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 UNIVERSITY, 
 
 LIBRARY 
 
 BOUGHT WITH THE INCOME 
 OF THE SAGE ENDOWMENT 
 FUND GIVEN IN 1891 BY 
 
 HENRY WILLIAMS SAGE 
 
Cornell university Library 
 
 R 707 .D32 
 
 Our medicicie men, 
 
Cornell University 
 Library 
 
 The original of this book is in 
 the Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31 92401 21 97491 
 
OUR MEDICINE MEN 
 
 BY 
 
 PAUL H. De KRUIF 
 
 NEW YORK 
 
 THE CENTURY CO. 
 
 1922 
 
Copyright, 1932, by 
 The Centobt Co. 
 
 Printed in U. S. A. 
 
TO 
 
 MY TEACHER OF BACTEEIOLOSY 
 THIS BOOK IS DEDICATED 
 WITHOUT HIS PERMISSION 
 
FOREWORD 
 
 A part of these essays has appeared in "The 
 Century Magazine," and their pubhcation has 
 aroused the profound displeasure of many serious 
 and possibly important persons. The pieces have 
 been variously denounced as destructive, igno- 
 rant, rotten, jvrong-headed, and detrimental to 
 progress. This writer deplores these criticisms, 
 for, while it is true that he had no intention to 
 moralize or to improve the world, he did attempt 
 to recount in a fair and restrained manner the 
 reactions which twelve years of contact with 
 medicine men have called forth in him. 
 
 He has made an earnest effort to be restrained, 
 but, try as he would, it was impossible to avoid 
 introducing a faintly ribald flavor into his writ- 
 ings. He hastens to assure his readers that this 
 has crept in not because meditine is in essence 
 wholly ribald or ridicidous. On the other hand, 
 he believes that of the five great professions it 
 stands next to that of engineering in its contri- 1 
 butions to progress. The ribaldry has appeared 
 by reason of a slight, but incurable, clownishness 
 and impishness of his own mind. For, imf ortu- 
 
 . [vii] 
 
FOREWORD 
 
 nately or not, all important and solemn things 
 excepting science and the high arts have to his 
 view overtones of the preposterous and bizarre. 
 
 The publishers have asked that he give the 
 raison d'etre of this book. It is as follows. While 
 fishing and loafing in the fastnesses of New- 
 foundland he was overwhelmed by the vision of 
 a great contrast, and, thus overcome, was forced 
 to give voice to it. He has tried to paint the pic- 
 ture of the contrast between the fine old practi- 
 tioners of the Osier type and the somewhat 
 ridiculous new pseudo-scientific ones; between the 
 white cold light of quantitative science and the 
 inky murk of a practice that is no longer an art 
 and has not yet begun to be a science. In brief, 
 he has tried to portray certain strong differences 
 between things that are pretentious and those 
 that are modest, between things that are false 
 and those that are true. 
 
 De Kruif 
 September 1, 1922 
 
 [viii] 
 
CONTENTS 
 
 CHAPTER PAOB 
 
 I The Dignity of the Medical Profession . S 
 
 II The Eole of Credulity 18 
 
 III On a Misconception of the Role of Physi- 
 
 cians . 35 
 
 IV T. G. H. AND THE Super-Doc .... 49 
 V The Cure of Disease 73 
 
 VI Pills Make Way for Prevention . . . 102 
 
 VII Religio Sanitatis 131 
 
 VIII The Molding of the Raw Material . . 158 
 
 IX The Science of the Study of Disease . . 192 
 
 X The Master Physician and the Anti-Phy- 
 sician 222 
 
OUR MEDICINE MEN 
 
OUR MEDICINE MEN 
 
 CHAPTER I 
 
 THE DIGNITY OF THE MEDICAL PROFESSION 
 
 THE dignity of medical men is as old as the 
 history of mankind. It was laughed at 
 by the ancient Aristophanes, who made dis- 
 paraging comparisons between the worth of their 
 services to the commonwealth, and their foppish 
 appearance and affected demeanor. It makes its 
 appearance in the paintings of Dutch artists of 
 the sixteenth century, who represented doctors 
 as richly dressed individuals of distinguished 
 bearing. The English physician of two hundred 
 years ago was famous for his immaculate dress, 
 his courtly manners, his gold-headed cane. The 
 successful medico of the present time, while not 
 usually to be placed in the category of the dude, 
 stiU is marked at once by an aura of professional 
 
 [3] 
 
OUR MEDICINE MEN 
 
 seriousness and gravity of bearing that is unmis- 
 takable even to casual observers. 
 
 It is natural and right that doctors should af- 
 fect this appearance, and that they should be 
 held in high regard. For the function of the 
 healer of our ills is certainly of greater impor- 
 tance than that of mob-masters or birch-men, and 
 at least as valuable and necessary as that of the 
 priest. The physician, like his clerical brother, 
 is of great value in feeding the hopes and sooth- 
 ing the fears of men. Until recent years, the 
 functions of these two have differed in shght de- 
 gree only, and they have been held in awe for 
 much the same reasons. 
 
 Like that of the priest, the position of the doc- 
 tor in the respect and awe of his fellow human 
 beings has always been impregnable. It has not 
 been shaken by the raillery of Aristophanes. 
 The epigrammatic invective of the great Da 
 Vinci has failed to disturb it. Butler's sarcasms 
 on doctors in "Hudibras" are smiled at and for- 
 gotten. The tolerance of Mohere's "L' Amour 
 Medecin" by French physicians is well known, 
 and modern healers, knowing the invulnerabihty 
 
 [4] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 of their trenches, think of "The Doctor's Di- 
 lemma" as a clever but superficial drama. None 
 of these masterpieces, which combine close obser- 
 vation with rnatchless wit, have had any effect 
 upon the authority or power of the medical pro- 
 fession. Thus it is evidently futile for writers 
 of far less skill to make an attempt in which great 
 satirists Ijave so signally failed. 
 
 They were one and all convinced that the 
 people of their times could exist as well, perhaps 
 better, without the ministrations of men who ap- 
 peared to them as bogus Magi. The fearlessness 
 and power of their attack deserves immortality, 
 but their railleries were considered as buffoon- 
 eries by the laity and dismissed with amiable 
 shrugs by the objects of their diatribes. Jt is far 
 from the purpose of the writer to attempt a 
 propaganda for the abohtion of the medical pro- 
 fession. The desire is only to inquire into the 
 causes for its present extraordinary magnificence 
 and prosperity, and to discover, if possible, 
 whether these are due to a commensurate in- 
 crease in the value of its services. 
 
 The state of flux existing in the majority of 
 [5] 
 
OUR MEDICINE MEN 
 
 human institutions at present is a commonplace 
 of observation. This condition has affected even 
 the medical profession, w^hich, until fifty or sixty 
 years ago, had undergone no important funda- 
 mental change for a thousand years. It is no- 
 ticeable that the doctor is rapidly losing his im- 
 portant role of comforter and friend. He is no 
 longer considered to be privy to the secrets of 
 black magic, or to derive his heahng pow^ers from 
 intimate acquaintance with gnomes, sprites, dev- 
 ils, or deities. He is venerated instead, because 
 of the growing belief that he is one of the chosen 
 disciples of the new God of Science. In the 
 middle ages the brothers of the Rosy Cross be- 
 fuddled their clients by their supposed posses- 
 sion of the philosopher's stone. At present the 
 healer awes his patients by coming to them reek- 
 ing of the laboratory, or by allowing them to see, 
 as if by accident, his scientific proceedings with 
 colorimeters, syringes, and guinea-pigs. There 
 are a growing nimiber of individuals who begin 
 to affect disdain for the ministrations and pre- 
 tensions of holy clerks. The success of physicians 
 in avoiding this contempt is due mainly to the 
 
 [6] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 Machiavellian celerity with which they have for- 
 saken the old gods at the moment of their decline. 
 Finding that the superstition that upheld these 
 latter for so long is beginning to be scoffed at, 
 the medico cleverly takes advantage of the new 
 credo in the omnipotence of science. 
 
 • The medical profession is proud of its sup- 
 posed connection with science. It forgets the 
 old gods easily and is not afraid to poke fun at 
 them. Its members do not fear to expose and to 
 laugh at the charlatanry, superstition, and igno's 
 ranee of even the best of old-time physicians. 
 They become mirthful over the solemn imbecili- 
 ties of the votaries of the legendary Egjrptian 
 I-em-hetep. They point with derision to the 
 therapy of those doctors of 4000 b.c. who ad- 
 vised that baldness be treated with a pomade 
 made up of equal parts of the fat of the lion, 
 hippopotamus, crocodile, goose, serpent, and 
 ibex. They rail good-naturedly at the ancient 
 rites of incubation practised by the priests of the 
 ^sculapian cult, and at the ministrations of Hy- 
 gieia and Panacea, who combined the function 
 of physician with that of hostler to the sacred 
 
 [7] 
 
OUR MEDICINE MEN 
 
 snakes. They form clubs to make merry over the 
 largely idiotic folk-lore of the BUndu Charakha. 
 It is common for them to refer facetiously to the 
 windy theories of Galen and to deprecate the 
 bonds in which these dicta held medicine for more 
 than a thousand years. They allude with merri- 
 ment to the mysterious drugs and abominable 
 concoctions of Paracelsus, and agree with Mo- 
 liere in his sarcasms on the sterile pedantry of 
 the French physicians of the time of Louis XIV- 
 
 In a word, they would have us believe that 
 the bigotry and superstition of the medicine man 
 have passed away, to be replaced by the glorious 
 spirit of investigation and open-mindedness of 
 Da Vinci and Galileo, of Newton and Fara^y. 
 Now, it is true that science has modified the prac- 
 tice of medicine. But it is absurd to pretend that 
 the present personnel of the profession is essen- 
 tially superior in intellect, or more free from 
 superstition, than the followers of the Hindu 
 "Vaghbota," or the disciples of the Greek Galen. 
 
