| CHAPTER XI DRUGGING IN MEDICAL PRACTICE. I firmly believe that if the whole materia medica as now used
could be sunk to the bottom of the sea, it would be all the better
for mankind, and all the worse for the fishes. There are but few people who have not at some time had use for the services of a doctor. Some are loud in praise of one school and equally loud in abuse of another. They take some medicine prescribed by their favorite doctor who practices their adopted system, get well, and attribute all to the merits of the drug administered, as they believe, with so much skill. As a matter of fact, the drugs may have had nothing whatever to do with their recovery; truly, they may have recovered in spite of the evil effects of the medicine. How else can the fact that drugs that have been declared to be almost opposite in their effects produce the same results, and drug schools find little of merit in the medication of each other? Their theories are radically opposed, and they sometimes criticize each other as bitterly as they do the osteopaths.
The following appeared in the Journal of the American Medical Association for April 26, 1899. The writer evidently had not much respect for much of the work of his own school, or a very exalted opinion of homeopathy; but expresses a well-known truth when he gives that school credit for revolutionizing the practice of medicine: "I trust it has been made clear that I do not regard all homeopaths with an unfriendly eye. There are different kinds of 'disciples,' you know. St. John was one kind, and the disciple who liked silver was another. According to Professor Hale, less than one per cent of Hahnemann's disciples are of the same class as St. John, and more than 99 per cent are disciples for revenue only. "Name one of the Hahnemannic precepts and I will name twenty disciples - representative men –leaders - who have repudiated it. The law of similars is just where Father Hippocrates left it. There is no more difference of opinion between representative 'new school' and 'old school' physicians in relation to this question today than exists between individual adherents of either school concerning the germ theory of disease. "And what does the difference relate to anyway? A mere theory of the mode of action of medicines in curing disease. That is all. Think of it! A theory - speculation - wind! A mere difference of opinion as to the way medicines produce their effects, is, in the year of our Lord, 1899, and in free America, the ostensible reason why a profession that is called 'liberal' should be divided into discordant elements! Oh, what a shame upon us all! What a shame ! "Homeopathy has done a noble work; it has served its purpose well. Look back a hundred years to the time of its birth and contrast the methods of practice then in vogue with those which are in favor today, and tell me whether a stupendous revolution has not been wrought, and largely through the instrumentality of Samuel Hahnemann. Then the practice of medicine, as it appears to us now, was almost senseless savagery. Bleeding, bleeding, bleeding, for everything. Blistering, purging, vomiting, salivating the sick to death. Doctors were fined and imprisoned in those days for allowing a sick man to die without bleeding him. Brissot is said to have been driven from Paris, not because he ever failed to bleed a patient, not because he questioned the universal applicability of the lancet, but because he had the audacity to propose a new method of bleeding. The traditions of Hippocrates and Galen had to be duly honored in those days. It is related of Achilles that when sick he consulted the oracle and was informed that he must lose thirty pints of blood and then be plunged into the icy waters of the river! But Achilles made a dive for the back door and with electricity in his heels departed from that place at a rate of a mile a minute, and never looked back until he reached the plains of Troy. I can imagine him now backing up with glowering earnestness the sentiment of Chimmie Fadden – T’ ‘ell with the doctors!' "Look at the prescriptions of those times and you will find that many of them include from ten to sixty ingredients. Ask my own students whether they would rather be bled, blistered, puked, purged, and salivated, and then be compelled to swallow a pint of some decoction every two hours till dead, or take their chances with calcarea carbonica, high?" A prominent homeopath, Dr. C. E. Walton, has paid his compliments to his allopathic brethren in the following language, and at the same time showed some misgivings as to his own school: "Much has been heard in the last seventy or eighty years about the 'regular' and 'irregular' physician. The first prescribes without any rule (except that of limitation), and is consequently 'regular;' the second tries to prescribe only by rule, and hence is conspicuously 'irregular.' At the present day we are not infrequently treated to the paradox of the allopath prescribing by the rule of both homeopathic selection and dose, and he is the irregular; while the homeopath, with his large doses of drugs furnished by the manufacturing chemists, lays himself quite liable to the charge of being regular. Does this mean that the homeopathic lamb is preparing to rise up within the allopathic lion, after the manner of a post-historic millennial scheme, or is the Kilkenny cat style of amalgamation working out another example of the 'survival of the fittest?"' The following cases are cited by the same eminent authority: "The case is that of a wealthy European whose attending physicians disagreed over his disease, whereupon he resolved to consult several physicians and to take their treatment if any course was perfectly agreed upon by three. He consulted many keeping an exact account of every consultation in a book for the purpose, resembling a ledger in large folio. But he did not succeed in finding any two who agreed respecting his case. Accordingly he did not follow any advice, but remained without treatment. The number of physicians he consulted was 477, and the number of prescriptions was 832, containing in all 1,097 remedies. "A similar case occurred in this country about ten years ago. Twelve of the leading physicians of each school were sent a description of a case with an urgent request to name the remedies indicated, inclosing the usual consultation fee, with the result that no two of the allopaths prescribed alike; in fact, each sent a widely different prescription from the others, while all the homeopaths, without an exception, prescribed the same remedy." The following is taken from a book written for the laity by one of the ablest exponents of the Eclectic school, Dr. Scudder: "A certain class of physicians claim to be regulars, and the direct descendants of AEsculapius. They further claim to possess all the science and literature of the profession, and to be par excellence. To hear them talk or to read their works, it would be supposed that they were the embodiment of perfection, and that it would be impossible for any persons outside of their ranks to know anything of the healing art. Yet it was these same men that, twenty or thirty years ago, gave calomel by the teaspoonful, and in every disease, and that bled in almost every acute affection. "There has been a very marked change for the better in this school. They have been forced by public sentiment to almost entirely discard mercury, antimony, and the lancet, and to adopt other and milder means of treatment. It is true, many hold on to their old errors with great tenacity, and others have discarded them under protest, and not as yet become acquainted with better means. But the change is going on, and they will be forced to complete it. "Our old school brethren are noted for their illiberality, their self-esteem, and their antipathy to change. Ever ready to investigate anything that is stamped as legitimate, born within the ranks and that does not conflict with their prejudices, they reject with contempt anything that comes to them from without. They have changed greatly within the last twenty years, and the change is still going on, and we hope that the errors will be forsaken in twenty years more. "May we not reasonably and justly conclude that the attenuated form of medication the infinitesimal doses - often receive credit when none should be awarded to it; that their influence is imaginary, and not real; that they exercise no positive curative agency in many, perhaps not in any case in which they are administered, but in which it is ascribed to them; that the effects are negative, and that the powerful influences, benefits, and advantages claimed, to follow from the exhibition of the millionth or decillionth part of a grain of charcoal, common sell, or of silex (and all other agents when administered in a form so attenuated), and carried out according to the doctrines of Hahnemann, are but an imposition on the credulity of the people, which must be apparent to any one who investigates the subject? Does it not seem to be a mere placebo the bread pills, or colored-water exhibited in a new form ? To believe that a dose of the most simple agent, so minute that it is entirely beyond the conception of the human mind, exercises such a powerful control over the human system when in a state of disease, requires an imagination so acute (it seems to us) as it falls to a lot of but few mortals to possess. As well may we imagine that the millionth or decillionth part of a grain of our daily sustenance, taken three times a day, will be sufficient to sustain life; that it will support the wants of the animal economy, and maintain all the varied processes of secretion, excretion, and innervation, as that a similar amount of salt, charcoal, etc., will effect great sanative changes upon the human body when in a state of disease."
