No. 3

March 1910

IN his most valuable "Report on National Vitality" Prof. Irving Fisher remarks that there is no reason why the medical profession "should have lost hundreds of thousands of patients to Christian Science except that these patients were benfited, and greatly benefited, by Christian Science after having received no benefit, and often injury, from the profession;" and that "had the profession made use of mental therapeutics not only could they have saved themselves the enmity of these hundreds of thousands, but they could have nipped in the bud the crude metaphysics which teaches the non-existence of disease and death and the uselessness of any therapeutic agent except those employed by the promulgator. The example of so-called 'Christian Science' is only one of several protests, more or less misguided, against the present practice of medicine."

We will acknowledge that Christian Science took its rise in a protest against some limitations of, or even failures, in medical practice. It must be admitted that the profession generally was travelling somewhat deeply in a rut of over-reliance in drugs, and needed to be reminded of the fact, but on the other hand it would never have been possible for the profession to do, nor will it ever be able to do by any use of mental influence what Christian Science has accomplished, for the sole reason that the art of medicine, aside from the overworked fetish of pill or tincture, has nothing savoring sufficiently of profound mystery with which to impress the patient, and when it attempts

the giving of mental treatment falls too near the commonplace.

Here and there, perhaps, a man of peculiar personality and with striking methods has done something comparable to the Christian Science healer, but it has soon been discovered that he was a common mortal with no hidden source of power, and his reign has been brief and circumscribed. Science, with all her many brilliant achievements, plods slowly in the everyday mind. She has never at any time swept the popular mentality by storm. Even her present attempt at a crusade against tuberculosis is but a shadow beside the medieval crusade organized against the infidel. Even the greatest triumphs of medicine have been received with reluctance-vaccination, for instance, is still fought bitterly by a certain class and looked upon with scepticism by still larger numbers. Anything shrouded in mystery, other than that which is inherent in the most common phenomena, and backed by the authority of some unknown power altogether out of the ordinary, arouses curiosity and belief in such minds. Christian Science appeals to just this class of people, for who with the first rudiment of a reasoning mentality could stomach even a few pages of the sacred book of this cult.

It is the element of mysticism which has given life to this movement--which has made it a movement—a modern half-truth occultism fraudulently engrafted upon a mightier mystery which has stood the test of time because of its larger element of truth. No self-respecting member of the profession

would have conceived, or could have made use of any such appeal to the minds of his patients. In the first place, we are lacking in a hidden fount of mental power such as Mrs. Eddy represents; we are wholly without sacred literature; and, lastly, the scientific mind—or even would-be scientific mind -cannot adjust itself to such methods as are employed so successfully by the mouthpiece of the Concord mystery. It is even difficult for him to comprehend a mentality which grasps at such a presentation of ideas, and he can therefore make no adequate substitutions of his own for the "crude metaphysics" which is so readily absorbed by followers of the new faith. Even the Emmanuel movement was born and is kept alive in the shadow of the church, and has done a work which was impossible to any but a most uncommon type of physi

cian.

The profession may have overestimated physical means of cure and have made too little use of mental appeal, yet the latter method of treatment certainly was not new to him, and had been successfully applied by many long before Christian Science was dreamed of.

So long as even "educated" people continue to have such crude ideas of cause and effect and no idea at all as to the true nature of disease and its cure, so long will the physician fail to attain as a faith-healer to the power now possessed by practitioners of Christian Science. What is more, so long as the nature of disease is so poorly understood the public will continue to find it easy to believe that it is all a matter of amount of faith whether they or their friends recover from disease, and unnecessary deaths and imperfect recoveries from sickness are likely to be added to the already long list against this form of "cure."

In the GAZETTE of April, 1909, we gave Christian Science and the Emmanuel movement due credit for the good they have done in stimulating the profession to a more serious study and use of mental treatment. We make no apologies for the sins,

either of omission or commission, on the part of the profession. We do not, however, believe that in the present state of public intelligence the profession could by any means in its power have made any such appeal to its clientele as that made by Christian Science, backed as it is by religion, legend, mystic mother, enchanted volume and extravagant claims. Without a similar backing of the machinery of mystery it would have been impossible to prevent the loss of "its hundreds of thousands of patients to Christian Science."

A THREE MILLION DOLLAR
SCHOOL OF MEDICINE.

THE recent announcement of a gift of $3.000,000 to the Medical Department of Columbia University has aroused great interest, for, even in these days of magnificent gifts to public institutions, a donation of this size is quite out of the ordinary.