 It is certain that this pretense of physicians 
 threatens to turn medicine from its primordial 
 and proper fimction of healing and soothing our 
 
 [8] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 ills, toward a quackish assumption of the dignity 
 of science. It is possible to study disease scien- 
 tifically, but it is absurd to presume that this can 
 be done by the rank and file of doctors. Yet the 
 confusion of the art of healing and the science 
 of the study of disease is wide-spread and disas- 
 trous. Its analysis and criticism will form the 
 principal subject of the dissertations that follow. 
 
 The physician should be venerated, not for 
 supernatural knowledge or for scientific acu- 
 men, but for his understanding of man's ills and 
 troubles, for raising his patient's morale, and 
 for applying, as a technologist, the thgia^eutic 
 and prophylactic discoveries furnished him by 
 the small group of scientists who actually study 
 disease. 
 
 The first indications of the decline of the 
 priestly function of doctors are to be found in 
 the awakening of the spirit of independent in- 
 quiry and rebellion against authority that 
 marked the Renaissance. For more than a thou- 
 sand years physicians had accepted almost with- 
 out reservation the tissue of dogma and solemn 
 nonsense promulgated by the arch-quack, Galen. 
 
 [9] 
 
OUR MEDICINE MEN 
 
 Vesalius was the first of the iconoclasts. The 
 ideas of Galen on the structure oTlhe human 
 body were to a large extent purely speculative, 
 Vesalius threw aside this sacred balderdash, and, 
 using purely objective methods, overturned the 
 prevailing notions of anatomy, making of it a 
 living science of observation. It might be ex- 
 pected that his colleagues would have acclaimed 
 him and accepted his demonstrations in the spirit 
 of scientific men. But this was by no means the 
 case. On the contrary, they ignored him or op- 
 posed him bitterly, and joined with those arch- 
 enemies of science, the clergy, in placing every 
 obstacle in his way. 
 
 Finally, in disgust, he gave up his splendid 
 work and became respectable. He married and 
 settled down as court physician to Charles V of 
 Spain, and so passed his best years in a degrad- 
 ing position, akin to that of the modern society 
 doctor. But at last he became disgusted with 
 his role of prostitute, and, inspired by the re- 
 searches of his former pupil, Fallopius, bril- 
 hantly revived his scientific activity. At once he 
 paid the penalty. He was scorned by king and 
 
 [10] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 courtiers, by priests and colleagues, and died an 
 obscure and poverty-stricken wanderer. 
 
 At the time of Vesalius, and for centuries 
 after, the church and the medical profession vied 
 with each other in denouncing and inhibiting the 
 spirit of fearless inquiry necessary to medical 
 progress. The doctors effected this by disdain 
 and ostracism of the colleague who was fired by 
 the itch to know. The church opposed him by 
 downright persecution, by torture and death. 
 This clerical opposition, contrary to belief, was 
 not confined to the Romish church. For ex- 
 ample, the most abominable instance of perse- 
 cution of science in all history is that of the burn- 
 ing of the anatomist, Servetus, by Calvin, the 
 father of Presbyterians. 
 
 For centuries after Vesalius, the progress of 
 the science of the study of the body and its 
 malaises was discontinuous and fragmentary. It 
 was opposed constantly by physicians of all 
 ranks. It was advanced as much by monks, 
 chemists, and even merchants as by orthodox 
 doctors. The few fundamental discoveries that 
 occurred at long intervals had no marked influ- 
 
 [11] 
 
OUR MEDICINE MEN 
 
 ence on the still priestly spirit of the profession. 
 In the seventeenth century, Harvey d^non- 
 strated_the_jcimil^^ the ' blood_and_so 
 
 founded experimental physiology. But his in- 
 vestigation did noTaiouse great applause among 
 physicians or cause experimental physiologists to 
 spring from their ranks. A little while after, 
 Leeuwenhoek, a Dutch merchant, who spent his 
 leisure moments in grinding lenses, discovered 
 the world of miCT^scopc beings, the existence of 
 which until then had beerTHajdly suspected. His 
 observations foreshadowed the revolutionary re- 
 searches of Pasteur, but during his time they 
 were largely ignored by the medicine men. 
 
 The eighteenth century, again, was one of a 
 few splendid achievements, set off in sharp relief 
 against a dark background of stupidity and stag- 
 nation. The advances were made largely by men 
 not of the cloth. The monk, Spallanzani, demon- 
 strated the regeneration of tissues, made sugges- 
 tive experiments in respiration, and refuted the 
 doctrine of spontaneous generation of life. The 
 Scotch chemist. Black, and the Frenchman, La- 
 voisier, elucidated the mysteries of respiration, 
 
 [12] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 and the Englishman, Jenn er, introd uce^, vaccina- 
 tio n aga inst smallpox/^These are the beacon 
 lights on the dark sea of sterile theory and empty 
 formalism. They were vigorously and conscien- 
 tiously opposed, or entirely ignored, by the medi- 
 cal rank and file. 
 
 It remained for the nineteenth century to wit- 
 ness the general penetration of the chaotic and 
 foolish body of medical folk-lore by experimen- 
 tal science. Physicians began to feel the buffets 
 that knowledge inflicted upon their quackery and 
 their idiotic theories. Chemistry and physics 
 ,and their technological application were bringiag 
 about the industrial revolution. It was natural 
 that the increase in importance of these sciences 
 should hasten their application to biology and to 
 medicine. Physics and chemistry had broken 
 away from the absurdities of alchemy. They 
 were obviously of great utility to mankind. 
 They were respected, while the priestly pedantry 
 of medicine began to be the subject of scorn. 
 
 Magendie was one of the first of the nine- 
 teenth century physicians to realize thoroughly 
 the prime necessity of these sciences in the study 
 
 [13] 
 
OUR MEDICINE MEN 
 
 of the body and its derangements. He was an 
 indefatigable experimenter, fearing to make even 
 tentative hypotheses and insisting always upon 
 the utter emptiness of vitaKstic concepts. He 
 felt that the science of the study of disease was 
 too young for theories. He believed that the 
 attention of experimenters should be devoted to 
 the discovery of facts. After Magendie, the 
 work of Schwann and of Caignard de la Tom- 
 indicated the role of minute living organisms in 
 the processes of fermentation, and suggested to 
 Pasteur that many diseases were similarly caused 
 by beings beneath the range of ordinary vision. 
 Pasteur's struggles to convince medical men 
 that his researches revolutionized their concep- 
 tion of disease are most instructive and illuminat- 
 ing. His ideas met with violent opposition or 
 complete indifference by all but a very few phy- 
 sicians. These gentlemen opposed him, mind 
 you, not on the ground of the fallacy of his no- 
 tions, but because he was a mere chemist, and not 
 a doctor, and as a result could know nothing of 
 disease. But he battled on with a splendid stub- 
 born determination, combating the appalling 
 
 [14] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 ignorance of the medical profession with unbe- 
 lievable patience and persistence. His encour- 
 agement came from a few friends, chemists, 
 physicists, and physiologists. 
 
 The turning point in the attitude of doctors 
 toward his work is to be found in the application 
 of his researches to surgery by the Enghshman, 
 Lister, and in his own dramatic demonstration 
 of the possibility of vaccinating cattle against 
 anthrax. His medical and veterinary opponents 
 induced him to stage a pubHc experiment, hoping 
 that its failure, which they ignorantly believed to 
 be certain, would finally discredit him and leave 
 them to the peaceful practice of their own imbe- 
 cilities and charlatanry. This plan proved a 
 veritable boomerang to Pasteur's persecutors, 
 the experiment was simple, but crushingly con- 
 vincing. Pasteur took a large number of sheep 
 and divided them into two groups. The first he 
 inoculated with his anthrax vaccine, the second 
 were left without treatment. A certain number 
 of days after the vaccination of the first group, 
 all of the sheep were injected with a virulent 
 culture of anthrax microbes. All of the control 
 
 [15] 
 
OUR MEDICINE MEN 
 
 sheep, i. e., those which had not been previously 
 inoculated, died in a few days. But, to the dis- 
 may of his tormenters, all of the vaccinated ones 
 survived without symptoms of the malady. This 
 beautiful experiment created confusion in the 
 ranks of the medical cult. What is more, Lister, 
 who was one of the few accredited physicians in 
 existence to show open-mindedness or even the 
 rudiments of sense, was revolutionizing the craft 
 of surgery by applying Pasteur's ideas. 
 
 These events finally brought doctors to the 
 realization that the days of their priesthood were 
 over. The study of disease had been elevated to 
 the dignity of a science, ironically enough, by a 
 mere chemist. But physicians did not blush at 
 this. They hurried to lay aside completely their 
 pretensions to mystic powers, and began to claim 
 for themselves the honor due to investigators 
 alone. 
 
 It was well for them that they shed the ancient 
 habihments of the medicine man. The raiment 
 of the priest was in the process of being reduced 
 to tatters by the assaults of the followers of Dar- 
 win, led by Huxley. Christianity and mysti- 
 
 [16] 
 
THE DIGNITY OF THE MEDICAL PROFESSION 
 
 cism were being shaken to their foundations by 
 science and evolutionism. The assumption of 
 the dignity of scientists enormously enhanced the 
 prestige of physicians everywhere, but it is in 
 America that this assumption has been most bold 
 and blatant. The American, generally deficient 
 in thorough education and sound culture, is 
 more naive than his European brother. So it is 
 the American doctor who presents the best 
 demonstration of this attempt of physicians to 
 replace their priestly dignity by questionable 
 claims to residence on the austere heights of sci- 
 ence. And it is this amusing spectacle that the 
 following chapters will endeavor to reveal, in a 
 restrained and dignified manner. 
 
 [17]' 
 
CHAPTER II 
 
 THE EOLE OF CREDULITY 
 
 THE supposedly dense and wide-spread ig- 
 norance of the human race in former cen- 
 turies is usually brought forward to explain the 
 quackeries of physicians of olden times. Liter- 
 acy was in those days the possession of a chosen 
 few. Power of independent ratiocination was 
 confined to but a small proportion of the literate 
 individuals. It would be natural, then, to sup- 
 pose that this lack of education might account for 
 beliefs that to us seem incredibly silly. The 
 modems look with amused tolerance upon people 
 who accepted the legends of the immaculate con- 
 ception and of the raising of the dead by Christ 
 or his disciples. They understand the cause of 
 the perpetuation of the yarn concerning lepers 
 who were cured by a simple laying on of hands. 
 It is not surprising that stews of insects or 
 
 [18] 
 
THE ROLE OF CREDULITY 
 
 rodents, and decoctions of the excreta of animals, 
 were firmly believed to be of great efficacy in the 
 therapy of many serious diseases. Wandering 
 medicine men at village fairs, itinerant mounte- 
 banks, charlatans of all sorts, might fool the un- 
 educated yokels with such remedies. 
 