Since the advent of Osteopathy drug medication has grown less popular with great rapidity. The sick want to be cured, and those who grow steadily worse under long-standing approved methods, readily accept Osteopathy, because it appeals to their judgment and has verifiable records of cures. The medical profession, with an ardor commendable in a more worthy cause, has held to many exploded notions among which drug medication is the most prominent. The rejection of drugs by some of the ablest practitioners has led many to believe that they are used less frequently and in less drastic doses than hitherto. While this is true in the practice of the most progressive drug doctors, it is not apparent that the total amount of drugs consumed per capita is less than formerly. On the other hand the large volume of business of the drug manufacturer and the pharmacist do not point to the immediate abandonment of the drug habit. Furthermore the prominence given to drug medication in all medical colleges shows that the method occupies a more prominent place in the mind of those who are making the doctors of the future than all other methods combined. Evidence of this fact is to be found in the published course of study of almost every medical college in the United States and in the testimony of the graduates of those schools. The growing habit of resorting to the use of "patent medicines" is also evidence that the use of drugs is far from being obsolete. And the capital involved in the manufacture and distribution of both patent and proprietary medicines lends assurance to the assumption that the business end of the proposition will receive increased attention. We may therefore expect that the drug habit will increase rather than decrease until a time when the people shall have become aware of the impositions put upon them by the practice, and throw off the shackles that are binding them soul and body with a merciless grasp. The rapid increase in the use of stimulants, narcotics, and sedatives is becoming a menace to our national life. We hear more of the effects of alcoholic beverages than of other forms of dissipation because the use of alcohol in some form is much more general and its symptoms are more apparent. The more subtle influences of morphine, cocaine, chloral, etc., and the greater secrecy maintained in their use, make their effects less noticeable than those of alcohol and tobacco; and the excuse for their use for medical purposes gives them a charm which makes them more enticing than the better known sources of dissipation. Almost every one knows that nearly all drug doctors administer drugs on the slightest occasion. The custom is so nearly universal that one feels instinctively that he must "take something" when ailing. It is not necessary to cite instance to show that medicine as practiced by the old schools is first, last, and always, the administration of drugs. The people have been taught that, and custom warrants the conclusion. The treatment of the late President Wm. McKinley is a case in point. It excited a great deal of interest and provoked much criticism at the tinge, and is destined to become a subject of as much dispute as was that of Washington more than one hundred years ago. The report of the medical staff attending him appeared in the New York Medical Journal, October 19, 1901. The skill with which the report evades a clear statement as to the cause of death is noteworthy. One reputable authority said the doctors killed him; another said it was a pity that they did not have a physician who knew the cumulative effect of drugs, naming digitalis. The case is mentioned here, not to criticize the eminent physicians in charge of the case, but to show that the "regular" school of practice depends very largely upon the use of drugs even in surgical cases. It is evident that many of the drugs used were antagonistic to nature, and that nature had but slight chance to get in her work. The report shows that there were eight surgeons in attendance, two assistants, and seven nurses. Below is given the drugs administered in different ways, exclusive of those used purely as antiseptics. He was shot at 4:07 P. M., September 6, 1901. Morphine and strychnine were given almost immediately, and ether for the anesthetic. Following the operation and before midnight, strychnine, brandy, morphine sulphate, and a saline enema. Second day, saline enema, digitalis, and morphine. Third day, digitalis, strychnine, Epsom salts, glycerine, sweet oil, soap, and whiskey. Fourth day, codeine, calomel, and oxgall. Fifth day, soap and water, and codeine phosphate. Sixth day, strychnine. Seventh day, whiskey, castor oil, digitalis, strychnine, calomel, oxgall, "atimulants" freely, and salt solution. Eighth day, strychnine, whiskey, camphoretted oil, "stimulants" more freely, liquid peptonoids, adrenalin, salt solution, nitroglycerin, camphor, brandy, oxygen, and morphine. He died at 2:15 A. M., September 14, 1901.
Humanity owes Dr. George S. Keith, of Scotland, a debt of gratitude for the bold stand he has taken against present-day medical practices. His "Plea for a Simpler Life" and "Fads of an Old Physician" are classics. His arguments are so convincing that only those who are wedded to their idols can fail to be convinced. In speaking of the treatment of influenza - grip - in a communication which, I understand, first appeared in the British Medical Journal in 1902, he says: "The after-effects are too well known to need mention, and the deaths from them have been much more frequent after a more or less prolonged period than were those from the original attack. These deaths are not returned as from influenza, but from the diseases resulting from it - notably from pneumonia and other chest affections. For myself, I have all along treated cases of influenza on the old method of leaving them absolutely to nature, and so far as my memory goes, I do not remember the loss of a single case. Certainly for twenty-five years after my late colleague and successor joined me, we did not lose a single case. "I have invariably found that influenza wisely treated leaves the patient in better health than before." This is in line with osteopathic experience. Bad after-effects are practically eliminated in cases treated osteopathically; and we are naturally led to suspect that most of the terrors of grip are due to drugging and other irrational methods of treatment. The same is true of many other diseases, such as pneumonia, typhoid fever, etc. Physicians often lay too much stress upon the effects of drugs upon normal animals in testing them to determine their therapeutic value. "One man's meat is another man's poison." Every individual is a law unto himself. Even the same individual is not at all times equally susceptible to the effects of a drug. Every one knows that even food may produce sickness, and has often noticed that some articles of diet may be relished at one time and may act as a poison, at least as an irritant, at another. We have all seen cases where strawberries or oysters, or even eggs, would always produce a deathly sickness. A quarter of a grain of quinine is more dangerous in some cases than twenty grains in others. Many times a drug doctor has to be warned against the use of certain drugs to prevent his risking the life of his patient by dangerous experiments. The American Journal of Physiology for July, 1903, has a valuable contribution as to the effects of drugs, etc., from which the following quotation is taken: "Nor our knowledge of the effects of all drugs, alkaloids, noxions or metabolic products, is mostly derived from a study upon normal animals or organs. Are the effects the same when the organs are deprived of their normal innervation? As far as we know this question has as yet hardly been seriously raised. Our experiments have demonstrated that the effect on pathological organs can be diametrically opposite to that on the normal one." A few choice quotations are given below from an article in International Clinics, which appeared in January, 1905, by George Hayem, M. D., Professor in the Paris Faculty of Medicine. "The oldest drugs endowed with undeniable therapeutic effect were bequeathed to us by empiricism; they are the so-called specifies: mercury, iodine, and quinine. A curious fact concerning them is that, in spite of the time that has elapsed since their discovery, contemporary science has not yet been able to ascertain precisely how they act. "And yet the science of chemistry, constantly progressing, has introduced a large number of substances into therapeutics without our being able to find a single specific. "Serum therapeutics, however, has so far given rather meager results and has proved richer in promises than in accomplishments. Although there is reason to hope that it has a brilliant future before it, it has disappointed us in many cases, and particularly in the attempts that have been made with it in tuberculosis, the greatest of our enemies. "So, while awaiting the dawn of new specifics, or the discovery of further active serums, we are standing with arms at rest, so to speak, having as weapons, the endless number of substances furnished by modern therapeutics." After citing several cases in which he shows that the patients are suffering more from the effects of the drugs taken than from the original disease, Dr. Hayem continues: "But, it will be objected, you cite only exceptional instances. I only wish it were so, but unfortunately these are every-day occurrences, and are met with at every step. I could mention analogous cases by the hundred. It is true that I see mostly chronic cases, and I hasten to say that in acute complaints instances are much rarer in which our medical action is productive of harm. "In chronic disorders that run a long course, the physician's part is really very difficult. The patients demand prescriptions, which, as they are generally useless, have to be replaced by others, and these in turn by others still, and so on for years. In many instances, again, the patients continue, without medical advice to take for long periods of time a preparation that they look on as harmless. But even the most inoffensive drugs become harmful, when taken indefinitely. By introducing a certain degree of variety in prescriptions, and by frequently changing a treatment, as I find is usually done, the harm done is in no wise diminished; its effects are simply rendered more complex. So that it is scarcely necessary for me to repeat what I have already said on former occasions; slow intoxication by drugs is the greatest danger that a patient with some chronic disorder runs. After denouncing, in no uncertain terms, the bad habit of dyspeptics stuffing themselves with sodium bicarbonate and alkaline mineral waters, he says: "In this connection I may remark that alkaline saturation, so far from lessening the production of free HCl [hydrochloric acid], produces the most marked and typical hyperchlorhydria that can be seen. That effect is sometimes so intense that the gastric juice becomes a sort of solution of free UCI. "When we see gastric patients growing steadily weaker and thinner, although eating a sufficient amount of food, it is rare that the disturbance of the general nutrition is not the result of medicinal intoxication." Similar facts are observed in other chronic disorders, and especially in tubercular patients. What occurs with the latter class of patients when we endeavor to stimulate nutrition, and to treat cough, pyrexia, or sweats by medicinal prescriptions? The therapeutic agents, powerless to hinder the evolution of the disease, soon lessen the appetite and produce harmful digestive disorders. "Pure air, sunlight, the thermic agents, and food are the normal stimulants of the system and the sources from which we derive our elements of maintenance and activity. These agents, called hygienic, are also those which suit a diseased system struggling against a never-ceasing cause of increased expenditure and loss of strength."
