would lower the tone of the
profession in the estimation of my countrymen would naturally reflect
on me as unfavorably as upon any other member, for I never claimed to
be anything else but an American physician, and, as such, I have an
ambition to elevate the rank and file to honor and respectability.
There is also a motive that underlies a work of this nature which
should appear justifiable to the author. It is absolutely necessary
that side-lights should be thrown into dark corners and recesses
that are usually screened from public notice. If there is a growing
deterioration in methods of proficiency and morals, the public should
know it, for who is the greater villain, he who trifles with human
life through officious ignorance and venturous operations, or the
midnight assassin, who, under cover of darkness, waylays his unwary
victim? The title “doctor,” from the Latin _doceo_, “I teach,” has a
halo of learning that it derives from the original significance that
was attached to it when it was first sanctioned at Bologna University,
about the middle of the twelfth century, where it first passed into the
faculty of divinity. It was afterwards introduced into the universities
of Northern Europe, and remained ever since a degree of distinction in
theology, law, philosophy, and medicine. In the German universities
_doctor_ implies also a license to teach within the university, as a
_privat-docent_.
When we now consider that no person can matriculate in a German
university who has not graduated from the gymnasium or high school,
it is clear that, under the above conditions, the title “doctor”
guarantees that the possessor is an educated person, not only of the
high school, but added thereto is the accomplishment in the specialty
of which he holds the doctor degree.
What may a “doctor degree” mean in this country? The title of an
illiterate and utterly incompetent person, who was by natural
environment and occupation a teamster, saloon keeper, barber, tailor,
or patent-medicine vender, etc.
If a woman, she may be retraced to an ignorant nurse, midwife, or
quacksalver, the conceited wife of a man who indulges her in the freak
of “learning to be a doctor,” for she had demonstrated her genius
for the profession by successfully treating a case of measles, which
started the doctor’s bee a-buzzing in her bonnet, until she passed
through a medical college; last, but not least, are the winsome
daughters of the millionaire or successful business man, who imagine
themselves too smart to make useful housewives and good mothers.
There is not a medical college in this State, and there are few, if
any, in the United States, that would not eagerly take in all of this
material, and guarantee to them beforehand, that they can graduate as
_medicinæ doctor_ in twelve months to three years, a five months’
course being considered a year.
The above comparison is a disgraceful commentary on the degree of
_doctor_ in this country, and the public should learn to know the
difference.
“The United States and Its Doctors” is the title of an editorial in
the July number of the New York _Medical Record_, and it says: “There
is certainly no more curious social phenomenon than that of the
extraordinary popularity of the medical profession in this country as a
means of securing a livelihood.
“This subject is one that is often dwelt upon, but we doubt if many
even yet realize the grotesque misproportion which medicine in the
United States holds to other bread-winning occupations. Here are some
of the naked facts in the matter:—
“France has 38,000,000 of population, 11,995 doctors, while it
graduates 624 medical students in one year. Germany has 45,000,000 of
population, about 30,000 doctors, and graduates 935 students in one
year. The United States has about 60,000,000 of population, 100,000
doctors, 13,091 medical students, and graduates 3,740 students in one
year.
“Germany, which has relatively less than half as many doctors as
America, is already groaning over its surplus. When one compares
France with this country, the excess of medical men here seems most
astonishing.
“A comparison of the United States with European countries, in whatever
way it is made, leads one to think that there is something almost
alarming in our medical productiveness.”
In connection with the above comparison, in which it is shown that
Germany has proportionately less than half as many doctors as the
United States, it will be interesting to learn the views of the German
profession. The Berlin correspondent of the Medical Press writes that
the “Deutcher Ærztebund,” Society of German physicians, felt it to
be their duty to warn the guardians of young men studying in the
gymnasiums or high schools, against entering the medical profession,
the state of overcrowding being so great as to _insure disastrous_
consequences. In glancing over the above figures, there is one very
important point which is greatly in favor of the German profession and
militates against the Americans. It is the enormous patent-medicine
trade and quacking that is done through it in the United States; on the
whole, this has been calculated to amount to at least fifty per cent
of all the doctoring that is done; that means, that where one hundred
doctors now practice for a living, fifty more could make a similar
living, were it not for the patent and quack medicine trade, which, in
some of the German States, is almost prohibited, and in others I know
it is entirely inhibited.