 But the theory that this universal success of 
 quackery was due to a lack of education receives 
 a rude buifet when we find that physicians and 
 philosophers of the first rank used the abomin- 
 able brews of the type just mentioned, with an 
 enthusiasm equal to that of the most obvious 
 fakers. For example, the early editions of the 
 "English Pharmacopoeia," the official handbook 
 of recognized physicians, recommended such re- 
 volting mixtures for the treatment of many iUs. 
 And the supposedly highly educated clients of 
 the most distinguished physicians were ready to 
 swallow such potions with enthusiasm, in the firm 
 behef that they were of great efficacy. 
 
 Such considerations force the conclusion that 
 it is wrong for historians of medicine to difPeren- 
 tiate between reputable physicians and quacks. 
 The difference between the two was a quantita- 
 
 [19] 
 
OUR MEDICINE MEN 
 
 tive one of minute degree. In reality, on the evi- 
 dence of the facts at hand, it would be right to 
 consider them one and all as fakers of the first 
 class. It may be objected that the reputable 
 physicians of olden times are not to be placed in 
 such low company, since they seriously believed 
 in the efficacy of their nostrums. But it is really 
 to be doubted whether their sincerity was any 
 greater than that of the lowest runagate, since 
 aU people come to believe firmly in the virtues 
 of any cause 'for which they stand, no matter 
 how siUy or how bizarre it may be. It is only 
 necessary that they repeat their slogans often 
 enough, or administer their remedies a sufficient 
 number of times. At any rate, if the fakers 
 knew that they were fooling the people, and if, 
 at the same time, physicians were convinced of 
 their own honesty, the fakers, as knaves, must 
 be ranked as superior in intelligence to the phy- 
 sicians, as fools. 
 
 It must be admitted that there is a faintly per- 
 ceptible and increasing amelioration of the al- 
 most universal gullibility of other days. On the 
 other hand, the most casual sort of observation 
 
 [20] 
 
THE ROLE OF CREDULITY 
 
 will show that credxility is rampant everywhere. 
 It may, indeed, be justly considered the most 
 wide-spread and evil of any of the numerous 
 faults and errors of humanity. It is credulity 
 that is the major cause of the childlike awe and 
 ready acceptance of the medical mythology of 
 to-day, as well as of other times. This fundamen- 
 tal intellectual defect is common to all of us. 
 It has been apparent even in a supreme intellect 
 like Descartes, who devoted a great part of his 
 time to haranguing against it. Descartes main- 
 tained that the attitude of systematic doubt of 
 all beliefs and concepts was the first essential of 
 sound philosophy, yet we find him making state- 
 ments in his physiological work "De Homine" 
 which to-day are known to be absurd and based 
 on unquestioning credulity. 
 
 The gullibility of the great body of the plain 
 people of to-day, to say nothing of the lower 
 strata, is too well known to justify lengthy con- 
 sideration. Thousands of solid citizens of our 
 communities, merchants, aldermen, Rotarians, 
 Kiwanisians, are firmly convinced that the terA- 
 porary lifting of the ban on spiritus frumenti 
 
 [21] 
 
OUR MEDICINE MEN 
 
 checked the recent terrible epidemic of influenza 
 and saved many hves. These same pillars of so- 
 ciety allow their wives to "dope" themselves with 
 the vegetable compound of Mrs. Pinkham, and 
 believe with their daughters that the systematic 
 imbibition of Nujol leads to the seductive and 
 irresistible pink complexion displayed on the ad- 
 vertisements in subway trains. These men fre- 
 quently know themselves to have derived great 
 benefit from the mauEngs of chiropractors and 
 the foohsh rumble-bimible of Freudian psycho- 
 analysts. They flock in thousands to the pros- 
 perous temples of the faith of the late lamented 
 scientific old lady of Boston. They indorse the 
 encomiums of David Belasco, Sir Gilbert Parker, 
 and others of the middle-class intelligentsia, in 
 regard to the new elixir of life called Sanatogen. 
 It is time to turn from the consideration of the 
 gullibility of the supposedly intelligent middle 
 class to that of the members of an intellectual 
 aristocracy, i. e., the college professors. Dr. 
 Frederick Peterson in an admirable essay en- 
 titled "CreduUty and Cures" disposes neatly of 
 the pretensions of our tutors to the doubting, 
 
 [22] 
 
THE ROLE OF CREDULITY 
 
 critical spirit. He mentions, for example, the 
 case of Professor John Dewey, who is conceded 
 to be of the crime de la crime of the American 
 best minds. This philosopher indorses enthusi- 
 astically the panaceas offered in a pompous tome 
 called "Man's Supreme Inheritance." The book 
 is a collection of childish piffle which claims to 
 point out the easy road to perfect health. It is 
 important to observe that the simple perusal of 
 the book does not effect this. It is necessary, 
 in addition, to consult its author, the famous 
 Alexander. 
 
 Another instance of appaUing credulity and 
 childlike faith is that of a professor of chemistry 
 in a great university of our Middle West. The 
 savant in question had been listening to a disser- 
 tation by a colleague in the department of phi- 
 losophy. The philosopher's remarks had led to 
 the conclusion that there was, at the present time, 
 no proof whatever of hfe after death. The lec- 
 ture over, the good chemist sought out the phi- 
 losopher at once and asked, "But do you really 
 believe that there is no proof of a future life?" 
 Receiving an affirmative reply, he turned away 
 
 [23] 
 
OUR MEDICINE MEN 
 
 with the remark that the philosopher could not 
 have read the book by Sir Oliver Lodge entitled 
 "Raymond." 
 
 This incident, you will all agree, is a sad and 
 illuminating one. The chemist in question is not 
 the kind of hopeless fossil who helps to snuff out 
 the spark of intellect in the eager young peasants 
 of one-building universities and minor denomina- 
 tional colleges. On the contrary, he is an im- 
 portant teacher in a large institution which is 
 proud to number its attendance in five figures. 
 He pubhshed important researches in his youth. 
 In his middle years, having become, perhaps, a 
 httle too respectable for the faint aura of irregu- 
 larity that attends active and fervent investiga- 
 tion, he wrote a text-book of physical chemistry 
 which presented that science in broad philosophi- 
 cal terms. Finally, his activities as author com- 
 pleted, he has reached his apogee as head of a 
 department, as expert administrator, as chair- 
 man of committees, and as assistant to faculty 
 ladies in the function of arbiter of the social 
 pretensions of the struggling smaller fry of the 
 imiversity corps of instructors. Yet he believes 
 
 [24] 
 
THE ROLE OF CREDULITY 
 
 whole-heartedly in a volume which must be dis- 
 missed by the judicious as a supreme example of 
 vmmitigated tosh. 
 
 The above instances demonstrate sufficiently 
 the peculiar derangements to which the greatest 
 American minds are prone. The laity disposed 
 of, it is necessary to examine into the gullibility 
 of the gentlemen who condescend to bestow this 
 name upon the populace at large. Credulity, 
 which makes it easy for doctors to propagate 
 their myths, is common as well to the medical 
 profession itself. This follows naturally from 
 the fact that the populace at large forms the 
 raw material from which physicians are made. 
 It is well known that entrance to a medical col- 
 lege is not based upon a requirement of inde- 
 pendence of intellect, but only upon credits 
 earned in a certain number of years of pre-medi- 
 cal education. Since these can be won by any 
 one shghtly above the mental capacity of an im- 
 becile, it is clear that the medical student must 
 be fairly representative of the average citizen, 
 and consequently prone to the same aberrations 
 of the intelhgence. Accordingly, if physicians 
 
 [26] 
 
OUR MEDICINE MEN 
 
 as a class are independent thinkers, in contrast 
 to the laity, it would have to be assumed that 
 the process of medical education had inculcated 
 this characteristic of individualized thought. 
 This assumption, as a later chapter will reveal, is 
 ridiculous and absurd. 
 
 The herd thought of the medico is accurately- 
 exposed by the above-mentioned Peterson. This 
 author displays a candor altogether astounding 
 in one of his profession. It is still more amazing 
 that his devastating statements are published in 
 the chief gazette of the American followers of 
 jEsculapius. This can be accounted for only on 
 the assumption that the editor knows the jour- 
 nal to be read almost exclusively by the medical 
 brotherhood, and that the freemasonry of the 
 guild will prevent the propagation of such scan- 
 dalous heresies. 
 
 The fifty years that have passed since Pas- 
 teur's fundamental studies have witnessed the 
 perpetration of a confusion and glittering array 
 of hoaxes on the medical profession. These have 
 followed each other with kaleidoscopic rapidity, 
 rising meteorically and disappearing like ex- 
 
 [26] 
 
THE ROLE OF CREDULITY 
 
 ploded rockets. While some of the fads have 
 arisen from a basis of soimd science, the majority 
 have had as httle validity as the remarkable 
 plaster described by Mark Twain. This poul- 
 tice, the purpose of which was to reduce inflam- 
 mations, was of such potency that, when placed 
 on the patient's head, it drew his limgs out 
 through his mouth! 
 
 The fact that doctors are at present less tena- 
 cious in their use of spurious remedies might be 
 presented as a proof of their superior enlighten- 
 ment. Accordingly, while the merits of the fa- 
 mous plaster described by Twain were undoubt- 
 edly believed in for thousands of years, certain 
 modem balsams enjoy a heyday of only a few 
 years' duration. In reahty, the readiness of 
 medicos to forsake old panaceas for new is a sign 
 of the current instabihty, caprice, and love of 
 change that plagues mankind. This is the most 
 important characteristic differentiating the pres- 
 ent civihzation from older cultures, which, if 
 equally dubious, were certainly more inflexible 
 and stubborn. 
 
