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fession produced a sentiment analogous to methods of treatment the case was prothe superstitious awe still felt, though in nounced incurable he might properly have diminished measure for the priesthood. retained it for palliative treatment.
Nowadays there is practically no mystery Even in the case of incurable diseases a about medicine, though there are many un- lack of excessive loyalty to any one physisolved problems. The very popular and cian enables a number of different men to highly colored press places before the laity obtain adequate experience with a variety the most recent discoveries, not always with of rare conditions. In the aggregate there a high degree of accuracy but still with is an exchange of patients so that no one sufficient to give an insight into general suffers except the incompetent and, occaprinciples and to afford an excuse for the sionally, someone receives an inspiration remarkable facility in passing judgment on which enables a disease to be removed from imperfect understanding which is character- the category of incurable. istic of modern civilization. And it must It must also be admitted that the profesbe admitted that in large measure the laity sion is to some degree responsible for the is correct in regarding the bond uniting defection of patients to Christian Science, patient and physician as a loose one. The Osteopathy and various other cults. The patient and his family may fear tuberculosis insistence on faith in the physician, as an without any reason, but having it in mind adjunct to definite therapeutic methods, the they are quite right in holding that no use of placebos, the more recent exploiting amount of personal acquaintance as a fami- of hypnotism and psychotherapy, have their ly physician will compensate for a lack of limit in Christian Science. The men who equipment for modern diagnostic measures. made a hobby of massage and movements, Similarly, with regard to any special fea- who insisted on their own particular highture in medical practice, it is obvious that priced masseur or masseuse, who talked special equipment and skill are necessary loudly against drugging patients, were the and, unless the specialist consulted is a real founders of osteopathy. shark, no harm is done even by the un- Experience has shown that, with few exnecessary choice of the laity to lay their ceptions, a definite serious disease or injury case before a practitioner without recourse will bring the adherent of any of these to the family physician.
cults back to regular medical science. The It must be admitted, also, that an excess palliative treatment of nurotics, the ineffiof loyalty to the physician is not without cient carrying along of "chronics” can no its drawbacks. Some time ago we were in- longer be depended upon by the physician. formed of a patient who had been continu- The very signal success of certain radical ously under treatment by one physician' for methods of treatment, surgical or medical, eight years without relief. So far as could has set a standard hich cannot be atbe judged a thorough study of the case tained in many conditions. The laity, natand possibly an operation, perhaps more urally enough, cannot understand this. The definite internal treatment, might have ef- man with incipient gastric cancer cannot fected a cure.
At any rate, the mere fact appreciate why he cannot be relieved as well of loyal attachment for years without re- as his neighbor who had approximately sults was really hurting the physician's rep- the same symptoms due to ulcer, hyperutation far more than the worth of his fees.
chlorhydria with ischochymia, or a curable If he had frankly stated his inability to cope hypochlorhydria with catarrh.
The man with the case and had sent the patient with a weak heart due to no organic lesion somewhere else, it would have been to his encourages his friend with a permanently own advantage, possibly to that of the pa- deformed valve or degenerated myocardium tient, certainly to that of some other physi
to expect the same relief. A patient long cian. If, after fair trial of two or three treated medically and then suddenly relieved
by a brilliant operation sets the mark for creased, and there should be a corresponda host of others whose condition involves ing improvement in quality. no factor that can be dealt with mechan- The fault of insufficient increase in popuically.
lation is laid upon the middle and upper
classes, who are accused of caring only for EUGENICS.
