The third genus of Terata Katadidyma is theIschiopagus. These twins are divided so much from above downward that the heads are at almost opposite ends of the double body. They are joined at the coccyges and sacra, and the spinal columns have nearly the same axis. The trunk organs are complete and separate, except that they are commonly fused in the pelvis. There may be two, three, or four legs, given off at right angles to the pelvis. This kind of monster is not rare. Förster collected twenty cases, and nine new examples{83}were reported in theIndex Medicusbetween 1879 and 1893. Ischiopagic twins were born in County Roscommon, Ireland, in 1827, and baptised separately. The Jones Twins, born in Typhon County, Indiana, in 1889, lived for about two years; they were ischiopagi, and they had the very unusual quality, it is said, that they differed in complexion and the colour of eyes and hair. A case was reported inAmerican Medicine, September, 1903.
Classed with the Katadidyma is the genusPygopagus, although it has four legs. This form is very rare. The twins are joined only by the latero-posterior aspects of the sacra and coccyges, so that the two individuals are placed almost back to back. The trunk organs are independent, except for some fusion near the point of juncture. Examples of this class are the Hungarian Sisters, born at Szony in 1701, who lived to womanhood; the negresses Millie-Christine, born in 1851, and who were recently living in North Carolina; and the Blazek Sisters of Bohemia. The negresses had common sensation in the legs, but Millie could not localise what part of Christine's legs was touched, andvice versa.
The second group of the double autositic monsters areTerata Anadidyma—terata divided from below upward. The first genus is theDipygus. This has a single body above, but a double pelvis with double lower extremities in the typical cases. There is an exact description of a double monster of this kind in the GaelicAnnals of the Four Mastersas early as the year 727 of this era. The chronicler says in that year on Dalkey Island near Dublin, "There was a cow seen which had one head and one body as far as her shoulders, two bodies from her shoulders hindward, and two tails. She had eight legs, and she was milked three times a day."
A perfect human Dipygus with two equally developed pairs of legs is unknown. Catherine Kaufmann, who was born in 1876, and who died in 1878, had a double pelvis with double pelvic organs in part, but she had only one pair of legs. There is a similar anomaly said to be living in Philadelphia at present. Blanche Dumas, born in 1860, had a double pelvis, double pelvic organs, and three legs. Mrs. B., born in 1868,{84}had four legs—the two inner ones were smaller than the outer pair. Her spinal column was divided up to the third lumbar vertebra. Her double pelvic organs acted independently. There are living male examples of this form of monster.
The next genus is theSyncephalus, called alsoJanusandJaniceps. Its lower body is double up to the umbilicus, the trunk single above that point; the head shows signs of doubling, and there are four legs and four arms; the bodies grow front to front. The head usually is large, therefore this monster is born dead.
Another genus is theCraniopagus—twins joined only by the skull or scalp. There are three species, named from the place of union—Craniopagus Frontalis, C. Parietalis, andC. Occipitalis.
A third group of double autositic monsters are theTerata Anakatadidyma, which are divided above and below, but joined from the navel to the head. There are three genera. The first, theProsopothoracopagus, is joined at the upper abdomen, the chest, and the faces; the spinal columns are separate. The faces are imperfect, the jaws are united; there is a broad neck with one oesophagus, and there is one stomach and one duodenum. This is a rare form, and it can not exist out of the uterus.
A second genus, theThoracopagus, has a thorax in common, and the inner legs may be united. It is, as a rule, still-born.
The next genus is theOmphalopagus, in which the twins are joined from the navel to the bottom of the chest. This double monster has the slightest union of all, and it is very rare. The Siamese Twins were omphalopagi. They quarrelled; one became a drunkard and the other remained temperate. They married two women, and Chang had ten children, and Eng twelve. Chang died while Eng was asleep, and the latter died two hours after he had waked and learned of his brother's death.
There is a genus, theRachipagus, the examples of which are joined behind like the class Terata Anakatadidyma that are joined in front.
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Four known attempts have been made to separate double monsters surgically, but all failed owing to crude surgery; modern methods might be successful in some cases.