 Interesting and amusing volumes might be 
 [27] 
 
OUR MEDICINE MEN 
 
 written in description of the cures, theories, and 
 isms that have raged in the medical profession 
 during the last fifty years. It is sad to relate 
 that some of these, which have had a firm scien- 
 tific basis, have fallen into disrepute entirely be- 
 cause of their idiotic misapphcation. Others, 
 arising from more or less sound experiments, 
 have been perverted through complete misappre- 
 hension of their values and limitations, and 
 through unwarranted commercial exploitation. 
 Take, for example, the case of bacterial vaccines. 
 Their use in the treatment of certain ailments 
 was first popularized in the medical profession 
 by the Enghshman, Almroth Wright. He 
 taught that for a vaccine to be valuable, it was 
 preferable to prepare it from a microbe isolated 
 from the patient himself. This advice is based 
 upon the fact that a given species of microbe 
 contains a variety of races, one of which may be 
 the cause of infection in certain individuals, an- 
 other the noxious invader in other persons. It 
 is known that the immmiity conferred by the 
 injection of a vaccine prepared from one race 
 might fail entirely to be effective against an- 
 
 [28] 
 
THE ROLE OF CREDULITY 
 
 other. Wright, therefore, argued that by ob- 
 taining the microbe actually infecting a given 
 patient, he would be certain to employ a germ 
 specific for that infection. Such a vaccine is 
 called "autogenous." 
 
 Now, the preparation of this autogenous vac- 
 cine involves time and considerable technical 
 skill. These two requisites are possessed, it is 
 well known, by very few of the rank and file of 
 physicians. The majority of them are notori- 
 ously busy and distracted. They find it neces- 
 sary to rush about from one case to the next, 
 and in general lead a life which is the antithesis 
 of that of a careful technologist or investigator. 
 The technical skill of most of them, in bacteri- 
 ology, is negligible. 
 
 Despite this, the reports of Wright, which 
 glowed with optimism, popularized the use of vac- 
 cines. "Vaccine therapy" became a slogan, first 
 among the more adventurous and advanced, then 
 among the generality of doctors. But the origi- 
 nal instructions of Wright were largely lost 
 sight of. It became the idea that, so long as one 
 injected a vaccine, the cure followed as a matter 
 
 [29] 
 
OUR MEDICINE MEN 
 
 of course. Frequently the real microbic cause 
 of the malady under treatment is not even ac- 
 curately determined. Rather, it is sloppily 
 sought for by a cook-book bacteriological technic. 
 If the result of this procedure is ambiguous, the 
 causative agent is shrewdly guessed at, and a 
 corresponding commercial "stock" vaccine is in- 
 jected. 
 
 The demand for vaccines rose as the slogan 
 spread. Few physicians stopped to inquire how 
 vaccine worked: it sufficed only to hear and to 
 believe that they cured many diseases. Organi- 
 zations which may be described as "vaccine fac- 
 tories" arose in the land to supply the growing 
 clamor. These, like all up-to-date commercial 
 institutions, undertook not only to supply the 
 needs existing, but created additional demands 
 by assiduous advertisement. This entry of the 
 vaccine into commerce furnished the coup de 
 grace to any remaining chance of its sound ap- 
 pUcation to the few ailments in which it seems to 
 be efficacious. The vaccine factories vied with 
 each other in thinking up new diseases for which 
 their products might be valuable. Their adver- 
 
 [30] 
 
THE ROLE OF CREDULITY 
 
 tising claims became increasingly absurd and ex- 
 travagant in the manner of the spirit of adver- 
 tisement that animates the majority of the suc- 
 cessful merchants of our nation. They stop at 
 nothing. Their impudent perversion of scien- 
 tific truth knows no bounds. Vaccines are placed 
 on the market for diseases the microbic cause of 
 which is unknown. It would not be astounding 
 to read that a vaccine has been perfected against 
 broken legs, diabetes insipidus, or concussion of 
 the brain. 
 
 The success of some of these commercialists 
 in debauching medicos resulted in an incredible 
 augmentation of their own prosperity. Consider, 
 for instance, the romantic history of an obscure 
 physician in a large Middle Western city. This 
 doctor, with a mediocre training in bacteriology, 
 began the manufacture of vaccine on a small 
 scale, assisted only by his children and a pre- 
 Bolshevik Russian socialist of dubious antece- 
 dents and honesty. Clever advertising, combined 
 with the incredible credulity of the physicians of 
 the city, gave rise to an enormous prosperity. 
 He now holds forth in a magnificent building, 
 
 [31] 
 
OUR MEDICINE MEN 
 
 ironically called a laboratory. He rolls about 
 ostentatiously in an expensive automobile. He 
 becomes a figure of prominence in his commu- 
 nity. It is of interest to note that some dignified 
 and reputable medical journals advertise his 
 dubious wares, although, at the same time, edi- 
 torially protesting against quackery of this type. 
 To sum up, the human instinct of credulity 
 makes it easy for physicians to hoax the laity and 
 for a few doctors to fool the medical profession 
 as a whole. It is not necessary to dilate further 
 upon this well-known human aberration. It is 
 only necessary to turn to the remarkable essay 
 of Schopenhauer on "The Art of Controversy" 
 for a lucid exposition of its mechanism and its 
 nefarious effects. The writer refers to this au- 
 thor with some trepidation. He is indubitably 
 a Teuton, and it is impossible for his admirers to 
 prove that he was not of German, but actually 
 of Polish, Flemish, or Czechish origin. In con- 
 sequence, let it be remembered that he is recom- 
 mended only to those Americans who do not 
 patriotically hate all Germans from the time of 
 Johann Sebastian Bach onward. 
 
 [32] 
 
THE ROLE OF CREDULITY 
 
 But to return to the reason for the recommen- 
 dation of Schopenhauer's essay. This philoso- 
 pher points out that the great majority of people 
 not only hate and fear, but are actually incapable 
 of independent thought. They prefer, rather, 
 to be intellectual sheep, and to follow the dicta 
 of individuals whose theories and utterances are 
 most pleasing to them. From this, it is easy to 
 see that the generality of a behef in anything 
 is no indication at all of its soundness and valid- 
 ity. One or two persons, who may have been 
 right or wrong, as the case may be, originally 
 stated the concept, or the supposed fact. It is 
 then handed on from one person to another, gen- 
 eralizing in direct proportion to its ease of com- 
 prehension and its soothing effect. 
 
 This appeal to authority, which in the art of 
 controversy is called argvmientum ad verecun- 
 diam is widely used in medicine, frequently with 
 disastrous effect. To attach the name of Wright 
 or Metschnikoff or Mayo or Ehrlich to a remedy 
 or method of treatment is to assure its indis- 
 criminate and wide-spread use. It is true that 
 the men bearing these names have been impor- 
 
 [33] 
 
OUR MEDICINE MEN 
 
 tant in the advancement of the study of disease 
 or of medical technology. But they were some- 
 times wrong, and at other times their cautious 
 and sound recommendations have been sadly 
 distorted by the uncritical enthusiasm and gulli- 
 bility of their horde of followers. 
 
 [34] 
 
CHAPTER III 
 
 ON A MISCONCEPTION OF THE KOLE OF PHYSICIANS 
 
 IT will be recalled that in a previous chapter 
 the present dignity of doctors was attributed 
 to their pretension to science. This pretense is 
 very widely accepted, although it rests upon an 
 obvious fallacy. The object of the present dis- 
 sertation will be the exposition of this error, and 
 the attempt to delineate the real function of the 
 physician. 
 
 At the present moment, much more is heard of 
 the term "medical science" than of the "practice 
 of medicine." And it is a short step from the 
 phrase "medical science" to that of "the science 
 of medicine." Now, it is clear that the latter 
 designation places medicine on a footing of equal- 
 ity to the well-established sciences of physics 
 and chemistry. This constantly awakens the 
 amusement or the ire of physicists and chemists. 
 
 [36] 
 
OUR MEDICINE MEN 
 
 It is true that the emptiness of such a pretense 
 would be laughable did it not lead to such great 
 intellectual confusion. But since clarity and hon- 
 esty of intellectual concepts are among the few 
 things of which mankind may be proud, it is 
 necessary to remove fallacious ideas of this na- 
 ture, and it is a wrong and essentially decadent 
 tendency to stand aside with a smile of superior- 
 ity, or to shrug one's shoulders with resigned 
 cynicism. 
 
 The confusion of thought which has given rise 
 to the term "science of medicine" is not confined 
 to upstarts, charlatans, and men of silly and 
 vapid intellect. On the contrary, physicians of 
 great dignity and distinction use it constantly. 
 Some years ago, for example, the presidency of 
 the American Medical Association was held by 
 a man of this caliber. His inaugural address was 
 concerned with the contributions of medicine to 
 civihzation, and in this oration the new president 
 stressed in an entirely laudable manner the im- 
 portance of science to medicine. But then, car- 
 ried away by his enthusiasm, he made claims that 
 are open to serious question. For instance, he 
 
 [36] 
 
MISCONCEPTION OF ROLE OF PHYSICIANS 
 
 asserted that "the history of medicine is the his- 
 tory of mankind." This remark imphes that 
 when civihzations have been complex and highly 
 developed, medicine was correspondingly impor- 
 tant and of great service. Now, it must be ad- 
 mitted that even a casual knowledge of history, 
 lay and medical, will convince any one of the 
 fvindamental absurdity of such a statement. The 
 civilizations of the Egyptians, Babylonians, 
 Greeks, and Aztecs were refined, and in many 
 respects greatly superior to our own. Yet the 
 medical practice and theory current in any of 
 these was largely a mass of superstitious twaddle, 
 propagated by priests who are not to be con- 
 sidered of scientific or even ordinary intellectual 
 persuasion. The contributions of such priest- 
 hoods to the success and health of these civiliza- 
 tions were undoubtedly so minute as to be virtu- 
 ally negligible. 
 