Notwithstanding the fact that many people have lost faith in drugs, and that many of the ablest M. D.'s have shown the fallacies of their use, thousands, yes millions, believe they possess a magic power to cure diseases. What better evidence of this fact than the vast amount of medicine sold either with or without a prescription from a doctor, or even the recommendation of a druggist? An article in Leslie's for January, 1904, states that in Detroit there are manufactured over 1,700 varieties of pills. It says: "If Detroit's crop of pills for a single year was made of any deadly poison, one-half of them would be sufficient to depopulate the entire globe, but this would so injure the pill business that it is not likely to occur. "If the annual pill harvest of Detroit was strung on thread, like Christmas popcorn, the rope of pills would reach twice around the earth, with enough over to tie in a bow knot. If this string of pills was cut in pieces each of the 36,000,000 women and girls in America could have a different necklace of pills for every day in the year, with an extra long one for each Sunday. "Detroit produces 4,000,000,000 pills each year, and yet this tremendous number is only about sixty per cent of the total quantity of pills made, so that to get a fair idea of the growth of modern civilization and the pill-eating mania the sum must be multiplied by two or thereabouts." The article shows how more than $20,000 were spent in one expedition in South America in search of new poisons from plants and animals that could be used in the preparation of medicines, and adds: "Since then that expenditure of $20,000 has given a return of many times that sum." The manufacturing druggist is a close competitor with the patent medicine proprietor in the sales of his wares. An item appeared in the public prints about two years ago stating that eight proprietary drug houses in the United States spent over $500,000 each annually in advertising their business. These were not 'patent medicines" that were advertised, but "proprietary medicines," sold only upon prescription of doctors. Concerning this growing evil, and the disgrace it is bringing upon the medical profession, Dr. Dan Millikin, in his presidential address before the Ohio State Medical Association a few years ago, spoke in no uncertain terms; but the evil has been increasing most alarmingly ever since he uttered his warning. He said: "There is now raging in our profession a pestilence which is somewhat analogous to the nostrum-frenzy among the laity. If it were manly to shuffle and find excuses for this, we might cite, as the inducing cause, the greed of manufacturing druggists, who are not content with legitimate profits, and who are by many devices cultivating the notion that they each have a monopoly of the knowledge requisite for the compounding of some 'special preparation.' "This abominable infection is growing. Only a short time ago a very able physician asked me if a patient we had been treating in common had not better take a ferruginous tonic for a short time. I agreed, and asked him his preference; he lightly said, 'Oh, give him some one of the newer forms of iron.' I inquired further, and found that he had a quack preparation in mind, and when I spoke lightly of it, he looked on your president pityingly, as one looks on an imbecile. A bright young doctor sent me word of one of my old patients, who is slowly dying with a senile heart; he is treating the old gentleman as well as he can, for he is giving him somebody's 'elixir of three chlorides,' though neither he nor I know what three chlorides, nor what the dose may be, nor what the three several indicators may be. He is one of the thousands, for it is not too strong a statement to say that the whole American medical profession has gone daft over these preparations of the manufacturing pharmacists, sold by pure impudence, and bought by the doctors through pure credulity. St. Louis is the headquarters of this shameful traffic, but every city and many of the small towns have their firms, all intent on getting rich through mystery and loud pretense. "It is the special object of this address to call your attention to the fact that these so-called special preparations do not differ in any regard from the patent medicines which are swallowed in such quantities by the laity to feed the inextinguishable laughter of the doctors. It is not in order for you or me to sneer at the girl who buys love-powders in the kitchen, or madame who buys subscription books in the parlor, if we, snickering in the office, are seduced by the dru=er's smooth tongue into the purchase and use of secret remedies. "The advertising of this sort of stuff has become a curse almost unbearable. The impudence of the advertisers rises to its superb climax when they put forth what appears to be journals, and send out broadcast, as 'sample numbers,' postage free! "Aye, and let us confess that the legitimate medical press is not without taint. I can show you whole issues of the best journals of our land containing no clean advertisements, such as should accost the physician, with the exception of here and there a call to drink pale ale, to buy trusses or artificial legs, or to go to a private lunatic asylum. All other space is evidently for sale to the highest bidder with the lowest notions of our work; and I shame to say that this low fellow with the long purse buys editorial notices of his secret preparations along with other spaces." The evils mentioned by Dr. Millikin are recognized by the profession at large. The two following recommendations appeared in the report of the proceedings of the American Medical Association at New Orleans, in May, 1903. It is not necessary to read between the lines to see that the profession itself is responsible for the deplorable state of affairs. The layman will also see that he must take what the "regular" physician prescribes, with all "the lack of knowledge on the part of medical graduates," because "no medical preparation," etc., no matter how efficient "is entitled to the patronage of physicians." "That inasmuch as the primary cause of the proprietary medicine evils is the lack of knowledge on the part of medical graduates, the course in materia medics should be supplemented during the last year in connection with therapeutics by a course in pharmacy especially designed to qualify the student to formulate his own prescriptions in the most eligible manner. "That the Committee on National Legislation be asked to consider the feasibility of the introduction in the next House of Representatives of an interstate measure prohibiting or limiting the sale of poisonous and dangerous patent medicines. "That no medicinal preparation for internal use, as distinguished from antiseptics, disinfectants, cosmetics, and dietetics, advertised as a remedy or cure to the laity, is entitled to the patronage of physicians, nor should such be admitted to the pages of the medical journals, nor to the exhibitions of the American Medical Asociation." An article in the New York and Philadelphia Medical Journal, April 30, 1904, by John H. Neal, M. D., gives warning of the same danger. Meantime, commercialism increases, the trade goes merrily on, the manufacturers become rich, the people pay the bills, and the grave swallows up the victims. Dr. Neal says: "There is one other question which I will mention, and then I have done. I refer to the dispensing of drugs. It seems to me that the profession has very largely drifted into a most unscientific and expensive habit; one which is expensive, not only to the doctors, but also to their patients, in more ways than one. Many physicians are allowing the manufactures of pharmaceutical products, so called, to do practically all the prescribing of drugs. Their salesmen make their regular tours, presenting samples of their products to the physicians, of the nature, quality, and strength of which they know nothing. They have a prescription in some form or other to meet every indication. A specific for every disease; yes, every symptom. Their principal argument is their cheapness. And, in many instances, they could not enlarge upon that in one respect. These concerns have the audacity to send to physicians, in many cases, their preparations in containers, on which are found labels stating the indications for their use, the doses, and how administered, but not stating the amount of, and in some cases, the ingredients themselves. I cannot conceive of an act more audacious. And it is, in my opinion, one of the most serious charges that can be brought against the profession, that it stands this abuse. These concerns can not be blamed for this condition of affairs. It has been brought about by the consent of the profession, which can also change the condition at its will."
Some drug companies, possibly all, are composed of a large number of M. D.'s who are owners of stock and who are pledged to use the goods manufactured by the company in which they are interested. I was assured recently by one who is interested in such a company, that its average net profit on its goods is eighty percent. Whether such companies are a less menace to the health of the people than many of the patent medicine companies, I leave to the thoughtful man of affairs to decide. The enormous profits upon drugs to the druggist who fills the prescription, the manufacturer who prepares the ingredients, and often to the doctor who writes the prescription, stimulate the business, so that the welfare of the patient is often lost sight of in the grasp for money. A circular letter from a prominent firm of "manufacturing chemists," bearing date of June 16, 1904, says: "We want you to know that Tablet ______ are in every way as efficient and unobjectionable in the treatment of rheumatism, neuralgias, and litheomic headaches as the _________ are in indigestion; and that our records show that we sold over three hundred millions of the latter tablets (thirty-Seven thousand to our most prominent local bacteriologist alone) in 1903; and that more than seventy thousand physicians are now either dispensing or prescribing these tablets." Is it any wonder that those who may find temporary relief by the use of such means soon find themselves victims of the drug habit or their natural functions so impaired that hope gives way to despair, even if half we are told about the quantity of drugs consumed is true? The business end of drug medication is also in evidence by the amount of advertising in reputable medical journals. An examination of several reveals the fact that seventy to ninety per cent of the advertisements exploiting curative agents are in the interests of drugs; and that twenty to forty per cent of the entire contents of the journals is given over to the same business. It is evident the doctors prescribe these drugs, the patients pay for them, and the drug gist receives his profit, or they would not be presented to the profession through this perfectly legitimate source. Suppose we admit that pure drugs are harmless, the evils of drug medication are not eliminated. There is money in the business to several parties, and if the profits cannot be made sufficiently large to satisfy the greedy, adulteration or "substitution" is resorted to. Read the following from an editorial in the Lancet Clinic, December 31, 1904: "Some weeks ago the Illinois State Board of Pharmacy, for the purpose of investigating the numerous reports that had been brought to their attention, sent to various druggists to be filled 130 prescriptions. These were then subjected to expert chemical analysis, and it was found that in 23 there was no trace of the drug prescribed, 66 contained 80 per cent of impurities; 10, 20 per cent; and but 31 could be regarded as pure - that is to say, containing exactly what was ordered. "This statement almost staggers human belief. While much has been written of substitution in medical journals and physicians have in a hazy sort of way become cognizant of the fact that such an evil does exist, no one has imagined for a moment that it has reached such awful proportions. But 31 pure prescriptions out of a total of 130! It is a discovery calculated to cause the gravest alarm in the minds of both profession and laity." Manufacturers of appliances have also been drawn into this frightful maelstrom of greed. A circular before me from a surgical and dental supply company contains the following: "Liberal commission allowed to physicians on all business sent us on elastic stockings, trusses, braces, and abdominal supporters." The "liberal discount" is about twenty-five per cent. A factory claiming to be the largest in the United States seems to be owned by the profession. Its circular says: "A share of stock in this company gives you a discount, ninety days' time, and a dividend on what others buy." Thus in addition to the fee to which the doctor is justly entitled from a professional standpoint, he can trace his profits back to the factory. From the large number of these devices placed upon the market it is hard to escape the conviction that many of them are prescribed for "profit only;" rather than the good of the one that must pay the bill with profits to so many financially interested in the sale. In this connection another fact should be recorded, namely, the paying of commissions on cases referred to them by other doctors. Through a decoy letter, a number of Chicago physicians were found, in the autumn of 1904, who paid such commissions. It seems the practice is quite common and has been growing steadily during the past five years. A dispatch to the Commercial Tribune, October 18, 1904, reports Dr. John B. Murphy as saying: "The paying of commissions is the most vicious, pernicious, and outrageous practice to which a doctor can resort. It is unfortunate that we can not stamp out this evil among ourselves, but publicity seems to be the only method of checking it. The public would soon lose confidence in a physician who was known to be paying commissions for the treatment of patients. "The practice means that the patient is being betrayed by the one in whom he has implicit confidence - the family physician. It means that his life is being auctioned off to the man who will pay the highest premium."