However, while praising the magnanimity and generosity of the donors, one should not fail to reflect that behind it all there is evidence of a certain business sagacity. Medical schools are not eleemosynary institutions, as many people seem to think, and the teaching of the art and science of medicine is no longer and can no longer be done gratis, as was true in the days of Hippocrates. Of the thousands of medical schools in this country, it is safe to say that niany of them are conducted with an eye to the profits that may accrue from the business, but it is also safe to say that such profits must of necessity be small where they exist. Moreover, it requires an immense amount of money to establish and maintain a medical school worthy of the name, and we trust that the benevolent donors to the College of Physicians and Surgeons will not fail to secure a satisfactory endowment to the institution, for it is quite certain that the running expenses cannot be met by the tuition fees.

In removing the school from Fifty-ninth

Street to Morningside Heights the Trustees are in reality trying out an experiment, for heretofore it was thought absolutely essential that medical schools should be located near hospitals in the busy sections of the city, and Fordham University is the only institution maintaining a center of medical instruction so remote from the crowded districts.

There is a great need of a University Hospital in affiliation with the College, and that is true of any progressive medical school which not only tries to maintain its standards, but seeks out the best for the education of its matriculates. Perhaps the Trustees will decide that it is better to leave the Sloane Maternity Hospital in its present location and to transform the school itself into a hospital, patients to which might be admitted from the adjacent Vanderbilt Clinic.

During the past few years the College has lost some of its very valuable and bestknown professors through death, resignation, because of advancing years, etc., so that the field is now open to the younger men, and there is undoubtedly a great future in store for the institution. Every college clinic should be a training school for teachers of medicine and surgery, who should not be obliged to practice medicine for a living. It is becoming more and nore difficult to secure efficient clinical assistants, simply because it does not seem profitable to the average young physician to spend his time away from his office in work that is essentially unremunerative and leads nowhere. By means of proper ranking of assistants, through examinations and promotions, it ought to be possible to train assistants to become teachers of medicine and gradually to relinquish practice and devote themselves entirely to didactic work.

The progressive school must provide for the instruction of graduate students and offer them opportunities for prosecuting scientific research. There is a growing tendency toward the great medical university, an institution quite apart from the cultural

university, in which advanced as well as elementary medical subjects shall be taught in all their various divisions and ramifications.

In a city such as New York, centralization of medical teaching in one or two great schools could not but benefit both the profession and the public. The "small” medical school has no "raison d'etre," for the secret of all successful modern business enterprises is organization and systematization-the grouping of as many departments as possible under one head, which in turn, shall be subdivided. It is only recently that problems of medical education have begun to be seriously studied—thanks to the Carnegie Foundation through its efficient head, Dr. Pritchett, and to the Council on Education of the American Medical Associationbut the need for such study and effort at uniformity of standards is so evident that further comment seems unnecessary.

The charge that there are too many medical students and too many doctors is commonly heard in these days, and at least one cause of this condition is the fact that there are too many feeble medical schools, in which the chief aim seems to be to acquire the title of professor of something-orother. Such centralization as we have mentioned would do away with this evil and establish medical teaching on a sound and rational basis.

Almost anyone can be some kind of a doctor, but it takes good brains, great industry, great energy, sufficient opportunity and much money to achieve an honored place in the crowded ranks of the medical profession of to-day. In its new home on Morningside Heights "the P. & S." will undoubtedly find a great increase of its facilities for doing just the kind of educational work that the twentieth century, still young in years, is going to demand.

PNEUMONIA IS CONTAGIOUS. THE death rate of pneumonia is really dreadful; sometimes it exceeds even that of consumption, which latter John Bunyan graphically spoke of as the Captain of the Men of Death. The difference is that in pneumonia the very young and the aged succumb most; whilst consumption gets its greatest harvest from those in the very prime of life.

Pneumonia, or lung fever, was formerly considered to affect only the lungs; but of recent years we have found it to be a general infection, such as develops from the growth and multiplication of pathogenic, disease-engendering germs. In pneumonia these germs have the lungs for their principal camping ground, though other organs and parts of the body are affected, sometimes even more seriously. Here, as in ail infections, two kinds of causes have to be taken into account: first, the specific cause, the germ; and then the predisposing causes, which weaken the body and so make it congenial soil for the germ to thrive in. The germ of pneumonia hunts in couples -it is the diplococcus pneumonia or the pneumococcus, which Fraenkel and Weichselbaum discovered about 1884. This germ is fairly resistant to drying and sunshine, when it is embedded in protective sputum; but when dried and powdered an hour's direct sunshine will kill it; it resists diffused sunshine better than direct, for it can. live in the former 55 days; it has been found in at least ninety per cent. of the cases of pneumonia in which it has been sought. It is found in the upper air passages the mouth, the nose, the throat and the bronchial tubes, even in the eyelids; of course, the "rusty sputum" of pneumonia patients contains it, and sometimes also even their blood; it persists for weeks or months in the mouths of pneumonia convalescents. Infection comes usually through inhaling the germs, which get into the lymph and blood channels, and this is why pneumonia is a general and not a local disease. So, besides being responsible for

lobar pneumonia, the pneumococcus may set up inflammation in many other parts of the body than the lungs-the heart, the spleen, the stomach, the kidneys.