 What is more, the great man stated that "medi- 
 cine has done more for the growth of science than 
 any other profession, and its best representatives 
 have been among the leaders in the advancement 
 of knowledge." This remark must be regret- 
 
 [37] 
 
OUR MEDICINE MEN 
 
 fully dismissed as empty and without founda- 
 tion. The genuine sciences of mathematics, as- 
 tronomy, physics, and chemistry, owe almost 
 nothing to medicine, and remarkably little to 
 physicians. An earnest attempt to call to mind 
 medical men who have been protagonists in these 
 fields reveals only the names of Young, Mayer, 
 Helmholtz, and Loeb. This is a feeble showing, 
 when one considers the high proportion of phy- 
 sicians among the supposedly intelligent men of 
 all times. 
 
 Now, the dearth of doctors among the superior 
 investigators in these fields would seem at first 
 glance to be remarkable. On the contrary, it is 
 really perfectly natural and very easy to ex- 
 plain. To tell the truth, the medical man, if he 
 remains in the practice of his profession, must, by 
 temperament and because of the demands of his 
 work, lack the very qualities that are necessary 
 to the investigator. This wiU be more apparent 
 in the subsequent analyses. 
 
 Another leader of medicos boldly asserts "that 
 medicine must even now be considered not as 
 
 [38] 
 
MISCONCEPTION OF ROLE OF PHYSICIANS 
 
 applied, hut as an independent science." In fact, 
 his remarks in general would lead one to believe 
 that physicists and chemists are to be degraded 
 to the ranks of handmaidens or body-servants, to 
 obey the commands of that super-scientist, the 
 modern doctor. In order to point out the fun- 
 damental error inherent in claims of this kind, 
 it is necessary to indicate the meaning of the 
 word "science," as it is at present understood by 
 investigators. In reality, science is concerned 
 with the investigation of the quantitative rela- 
 tionships of factors governing natural phe- 
 nomena. Descriptive science is a misnomer. It 
 must inevitably be a prey to the inaccuracies im- 
 posed by the limitations of the perceptions and 
 by the personal equation. It is to be compared 
 to the reports of the explorer traveling in a far 
 country. These reports are frequently interest- 
 ing, but are colored to a large extent by the ur- 
 bane hospitality or the hostile attitude of the in- 
 habitants. In quantitative science, on the other 
 hand, some measure of agreement between dif- 
 ferent investigators can be arrived at. And it 
 
 [39] 
 
OUR MEDICINE MEN 
 
 becomes more and more possible to express quan- 
 titative data in equations, from which verifiable 
 predictions can be made. 
 
 It is well known that the scientific worker must 
 be cool, disinterested, and impartial in making 
 his experiments and in recording their results. 
 It is well for him to show imagination and fire 
 in formulating his hypotheses and at the birth 
 of his ideas. It is inspiring to think of that an- 
 goisCj so beautifully described by Verhaeren, 
 with which the scientist attends the confirmation 
 or collapse of his theories. But during the ex- 
 periment he must weigh accurately and measiu-e 
 exactly; he must be completely impartial in re- 
 cording the preponderance of one or the other of 
 the factors revealed by his results. He must not 
 hurrah for one, or hate the other. They must 
 be to him as so many undifferentiated paving 
 blocks are to the pedestrian, or so many undif- 
 ferentiated doughboys to our great General 
 Wood. 
 
 Now, it is well known that the supposed func- 
 tion of the medical practitioner is to cure dis- 
 ease. His relationship to his patient should be, 
 
 [40] 
 
MISCONCEPTION OF ROLE OF PHYSICIANS 
 
 therefore, that of a comrade coming to the aid 
 of a stricken friend. He must desire the suc- 
 cessful recovery of his client. He must hate the 
 microbe that harasses the sufferer so malignantly. 
 This state of enthusiasm for the patient and 
 enmity toward his disease is clearly a highly emo- 
 tional one. It has been demonstrated that such 
 emotions are out of place in science, no matter 
 how valuable they may be in other walks of life. 
 Hence it is futile to bring the business of the 
 physician into the scientific domain. 
 
 When the practitioner of medicine ceases to 
 be the optimistic and sympathetic friend of his 
 patient and becomes the cold man of science, he 
 loses a large part of his value. People in general 
 know this and consequently shun a doctor of this 
 type, no matter how able he may be. They go, 
 instead, to a physician of minor attainments, but 
 of a buoyancy and human quahty that is very 
 valuable in maintaining the morale of both the 
 sufferer and his family. 
 
 Distinguished physicians, who wish to pass be- 
 yond the necessary limitations of the art, still 
 realize the necessity of the qualities of humanity 
 
 [41] 
 
OUR MEDICINE MEN 
 
 in doctors. This will be clear from the remarks 
 of the gentleman who was just quoted as de- 
 manding that medicine be called an independent 
 science. He adds that, while disease must be 
 studied in the modern university hospital, at the 
 same time nothing should he left undone to cure 
 the patient. This statement contains a contra- 
 diction that reduces it to absurdity. For, in or- 
 der to study the various phases of a disease with 
 the requisite thoroughness, it is frequently neces- 
 sary to abstain from any interference with its 
 course. This is also true of investigations of 
 therapeutic measures. 
 
 Accordingly, when our friend demands that 
 nothing be left undone to cure the patients, he 
 asks, in effect, that the first principle of a vaUd 
 experiment be abrogated. Some of the patients 
 will of necessity have to remain without treat- 
 ment, if it is desired to conduct a sound investi- 
 gation. This will be evident from the following 
 example: The first principle of a sound experi- 
 ment, concerned, let us say, with a test of the efii- 
 cacy of X-rays in the treatment of cancer, would 
 be the selection of a large number of patients 
 
 [42] 
 
MISCONCEPTION OF ROLE OF PHYSICIANS 
 
 having the disease in a certain stage. All of these 
 individuals would then be placed under identical 
 conditions in regard to diet, nursing, and general 
 care. Then, a part of the sufferers would be 
 subjected to accurately measured doses of the 
 Roentgen rays, while an equal number would 
 receive no treatment at all save the general care 
 just mentioned. Now, if the X-rayed group 
 showed a large proportion of cures or ameliora- 
 tions, while the majority of the other subjects 
 became worse or died, it might be reasonably con- 
 cluded that the rays showed some curative effect. 
 The untreated cases, called controls, would then 
 have sacrificed themselves to the progress of sci- 
 ence. But if this were done it would constitute 
 a neglect of the demand of our good doctor that 
 nothing be left imdone to cure the patient. 
 
 Granted that such an experiment could be 
 made on a large number of cases covering a long 
 period of time, it is doubtful whether it would be 
 feasible to make the attempt. In the present 
 stage of civilization, it would certainly not be 
 advisable. Imagine, if you will, the clamor and 
 uproar that would ensue among the family and 
 
 [43] 
 
OUR MEDICINE MEN 
 
 friends of the "controls," that is to say, the un- 
 treated patients. Lack of space prevents the 
 depiction of such a scene. In reality, the family 
 and friends would by present standards be right 
 in their protests. Humanity as a whole is cer- 
 tainly not ready for a generalized martyrdom to 
 the progress of knowledge. It is not ready to 
 take the place of the laboratory guinea-pig. It 
 is a long way from the state of the disemboweled 
 itch to know that was the possession of the an- 
 cients in the fifth part of Shaw's "Back to Me- 
 thuselah." 
 
 Fortunately for us, the greater part of prac- 
 tioners have not reached the judicial, unemo- 
 tional state necessary to the proper conduct of 
 such an experiment. When a remedy is placed 
 at their disposal, they usually administer it to 
 as many people as desire their services, and, in 
 their enthusiasm for the supposed efficacy of the 
 cure, remark, "To hell with controls." They 
 rely for knowledge as to its eflBcacy upon their 
 "impressions," or upon the statistical method. 
 This method, in brief, counts the degree of mor- 
 tality in the cases treated with a given nostrum, 
 
 [4.4] 
 
MISCONCEPTION OF ROLE OF PHYSICIANS 
 
 as compared to the mortality in a previous series 
 of cases not treated at all, or treated differently. 
 This method is full of errors, as any one can 
 plainly see. 
 
 On the other hand, their enthusiasm and unc- 
 tion in administering the drug may greatly raise 
 the morale of the patient, better enabling him 
 to battle with his malady. So, happily, it may 
 matter little whether the treatment, per se, has 
 an effect on the disease. It is enough that the 
 patient take a spiritual brace. Nature will often 
 do the rest. 
 
 It follows naturally from these considerations 
 that the place for the study of disease is in the 
 laboratory. The subjects of the study here are 
 animals in which the manifestations of the mal- 
 ady are as nearly as possible similar to those in 
 the human body. Such investigations, to which 
 it is now realized that physics and chemistry are 
 absolutely essential, begin to bring the study 
 of disease into the category of the fundamental 
 sciences. It is clear that if humanity wishes to 
 be rid of its ills it should place every facility in 
 the w§y of laboratories, apparatus, and experi- 
 
 [45] 
 
OUR MEDICINE MEN 
 
 mental animals at the disposal of able and honest 
 investigators. Rich men, who set up laboratories 
 out of altruistic or other motives, deserve to be 
 pardoned by their less fortunate and conse- 
 quently envious countrymen who denounce them 
 as commercial brigands. And if a genius should 
 arise in the land who could make anthropoid 
 apes as plentiful, healthy, and cheap as guinea- 
 pigs, mommients should be raised to him and |his 
 name should be sung in the epics of future gen- 
 erations. For it is natural that disease may be 
 most advantageously studied in creatures that 
 are closely akin, if not completely identical to the 
 human being. 
 
 In resume, it is unsoxmd to consider the doc- 
 tor as a scientist, in his relation to the patients, 
 or to think of medicine as an independent science. 
 The practice of medicine is something of an 
 entirely different nature. It is to the greatest 
 extent an art; it is partly craft; it begins to 
 smack of a technology or applied science. 
 