The belief is general that drugs are prescribed by doctors much less than formerly. While the total amount consumed is doubtless increasing daily, the amount used by the most intelligent and the most conscientious doctors is constantly decreasing. Dr. John Maddens, of Milwaukee, spoke as follows in American Medicine for February 1, 1902: "Each year sees more than one time-honored remedy become limited in its use or else fall into complete desuetude. A quarter of a century ago the student loaded the pages of his note book with complex formulas, each containing from two to ten different ingredients, to be cherished until the time should come when he would be a giver of drugs. These formulas were definite instruments that the fathers in the profession used to cure disease. Each disease had its treatment indicated in sets of formulas, some to be given if it ran an uncomplicated course, others to be given to meet complications and crises. "Just glance over the pages of any comprehensive Practice of Medicine, published fifteen or sixteen years ago, and note the drugs used in, or recommended for, yellow fever - emetics, purgatives, sudorifies, ipecac, castor oil, calomel, the salines, jaborandi, mustard, quinine, as much as twenty grains at a single dose, with a half dram of tincture of opium; mucilages, linseed, slippery elm, gum arabic, opium, potassium bromid, chloral, external applications of ammonia, camphor, and common salt, embrocations of turpentine, gelseminum, digitalis, aconite, veratrum veride, ergot, turpentine (internally), gallic acid, tincture of chloride of iron, sodium bicarbonate, morphine, creosote, seltzer, apollinaris, champagne, chloroform, and cantharides" Dr. Oliver Wendell Holmes, poet, scholar, doctor, spent much of a long and useful life trying to lessen the drug evil. The following often misquoted statement appeared in a lecture before the Massachusetts Medical Society in 1801, and twenty three years later he defended his position in Note C, mentioned in the quotation. There is much in Dr. Holmes's volume of "Medical Essays," as well as in his poems, that will interest the intelligent reader. "Presumptions are of vast importance in medicine, as in law. A man is presumed innocent until he is proved guilty. A medicine that is a noxious agent, like a blister, a seton, an emetic, or a cathartic - should always be presumed to be hurtful. It always is directly hurtful; it may sometimes be indirectly beneficial. If this presumption were established, and disease always assumed to be the innocent victim of circumstances, and not punishable by medicines, that is, noxious agents, or poisons, until the contrary was shown, we should not so frequently hear the remark commonly, perhaps, erroneously, attributed to Sir Astley Cooper, but often repeated by sensible persons, that on the whole, more harm than good is done by medication. Throw out opium, which the Creator Himself seems to prescribe, for we often see the scarlet poppy growing in the cornfield, as if it were foreseen that wherever there is hunger to be fed there must also be pain to be soothed; throw out a few specifics which our art did not discover, and is hardly needed to apply (Note C); throw out wine, which is a food, and the vapors which produce the miracle of anaesthesia, and I firmly believe that if the whole materia medica as now used could be sunk to the bottom of the sea, it would be all the better for mankind, - and all the worse for the fishes." Dr. Holmes did not live to see the good work of opposition to the promiscuous use of drugs finished. Many other M. D.'s have battled in the same cause; but they are as one against ten thousand. Dr. Wm. Osler has done much towards puncturing the fads of modern methods. Note what he says about germs in the first paragraph quoted below, pneumonia in the second, and present medical practices in what follows. From the last sentence the reader will see that this great doctor's mind seems to be fixed upon the use of a few drugs; but he does not seem to be able to live up to his idea of treating even typhoid fever, if we are to believe the statement of the papers as to his treatment of the late Senator Hanna. Here are a few of the good things Dr. Osler says in his famous address on Medicine in "The Progress of the Century." "They [bacteria] give to the farmer the good quality of his crops, to the dairyman superior butter and cheese; they assist in large measure in freeing our rivers and lakes from harmful pollutions. Here it should be strongly emphasized that those bacteria which cause disease are only of a few species, all others contributing to our welfare in countless ways. "We know the cause of the disease [pneumonia]; we know only too well its symptoms, but the enormous fatality (from twenty to twenty-five per cent) speaks only too plainly of the futility of our means of cure, and yet in no disease has there been so great a revolution in treatment. The patient is no longer drenched to death with drugs, or bled to a point where the resisting powers of nature are exhausted. "The century has witnessed a revolution in the treatment of disease, and the growth of a new school of medicine. The old schools - regular and homeopathic - put their trust in drugs, to give which was the Alpha and the Omega of their practice. For every symptom there were a score or more of medicines - vile, nauseous compounds in one case; bland, harmless dilutions in the other. The new school has a firm faith in a few good, well-tried drugs, little or none in the great mass of medicines still in general use. Imperative drugging - the ordering of medicine in any and every malady - is no longer regarded as the chief function of the doctor. Naturally, when the entire conception of the disease was changed, there came a corresponding change in our therapeutics. In no respect is this more strikingly shown than in our present treatment of fever -say, of the common typhoid fever. During the first quarter of the century the patients were bled, blistered, purged, and vomited, and dosed with mercury, antimony, and other compounds to meet special symptoms. During the second quarter, the same, with variations in different countries. After 1850 bleeding became less frequent, and the experiments of the Paris and Vienna schools began to shake the belief in the control of fever by drugs. During the last quarter sensible doctors have reached the conclusion that typhoid fever is not a disease to be treated with medicines, but that in a large proportion of all cases diet, nursing, and bathing meet the indications. There is active, systematic, careful, watchful treatment, but not with drugs. The public has not yet been fully educated to this point, and medicines have sometimes to be ordered for the sake of the friends, and it must be confessed that there are still in the ranks antiques who would insist on a dose of some kind every few hours. "The battle against poly-pharmacy, or the use of a large number of drugs (of the action of which we know little, yet we put them into bodies of the action of which we know less), has not been fought to a finish. There have been two contributing factors on the side of progress - the remarkable growth of the skeptical spirit fostered by Paris, Vienna, and Boston physicians, and, above all, the valuable lesson of homeopathy, the infinitesimals of which certainly could not do harm, and quite as certainly could not do good; yet nobody has ever claimed that the mortality among homeopathic practitioners was greater than among those of the regular school. A new school of practitioners has arisen which cares nothing for homeopathy and less for so-called allopathy. It seeks to study, rationally and scientifically, the action of drugs, old and new. It is more concerned that a physician shall know bow to apply the few great medicines which all have to use, such as quinine, iron, mercury, iodide of Potassium opium, and digitalis, rather than a multiplicity of remedies, the action of which is extremely doubtful."
The cry going up everywhere for relief from the thraldom of drugs is heard here and there by the drug doctor; and he is forced by the impetus of public sentiment to acknowledge the mere "psychical effect" of most drugs and the "poisoning effect of many of the popular drugs and nostrums in common use." An article by J. K. P. Bowen, M. D., entitled "A Plea for the Use of Less Drugs in the Treatment of Typhoid Fever," in the Philadelphia Medical Journal for April 11, 1903, is well worth perusing. Among other good things, he says: "Psychotherapy, or every-day practical suggestion, is an important factor in the treatment of most diseases, for aside from the psychical influence, but little of the drugs taken result in good. How frequently the physician is tempted to prescribe a medicine in treatment for his drug-believing patient for its psychical effect. "The Americans take four times the amount of drugs taken by Europeans, and our death rate is greater, especially from acute diseases. How many of the peculiar symptoms, universal complications and fatal terminations are due to the treatment! The statistics of the last few years show conclusively that physiological treatment with only an occasional medicinal auxiliary gives decidedly the best results. Physiological therapeutics utilizes vital forces, aids in cell growth, strengthens vital resistance, and promotes natural elimination and not the corroding, depressing and poisoning effect of many of the popular drugs and nostrums in common use. Many mild cases of most any acute disease will recover under any kind of medicinal treatment in spite of the diseased condition and the drugs, too, and occasionally, the effect of the drug is left on the system permanently, or the drug habit is acquired, which is one of the most appalling and unfortunate circumstances that could befall human form." Drug doctors have endeavored more than once to stay the constantly increasing tendency on the part of the thoughtless to use drugs, except when prescribed by one of their own school. But the people were taught that habit by the drug doctors themselves. Drug medication is the foundation rock upon which their system is builded; hence, it will take years, perhaps generations, to undo the evils growing out of the practice. The following quotation is from the Cleveland Medical Journal, January, 1902. The same issue contained an article which every osteopath would sanction, advocating the passage of a bill requiring "the makers of patent medicines to print the true formulas of their nostrums on all labels." It also gave three pages against the osteopathic bill then pending before the legislature (Chapter IV); thus trying to prevent the people from using non-drug methods and at the same time trying to compel them to patronize only those who administer drugs and incidentally only those who prescribe for a fee and require the patient, in having the prescription filled, to contribute to the profits of at least two or three parties to the transaction. "The newspapers of this city recently and very properly have been agitating against the general sale of cocaine, which is reported to be going on. Cocaine wholesales at six dollars an ounce, and one druggist here is reputed to buy the drug in one hundred pound lots! But the newspapers miss the real source of danger, which lies in the multitude of patent medicines bought freely by the public and containing as their only active agents morphine, cocaine, and other narcotic drugs. It is these which give to many unfortunates their first taste for 'nerve tickling' and soul-destroying drugs."