personal ease and of showing indifference The future of the race in this country, to the welfare of the state in not rearing either from the standpoint of numbers or families as large as those of their forefaof quality or of both, is becoming a matter thers or of their neighbors in much humbler of some anxiety to many thinkers. Hereto- circumstances. Various theoretic schemes fore the increase of the population has been have been devised, at least in Europe, for the main item of interest so far as the wel- stimulating this class to be more prolific; fare of the state was concerned. Numbers such as the giving of state aid in rearing were necessary to keep the community intact children. The funds for this purpose are, by defending it against the various preda of course, to be raised by taxing those who tory peoples that surrounded it. Men were fail to swell the number of the community. needed as food for wars, and women for Save for the aforementioned purpose of bringing forth human filling for military military defense against possible invaders, ditches. We are but a few generations re- we are not aware that anyone has expressed moved from the days of the Napoleonic alarm at our mere lack of numbers. There wars, and, as shown by our too frequent is some ground, however, for deploring lynchings, we have only turned the corner the proportionate increase of the very lowfrom barbarism toward which it is easier est classes of society. This problem is not to lapse than it is to progress to something to be met by urging the better class to bring beyond. There is evidently some ground into the world more children than they feel for fear of lack of numbers, though most of that they can provide for on the scale which us hope that militarism is really going out modern living requires, but rather in limitof fashion for good and all, notwithstand- ing the numbers who come into the world ing the anomalous national outlay in scare unwanted and unloved and to whom it is battleships. To the most of us, at any rate, impossible for the parents to give a fair the mere decrease in the birth rate gives chance in life. There are those who have little concern either for the present or the dared say that it is a crime to bring such future.
children into existence. This is but putting It is the quality of the race that seems of into theory what the better classes are putmore moment, and the infant science of eu- ting into practice. It is not all a matter of genics—or the study of means and methods desire of "ease and comfort” on the part for producing a better race—must interest of these parents, but a foresight of what the all whose thought and thoughtfulness large family now means in its bringing up. reaches into the future. Already some It goes without saying that where child practical advance has been made in the follows child with the rapidity of unhamapplication of our knowledge in this pered nature, each cannot receive that care direction. Laws have been passed in needed for proper health and development, at least one state making a preliminary for equipment in life means more nowadays medical examination and a certificate of than the possession of a breech-clout and good health necessary to the procuring of a some proficiency in wielding a boomerang. marriage license, while in other states laws The better classes feel more keenly their for the sterilizing of certain criminals and responsibility to offspring, and they show defectives have been enacted. Through
Through their good sense in not overburdening their these regulations the number of the popula- resources. We doubt whether the reduction tion of a less desirable type is to be de- in children from mere “love of ease" on the part of parents is of any serious conse- KNOWLEDGE AND WISDOM IN quence.
PRACTICE. The better classes should be given credit for knowing what they are about and for The primary purpose of the medical colsuperior humanity in producing smaller lege is, of course, to teach the science of families, while it would be far better if re- medicine. Science is knowing; and before striction could be applied to those who do all the matriculant is to be grounded in not take the matter of parenthood with suffi- the fundamental facts and the first princicient seriousness. Such a restriction would ples of the various branches. Upon such relieve the state, and consequently the upper
essential basis is then to be grounded the tax-paying class, from a burden of expense art of medicine, the qualification for pracin keeping up benevolent institutions which tice. And here much is oftentimes lacking; are largely filled with the imperfectly cared for there is much more needed than the for (physically, mentally and morally) off- capacity for assimilating facts. To this spring of the lower class. It is true that end some additional traits are requisitethe children of this class who do have half which the student should indeed have been a chance are often more virile and effective possessed of before his entrance: For exmaterial than the offspring of those who ample, the selective faculty, good judgment, have climbed higher in life at the expense
and discernment (or intuition). If these of more or less physical exhaustion and traits are not inherent it should be sought, vital deterioration. A little pruning, how- in so far as is possible, to inculcate them ; ever, would help the product of the former though (as they should be instinctive in the class, while the forcing of reproduction man) the best medical teacher may fail in among the latter will hardly make them the effort. Herein lies a most important more vigorous and useful to societv.