 Its craft is important in surgery, which de- 
 pends largely upon the same dexterity necessary 
 to goldsmiths, pianists, wood-carvers, bartenders, 
 
 [46] 
 
MISCONCEPTION OF ROLE OF PHYSICIANS 
 
 watchmakers, carpenters, and sculptors. Its 
 technology is important in the diagnosis and 
 treatment of disease. Here the physician should 
 always be on the alert to apply the discoveries 
 made by the student of disease in the laboratory. 
 But in doing so he should not consider himself 
 a scientist. For, in diagnosing what ails a pa- 
 tient, he seeks to locate a hidden source of danger 
 or annoyance in the body of the sufferer. To do 
 this, it may be necessary to make use of discov- 
 eries, just as the famous detective Burns might 
 employ a scientific discovery in hoimding out a 
 criminal who is a sotirce of annoyance in the 
 body politic. Yet no one wotild assert that 
 Burns is a scientist. He is simply an excellent 
 detective. The last and most important fimc- 
 tion of the physician is still his art, which con- 
 sists largely in the emotional relationship he 
 must bear toward his patient. In this, all good 
 doctors, from Hippocrates to Osier, have been 
 proficient. This is in its nature antipathetic to 
 the scientific attitude. The less it is contami- 
 nated with science, the better. 
 
 As for the study of disease, that should be 
 [47] 
 
OUR MEDICINE MEN 
 
 left to those intellectually curious and largely 
 heartless individuals whose desire is incessantly 
 to know, to discover, to find out the how of 
 things. The best of them have scant interest in 
 the malaises of patients ; their curiosity concerns 
 itself with the malaise in itself. Contrary to 
 their own occasional pretension, and to the in- 
 variable description of them in newspapers and 
 popular gazettes, their desire is not primarily 
 to relieve suffering humanity. They are driven 
 to their task by that strange instinct that gave 
 rise to the impudent and dangerous explorations 
 of Henry Hudson, and to the unholy and hereti- 
 cal probings of Gahleo. 
 
 [48] 
 
o 
 
 CHAPTER IV 
 
 T. G, H. AND THE SUPER-DOC 
 
 NE of the most distressing tendencies in 
 ^-^ American medicine is the decHne of the 
 old-fashioned general practitioner, and his re- 
 placement by the modern so-called scientific phy- 
 sician and group doctor. This is sad, not be- 
 cause it will have a very perceptible harmful 
 effect upon the average length of life or upon the 
 general health of our countrymen. Indeed, it is 
 possible that the services of the new physician 
 may be, in some ways, more important than those 
 of his predecessor. But there is cause to lament 
 the passing of "old doc," because his going 
 means the disappearance of a charming charac- 
 ter, a wise counselor, a comforter in time of dis- 
 tress, a rock to cling to in the storms of disease 
 and in the presence of death. His twilight must 
 flu one with melancholy, because he was usually 
 
 [49] 
 
OUR MEDICINE MEN 
 
 a figure of simplicity and sincerity and real dig- 
 nity in our communities, which, God knows, are 
 ah-eady more than filled with hypocrisy, char- 
 latanism, loud advertisement, meretricious effi- 
 ciency, pretense, vulgarity of all kinds. 
 
 The adorable figure of the doctor of the old 
 type has been beautifully described by pens that 
 put this one to shame. Oliver Wendell Holmes 
 has painted the physician of the middle of the 
 nineteenth century, Dreiser has characterized 
 him admirably in his book, "Twelve Men." One 
 of his type will remain, to the writer, an impres- 
 sive and altogether imforgettable figure, who 
 helped him through the annoying maladies of 
 childhood, and advised him with priceless wis- 
 dom dvu-ing the tortures of adolescence. 
 
 T. G. H. received his medical education in the 
 early eighties at the University of Michigan, and 
 settled down immediately afterward to practise 
 in a village in the western part of that State. 
 Here he remained for more than thirty -five years, 
 as the principal physician and as a figure of im- 
 portance, doing incalculable good among the 
 villagers and the inhabitants of the surrounding 
 
 [50] 
 
T. G. H. AND THE SUPER-DOC 
 
 country-side. His appearance impressed one in- 
 stantly with confidence. He was stockily built 
 and of middle height. His head and shoulders 
 were massive and his jaw clean-cut and strong. 
 He gave the impression of crag-hke solidity and 
 simplicity. His expression was ordinarily 
 thoughtful and stern, but his gray eyes twinkled, 
 at intervals, with understanding of human sins 
 and peccadillos, and his rare outbursts of chuck- 
 ling laughter were hearty and inimitable. He 
 was religious to the point of fanaticism. Yet his 
 long experience and keen observation of human 
 frailties made him in many ways a tolerant and 
 wise coimselor. When the writer, troubled with 
 the collapse of his religious faith through secret 
 readings of Ingersoll and Darwin, came to him 
 with a recital of his doubts, the good doctor, in- 
 stead of denouncing free thought and science, 
 replied with a history of his own youthful 
 struggle with the eternal enigmas of life. 
 
 His ability in diagnosis was of the first order. 
 It showed that combination of careful observa- 
 tion, long experience, and rare good sense that 
 led one to consider his judgments to be intuitive, 
 
 [51] 
 
OUR MEDICINE MEN 
 
 rather than to be based on memory of principles 
 rammed into him in his college courses. He 
 made little use of modern diagnostic parapher- 
 naha. He was not acquainted with the technic 
 of blood counts, Wassermann reactions, or de- 
 termination of blood urea. He did not pooh- 
 pooh at them as new-fangled. On the other 
 hand, he seemed impressed with their impor- 
 tance. But one felt that he was able, by short 
 cuts, to arrive at fully as sound conclusions as 
 those gained by the aid of these elaborate and 
 expensive tests. His apparatus of diagnosis 
 consisted of a thermometer, a stethoscope, a few 
 test-tubes and reagents for simple urinalysis. 
 These alone aided his clear mind and intuitive 
 judgment in arriving at diagnoses of astounding 
 accuracy. 
 
 At the same time, he was never afraid to admit 
 that he was baffled in the study of some obscure 
 malady. This characteristic, so much a part of 
 his fundamental frankness and honesty, added 
 to the confidence that every one had in him. He 
 was like old Skoda in his refreshing therapeutic 
 nihilism. He was no peddler of yarbs and 
 
 [52] 
 
T. G. H. AND THE SUPER-DOC 
 
 simples, but was, on the other hand, a firm be- 
 hever in the power of nature to cope successfully 
 with many diseases. He reminded his patients 
 constantly of this fact, and disdained to take the 
 credit for cures that the universal mother had 
 herself effected. Accordingly, it may be imag- 
 ined that he scorned the great majority of his 
 quacksalving colleagues, who administered in- 
 nocuous concoctions, and then took the credit to 
 themselves if their patients recovered. 
 
 In addition to his merit as a diagnostician, T. 
 G. H. was a general surgeon of more than ordi- 
 nary ability, and was one of the first of the 
 Americans to apply the principles of asepsis to 
 his operations. These were performed, mind 
 you, not in the immaculate and elaborately 
 equipped operating-rooms of modern hospitals, 
 but in the home of the patient, with a single 
 nurse, and frequently only with members of the 
 family as his assistants. Despite these handi- 
 caps, his record of recoveries would do credit to 
 a modern surgeon who has all of the modern ap- 
 paratus and a veritable retinue of helpers at his 
 command. Yet he was charmingly modest de- 
 
 [53] 
 
OUR MEDICINE MEN 
 
 spite his success. The writer recalls one of the 
 good man's favorite reminiscences. When still 
 young and rather inexperienced, T. G. H. was 
 called hurriedly to a distant sawmill to attend 
 the owner, who had been terribly injured in a 
 buzz-saw. The doctor drove for miles through 
 the country-side, and arrived to find the man in 
 a dying condition. He did not hesitate, but per- 
 formed on the spot a difficult shoulder- joint am- 
 putation, at that time a rare feat of surgery. 
 The man recovered and hved to aid in the de- 
 forestation of Michigan for many years. The 
 surgeon told this story with great gusto, but al- 
 ways deprecated his own part in the remarkable 
 recovery of the sawer of logs. He insisted 
 rather that it was the man's astounding tough- 
 ness and power of resistance that enabled him to 
 withstand an operation performed under such 
 difficult conditions. He constantly preached the 
 necessity to the surgeon of sound mechanical 
 knowledge. He realized that the wielder of the 
 knife is, in essence, a sort of glorified repair man. 
 This practitioner was tireless in his ministra- 
 tions to his clients. In the old days, with a 
 
 [54] 
 
T. G. H. AND THE SUPER-DOC 
 
 horse and buggy, more recently in a clattering, 
 mud-spattered Ford, he was to be seen, early and 
 late, in the streets of the town or on the abomi- 
 nable roads of the surrounding country-side. 
 Called in an emergency from a distance, he in- 
 variably responded. He did not make pre- 
 hminary inquiries into the prosperity of the pa- 
 tient. In regard to remuneration, his schedule 
 was anything but rigid. Those who could do so 
 paid well for his services; the less fortunate 
 rewarded him as they were able, or not at aU. 
 T. G. H. is dead, taken away too soon from a 
 community that loved him and in the end kiUed 
 him by its incessant demands upon his strength. 
 General physicians of his extraordinary ability 
 become more and more rare. Communities of the 
 type that he served have now to be content with 
 mediocrities or sixth-rate graduates of modern 
 medical colleges. The more promising students 
 are lured from attempting the difficult but use- 
 ful life that was his. They cannot resist the 
 temptation of the gaudy rewards of money and 
 notoriety that attend the successful metropolitan 
 speciahst or consultant of to-day. 
 
 [55] 
 
OUR MEDICINE MEN 
 
 The absorption of the best talent by special- 
 ties, consulting practices, and, finally, by that 
 coalition of speciahsts known as the "group," is 
 a phenomenon to be ascribed largely to the rise 
 of modern surgery. Its augmentation of mag- 
 nificence and importance is one of the most ro- 
 mantic occurrences in modern affairs. For, from 
 his ancient association with barbers, the surgeon 
 has climbed to an eminence of the utmost dizzi- 
 ness. He is the most prosperous of physicians. 
 The general practitioner, who once scorned the 
 knife as a weapon fit only for such humble per- 
 sons as tonsoriahsts, is now at the beck and call 
 of his former servants. 
 