While many physicians are trying honestly to check the giving of
drugs, others are not only wedded to their idols but try to force
all to worship at the same shrine. A medical formulary issued in
1901, "comprises over 1,600 formulas in actual use by medical
practitioners and covering also the newest remedies of recognized
merit." In another "will be found 2,600 prescriptions
collected from the practice of physicians of experience, American
and foreign, nine hundred and twenty-two American and foreign authorities
being represented." The two formulas given below are for "colds
in the head." The first is from one of the formularies mentioned
above; the second is from Anders' "Practice of Medicine,"
a standard work. When we learn that Fowler's Solution "is a
1 percent solution, prepared by boiling together Arsenous Acid [white
arsenic, 'ratsbane'] 1; Potassium Bicarbonate, 2; Compound Tincture
of Lavender, 3; and Distilled Water to 100;" and that Seidlitz
powder has "of Potassium and Sodium Tartrate 120 grains; of
Sodium Bicarbonate 40 grains, mixed in one paper; and of Tartaric
Acid 35 grains in another paper," we get a clearer idea of
the complexity of drug medication, even for a bad cold. Euquinine, - - - - 20 grains. "At the outset a purge consisting of calomel (gr. ij - 0.129 ), or a pill of blue mass (gr. v - 4.324) at night, followed by a Seidlitz powder in the morning, is advisable. To children a dose of castor oil may be given. The early administration of a diaphoretic, such as Dover's powder (gr. v-x -0.324. - 0.345) at night may arrest the complaint, and quinine in a large dose (gr. xij-xv - 0.77 -0.992) at night may cut short the cause of the disease. When the above mentioned abortive measures fail, the following tablet produces good results: Quinin sulphat., - - - - gr. ijas (0.162) "For the fever aconite may be employed, and, if the throat is involved, bryonia may be given in conjunction." The frightful destruction of morals, health, and life by the use of opium and morphine, often administered under other names, is appalling. The scores of preparations that are always depressant, as headache powders, are also getting in their deadly work. As is well known., cocaine is one of the most dangerous drugs used by the medical profession. It destroys both soul and body. Its victim disregards truth and ignores property rights. In other words, he will lie and steal without any compunctions of conscience. His bodily functions also soon become impaired beyond all hope of recovery. Recently there has been an epidemic of crime among the negroes in Cincinnati which the police authorities attribute to the use of cocaine. Who is responsible for this new menace to health and morality? The druggist is held up as the chief offender for" selling it "without a prescription." But is not he who gives the prescription in the first place the original and primary offender? Here is what the Alkaloidal Clinic for May, 1904, had to say on this subject: "While many of these and other forms of drug habit are directly blamable to thoughtless and careless members of the medical profession, who all too quickly give to neurasthenic patients prescriptions for narcotics, yet it is our friend, the druggist, who, for purely mercenary reasons, continues to fill and refill these prescriptions till the sufferer degenerates into a ten cent cocaine habitue or morphine fiend, on whom the bulk of the burden rests. Doctor, you should think more than once or Twice before you give a prescription for a narcotic. And, brother Drug-man, you should never refill such a prescription. If it should be repeated let the doctor take the blame and write a new one. Better both cut it out." The dangers from the use of alleged catarrh cures are well known to all intelligent physicians. The people have been warned many times, but the diabolical traffic does not seem to have diminished. The following clear statement as to their evil effects appeared in a recent issue of The Medical World: "It is well known that many secret catarrh cures contain cocaine. The object is to get the patient in the habit of taking the catarrh snuff with every prospect that he will continue it indefinitely. Other secret nostrums advertise to cure catarrh, asthma, hay fever, bronchitis, consumption, etc., to be taken internally, are launched on the same basis and for the same purpose. "Inducements are made to take 'a full month's treatment,'
and then instructions are given how to order, and the victim is
told that the goods will bear no external marks. The reasons are
obvious; the plan is transparent to those who will open their eyes.
Doctors should explain this to the laity whenever occasion offers.
If we had a law like that of Germany, requiring the formula on every
bottle or package, the ignorant could not be so easily entrapped
into the slavery of drug habits. That such should exist in the 'land
of the free' is an outrage." "An analysis of the papers presented during the late meeting of the New York State Medical Association at the Academy of Medicine in New York, offers some interesting features in connection with one of the most representative bodies in this country. Besides the president's address, there are forty-eight papers on the program. The larger percentage of these are able documents, and fairly represent the whole. Diagnosis may be credited with eleven, or about fourteen per cent; etiology with four, or about eight percent; mixed papers in which there may be some allusion to the use of drugs, though this is by no means certain, three papers - six percent; special therapeutics (not drugs), one paper; special idiosyncrasy, one paper; and last on the program, on the final day of the meeting, 'Brief Comments on the Materia Medica, Pharmacy, and Therapeutics of the Year Ending July 1, 1901.' "So it seems that therapeutics, by the use of drugs, received a trifle over two percent of the time of this meeting, and this only at the end, after interest has subsided and most of the members have gone home. "Was this the ease in the days of our fathers in the days of Alfred Stifle and his compeers? "Do our associates, when making out the program, consider that ninety-five percent of all the cases with which the practitioner has to deal are medical cases? Why then this pitiful less than two percent consideration?" The statement made before a Chicago Medical Society in January, 1904, by Dr. A. D. Bevan, that "drug treatment is useless in cases of pneumonia," might be expected to cause some surprise to the laity, but should not have aroused such a discussion in the profession as it did. Such well-known writers on medicine as Hilton, Keith, Hughes, Anders, Osler, Billings, and others had already said enough to convince the profession that drugs in such cases were useless, if not positively harmful. But the teachings of centuries are not easily set aside and the prejudices of ignorance must not be overlooked. Give drugs for their "moral effect," as suggested by doctors who protested against Dr. Bevan's statement. The following account of the controversy appeared in the press reports, and is not denied by the medical journals; but it made some of them decidedly hysterical: "'Drug treatment is useless in cases of pneumonia. The medical profession, so far as medicines are concerned, can be of no assistance in the light against this disease. The sooner the profession will acknowledge this to the public and set to work to discover some specific to save pneumonia patients, the better for all concerned' "This startling statement by Dr. Arthur D. Bevan, who stands high in the profession, has stirred up the members of the Chicago Medical Society at their meeting. "Several physicians sprang to their feet to protest against this arraignment. All had to admit, however, that there is no definite remedy known, and they based their protests solely on the contention that they might influence the patient favorably by easing him somewhat and by the moral effect of their presence." The Osteopathic Physician, February, 1904, contained the following caustic comment upon the above incident. "So they go on admitting that the 5,000 drugs already listed in the United States Dispensatory are of no service in this and that ill, while they are a positive harm in some other one, but still multiplying trouble by inventing new drugs, led on by the ignis fatuus that some day inert matter will be found in cunning formulae which will solve the mystery of creative life and actually impart vitality to vitiated protoplasm. "Alas, vain search ! Alas, futile alchemy worse than the attempts at transmutation of lead to gold in the olden time! Worse than the search for a Fountain of Immortal Youth because not alchemists, not romanticists, not poets, not devotees of superstition, but men of science engage in this child-like bootless task! "We feel sorry for our benighted brethren of regular medicine. It may be a bit Pharisaical to admit it, but we can't help it. They seem to us to be fetich-worshipers, pure and simple, in this blind searching for panaceas of life's myriad ills. Knowing as much as they do of all the co-ordinate branches of a liberal scientific education, it seems inexplicable to us that they should make such poor use of their knowledge and talents. Truly, it is not what men know, but how they use it, that counts in medicine."