The second order of double monsters comprises the parasitic class. There are three genera of these terata, with five species and seventeen varieties. The chief of these only will be mentioned. TheHeterotypusis a parasitic child which hangs from the abdominal wall of the principal subject. Varieties of this species are theHeteropagus, which is a parasite with head and arms; theHeterodelphus, which has no head; theHeterodymus, which has a head, neck, and thorax. TheHeteralitisis a second species, in which the parasite is inserted at a distance from the navel of the autosite. TheEpicomusis the only example, and it consists of a parasitic supernumerary head. ThePolypnathusis a parasite attached to the jaw of the autosite. When fastened to the upper jaw, it is anEpignathus; at the lower jaw it is anHypognathns. Another group is made up of terata having parasitic legs which are attached to different parts of the autosite,—to the pelvis, the head, the abdomen, and so on. Finally, there is theEndocyma, which is a parasite enclosed within the body of an autosite.
Parasites are nourished through the blood supply of the autosite, and the parasites usually are incapable of motion. The autosite can feel when the parasite is touched, and in some cases the autosite can localise the touch. In India, in 1783, a child was born which had a supernumerary head attached to the autositic head, crown to crown; it lived four years. The parasite's eyes were always partly open, but they appeared to be incapable of intelligent vision. They contracted under strong light, and when the autosite was suddenly awakened both sets of eyes moved.
Gould and Pyle (Anomalies and Curiosities of Medicine) give an account of an Italian boy, aged eight years, who had a small parasitic head protruding from near the left third rib. Sensibility was common. Each of the heads received baptism (one was called John and the other Matthew), and there was question as to whether extreme unction should be administered to the parasitic head. A similar case occurred in{86}England in 1880 (British Med. Journal), and the parasitic head could be pinched without attracting the attention of the autosite.
Teratologists now exclude Dermoid Cysts from the lists of terata. The hair, teeth, and particles of bone found in these cysts are looked upon as the development of abnormal ectodermic and endodermic cells, rather than as evidence of a separate personality.
There is only one well-authenticated case of a triple monster, and this happened in Italy in 1831. The monster had a single broad body with three distinct heads and two necks. It was killed in delivery.
In Katadidyma (terata divided from above downward), when we have dicephali, ischiopagi, or pygopagi, there are evidently two individuals present. Is the Diprosopus, however, the two-faced monster, possessed of one or two souls? The cases vary, as we said, from examples with two distinct faces and four ears to cases that have merely two noses. What portion of a human body is required to contain a new soul? That is an interesting question for the psychologist and a very practical one for the moralist, and no moralist has yet attempted to solve it. The presence of a brain is not essential, because acephalous monsters develop without brain, and they are born alive; they have a vital principle which is identical with the soul.
Among the Terata Anadidyma (divided from below upward) the Syncephalus and the Craniopagus are unquestionably two persons. Is the Dipygus (single down to the navel, double below) one or two persons? Mrs. B., the example already given, was as double below the navel as any Dicephalus is above that point. She had features so well ordered in unity that she was a pretty woman, but that unity ceased at her waist. Was her husband unknowingly a bigamist? I think he was. After a consideration of the fission of terata, and the non-essential quality of the brain, why should fission that started at the feet differ from fission that started at the head?
In theRituale Romanum Pauli V.(tit. ii. cap. i. nn. 18, 19, 20, 21), the following directions for the baptising of terata are given:
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18. In monstris vero baptizandis, si casus eveniat, magna cautio adhibenda est, de quo si opus fuerit, Ordinarius loci; vel alii periti consulantur, nisi mortis periculum immineat.19. Monstrum, quod humanam speciem non praeseferat, baptizari non debet; de quo si dubium fuerit, baptizetur sub hac conditione:Si tu es homo, ego te baptizo,etc.20. lllud vero, de quo dubium est, una ne, aut plures sint personae, non baptizetur, donec id discernatur: discerni autem potest, si habeat unum vel plura capita, unum vel plura pectora; tunc enim totidem erunt corda et animae, hominesque distincti, et eo casu singuli seorsum sunt baptizandi, unicuique dicendo:Ego te baptizo, etc Si vero periculum mortis immineat, tempusque non suppetat, ut singuli separatim baptizentur, potent minister singulorum capitibus aquam infundens omnes simul baptizari, dicendo:Ego vos baptizo, in nomine Patris, et Filii, et Spiritus sancti. Quam tamen formam in iis solum, et in aliis similibus mortis periculis, ad plures simul baptizandos, et ubi tempus non patitur, ut singuli separatim baptizentur, alias numquam, licet adhibere.21. Quando vero non est certum in monstro esse duas personas, ut quia duo capita et duo pectora non habet distincta; tunc debet primum unus absolute baptizari, et postea alter sub conditione, hoc modo:Si non es baptizatus, ego te baptizo in nomine Patris, et Filii, et Spiritus sancti.