 In the sixteenth century, surgeons in general 
 were said by Clowes to be "shameless in counte- 
 nance, lewd in disposition, brutish in judgment 
 and understanding." They were recruited, ac- 
 cording to the same author, from "tinkers, tooth- 
 drawers, peddlers, ostlers, carters, porters, horse- 
 gelders, and horse-leeches, idiots, apple-squires, 
 broom-men, bawds, witches, conjurers, sooth- 
 sayers and sow-gelders, rogues, rat-catchers, 
 runagates, and proctors of spittle-houses." In 
 
 [56] 
 
T. G. H. AND THE SUPER-DOC 
 
 short, the ranks of this now honorable craft were 
 filled in ancient days by the very flotsam and 
 jetsam of humanity. 
 
 Indeed, for many centimes it took a consider- 
 able amount of courage to practise as a surgeon, 
 and the endless dismal succession of quacks and 
 rascals is lightened only by the occasional ap- 
 pearance of men of talent and honesty, like 
 Pare and Himter. But with the discovery of 
 anesthesia in America, and, what is more impor- 
 tant, the application of Pasteur's researches by 
 Lister, a great change began to take place. Lis- 
 ter proved that the application of the principles 
 elucidated by Pasteur permitted of the explora- 
 tion of the deepest recesses of the body with com- 
 parative safety. The chances of death by mi- 
 crobes introduced by the surgeon's manipula- 
 tions became remarkably less. This resulted in 
 a great decrease of the appalling amount of homi- 
 cide perpetrated for ages by surgeons of all 
 ranks. Diseases such as appendicitis, inflamma- 
 tion of the gall-bladder, various timiors, et cet- 
 era, can be dramatically cured by surgical in- 
 tervention. 
 
 [57] 
 
OUR MEDICINE MEN 
 
 The craft of the repair of the body developed 
 with surprising rapidity, and it is natural that 
 Americans, famed always for their technical in- 
 genuity, should play a prominent part in the 
 amazing growth of this now dignified occupation. 
 Murphy, the Mayo brothers, Halsted, Finney, 
 de Nancrede, and Gushing are only a few of our 
 countrymen who have played a prominent part 
 in the development of surgical technic. These 
 men, whether specialists or not, were in the first 
 instance general surgeons of great ability. What 
 is more, they combined a wide general knowledge 
 of pathology and diagnosis with their mechanical 
 and manual skill. 
 
 The technic and methods of surgery are to- 
 day things to admire and to wonder at. In the 
 hands of honest persons, the craft is certainly 
 one of humanity's most laudable boons. It is 
 only the prostitution of this honorable and use- 
 ful craft by an increasing horde of commercial- 
 ists and unprincipled pirates that is to be de- 
 plored. 
 
 The success of the distinguished surgeons just 
 mentioned stirred hordes of men of mediocre 
 
 [58] 
 
T. G. H. AND THE SUPER-DOC 
 
 talent to attempt their emulation. Unable to 
 master the wide field of knowledge covered so 
 ably by these protagonists, the imitators began 
 to specialize in the absurd manner of the physi- 
 cian-priests of the dynasties of the Pharaohs, 
 who confined themselves to the treatment and 
 butchery of strictly isolated organs or even went 
 so far as to concentrate their supposedly bene- 
 ficial manglings upon a single disease. What is 
 stiU more foolish, the rank and file of the would- 
 be wielders of the knife begin their speciaHzation 
 not after a comprehensive experience, but im- 
 mediately following the admittedly insufficient 
 four years in medical college and two or three 
 years of hospital service. Their ignorance makes 
 it impossible for them to take into account the 
 intimate physiological relations existing be- 
 tween different parts of the body. They seem to 
 be aware only of the appendix, or the gaU-blad- 
 der, or the tonsils, or the internal ear, or the tur- 
 binated bones of the nose. 
 
 Each looks upon the organ, for the slashing of 
 which he has developed a penchant, as his legiti- 
 mate prey. It is a secondary consideration 
 
 [59] 
 
OUR MEDICINE MEN 
 
 whether the part be healthy or plagued by a 
 malaise. These specialists are inspired with a 
 mania for indiscriminate incision. Sofne of them 
 seem to believe that the general extirpation of 
 certain appendages would result in an unheard- 
 of salubrity for the human race. The useful 
 services of superior men of the type of the Mayos 
 naturally brought a commensurate financial re- 
 ward. And it is this increase in the emolument 
 of deserving surgeons that has led to the unre- 
 strained absurdities and excesses of imbecility 
 which are perpetrated by the rank and file of the 
 wielders of the knife. 
 
 "Why slave as a general practitioner," argues 
 the medical student, "when I can become rich 
 and notorious by a wholesale removal of tonsils?" 
 This opportvmity for venality has inspired the 
 most daring and unheard-of excesses of commer- 
 cial brigandage, practised with the dignity and 
 unction and respectability that allows it to 
 flourish with hardly a word of protest. Opera- 
 tions are advised on the flimsiest evidence of 
 their necessity. Frequently they are performed 
 on healthy individuals. The case of a promi- 
 
 [60] 
 
T. G. H. AND THE SUPER-DOC 
 
 nent surgeon of New York comeS to mind. This 
 medico was visited by a college student who had 
 got into a hopeless mire of debt. The student's 
 father was rich, but was disinclined to settle the 
 obligations. The youth, therefore, in a fit of 
 inspiration, consulted the surgeon, demanding 
 that his appendix be removed, and advising that 
 a bill for forty thousand dollars be sent to his 
 parent. Half of this was to be the reward of the 
 surgeon; the remainder was to be used in pla- 
 cating the wolfish creditors of the student. The 
 surgeon readily agreed to the plan, performed 
 the operation, and sent in his statement. The 
 grateful father, happy that his son's hfe had been 
 saved, gladly sent the forty thousand dollars in 
 settlement of the bill. 
 
 This incident allows one to wonder whether the 
 gild of surgeons has advanced ethically and mor- 
 ally beyond the status of the quackish runagates 
 and bawds of the time of Clowes. These last 
 performed their unspeakable herniotomies, 
 pocketed their shilling, and remained in the gut- 
 ters of himianity, where they belonged. But 
 the surgeon just mentioned, not one whit less a 
 
 [61] 
 
OUR MEDICINE MEN 
 
 charlatan than the ancient horse-gelder, receives 
 Ms twenty thousand dollars, increases in mag- 
 nificence and dignity, and rises higher in the re- 
 gard of his colleagues and his chentele. 
 
 Another instructive example of astounding 
 ignorance, if not of downright knavery, is a re- 
 cent incident in a Middle Western city. Several 
 patients in the most pretentious hospital of the 
 town, who had just submitted to operations for 
 the removal of the appendix, suddenly developed 
 smallpox. Investigation disclosed that they had 
 visited their physicians, complaining of symp- 
 toms which were actually premonitory signs of 
 variola. The good doctors referred the cases to 
 a surgeon, who declared them to be suffering 
 from appendicitis. They were rushed to the hos- 
 pital and operated upon without delay, not, as it 
 turned out, because of a malaise of the useless 
 intestinal appendage, but actually for smallpox! 
 All of them recovered from this disease, and it 
 would not be surprising to find the perpetrator 
 of this piece of asininity solemnly advising the 
 operation as a new treatment of variola. 
 
 The absurdities of specialization are becoming 
 [62] 
 
T. G. H. AND THE SUPER-DOC 
 
 SO palpable that surgeons begin to look about 
 for some modification of their present status. 
 They reason that if medicine has become so com- 
 plicated and of so wide a range that an ordinary 
 individual can master only a small section of it, 
 the logical procedure would be the formation of 
 an association of men with different penchants, 
 who might cooperate in the removal of the or- 
 gans and in the resulting occasional relief of our 
 suffering citizens. They begin to realize, also, 
 that the time required to perfect the technic of 
 the operations leaves none for the study of the 
 art of diagnosis. They rightly argue that it 
 would be a step forward to perform their ex- 
 cisions upon persons, the exact nature of whose 
 illness had been determined. This would be 
 greatly perf erable to the widely existing present 
 practice of operating upon persons whose mala- 
 dies had been cheerfully guessed at, either by the 
 surgeon or by some satellite practitioner, with a 
 shrewd eye toward the splitting of the surgeon's 
 fee. 
 
 As a result of these sage cogitations, groups of 
 specialists begin to spring up in the land. This 
 
 [63] 
 
OUR MEDICINE MEN 
 
 group is essentially a business partnership of 
 specialist surgeons, who associate themselves 
 with an internist, or diagnostician. This last de- 
 termines the nature of the disease, and distributes 
 the patients, let us hope with impartiality, to 
 the various operators. The diagnostician sur- 
 roxmds himself, in turn, with a body of hench- 
 men, known collectively as "laboratory men." 
 In large groups there may be several of these 
 satellites, who are regarded a bit snifRshly by 
 their chief, the internist, and who are beneath 
 condescension by the surgeons. 
 
 The procedure then is roughly as follows : The 
 patient appears before the internist, to whom he 
 may have been referred as a last resort by some 
 practising physician. The sufferer is examined 
 thoroughly by the diagnostician, who causes an 
 array of chemical, pathological, bacteriological, 
 and radiographic procedures to be carried out by 
 his corps of laboratory workers. These tests are 
 important — and very expensive to the patient. 
 The resulting data are now correlated, if pos- 
 sible, with the findings of the physical diagnosis, 
 and out of this melange of facts, which are some- 
 
 [64] 
 
T. G. H. AND THE SUPER-DOC 
 
 times obscure and even contradictory, comes 
 some kind of determination of the client's 
 malady. The sufferer is then referred to the ap- 
 propriate surgeon of the group, who proceeds at 
 once to the operation. Fortunately for the busi- 
 ness affairs of the group, it is frequently neces- 
 sary to perform a series of operations upon pa- 
 tients, whom the various scientific tests show to 
 suffer from a comphcation of diseases. 
 