An important consideration just here is that of mixed infection; in many infections such as pneumonia, a number of different microbes may be found active, in addition to the one which is the essential cause. And this mixed infection will oftentimes make fatal a disease, which would otherwise not prove so. Thus, some cases of pneumonia are very grave, indeed, and quite hopeless, whilst others recover most satisfactorily; in the former germs more virulent and deadly than the pneumococcus are allied with it.

Infection in pneumonia was recognized long before we knew the essential germ; it was generations ago known to be prevalent in certain given houses, barracks, jails, schools; epidemics were recognized; in hospitals direct infection was easily traced. Nurses and doctors seldom succumb to pneumonia, infectious as it is; one among several good reasons for this is that they know precisely what means of prevention they must employ; they do not (or should not) see cases when they might become susceptible by reason of bodily weakness or ill health; and they have no fear, which is a potent factor in the development of any infection.

As has been stated, after the pneumococcus we have to consider predispositions, which, in the physician's experience, loom up very large, indeed. Take, for example, a family of five or six. One or two among them will succumb to pneumonia, whilst the others will escape. Why don't they all suffer, since in the family relation they must all have been about equally subject to the germinal attack? The reason lies in that the bodies of those who have contracted the disease were predisposed, whilst in the bodies of those who have escaped the organs and tissues were sufficiently vital to triumph over the infection—they were able, by means of such protective agencies as

phagocytosis and the opsonic index, to render the germ impotent, and even to consume and destroy it.

Resistance to the pneumococcus is decreased under various conditions: Children under six are very prone to pneumonia; the tendency then diminishes up to the fifteenth year; then for each subsequent decade it progressively increases. Venerable people are very prone to pneumonia, and are very like to die of it: from the forty-fifth to the sixty-fifth year the death rate per 100,000 is 263; from sixty-five on it is 733 per 100,000. The colored man is more likely than the white to suffer. Men are more prone than women, undoubtedly by reason of the greater hardships and exposure the family's breadwinner has to suffer. The winter months, but especially in those times in winter when the weather is changeable and unsettled-as in December and March-there is likely to be much pneumonia. Cold and wet, especially when the extremities are chilled and wet, predispose decidedly by lowering resistance. The cold alone is not responsible for this; Arctic explorers are amazingly free from such affections as pneumonia, though when they return to civilization they are as like as anyone else to succumb. The reason lies in that the pneumococcus is unknown-as yet -in the rare, clean, pure Arctic air, whereas it is all too prevalent among us. “Taking cold" is really oftentimes taking heat; there is here at bottom a disturbance of the bodily equilibrium. Chilling of the skin brings about a disturbance of the normal equilibrium of the general circulation; some organs as the lungs will have an excess of blood, whilst elsewhere there will be an anemia, a depletion. And this instability disturbs and decreases the body's antibacterial activities.

Fatigue very decidedly predisposes the body to pneumonia; men who must work arduously through long hours and in inclement weather are apt to come down with it. Medical men of large practice, who become exhausted through much work day and night, often succumb by reason of this.

Unhealthy conditions of the upper air passages"respiratory catarrhs"- tend to pneumonia. There are chronic diseases of the heart, kidneys and the digestive tract upon which pneumonia is oftentimes superimposed; and then there is likely to be a fatal result. Most people, by the way, do not die of the disease which has most persistently and most seriously affected them; it is some such "terminal affection" as pneumonia that brings about the end.

Injuries to the chest will frequently predispose to pneumonia, the external wound may be very slight, whilst the internal injury may be extensive. Alcoholism is an enormously predisposing factor; this is especially so by reason of the dreadful stuff which poor men are apt to consume. Pneumonia is more frequent in cities than in the country, because of the more strenuous life and irregular life in the cities, the germladen dust, the tenement life, the overcrowding and consequent increased liability to infection. It is considered that new-. comers to cities are less prone to pneumonia than the city-born; no doubt because such newcomers have not yet become enervated by city life.

How to prevent pneumonia? So far as the predispositions are concerned the prophylaxis is easy to infer from the statements here made. The measures against infection should be very much as in tuberculosissuch measures as the anti-tuberculosis propaganda has popularized. The sputum is disinfected; attendants upon pneumonia cases keep their own mouths and throats very clean by means of dentifrices and gargles; they wash their hands very frequently in disinfectants. After the patient's recovery or removal his room is fumigated, as for any infectious disease; if there have been several cases of pneumonia we had best fumigate the whole house. At any rate we should clean such rooms with wet cloths instead of by dusting and sweeping. Those who have no occasion had best keep away from pneumonia patients, though there is, of course, no occasion to be frightened by them as if they had the plague.