part played in preliminary coilegiate eduThe problems of eugenics are exceedingly cation, during which such traits are the complex, and it must go slowly in working more likely to be developed. out plans for racial improvement. Its data It is remarkable how men not particularly so far is all too indefinite, and its first efforts brilliant in memorizing are able oftentimes must be to make sure of its ground by pro- to discern correctly a medical situation. ducing better statistical records throughout Merley a group of the facts will not suffice the country. Legislation toward obtaining for a good diagnosis. Of course all the better knowledge of present vital conditions ascertainable data are first to be gathered can do no harm and should precede other and noted, else no reliable, scientific deducmore active measures. In the meanwhile tion can be made. Then, after a broad surthe vitality of the children of future pa- vey of the case history, the student should rents of all classes--needs to be given the be encouraged to discriminate between esbest conditions for its unfolding and preser- sential points—such as really bear upon the vation. This for the present is our main matter-and those comparatively irrelevant. concern. As men and women are brought Then a conclusion must be reached from a to a better condition of vitality it will seem judgment of many factors: one among these to them less of a burden to bear children and might be irrelevant; several taken together to supply their twentieth century needs. At would be suggestive; a number of them the same time they will look forward with combined would be conclusive. less anxiety for a future generation who, The part played by the traits here set forth they can feel, will be more fully equipped in the evolution of the good practitioner for life's experiences. To such parents has been excellently illustrated by Richlarger families will seem more of a blessing
ardson.* In one of his examinations in and the problems of race betterment will
*Richardson, M. H. Responsibilities of Surgery. be half solved.
Journal of the Am. Med. Ass'n, Oct. 7. 1905.
surgery at the Harvard Medical School he at all likely to coincide though written in asked his advance students to give the the best faith, by reporters presumably diagnosis in certain carefully described cases trained to observe and to record observataken from his note books. In some of tions. (Le Bon, in his book "The Crowd," these cases there had been much difference is here very illuminating.) For the matter of opinion among very experienced physi- of that, ask any six physicians to examine cians; yet some of the students, interpreting the same chest, but each in a room by himthe histories properly and drawing the cor- self; and note then, if their statements of rect conclusions gave invariably the right the physical signs are altogether harmoanswers. Many of these successful students nious. (and herein lies the difference between med- Another qualification imperative in caseical knowledge and medical wisdom) did taking is that no datum, however insignifinot show the learning of the others, who cant it may seem, shall escape detection and generally reached wrong conclusions. "The record. The ideal anamnesis must go back student whose deductions were in every to the patient's grandparents, at least; and
correct will without question make as much further as possible. It should much more successful practitioners than continue thence to the family history, the the students who, exhibiting much more previous illnesses and habits, the symptoms learning, picked out the unimportant feat- from the time of being seen, with the minures in the histories of the cases, and on utiæ of the physical signs and of the aids these unimportant features based correct de- given in the pathological laboratory. Next ductions, which were, as to the real lesion, are to be entered the diagnosis and progalways wrong."
nosis; then every detail of temperature, Chess-playing should help to develop the respiration and the rest, every therapeutic discriminative faculty in the medical fledg- ineasure, and the record of its effect; and ling
finally, should the patient unfortunately Moreover, after the student has been well for himself (but mayhap fortunately for grounded in the essentials of medical sci- science) have succumbed, the exhaustive ence there is nothing so vital to his success record of the autopsy. as good case-taking; by no other means The sum-total of medical knowledge is can he so surely be made a useful physician. achieved only by the study of cases that Some of the most valuable works of our reach the post-mortem table. Thus only teachers are now in the case-history form ; can we comprehend the statement concernand in our sister profession of the law the ing the success of an eminent consultant "case" has been made the basis of class- that at the outset of his career "he buried soom work.
himself for ten years in the morgue.” AtThe foundation of good case-taking is tending physicians, pathologists, bacterioloaccurate observation; and this is no small gists gathered together at the autopsy table thing to take into account.
are now able to review the whole case; the ception of phenomena, followed by correct possible errors in diagnosis and treatment; writing of the findings, is not common; it the reasons why the therapeusis has not is in fact rare. And the development of availed. The data collected during life are such accuracy in the use of the senses, and compared with those revealed after death; in the recording of observations, is one of all correct antemortem findings are verified, the most valuable results to be hoped for all erroneous opinions disproved. Only by in scientific training. For example, the ac- such rational and eminently practical study counts of eye-witnesses to any common- is medical science directly, and the race place and ordinary scene are almost never indirectly, benefited; not without these in accord; newspaper "stories” of any event means is the student's education adequately are well-termed thus, since they are not achieved.