It has been only a few months since the X-ray and radium were heralded as sure cures for cancer. The present writer said then to a very sick patient that she would live to see those medical fads things of the past, just as scores of others that had been relegated to the therapeutic waste-basket are now known only to history. The prediction is already verified according to expert witnesses. P. J. M. McCourt, M. D., in an article in the Medical Review of Reviews, April, 1904, makes the following statement: "Aside from operative procedures, the only assumed remedies for carcinoma at present are the 'X-rays' and the radium rays. It is laudable that these and all available agents should be studied and subjected to crucial - not commercial - tests; but it is noxious that we should be deluded by the extravagant claims of undignified enthusiasts of 'cures' which are wholly chimerical. I would not depreciate the rational work of others; we are or should be - seekers for the truth in our own way. But the only therapeutic result thus far produced by the Roentgen and radium rays has been the occasional temporary suppression of epithelioma, soon to be followed by local recurrence, metastasis, or general diffusion throughout the system. And in view of the apparent causation of carcinoma, no other results could have been anticipated. The unknown has a fascination for many, sometimes even for logicians; and of these rays we as yet know practically nothing - except their dangers." But the author has his own method of treating this loathsome disease, which may have biased his mind against other methods. The injection of blood serum from a diseased horse as au antidote for diphtheria, and the pus from the sores on a diseased cow for small-pox, is refinement compared with the dosing of the cancer toxins prepared as described below. Note the results. Only fourteen percent, "apparently restored to their former condition of health." The results upon the whole do not appear to be as successful as the do-nothing method. A. F. Jones, M. D., in the Journal of the American Medical Association, May 9, 1903, after giving four cases, says: "In two of our cases the neoplasm disappeared spontaneously, the disappearance depending, no doubt, on some form of katabolism not yet understood." Katabolism is the tearing down act in the process of nutrition, and is quite well understood. Are we to infer that Dr. Jones believes in a special "form" of katabolism for each disease? Here is Dr. Me Court's method and its results "The cancer-tissue is pressed and triturated in purest vegetable glycerine, and the juices thus obtained are separated until micro-organisms are no longer found. The resultant fluid contains all the ptomaines or alkaloids of the cancer virus, as well as those of other materiae morbosa - syphilis, scrofula, tuberculosis, erysipelas, malaria, etc. - associated with them in the subject from whom the virus was collected. "'In five percent - the advanced and extremely malignant - the toxins were found to be entirely valueless. In ninety percent, relief from pain, foetar, hemorrhage, insomnia, vesical and rectal tenesmus, etc., has been marked and life materially prolonged. And in fourteen percent, indurated glands have become normal, ulcers have healed, body weight has increased, a complete cessation of all objective and subjective symptoms has ensued, and the patients are, apparently, restored to their former condition of health. "Whether this relief is permanent can be answered only by time. Even hope must be in abeyance until years of attentive and anxious observation have passed. Meantime, I have not told the whole truth on behalf of the cancer toxins."
The serum method seems to be the most natural successor to the drug method of treating diseases. Many of the drugs used in common practice are obtained from diseases of plants or animals. Serums are always secured from animals diseased artificially. The animal is inoculated with the desired disease, as diphtheria, tuberculosis, or tetanus, and the serum of the blood which contains the antitoxin to the products of the disease germs with which the animal was inoculated is prepared for the market. Only a few years ago it was hailed as the open sesame for the cure of all germ diseases. Many kinds of serums have been prepared, and still the profession is at work along that line. The serum for tuberculosis has proven to be an absolute failure, and the profession has even lost faith in its use for diagnostic purposes. That tetanus (lockjaw) has been increased by the use of the serum is now quite generally conceded. But the profession as a whole still claims that the serum treatment is the only one for diphtheria, and it is little less than suicide for a drug doctor to express doubts as to its success. For the laity or an "irregular" to question the correctness of the statistics that show the positive benefits to be derived from the serum treatment of diphtheria is to have his honesty or sanity questioned; and the look of contempt, or even scorn, with which he is met, is apt to make him wonder whether truth is truth or falsehood. Occasionally old school medical authorities will speak the truth as they see it, even though all their professional brethren seem to be against them. An article by Boucher, entitled "Extraordinary Gravity of Diphtheria since the Introduction of the Behring and the Roux Serums," appeared in the Journal de Medicine de Paris, April 3, 1904. A translation by Dr. T. C. Minor, a regular, is found in the Eclectic Medical Journal, June, 1904. Statistics to prove the fatal results due to the administration of antitoxin for diphtheria are given. The following quotations contain the pith of the article: "Every day, in the great public press, editors as ignorant as Pasteur of the great principles of our science, proclaim with conviction that hydrophobia is vanquished by the divine and immortal chemist, and that diphtheria has been conquered by Disciple Roux. For hydrophobia it is now well known, well demonstrated, and positively proved that fatal cases have doubled since Pasteur's invention. Then, too, we have statistics, coming from all sides, that the mortality from diphtheria has also increased since the introduction of Behring serums, recopied by the eminent Roux. "The study of the mortality of Basle leads one to the same conclusion. In fact, according to the works of Lotz that appeared in Correspondent Blatt fur Setweizer Artz, 1898, it is shown that in the ten years between 1885 and 1894-that is to say, before the serotherapeutic epoch - an annual mortality of 29 cases is noted; and in the years that follow the mortality was raised to 45, and even reached 69. Let it be understood meantime that there are always periods of lowering in morbidity and mortality from all causes. It would be illogical to assume that temporary periods of lower mortality were due to serum. "Such are the indisputable facts observed in more than fifty thousand cases. Meantime many medical confreres who might be considered as good practitioners and even as clinical observers, claim that their patients have been aided by serums with truly excel lent results. "How explain this medical mirage, and make these propositions appearing antinomical, agree? To my mind it is a very simple matter. To make false membranes disappear, which, for all the world represent a material expression, one of the disease - these false membranes that choke the patient, and by suppuration give the malady its very frightful character - such is the pursuit and attempt of the physician. For, if the false membrane is made to disappear, hope for the recovery of the patient is reborn, and the dawn of the cure appears. If, later on, complications follow, if the kidneys, bronchi, lungs, or heart are attacked, if death terminates the sad scene, the practitioner himself is put beyond blame by the family, for did he not cause the visible signs of the malady to disappear before the patient's death? was the suppuration not stopped? Yes, he did his best. Now the inoculation of anti-diphtheritic serum makes the false membrane fall off rapidly, not because of any specificity it is supposed to contain, but purely through mechanical action. We know that artificial blood serum will produce the same results. For the augmentation of sanguinary pressure, caused by the ingestion into vascular system of a certain quantity of a liquid, is certain to reach the point of inflammation; that is to say, the spot where the inflammation is most considerable, a serous transudalion occurs that permits the false membrane to become easily detached. I imagine that this hyper-pressure can not occur without exercising a profound repercussion on the heart, even up to the point of inducing cardiac collapse. Sommers' observations leave no doubt on this point. On the other hand, if I report the account rendered by the works presented to the Congress of Nancy by learned bacteriologists, these indicate that the inoculation of serum is often followed by ulbuminuria and that nerve trouble is the result, expressed at times by attacks of auria or nephritic hemorrhage. I have thus the right to conclude that the inoculation of anti-diphtheritic serum gives a natural explanation of diphtheria attacking the heart or kidneys, being the direct cause of these complications. "All my confreres who have observed the progress usual to this affection agree with me, I are sure, that these rapid deaths, absolutely abnormal, were occasioned by complications induced by the serum. I make this remark in order to answer a young official, chief of a clinic, who assured me in a patronizing manner, that serum never induces accidents. In reality the Roux serum never exercised any beneficial action on diphtheria; and if a number of sincere practitioners affirm its efficacy, it is because they have been misled by the fad of the moment, and forgot the true proportion of deaths from diphtheria before the era of Pasteur, and besides have considered simple cases of angina diphtheria, simply because they showed a bacillus; so they used the serum as a cure, when the same cases would have recovered with any simple treatment. "Are we then wise in concluding, once and for all, that Roux's serum is absolutely murderous and a danger to the public health ? So why, under the pretext of spreading confidence, giving convolutions, and boasting, like some editors of the public press, will thinking men indorse a remedy that not only poisons but kills." Elmer Lee, M. D., New York, commented on- the above article from the French journal in the following language, as printed in the New York Tribune in the summer of 1944: "The claims that are seductively held out that cases treated early by antitoxin would recover, have utterly failed. The claim subsequently that cases treated by antitoxin recover more quickly than those not so treated has utterly failed to be true. The claim that the death rate would be lessened has proved to be a disappointment. The claim that antitoxin was harmless has been proved to the contrary by many fatal terminations. It is not the purpose to impute insincerity or lack of intelligent experimenting on the part of the profession concerned in experimenting with antitoxin, but the promises of better results through its use have unfortunately failed to be substantiated. The human system, when laboring under morbid influences, needs rather those elements which can add strength and vigor to the vital resistance. "The records of the cases treated in the Willard Parker Hospital of New York City, prove that antitoxin is dangerous and even fatal. The statistics of that hospital establish that the further use of antitoxin is unjustifiable. Dr. Joseph E. Winters, of New York, has sought diligently to establish the value of antitoxin, but the clinical experiences have forced him, unwillingly, to condemn its use. Professor Lennox Browne, of London, patiently and earnestly sought for clinical reasons, to further the interests of antitoxin. His conclusions are emphatic and pronounced against it. Dr. Welch, of Philadelphia, also deprecates the use of antitoxin in the Municipal Hospital of that city." The testimony of another eminent authority is cited to the same effect. This is from The Medical Brief, April, 1905. It is published in St. Louis, where thirteen children were killed by antitoxin within a month in 1902: "Suppose you stop and think about this serum question a moment. "If you should take the serum of a dead man, which, as you know, is highly poisonous, and add enough carbolic acid or trikresol to make it absolutely inert, it would be safe for you to inject it into a living man. If, now, this man were suffering from a disease, and good results followed the injection, would you not ascribe the improvement to the antiseptic rather than to the inert serum? How can it be the serum, when that has been killed, its identity destroyed, by the action of the antiseptic? "This is precisely the condition antitoxin is in today, and in spite of the money invested in its manufacture, and the various interests tied up in it, the serum idea is on the decline, and no power on earth can stop its passing out of use in the course of years."