When the Society of German physicians warns the German people that an
overcrowding “insures disastrous consequences,” what does it mean?
This is a question which, we presume, was answered in Germany, and
it is certainly worth our while that we should answer it here, and
in this we have decidedly the advantage, because in that country the
answer was entirely based upon what was anticipated, while in this
we can answer from what we have already realized, namely, disastrous
consequences to honor and to integrity on the one side, and to health
and security against imposition on the other. To this I have already
referred. Everyone competent of judging, and who has lived in that
country, knows from study and observation that the arrangements and
conveniences there for treating the sick are in a much higher state of
perfection than with us. Hospitals and physicians are as accessible to
all classes as the most humane and philanthropic heart can desire, and
now we learn that if this wholesome state of affairs shall continue
with less than half the proportion of doctors that we have here,
there must be no further increase of physicians, or it would insure
_disaster_. This statement and warning a close and careful observer
clearly appreciates. The writer was personally acquainted with a large
number of German practitioners while in that country, and knows as
an actual fact that while their fees were and are much smaller than
anything ever paid in this country, they had not overmuch to do, and
were only leisurely employed. This applies to some of the greatest
and world-renowned medical professors, as well as to the ordinary
general practitioners. But there is a reason for all this, too.
These men as a rule are honest, they are no money grabbers, they are
thoroughly competent and scientific and manufacture no diseases to suit
emergencies nor conjure up complaints that have no real existence. If
their number were doubled, if the normal proportion were disturbed,
the _disaster_ would surely follow, professional demoralization would
ensue. So the German profession sounds a timely note of warning ere the
canker of selfishness has destroyed the noble altruistic principles of
physicians, without which the doctor is as likely to be a messenger
from hell as a ministering servant from heaven.
Medical legislation in this country has been nothing less than a
farce, partly because the general public is not aware how abased the
profession is, and partly that Americans are extremely jealous of what
they term personal liberty. It is being attempted to remedy some of
the abuses of the medical profession by regulating the practice of
medicine by State Examining Boards. Experience has demonstrated that
these boards are but the excrescences of the various medical colleges,
who are themselves the root of the very evils that are sought to be
remedied. The duties of these boards are simply to make themselves
officious, and to inquire into the source of the credentials or
diplomas of the applicants for a license to practice medicine, and
not into the qualifications or competency of the applicants. All that
is necessary under such laws is simply to present a diploma of some
sort; whether it was stolen, or the diploma of a dead man, or gotten
from any of the numerous worthless colleges, is not made the subject
of inquiry; and as by far the greatest number of quack-salvers in this
country have diplomas, the law falls short of remedying quackery.
There are, usually, enough boards of examiners, representing the
different schools, so that the different interests of the diploma
manufacturers are well represented. A medical examining authority whose
functions and powers do not go higher or beyond the mere granting of
licenses, or which does not examine into the qualifications of the
persons who possess diplomas, is utterly absurd, because it is no
protection against ignorance and imposition. A law that presumes that
all persons holding diplomas are qualified and competent to practice
medicine, is essentially wrong, or inadequate to fulfill the purpose
for which it was designed. I have known graduates from what were
considered good colleges who could neither write a safe prescription
nor diagnose a case.
There is only one way towards an approach to an efficient and
intelligent board of medical examiners, and that is, one single State
board in which the different schools may be represented as to their
pet theories of prescribing medicines, but in all other departments
of medical science and art there must be a uniformity of talent and
qualification.
There must be a _standard of excellence_ established by the State,
which is higher than and above the recognized standard of any medical
college, for no medical college is trustworthy in this respect.