AUSTIN ÓMALLEY.
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The influence of the clergyman or the charitable visitor in matters of health and sanitation can scarcely be overestimated. The removal of prejudices with regard to sanitary regulations for the prevention of disease and modern advances in the treatment of disease is an important social duty. There is no doubt that if this influence be properly directed, sanitary measures of various kinds will be much more readily enforced and the precautions necessary to prevent the spread of serious infectious ailments more faithfully observed. As this amelioration of sanitary conditions will affect mainly the poor, lessening their suffering and adding to their possibilities of happiness, its accomplishment becomes a great Christian duty, obligatory on all those who are interested in the uplifting of the poorer classes.
Professor Virchow, the distinguished German pathologist, used to say that popular medicine was in all ages at least fifty years behind scientific medicine. He had himself discovered the principles of cellular pathology nearly half a century before his death, yet he declared that the popular mind still believed in the old doctrines of humoral pathology,—that is, that the conditions of health and disease depended on the constitution of the fluids of the body (the blood, the bile, the mucus, and so forth), and had not generally accepted modern advances in medical knowledge of the underlying basis of disease in the solid tissues. There is no doubt that many old-fashioned notions long since discredited by physicians are still very generally accepted by the popular mind, and even the intelligent classes sometimes harbour convictions with regard to the good or evil effects of habits{89}of life, diet, and the operation of drugs of various kinds that are entirely contrary to present-day medical knowledge.
It is extremely important, then, that the clergyman or charitable visitor, in giving views on medical matters, which are sure to have much more weight than he perhaps attributes to them himself, should be careful not to make statements for which he has not good authority in modern medical science. It is very easy, in a matter of this kind, to state principles that are not the result of education, properly so called, but are gleaned from early false impressions obtained one knows not how or where, entirely without definite consciousness as to their real origin. The physician himself finds that he is compelled to be careful of this same tendency to put too much stress on traditions with regard to health which he imbibed before he began to study medicine. It is perhaps not so surprising, then, to hear physicians complain often that clergymen instead of being a help are sometimes a hindrance to the enforcement of modern hygienic rules, because they still cling to old-fogy notions of hygiene and sanitation retained from a defective early training. Owing to the influence that the clergyman is sure to exert, this becomes an extremely important matter. Great harm may be done and the physician discredited, almost without a realisation, on the part of the clergyman, that he is interfering in another's department. Sympathetic coordination of clerical and medical efforts would accomplish much good that is now unfortunately left undone.
There is no doubt that for the important crusade against tuberculosis, for instance, the aid of the clergyman will accomplish much for the reduction of the death rate from this disease. What is needed at the present moment is a universal conviction that tuberculosis is not an hereditary but a communicable disease. This does not mean that it is virulently contagious and that as a result sufferers from tuberculosis must at once be segregated from other members of the family and from the community generally; but it does mean that careful precautions must be taken with regard to the disposal of sputum, with the enforcement of the most exacting cleanliness on the part of consumptives themselves.{90}It also means that the person suffering from the disease should not sleep with those as yet unaffected, nor be allowed to live in very close contact, especially with children or susceptible individuals.
The persuasion that tuberculosis is not hereditary will do much to encourage patients suffering from the disease to feel that they are not hopelessly doomed. At the present time it is not unusual to find patients so discouraged, when told that they have tuberculosis, that it is almost impossible to secure a favourable reaction to any mode of treatment. They have seen members of families die one after another, or they have heard stories of the inevitable way in which consumption wiped families out of existence, and they give up hope and become quite cast down. Needless to say, while in this condition any treatment is practically hopeless. On the other hand, the conviction that tuberculosis is only an infectious disease, quite curable in the majority of cases if taken in time, is of itself a most important aid in the treatment of the disease, since courage and faith are the principal requirements for successfully combating the affection.