Physicians cannot deny that their prescriptions are often neither more nor less than the preparations sold in the form of patent medicines. Druggists will tell you that compounds sold as patent medicines are often dispensed upon the prescription plan. The medicine is, of course, removed from the original package and the, label is not allowed to reveal its identity. It is truly unfortunate that such things are done, and doubly unfortunate for many poor victims of disease that they know that such things are done. They find they can get something of the druggist that seems to do them the same good for much less trouble and money than if they would go to the doctor. Most of them think that if "a little does good more will do more good," and they thus drift almost imperceptibly into the drug habit. Doctors sometimes give the warning, but often it is too late. The warning may not reach the victim, and if it does, the belief that mercenary motives may have been the impelling force that caused the warning, prevents its being heeded. Concerning the abuse of "our so-called tonic medicines," an editorial in the International Medical Magazine, December, 1902, said: "But there is a growing tendency on the part of the laity to abuse greatly remedies of this class, and, for this tendency it is to be feared that we physicians are largely to blame. It is so customary with us whenever a patient comes complaining of debility, to prescribe strychnine, quinine, or some other bitter stimulating medicine for the avowed purpose of toning up the system, that the patients naturally infer that whenever one is weak a tonic is the proper remedy, and as the quack medicine men are thrusting continually upon the public great quantities of compounds labeled 'tonic,' it is quite natural that these should frequently be purchased directly from the venders without first seeking the advice of a physician. "A vast amount of harm is certainly done by this extensive and indiscriminate consumption of stimulating drugs, whether self-prescribed or prescribed by those physicians who do not take the trouble to ascertain the cause of the alleged debility. In many cases the latter is due to organic or serious functional disease in some organ of the body, which is aggravated instead of being benefited by the tonic. Bright's disease, diabetes, tuberculosis, syphilis, and certain of the numerous diseases of the gastro-intestinal tract are among the many maladies which produce debility, and, with the possible exception of tuberculosis and the more atonic forms of indigestion, none of these are likely to be benefited, to any considerable extent, by purely tonic or stimulating remedies." The increased prevalence and fatality of pneumonia, kidney troubles, cancers, and nervous and mental disorders are unquestioned facts. The almost universal use of alcohol, opiates, and other narcotic drugs by drug doctors, and the, widespread use of these poisons, including tobacco, furnish us with a clue as to the lines along which we must work if we would check the frightful pace with which some diseases are carrying their thousands to untimely graves. The late N. S. Davis, M. D., had this to say on that subject in International Clinics, Volume I, Fourteenth Series, 1904: "There are no articles of food in general use that are supposed to increase the susceptibility to attacks of pneumonia. "The same, however, can not be said in regard to certain drinks and narcotic drugs that are extensively used in all the countries of Christendom. Of these the most important and most extensively used are, alcohol, as it exists in all the fermented and distilled liquors and in many of the proprietary medicines and artificial foods; tobacco; and the different preparations of opium. According to official reports more than $1,000,000,000 are paid annually by the people of the United States for alcoholic liquors, and nearly as much more for tobacco. And the people of nearly all of the countries of Europe consume still larger quantities of both these agents in proportion to their populations. Both these agents, like all other anesthetic and narcotic drugs, enter the blood and in it are carried to every structure of the body and directly diminish the sensibility and action of all nerve structures in proportion to the quantity used. "The alcohol especially not only diminishes the sensibility and activity of the cerebral and nerve structures, but, by combining rapidly with the free oxygen of the blood, it thereby lessens the action of that important agent in maintaining natural tissue metabolism and secretion. Consequently, if its use is continued from day to day, even in moderate doses, it favors the retention in the system of toxic agents, both chemical and bacterial, and so impairs the protoplasm as to encourage tissue degenerations and marked impairment of the vis medicatrix naturae, or vital resistance to the influence of all toxic or disturbing agents. And in regard to pneumonia, every important work on the practice of medicine published during the last half of the nineteenth century mentions the habitual use of alcoholic liquors as one of the more important predisposing causes of the disease and as greatly increasing the ratio of its mortality. But the protoplastic impairment and diminished vital resistance are not limited to the individual drinkers, but are perpetuated in their posterity to the third and fourth generations. Therefore, it is often one of the chief determining causes of death in persons who had never drank alcoholic liquor, but had been born of parents who were habitual users of that agent. It is by such impairment of vital resistance in both parents and their children by the use of alcoholic liquors and ether narcotic drugs that pneumonia and other affections of the lungs, kidneys, liver, heart, and brain are made to increase faster than the increase of populations. "And if we candidly keep in mind the enormous quantities of alcoholic drinks, tobacco, opiates, and other narcotic drugs that are being used by the people of this and other countries, and their direct effects on the vitality of both those who use them and on their children, and their indirect effect in creating and perpetuating poverty, with all its unsanitary accompaniments, we shall have an ample explanation or reason why the ratio of deaths from diseases of the lungs, liver, kidneys, heart, and brain continues to increase, notwithstanding all the modern sanitary improvements aided by the active warfare now being vigorously prosecuted against pathogenic germs and their ptomains."
The people have, in many instances, called a halt upon the promiscuous drugging of the drug doctor; but have often fallen into the more dangerous pitfalls of the patent medicine venders covered up by the respectability of the advertising media and false and arrogant claims that the medicines are harmless. They have been taught the use of "dopes" by the medical profession, but they now know something of the evil consequences. An intelligent laity is beginning to realize the extent of the injury being done by "patent medicines," and all kinds of secret nostrums, whether prescribed by the doctor or sold by the druggist, and the reaction has already set in. Edward Bok truthfully portrays the situation in The Ladies' Home Journal for May, 1904. He quotes from the report of the State Board of Health of Massachusetts concerning the percentage of alcohol in a large number of popular medicines as follows: "The following percentages of alcohol in the 'patent medicines' named, are given by the Massachusetts State Board Analyst, in the published document No. 34: Lydia Pinkham's Vegetable Compound, - - - 20.6 % Mr. Bok criticized the members of the W. C. T. U. for permitting the use of property under their control for advertising patent medicines containing alcohol, but did not call attention to the dangers from the use of other drugs in nearly all medicines of the class named that are even more subtle in their harmful effects. Opium, morphine, chloral, cocaine, digitalis, strychnine, arsenic, bromine, quinine, prussic acid, aconite, acetanilid, phenacetin, antipyrine, atropine, codeine, heroin, iron, mercury, nux vomica, croton oil, salicin, salol, sulfonal, trional, and other equally dangerous drugs are used in compounding medicines that axe extensively advertised and of course in constant use. Unfortunately the W. C. T. U. is perhaps unconsciously using its influence to extend the drug habit. One of the circulars distributed by the organization entitled "Alcohol not Needed in Medicine," was written by a Chicago drug doctor. It says: "Digitalin and strychnine give effects that are not disputed, and with these agents at our command, in reliable and convenient shape, we can have no need for alcohol. "Alcohol is used as an analgesic, to relieve the pain of colic, but it is slower than chloroform or ether internally, and less lasting than cannabis; while the combination of atropine and strychnine with glonoin to hasten the effect, is so satisfactory that the older agents may well be relegated to an innocuous desuetude." Other remedies mentioned in the circular are capsicum, pilocarpine, camphor, rhubarb, iron, acid pepsin, diastase, aconite, hyoscymine, phosphorous, and the salines, astringents, antiseptics, and serums. Concerning those mentioned in the quotation above, Cushny, in his book on "The Action of Drugs," says: "Digitalin - Even small quantities, such as are used therapeutically, cause stimulation of certain parts of the central nervous system, for the activity of the inhibitory cardiac center in the medulla is the cause of the slowness of the heart which is seen in therapeutics and in experiments on mammals. "Strychnine - The alkaloids of the strychnine group have a powerful stimulant action of the central nervous system, especially on the spinal cord, throughout the vertebrate kingdom. The stimulation of the spinal cord by strychnine is followed by depression and paralysis. Some authorities hold that even during the first stage the stimulation is mixed with depression. "Ether and Chloroform - The action of ether and chloroform on the central nervous system is evidently similar to that of alcohol, and ether has not infrequently been used as a habitual intoxicant. These anesthetics produce the same progressive paralysis of the central nervous system as alcohol. "Cannabis - The effects of cannabis indica are chiefly due to the changes in the central