The State in its sovereignty must prescribe what shall constitute
a medical education, and the requirements should be embodied in
the statutes. A license or degree from that source, after a final
examination, should be the only legitimate license to practice medicine.
Such a method would establish a system that would clearly define the
status of every medical practitioner. The board must have the power,
and it must be their duty, to examine each and every applicant for a
license, as all candidates for the army medical service are examined.
All this noise and talk about a preliminary examination and an extended
course of medical study are simply the vaporings of superficial minds.
It is neither the preliminary course, nor the length of time that a
person consumes in trying to become a doctor, in which the public
is interested, but what kind of doctor a person is when he hangs
out his shingle and begins to practice, whether he is competent to
do that which is expected from him in the hour of sickness or great
peril, irrespective of any diploma or any medical college. Foreign
graduates should be amenable to the same examination, for behind
these, too, belongs the interrogation point. The gushing mediocrity of
some of these diploma holders gives rise to the suspicion that their
credentials are not genuine.
As an American to the manor born, I would not for a moment deny the
humblest citizen an opportunity to elevate himself to the highest
professional honors; but why can he not be required to thoroughly equip
himself and prove, by oral and written examinations on subjects of
preliminary education, that his mind has become disciplined for broader
or special studies, irrespective of any course in a college? After
the State has satisfied itself of the proficiency of the applicant in
scholastic acquirements, it should go further, and examine into the
qualifications for a degree of medicine, just as they do in the _U. S.
Army_, only with this exception, that no diploma of any medical college
should be required from the candidate, and if he has one it should not
be recognized.
This would simply incorporate in the State laws the distinctive feature
of the University of London, which examines and confers graduation on
persons who have received instruction in such institutions at home and
in the colonies as have satisfied a Secretary of State with regard to
their studies.
This university also has and exercises a power of examining for degrees
persons who have not been at any institution. Nothing could be more
democratic than for the State to make such a provision for State
medical examinations. The German Government does precisely the same
thing, with the exception that it makes graduation from the medical
department an essential prerequisite. It has a State board of examiners
to examine all graduates in medicine of their own universities, to
further prove if they are really qualified. A diploma in Germany is of
no value; it is the so-called _ærzliche Approbationspruefung_, _State’s
examination_, that gives the license to practice legally.
When this is found necessary, notwithstanding the high standard of
German medical schools, how much more is this safeguard against
incompetency needed with us? I have endeavored to prove from the
methods of Germany and the course of the _United States_ medical
department that diplomas cannot be accepted as _bona-fide_ evidence
of a medical education. With us a half dozen doctors can get together
any time, incorporate a medical college, call themselves professors,
and start out advertising themselves and their college for the purpose
of manufacturing diplomas and doctors. Why, a diploma under these
conditions should not be worth the parchment it is written on, as
evidence of a medical education, unless attested by a higher and
perfectly independent authority!
If the public once understood that too many doctors are dangerous to
the morals and health of society, they would be quite as anxious as the
most enthusiastic medical educator to remedy the evil.
The question of too many doctors is one of economical and social
science, not of medical science, and, therefore, it can only be
intelligently considered from these philosophical standpoints. It is
a well-understood and accepted law of political economy that in the
industrial pursuits, whether in the manufacturing departments or in
agricultural production, the surplus or glut in the market of any of
the products of industry, reduces the price and stimulates consumption,
which, in the course of time, is regulated by a suspended or reduced
production, thus restoring a healthy equilibrium. It would be an
absurdity to apply the same rule to a surplus of doctors, because
human ills or diseases do not increase in proportion to the surplus of
doctors, nor will fees be any less. But the surplus, in order to live,
must live on the earnings of the community, and here the disastrous
consequences appear.
The credulous, and those who often may imagine that they require
medical advice, become the unconscious victims of the unhealthy
disproportion, for the doctor seizes the opportunity to make a case,
while the normal proportion of cases do not reach around. Thus, it
is calculated that at least fifty per cent. of all the diseases for
which patients are treated are fictitious as far as actual disease
is concerned, and the remaining fifty per cent. are, in the majority
of instances, overdosed and overdoctored. For this reason medical
legislation would not make a privileged class of physicians, nor
throw unusual safeguards around medical practitioners, but medical
legislation is to protect the people themselves from imposition and
quackery.