We have had any number of newly invented remedies for consumption in the last twenty-five years. Scarcely a year has passed in which some new form of treatment, often eventually proved to be the resuggestion of an old therapeutic method, has not been heralded as a positive cure for consumption. In every case the first patients treated by the discoverer of the new remedy have rapidly improved under his care. In the hands of others, however, such results have not been obtained, or only for a very short time at the beginning of the treatment. After a time the new remedy failed in its inventor's hands. The true reason for the improvement was then seen to be, not the remedy suggested, but the favourable influence on the mind of consumptives produced by the faith of the inventor in his remedy, and their reaction to this powerful suggestion when they were put under proper conditions of an abundance of fresh air and a plentiful diet.
This shows, too, the reasonableness of the modern treatment of consumption, which consists not in the giving of{91}drugs, but in securing for the patient a plenty of fresh air for many hours a day and the encouragement to consume a liberal amount of nutritious food. Most of the much advertised remedies for consumption are really harmful rather than beneficent. Many of them are ordinary cough mixtures containing considerable opium, which lessens the cough, it is true, but also lessens the appetite and locks up the bowels. Besides, the cough is nature's method of removing material from the lungs which has become disintegrated, and if allowed to remain will certainly bring about the spread of the infection in the pulmonary tissues. Cough is a natural protective reaction to be encouraged, and is not in itself a source of evil needing to be suppressed. If cough is bothering the patient so much at night as to cause loss of sleep, then it is necessary to make a choice between two evils and somewhat to suppress the cough, even though it involves certain other inconvenience to the patient. All these so-called consumption cures contain materials that are almost sure to disturb the appetite and upset the stomach. The fate of a consumptive patient absolutely depends on his stomach; just as little, then, of medicine must be employed as possible. This will indicate the necessity for clergymen rather advising against than in favour of these proprietary medicines which have been definitely known to do so much harm in recent years. Many a patient delays an appeal to medical aid so long, as the result of trusting to such medicines, that a curable case of consumption becomes incurable, or else develops to such a condition as to require years of treatment on the fresh-air, abundant-food plan, where months would have sufficed before.
A very interesting phase of social medicine is the ease and confidence displayed by people, often of more than ordinary intelligence, in recommending various proprietary medicines of which they know nothing except the fact that someone says he, or more often she, was cured of something or other by their use. A chance remark like this to a sufferer becomes a high recommendation. The hardest problem the doctor has before him is to find out what is really the matter with his patients. Not infrequently people having apparently the same set of symptoms are suffering from quite different{92}ailments. A symptom like a sore throat, for instance, may very well be due to any one of at least a half-dozen of causes, most of which require their own peculiar treatment. When the affection under consideration is as indefinite as a tired feeling, or indigestion, or some one of the many ailments included under the term biliousness or kidney trouble, from which people are supposed to suffer, then the diagnosis problem becomes by far the most serious question in the case, and is often very difficult. The trained physician prudently hesitates, but the inexpert in medicine steps in and quite volubly announces what the ailment is in his opinion, and what will probably do it good. A little knowledge is indeed a dangerous thing in medical matters. If it be remembered that there is a very general impression among medical men now, as the result of recent acquisitions of scientific information with regard to the origin, pathological basis, and course of disease, that very probably more harm than good has been done by the administration of medicines in the past, not only the futility of lay (or clerical) prescribing will be manifest, but also somewhat of the amount of harm that may be done.
It is often a matter for painful surprise, then, to find that clergymen and members of religious communities allow their names to be used in the recommendation of remedies of whose composition they know nothing, for a disease of which they know less, if possible. This evil becomes especially poignant when the columns of our reputable religious press are allowed to be used for the purpose of exploiting the public in these matters. The remedies most often recommended are the so-called tonics. These are best represented by the sarsaparillas, and by various cures for catarrh, indigestion, and kindred indefinite ills, of which there are a great many on the market. These are not secret remedies, since their composition is well known by those of the medical profession who care to secure the information. Some six years ago an analysis of most of them was made by the Massachusetts State Board of Health. [Footnote 1]
[Footnote 1: 28th Annual Report Mass. Board of Health; food and drug inspection, 1897.]