nervous system, in which it induces a mixture of depression and stimulation. "Atropine - Atropine acts as a stimulant to the central nervous system and paralyzes the terminations of a number of the nerves, more especially of those that supply involuntary muscle, secretory glands and the heart. Most of the secretions are decreased by the application of atropine - salivary, mucous, milk and sweat. "Glonoin - ('A one percent alcoholic solution of nitro-glycerin.') They are certainly the most powerful depressants of the blood pressure known." Mr. Bok has evidently made a study of "patent medicines" and learned that there are many ingredients in them more dangerous than alcohol. Indeed, the alcohol they contain may be one of the least harmful elements in many of those wily concoctions. Some of the dangers from their use are pointed out by Mr. Bok in the Ladies' Home Journal, March, 1905, in an article on "Why Patent Medicines are Dangerous." Mr. Bok makes much of the fact that "patent medicines" are "secret nostrums." So are most of the preprescriptions of the M. D.'s "secret nostrums" to their patients; and if Dr. Millikin's statements are trustworthy, they are "secret nostrums" to most of the doctors who prescribe them. While abuse will probably be heaped upon Mr. Bok as for his former article, it is to be hoped that he will continue his good work and thousands will bless him for his bold stand for right. The voice of warning has been raised many times against the use of headache powders. The following from The Youth's Companion, May 26, 1904, is true - not only of headache powders, but of a host of other remedies declared to be sure cures for disturbances of the stomach, liver, heart, kidneys, etc.; "It may be said, with little fear of contradiction from those who know the facts, that if a cast-iron law forbidding the use of any drug whatever in the treatment of headache could be enacted and enforced, there would be much less misery for the coming generation than for this. "A sufferer from repeated headaches who has found a means of relief in 'headache powders' or other even less harmful drug, may dispute this assertion, but the victims of some drug habit or the friends of one whose heart, poisoned by acetanilid or antipyrin, has suddenly ceased to beat before its time, will look at the matter from another point of view entirely." When journals like the Ladies' Home Journal and the Youth's Companion speak out boldly against the use of drugs, we are not justified in impeaching their motives. One of their most profitable sources of income, advertising these nostrums, is deliberately cut off in the hope of teaching their patrons the way to a purer, more healthful life. But the medical profession also has given warning. The following is from a paper read before the Pennsylvania Pharmaceutical Association, June 23, 1903, by R. V. Mattison, Ph. G., M. D. Dr.. Mattison's warning would have more weight, were he not president of a company which has at least fifty-four preparations for sale, some of which, as bromo caffein and salicylic acid, are as injurious, in some ways, as the coal tar remedies. But let us give him credit for his clear statement of the truth and quote his exact words: "Do the manufacturers of the headache powders know that the coal tar derivatives are dangerous? Certainly. For what other reason do most of them combine caffein with their powders? Does the public know the coal tar derivatives are dangerously depressing? Yes; this property of these synthetic products has been announced by the profession, and heralded by the daily press, beside which many instances have been brought to the public notice. Does the manufacturer know that the public knows these remedies are dangerously depressing and toxic? Yes; and this is one reason for his keeping a knowledge of the composition of his particular headache powder, or tablet, from the public, and the only excuse for his placing upon his packages such words as 'Guaranteed Safe,' 'Guaranteed Non-Toxic,' 'Non-Toxic,' 'Not Depressing,' etc. Is he any better than the culprit who turns a switch to hide the red light of danger, and wrecks a train that he and his gang may loot and plunder?" These are questions that, like Banquo's ghost, will not down. When the people become aware of the way in which they are imposed upon, we may hope for relief. The interest is growing. Secretary Beatty, of the Utah State Board of Health, has had State Chemist Harms analyze a number of patent medicines. The Daily Medical, March 7, 1904, has the following, in facetious mood, to say as to the result: "One alleged remedy, widely advertised as 'Hyomei,' a liquid preparation for catarrhal troubles, was found to be crude oil of eucalyptus diluted in oil of vaseline. The oil of eucalyptus is one of the ingredients frequently employed in making antiseptic solutions, and Dr. Beatty says it has no curative properties whatever. It does temporarily cool, and to that extent relieves the inflamed membranes, but that is all. The bottle procured by Secretary Beatty contained one-third of an ounce, and according to quotations given him by the jobbers, such a bottle costs not to exceed one cent. The retail price printed on the label was $1. The doctor was temporarily deprived of breath on realizing the nerve that engineered out such a profit as that. "'Kauffman's Sulphur Bitters' was another 'remedy' for about fifty different ailments of a patient's insides. On the label was printed 'No Alcohol,' but the state chemist found 23.4 per cent of alcohol in the pint bottle which sold for $1. Moreover, there was not even a trace of sulphur, and the alleged restorative had no curative properties that could be discovered. "'Swamp Root' was a third 'remedy' for all the ills the flesh is heir to - particularly in the line of renal troubles. This patent medicine is advertised to cure Bright's disease, and bladder complications. The chemist found 9.6 per cent of alcohol in the pint bottle, with a large percentage of sugar and juniper berry. "'Pain's Celery Compound' was a fourth, a one dollar per pint 'remedy' for a wide and varied assortment of ills, great, medium, and small. The analysis showed 20.9 per cent of alcohol, as much as will be found in wine, and also the presence of a large amount of fusel oil. Dr. Beatty said this made it worse than straight whiskey. "But the chef d'ouevre of the collection was Birney's catarrhal powders. In this precious stuff, Chemist Harms found nearly 2 percent of cocaine, with 90 percent of sugar preparations and inert substances to hold the deadly drug. The preparation is sold in small vials, each containing 1.5 grains of cocaine. Dr. Beatty said that this is absolutely sure to cause the cocaine habit if persisted in. It is sold by the gross, and already has many victims. The doctor said also, that in the rear of a certain house in this city had been discovered a bushel of these vials empty; and called attention to the fact that it was a crime to sell any preparation containing cocaine except on the prescription and advice of a physician. He said that people are deceived by the sense of relief afforded, and before they know it are in the clutches of the cocaine habit, which is worse than any other habit known." Is it not high time that all intelligent people should unite in an effort to put a stop to such impositions? But let us not be too severe in the arraignment of the patent medicine manufacturer only; for we suppress the truth if we do not show the manufacturers of proprietary medicines and many M. D.'s equally culpable. Drug doctors, like other people, are susceptible to the influence of illustrated advertisements. The cuts opposite are taken from a well known medical journal. The first calls attention to the "only master" for gout, and the second advertises a remedy spoken of as "bloodless surgery." But all virtue is not concentrated in one school and all vice in another. An osteopathic circular before me contains an advertisement of a certain brand of whiskey and another of a make of bitters which the Massachusetts State Board Analyst says contains 42.6 per cent of alcohol. The national and state organizations have tried to purge the profession of such osteopaths, just as medical societies have tried to rid their own profession of the incubus of the purely commercial doctor, who has no regard for the welfare of his patients, except to filch from them that which enriches himself. Unfortunately, drug doctors are not always familiar with the effects of drugs. They evidently do not, in many cases, clearly recognize the difference between the symptoms produced by the disease and those produced by the drugs administered. That death conceals many a mistake of the doctor and the druggist is not a joke; it has become a truism. Sometimes very grave results have followed the administration of drugs, which have been attributed to natural causes. Such mistakes on the part of drug doctors who counteract symptoms by powerful poisons, naturally raises the question as to whether they are or are not competent to pass judgment as to the cause of death. A case in point is that of Jane Tappan, a trained nurse in a Massachusetts hospital, who poisoned to death thirty-one patients in 1902. The poisons administered were drugs used as curative agents. She afterwards admitted the fact, and her confession was accredited by the authorities; but the physicians who were supposed to be skilled in the effects of drugs did not suspect poisoning and certified that the thirty-one deaths were due to natural causes. Yet they presume to insist that they only are qualified to give a death certificate. In July, 1904, an attorney in Cincinnati gave an opinion that osteopaths were not competent to sign death certificates because they are not skilled in the use of drugs. How any one could conclude that an osteopath has a right, under the law, to treat all diseases in all their stages, from birth even to their culmination in death, and not certify as to the cause of death, is left to the imagination of the reader; and how he could conclude that a knowledge of drugging is necessary to determine the cause of death is a nut for the scientist to crack. His decision may imply, but evidently was not so intended, that people are often killed by the administration of drugs and only those trained in a knowledge of their effects, and no others, are competent to reveal, or conceal, the cause of death when due to drugs. |