THE DIVINE WEED.
came a pennyroyal or cubeb fiend. All these
articles of juvenile experience furnish One of the most baffling problems of abundant smoke wreaths and as much which explanation has been attempted is "rhythmic movement” as tobacco itself. that of the reason for the enjoyment de- Evidently there is something in the drug rived from the use of tobacco. Our modern which appeals to the mind through its bodilaboratory researches in pharmacology elab- ly effects, doubtless through some depresorate as they are, have failed to make the sant action by which it partially closes the matter one whit clearer. As stated by Cush- sensory approaches to the brain and allows ny, “The enjoyment derived from the use it to dwell in less disturbed self-satisfaction. of tobacco has never been explained, and The very fact, however, that smoking in it is not even proved that nicotine is essen- the dark gives less or no pleasure, attests tial to the pleasurable results; considera- the vast effect which sensory accompanition of the pharmacological effects of nico- ments play and how sadly these are missed, tine gives no clue, for these are of the oppo- while it rules out the importance of rhythsite nature. ... It seems doubtful whether mic activity which goes on as well in the the nicotine ordinarily absorbed has any ac- dark as in the light. Dr. Cavanagh, of Lontion whatever. Perhaps the local effects on don, has recently stated the smoke theory the mouth, nose and throat play a larger of tobacco more elaborately in connection part in the effects of tobacco than is gen- with the hygiene of the eyes. He says that erally recognized. A certain amount of the benefit claimed for tobacco would seem rhythmic movement demanding an exertion to depend upon the actual visual perception seems in itself to have a soothing, pleasure- of the clouds of smoke which "acts as a giving effect, for it is otherwise impossible rhythmically recurring shield from harsher to explain the satisfaction enjoyed by many eye stimulation . . . it soothes by its own in chewing tasteless objects such as gum or color as well as by cutting off the sensastraws. A curious fact which goes to show tions," and he believes it rests the eyes that tobacco smoking is not carried on for further by relaxing accommodation.. While the sake of the nicotine absorbed is that this is all very ingenious, we doubt if the the pleasure derived from a pipe or cigar most extreme preacher of the most disasabolished for many persons if the smoke is trous results of eye-strain could agree that not seen, as when it is smoked in the dark." tobacco smoke affords much relief to this
That nicotine or some other contained condition, much less that this is the ground substance has some effect upon the body for the formation and continuance of the everyone who has tried "his first cigar” has smoking habit. If so, it is exceedingly exhad indelibly impressed upon his conscious- travagant for smoke suitable for the purness. There is proof universal here, and pose could be furnished much more ecoevery man has been his own pharmacologi- nomically. Doubtless it affords an infinitescal laboratory in the matter. The leaves of imal effect in this direction, but we think the Pituri plant which is used by the na- the direct action on the conjunctiva or tives of Australia in the same way as to- through the nasal
membranes bacco contains a substance which is practi- would more than offset such results, and cally identical, in its physiologic action, with there are the dangers of toxic amblyopia nicotine. Except this plant, so far as we which would increase with the increasing know, no other material, even in this day amount of smoke clouds. of substitutions, has ever been successfully To the mind of the writer there is one used instead of tobacco. No young man, thing in connection with smoking which, in as far as we are cognizant, ever became addition to its probable influence in stupifvhabituated to the smoking of hayseed, or ing certain realms of the nervous system, formed the corn silk habit for life, or be- helps to explain the effects of the habit,