The principal active agent in all of these remedies was{93}found to be alcohol. In most of them it exists in a proportion about equal to that in which it is supposed to occur in ordinary whiskey. Some of them are even stronger in alcoholic contents than the whiskey usually sold in our large cities. This matter has seemed so important that we give the official figures of the Board of Health.
TABLEFrom the Report of the Massachusetts Board of HealthTonics and Bitters
The following were examined for the purpose of ascertaining the percentage of alcohol in each. Some of them have been recommended as temperance drinks!
The dose recommended upon the labels of the foregoing preparations varies from a teaspoonful to a wineglassful, and the frequency also varies from one to four times a day, "increased as needed."Many so-called tonics not on this list are also known to contain alcohol,{95}though not as yet officially analysed so as to give exact figures. Most of the cure-alls for women's ills contain alcohol in noteworthy amounts, this being in fact usually the only active ingredient in them.
As the analyst of the State Board of Health of Massachusetts is a thoroughly competent chemist, and as these figures have now been before the public for over five years without any contradiction on the part of the manufacturers of these remedies, though it is evident how undesirable the truth of the matter is from an advertising standpoint, there can no longer be any question as to the authoritativeness of the proportions of the alcohol in the remedies as given.
It is rather sad to think of mothers giving these remedies to their children, hopeful of the good they may accomplish, when, as a matter of fact, it would be so much simpler and just the same in the end, to give them, instead of a tablespoonful of the favourite sarsaparilla, whatever it might be, a tablespoonful of dilute whiskey. As was noted in the volumes on thePhysiological Aspects of the Liquor Problempublished recently by a sub-committee of the Committee of Fifty for the investigation of the liquor problem, not a few prominent total abstinence advocates have put themselves on record as recommending these remedies, though there can be no possible doubt of the great harm likely to arise from their use. There are many physicians who feel sure that some of the alcoholic habits in women, whose origin it has been hard to account for, were really contracted during this secret "tippling" process under the form of a tonic remedy. Everyone knows that any tonic, in order to be effective, has to be gradually increased, so it is not surprising that in many cases physicians have heard of patients taking six to ten tablespoonfuls of some tonic remedy every day. This would be the equivalent, in some cases, of from three to five ounces of whiskey—a rather liberal allowance even for a confirmed whiskey drinker.
As noted by the Massachusetts Board of Health, the dose recommended upon the labels varies considerably, but practically all agree in suggesting that the amount of the remedy taken shall be increased as needed. A simple presentation of this subject will surely be sufficient to arouse clergymen{96}to a proper sense of their duty in this matter. Senators, judges of Supreme Courts, Congressmen, and even university professors and teachers may be so benefited by dilute whiskey, taken early and often, as to be tempted to furnish testimonials for them (for a due consideration usually), but clergymen should at least know something of the consequences of their act before committing themselves.
An almost precisely similar state of affairs obtains with regard to another class of favourite popular remedies. A number of so-called blood-purifying remedies have been recommended at various times, and here, as in other things, it is surprising to find how many intelligent people lend themselves to the exploitation of the public in the interests of the proprietary vender, who cares only to sell, and cares very little what effect his remedies may produce. Most of the sarsaparillas are said to be blood purifiers. It is surprising what vogue this word "sarsaparilla" has obtained. A little more than half a century ago a German chemist and pharmacist announced that the sarsaparilla plant contained certain principles that could be extracted by boiling, and that form excellent remedies for atonic and anaemic conditions. This announcement was received by the medical profession very kindly, and immediate tests as to the efficacy of the new remedy were made. As a result of these tests, within a few years the inefficacy of sarsaparilla became very clear. It is almost entirely without effect upon the human system. In the meantime, however, the word "sarsaparilla" was one to conjure with for the popular mind, and the sarsaparilla remedies began to be manufactured. Millions have been made on them and out of the public. The only active agent as regards tonic qualities which they contain is, as we have said, alcohol. Most of them however, contain at least one other well-known drug likely to be at least as harmful as alcohol. This is iodide of potash. Very few of the so-called sarsaparillas are without a notable proportion of this strong mineral salt, as the Massachusetts Board of Health said.