The reason for the overcrowded state of the profession is not alone
the laxity of medical laws, or the low standard of medical education
in most of our colleges, but the general tendency of the country
population to drift into the cities. Honest labor has not the dignity
which its importance demands, and a radically faulty method of
common-school education is another reason. Utilitarian manual methods,
in which the hands are educated for useful employment and the minds to
habits of industry, are to be wished for. Young men who have acquired a
technical education in mechanics and arts will learn to respect labor
in every department, and their ambition in life will be greater than to
swing a cane or wear a silk tile.
In proportion as the productive employments are made respectable, this
questionable ambition to become M. D.’s will fall off.
History tells us that the opulence of Rome was speedily accompanied by
a decline of its agriculture, after which came the fall of the Roman
Empire, because the country population became too indolent and restless
and flocked to the cities for an easier and luxurious living. History
in this respect seems to be repeating itself. We are always talking
of encouraging the beauty and growth of our cities, but not one word
of encouraging agriculture; no one talks of encouraging farm life
and making it profitable and attractive, so that men and women would
prefer the more independent subsistence in the country to a shabby
gentility in the city. Some reader may ask, What has all this to do
with doctoring? I say that the answer must already have been apparent;
it becomes the duty of everyone to interest himself, that the division
of labor shall be apportioned so as to do the greatest good to society.
We have a national characteristic which shows itself in an abnormal
conceit for everything American in a degree that is not essential
for true patriotism and love of country. But when by comparisons we
learn that there are abuses and errors which are destructive to a
healthy intellectual and material growth, we must have the honesty and
independence to acknowledge them, and busy ourselves to find a remedy
for existing evils.
The physician who can assist in the amelioration of society by
administering to human ills which are the result of unwise laws, is
accomplishing as much good as if he writes prescriptions or _bleeds_
patients. The sooner everybody recognizes the fact that the time has
come to deflect the current of ambition from the practice of medicine
as a means of making a living, the sooner will untold suffering be
lessened, and there is no honest-minded physician who does not heartily
agree with me. Mercenary persons, and ignorant or unscrupulous doctors
who run diploma mills, may criticise severely the honest sentiments
here expressed, but the truth is so apparent, that he who runs may see
the inevitable consequence of this unhealthy competition. Professors
of colleges have a direct interest in the ignorance and incompetency
of their graduates, because they are the means of calling them into
consultation on every possible occasion in trifling ailments, and if
the disease belongs to some specialty, they have the cases entirely
turned over to them, because, in the mind of the incompetent and
newly-made doctor, the professor who was the means of getting him a
diploma, poses as the _beau ideal_ of medical wisdom. In this way
it becomes exceedingly profitable to be a professor. If there are
not enough medical colleges in a community to afford places for the
ambitious, it is considered to be one of the best-paying financial
investments for a company of physicians to start one, and in most of
these concerns it is easier to get a diploma as a doctor than to learn
to be a good dressmaker or shoemaker.
Hence there is only one remedy to control the educational aspect of
this evil, and that is to take medical colleges entirely out of the
hands of private individuals and make the State the only source of the
necessary credentials to practice medicine.
An American system of medical education fostered by the State would
be productive of grand results, because, under the shadow of our
free institutions, the mind transcends the circumscribed sphere
of despotism. This has already been proven in numerous instances,
notwithstanding unfavorable surroundings.
Forming the galaxy of great names that illumine the milky way of
science, there are none brighter than a Gross, a Flint, a Sims, and
some others. These were great American authors and physicians, who
never pretended anything else; they never dreamt of the Don Quixotic
escapade of pretending to be American professors while they appended
to their names initials or abbreviations of questionable credit from
foreign institutions. The brilliancy of true genius was their only
passport to fame.