"With but few exceptions they contain a considerable percentage of a very active and powerful remedy, the iodide of potassium. The sale of such an article in unlimited{97}quantities by druggists, grocers, and others is censurable. More than this, the method of its sale is dishonest, since the unwary purchaser is led to believe that he is purchasing a harmless vegetable remedy, namely, sarsaparilla.
"It may be seriously questioned whether the blood of persons who take iodide of potassium continuously is not decidedly impoverished, instead of being purified, as is claimed by the manufacturers. It is not uncommon to find persons who have used continuously six, eight, or ten pint bottles of one of these preparations.
"Unlike sarsaparilla, the iodide of potassium is classed among poisons by nearly every writer upon toxicology."
Practically all the proprietary remedies have their most potent principle in the supposed mystery of their composition. As a matter of fact, all are simple prescriptions, well known to physicians, and owing their successful treatment of many ills much more to the printer's ink used to secure their sale than to any pharmaceutical ingredient which they contain. No important remedy has ever been put on the market by advertising methods. Exposure of the charlatanry of such methods will not, however, cause an interruption of their sale. Long ago Barnum said that people wish to be humbugged, and there is no doubt that they have been, are, and will be humbugged just to the extent to which they lay themselves open to the alluring methods of the advertiser. It does seem too bad, however, that the influence of the clergymen and of religious as well as charitable visitors—an influence acquired because of the confidential position they occupy and the feeling of good faith their mode of life inspires—should be abused for the encouragement and extension of what is manifestly a great evil.
Alcohol and iodide of potash are not the only drugs likely to do harm that are incorporated in proprietary medicines. Great complaints have recently been made with regard to the spread of the cocaine habit in this country. Not a few of the remedies that are supposed to give immediate relief to colds in the head contain cocaine in dangerous amounts; and there seems no doubt that in many cases the drug habit for this substance has been acquired innocently and{98}unconsciously at first by the use of such preparations. These are only the more notable evils likely to result from the indiscriminate employment of medicines of whose composition there is complete ignorance, and of whose effect there can be only the judgment dependent upon the subjective feelings of the patient. It must not be forgotten that the patient's feelings are for the moment often favourably influenced by some substance that may do no good to the ailment, though making the patient less sensitive to any symptoms from which he was suffering; but in the end doing positive harm, because of the contraction of the alcohol or some drug habit, or because the suppression of symptoms may be the very worst thing for the patients, since it allows the underlying ailment to progress to a serious stage without forcing them to have it treatedin radice.
These are only a few examples that show very well the inadvisability of recommending in any way medicines of which one does not know the exact contents. The present writer has had one example of how utterly disingenuous, though one feels much more like calling it rascally, the manufacturers of so-called patent medicines or proprietary remedies may be. One of the remedies widely advertised for the cure of epilepsy, or fits, is announced always as containing no harmful drugs, no bromide of potash. The manufacturer of the remedy was asked how he could say any such thing, since it was very evident even to the taste that the remedy contained bromides. "Oh," he said, "yes, it contains sodium bromide, but not bromide of potash." Almost needless to say, sodium bromide is at least as harmful as potassium bromide, and the advertisement is entirely for purposes of deception.
The poor epileptics have been a source of revenue for quacks and charlatans as long as history runs. At the present time one not infrequently finds testimonials from convents, asylums, reformatories, and the like, asserting the value of some particularly advertised remedy for this disease. All these remedies contain bromides. The treatment of epilepsy is now better understood by physicians and it is generally recognised that the two things that epileptic{99}patients need are outdoor air and as far as possible all freedom from responsibility. Bromides will, for a time, control the number and frequency of the attacks, but if used indiscriminately, and especially if employed without any proper realisation of their possibilities for harm, these salts are almost sure to make the condition of the patient much worse than before, to bring on a state in which mental symptoms predominate over physical, and in which the patient may go into dementia, or some form of mental alienation. Especially is this true with regard to epileptic children. Continuous dosing with drugs of any kind is sure to do them harm rather than good. Care for their diet and rest and the removal of all sources of disturbance of their digestive tract is more important than any other method of treatment.
The poor children have to suffer many things from many people. People hesitate, as a rule, to accept recommendations with regard to the administration of drugs to their animals when the person who gives the recommendation is known not to be an expert in the matter. Almost any suggestion, however, with regard to the dosing of their children is likely to be followed by loving but indiscreet mothers. It is well known now, and in many cases is admitted, that the so-called soothing syrups so often given to children contain opium in quite appreciable quantities. Needless to say, nothing much worse than this could possibly be given to children. The child soon becomes accustomed to its daily dose of opium and craves the repetition of it. It will not sleep without it, and as this adds to the sales of the remedy, this special ingredient continues to put money in the pockets of the manufacturers, but at the expense of the nervous stability of the child, and lack of resisting power later in life. It would be hard to say how many of the nervous wrecks so commonly met with in young adults now are to be attributed to this unfortunate state of affairs early in life; but undoubtedly this evil has had much to do with the noticeable increase in the nervousness of our people. The more nervous the heredity of the child, the more it must be guarded against such mistaken methods of inducing sleep, or the result is sure to be serious.
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Scarcely too much can be said in condemnation of most of the proprietary remedies for constipation, though it is in this department of medication that the non-medical are freest with their advice. First, the cheapest possible drugs are selected by the manufacturers of such remedies. Secondly, those drugs especially are employed which, while producing the desired immediate effect, are always followed by a reaction which requires further use of the medicine. One finds testimonials, however, from all classes of the community, even from clergymen, with regard to such remedies, though at the last international medical congress it was confidently asserted, by three of the most prominent specialists in digestive diseases in the world, that the modern problems in digestive disturbances are so much more intricate than they used to be, and the affections which develop are so much more difficult of treatment, because of the use of these unsuitable remedies, and the consequent habituation to drugs, which has been acquired during the prolonged period of their employment.
In recent years catarrh has become the word that is supposed to attract popular attention most, and accordingly is the watchword of the proprietary medicine manufacturer. A long time ago, that is, about half a century ago, catarrh was supposed really to mean something in medicine. Those were the days of humoral pathology, when disturbances of secretion were supposed to be the basis of all disease. Accordingly, whenever there was an excessive discharge from the nose, a patient was said to be suffering from catarrh, and as the nasal secretion was supposed to be connected in some way with the brain, it is easy to understand how significant such a pathological condition might well be thought. In more recent years, the word "catarrh" has still been employed by physicians who thoughtlessly employ terms that they think will be better understood by the laity, owing to their familiarity with them, though they have been outlived in medicine. From representing an affection of the nose, catarrh, as a consequence, has come to be employed for an excess of secretion from any mucous membrane. Accordingly we hear of catarrh of the stomach, catarrh of the bladder, or catarrh of the{101}bile-ducts, and there has come to the general public a notion that catarrh is an all-pervading affection whose ravages must be prevented, at all hazards, and whose beginning must be the signal for prompt medical treatment.
As a matter of fact, catarrh, when it means anything, means only that stage of inflammation in which there is an increased secretion and which represents an inflammatory condition so mild as often to be described as only hyperaemic, that is, due to an increase of blood in the part. It is rather easy to understand that if more blood flows through a mucous membrane, there will be greater secretion from it than would normally be the case. This is what happens in the production of catarrh. As a rule, it is only a passing congestion without any lasting changes in the tissue. Catarrh may, however, continue to be present if the irritation, which originally caused the congestion, be allowed to continue. It is this irritation, however, which needs to be treated, and not the catarrhal inflammation, which is only a symptom of it. The three most used words in popular medicine,—catarrh, rheumatism, and gout,—when traced to their etymological signification, mean the same thing. Catarrh means a flowing down, rheumatism a state of flowing, both being formed from the Greek verb, to flow, while gout is derived from the Latin wordgutta, a drop, which hints at the excess of fluid that is supposed to be the basis of the disease.
For these three diseases, however, the most varied remedies have been proposed, and practically entirely without success, when tested, in a large number of cases. As a matter of fact, under the two words catarrh and rheumatism, there is grouped a series of affections very different from one another, and requiring very different treatment. The important thing is not so much the suggestion of a remedy as the recognition of the particular cause which in one case is producing an excess of secretion and in the other is giving rise to the so-called rheumatic pain. When the exact cause can be found, it is usually not so difficult to succeed in preventing the recurrence of the troublesome symptoms. It is with regard to these two diseases, however, that in non-medical circles even intelligent men are ready to give advice. They constitute{102}the most puzzling problem that the physician has to deal with, but the non-medical mind waives the difficulty and suggests the remedy. In this matter one is forcibly reminded of a famous expression of Josh Billings, who used to say, "It is not so much the ignorance of mankind that makes them ridiculous as the knowing so many things that are not so."
Clergymen, lawyers, members of Congress, and of various state legislatures, all permit their portraits to appear, advertising the merits of some trumped-up cure for catarrh or rheumatism. It is interesting to realise, then, that in most cases, according to expert testimony, the remedy they recommend so highly consists of nothing more than diluted alcohol flavoured so as to taste like medicine. The only real effect is the alcoholic exhilaration which follows its ingestion and gives the sense of well being, because of which the testimonials are provided. As one of the medical journals said recently, it would be very interesting to make a list of the men and women throughout the country who, by permitting their portraits and recommendations to be used in the advertisements of various patent medicines, have practically confessed that they like to take their whiskey rather dilute but mixed with a little bitters. The whole question illustrates the tendency of the proprietary medicine man to exploit some phase of medicine long after it has ceased to be of interest to the medical profession.
With regard to all of these things clergymen may do a great humanitarian work by protecting the poor from the efforts of advertising remedy-makers to get their hard-earned money. It is sometimes said that long years have been spent in the preparation of a remedy. This not only is never true, but never has been true in the history of proprietary medicines. Some one who has an eye to business gets hold of a prescription of which he knows nothing, but of which his advertising agents are able to say much, and the result is sometimes a fortune for the advertiser. There is always a pretence of philanthropy, but it is the mask of heartless hypocrisy. Unfortunately many of our religious journals are tempted by the promptly paid bills of such manufacturing concerns to print their advertisements. They are aiding in a{103}deliberate swindle, and if this were better understood there would be much less suffering and fewer vain hopes. The best-managed newspapers and magazines in the country are now absolutely refusing all medical advertisements. This is the only proper attitude in the matter, for there is a place to advertise medicines, if they are worthy, and that place is the medical journals. If the popular advertising could be reduced, we should soon have much less of the proprietary medicine evil.
There are many ways in which clergymen by their example, their advice, and their influence can be of great assistance to practitioners of medicine. It is very sad, then, to find that some of them, having elabourated theories of their own on certain subjects, or having taken up with peculiar notions, are in opposition to the accepted medical teaching of the world. Occasionally they are found among the ranks of the anti-vaccinationists, though if there is anything that has been demonstrated to a certainty, it is that vaccination has practically eradicated smallpox, considering the frequency of the disease a century ago, and that it would absolutely eradicate it, if the practice could be made universal. Statistics are at hand to demonstrate this beyond all possibility of doubt. There are a certain number of people, however, who apparently, out of a desire for singularity as much as anything else, refuse to accept the evidence. It is very unfortunate to find clergymen among them, for it tends to bring the clerical judgment into disrepute.
Nearly the same thing might be said of antitoxin for diphtheria. Clergymen seem to consider it necessary for them to have their minds made up as to whether the use of diphtheria antitoxin is advisable or not. If they have once committed themselves to the expression of the opinion that antitoxin is of no value, then no amount of evidence will succeed in changing their opinion. Under these circumstances it becomes extremely difficult at times for physicians to succeed in having families permit them to treat their patients after the manner in which they are convinced the treatment should be carried on. If such clergymen would only realise that the clergyman has, as a rule, much less right to express{104}opinions on medical subjects than has the physician to air views with regard to theological principles, there would be much less friction, and it would be better for patients in the end.
There are certain sanitary regulations that clergymen should not only not oppose, but endeavour, by every means in their power, to have those who respect their opinions follow out as carefully as possible. Such sanitary regulations have in the past twenty-five years practically cut down the death rate of our large cities a half. There is no greater source of alleviation for the physical evils, at least those which afflict the lower classes, than the due enforcement of modern sanitation. There are prejudices, however, that must be overcome, and the clergyman should be found beside the doctor, helping him rather than opposing him, as is sometimes the case.
JAMES J. WALSH.