 The effect upon the purse of a person finding 
 it necessary to seek the ministrations of the group 
 is devastating in the extreme. All of the vari- 
 ous laboratory tests, the physical examination, 
 the anesthetic, the nurse, the operation, are care- 
 fully charged for on the itemized bill. Fre- 
 quently he emerges from the frying-pan of his 
 illness, his life doubtless saved by the laudable co- 
 operative efforts of this group of scientists, only 
 to step into the fire of a load of debt which is 
 almost insupportable. 
 
 The quarters occupied by these associations of 
 experts are the very antithesis of the untidy, 
 dusty, modest sanctum of the old-fashioned 
 "doc" of other days, so charmingly sketched by 
 
 [65] 
 
OUR MEDICINE MEN 
 
 Opie Read. "In this professional hut there was 
 only one window, the glass of which was dim with 
 dust blown from the road. The furnishings of 
 the office were less than modest. In one corner 
 a swayed bed threatened to fall, in another a 
 washstand stood epileptic on three legs. Nailed 
 against the wall was a protruding cabinet, giving 
 off sick-room memories. The village druggist, 
 compounder of essences of strange and peculiar 
 'yarbs,' might have bitter and pungent medi- 
 cines, but old doc, himself an extractor of wild 
 juices, had discovered the retching secret of the 
 swamp. To go into his office and come forth 
 with no sign of heaving was a confession of the 
 loss of smell. Sheep-shearing fills the nostrils 
 with a wooly dullness, but sheep shearers could 
 scent old doc as he drove along the road." 
 
 Not so the offices of the modern group of 
 specialists. Their suites of rooms are situated in 
 magnificent office buildings. Frequently edifices 
 of many stories are devoted to the housing of 
 collections of styhsh doctors. The central 
 waiting-room bears little suggestion of medical 
 affairs. It is fitted faultlessly in expensive and 
 
 [66] 
 
T. G. H. AND THE SUPER-DOC 
 
 luxurious antique furniture. It has that "sul 
 dued air of elegance and refinement" so niuc 
 sought after by those of our commercially sue 
 cessful Countrymen who wish to shed thei 
 pristine vulgarities. Its walls are hung wit] 
 portraits of famous medicos. Upon a centra 
 library table repose neatly arranged copies o 
 the better and more sober type of Ameridai 
 gazettes and there is a noticeable lack of thi 
 more vulgar type of periodical that diverts th 
 moments of waiting in even the best barbe: 
 shops. Around the walls are arrayed bookcases 
 garnished with fat medical tomes and with end 
 less ranks of bound volumes of medical periodi 
 cals. 
 
 The place is presided over by a businesslik( 
 yet discreetly sympathetic being, usually in i 
 uniform suggesting that of a nurse, who com 
 bines tl(e function of reception committee witl 
 that of telephone operator and maker of appoint 
 ments. The remainder of the suite, whicl 
 includes consultation- and examining-rooms 
 minor operating-room, laboratories, ateliers foi 
 radiography and photography, has the same ai 
 
 [67] 
 
OUR MEDICINE MEN 
 
 of scientific austerity, of efiiciency, elegance, 
 cleanliness, and expensiveness. Especially of 
 expensiveness. 
 
 It will be clear that the maintenance of an 
 institution of this type is only to be supported 
 at a formidable cost. The salaries of the staff 
 and of such lesser lights as dentists, laboratory 
 men, radiographers, nurses, technicians, bottle 
 washers, librarians, ofiice girls, telephone opera- 
 tors, char-women, add to the immense amount 
 necessary for rent and equipment. 
 
 What is more, the Olympians of the group 
 find it necessary to visit clinics in distant cities, 
 to go abroad at not infrequent intervals, to main- 
 tain automobiles of an elegance suitable to their 
 stations, to live in social milieu commensurate 
 with their dignity and intellect. All of these 
 things are necessary to the acquirement and 
 maintenance of that prestige which has become 
 an integral part of the character of the modern 
 physician. 
 
 From this it natiu-ally follows that the charges 
 i to the patient must be correspondingly enormous, 
 ; The business organization of the group is usually 
 
 [68] 
 
T. G. H. AND THE SUPER-DOC 
 
 conducted with a truly American efficiency, and 
 with an impersonahty and heartlessness so neces- 
 sary to all sound economic enterprises. For it 
 is this, in fact, that medicine is rapidly becom- 
 ing. The high fees obtainable by the expert 
 doctor have made medicine what it has seldom 
 been in the past — a paying business. This ma- 
 teriahstic element is essentially foreign to the 
 spirit of the true physician. Like the functions 
 of the educator and priest, that of the good 
 doctor has been one of self-abnegation, of de- 
 votion to ideals. These ideals, which are nec- 
 essary to a calling that should be altruistic 
 and partly religious in its nature, have been ; 
 rudely upset by the entry of economic enter- 
 prise. 
 
 It may be imagined that the services of these 
 expert super-docs are accessible only to persons 
 well endowed with worldly goods. The rank 
 and file of us must be content with the ministra- 
 tions of the more humble practising physician, 
 who becomes less and less the idealist of the old 
 days and, who represents now the mediocrity, 
 whose lack of ability or personality makes im- 
 
 [69] 
 
OUR MEDICINE MEN 
 
 possible his attainment to the dignity of the 
 specialist. In addition to the rich, the services 
 of the super-doc are available occasionally to the 
 very poor. These he attends as a teacher in a 
 hospital clinic. For the title of "clinical profes- 
 sor" is an important adjunct to prestige, and, by 
 the same token, a business asset. 
 
 The affluence of the specialist has of necessity 
 reacted badly upon the general practitioner, who 
 finds his more wealthy patients deserting him 
 for the medical experts. Hence, deprived of his 
 most important source of income, he is forced to 
 be less charitable to his less fortimate clients. 
 Accordingly, it is natural that the ancient and 
 praiseworthy spirit of altruism and economic 
 negligence is being swept altogether out of the 
 profession of medicine. 
 
 The inaccessibility of expert medical attention 
 to the middle classes has led to the demand for 
 the complete removal of the motive of gain from 
 medicine, by its socialization. The writer recalls 
 an eloquent plea for this step, made by a brilliant 
 and disinterested professor on the opening day 
 of the school year in an important medical col- 
 
 [70] 
 
T. G. H. AND THE SUPER-DOC 
 
 lege. The reception of his cogent arguments by 
 both students and faculty was anything but cor- 
 dial. The majority of the imdergraduates had 
 apparently never given the matter any consid- 
 eration whatever. The clinical professors, most 
 of them luxm-iating in outside incomes of an 
 agreeable corpulence, were manifestly unim- 
 pressed by the forceful appeal. It is highly 
 unlikely that any important step toward the 
 socialization of medicine will be made in America 
 for some time to come. Should certain foolishly 
 visionary and idealistic individuals attempt it, 
 the bitter opposition of the majority of physi- 
 cians, and especially the super-docs, may be 
 safely predicted. 
 
 The question remains whether this new aline- 
 ment of the medical profession results in an im- 
 provement of service commensurate with its in- 
 creased emolument. Certainly the refinements 
 in diagnosis, the blood counts, pathological tests, 
 metabolic studies, bacteriological examinations, 
 X-ray plates, afford facilities vmknown to the 
 physicians of the amnen regime. On the other 
 hand, the very presence of all of these aids leads 
 
 [71] 
 
OUR MEDICINE MEN 
 
 the modern physician more and more to neglect 
 the careful and essentially simple methods of 
 observation and physical examination so notably 
 developed by Laennec and Skoda, by Widal and 
 Osier. The more heavily the physician leans 
 upon the science of the study of disease, the more 
 he is likely to neglect facts that might be directly 
 and simply determined without an imposing and 
 confusing array of modern gimcracks. The 
 famous surgeon, de Nancrede, expressed these 
 thoughts succinctly when he exclaimed, in an 
 outburst of choler, "It is commerciahsm and 
 science that are ruining medicine." 
 
 [72] 
 
CHAPTER V 
 
 THE CUKE OF DISEASE 
 
 IT has been recognized for a long time that one 
 of the most serious errors in human mental 
 processes is the tendency to reason in the manner 
 of post hoc, propter hoc. Such reasoning as- 
 sumes that when two events occur simultaneously 
 or in sequence, one must necessarily be the cause 
 of the other. Such ratiocination is met with 
 every day. It is easy to cite numerous examples. 
 For instance, during one of the years of the 
 World War, America was visited by a great 
 many thunder-storms and a large amount of 
 rain. There was heavy bombardments in Eu- 
 rope, and it was concluded that these must be 
 the cause of our excessive rainfall. This funda- 
 mental error in thought ranks with credulity in 
 the perpetuation of medical mythology. It has 
 been of fundamental importance in the creation 
 
 [73] 
 
OUR MEDICINE MEN 
 
 of that bulky and absurb tome of officially recog- 
 nized drugs known to doctors as the "Pharma- 
 copoeia." It has given rise to myriads of quack- 
 eries less respectable than those practised by 
 oflScial medicine men from the beginning of time. 
 Its importance in the perpetuation of a notion 
 that a drug is efficacious can be shown by a sim- 
 ple example. Some nostrum is administered to 
 a person suffering, let us say, from a severe belly- 
 ache. Shortly after the drug has been applied, 
 the dolor vanishes. It is natural to conclude 
 that this amelioration has been brought about by 
 the remedy. But this is by no means necessarily 
 the case. Many other causes may have operated 
 to cure the sufferer of his grievous pain, and 
 when the nostrum is subsequently administered 
 to a hundred other individuals with a similar 
 number of annoying sensations in the abdominal 
 region they may possibly continue to writhe in 
 agony for many hours. This, however, does not 
 matter in its consideration as an effective remedy. 
 One physician, or one old yarb-mongering crone, 
 or one quacksalver, has at one time observed the 
 ache to disappear shortly after this drug was 
 
 [74] 
 
THE CURE OF DISEASE 
 
 administered. And this suffices to incorporate 
 it in the. variegated and amusing therapeutic 
 folk-lore for hundreds of years. 
 
 Tm-ning to Garrison's history of medicine, 
 one may find many amusing examples of the 
 absurdities, not to say criminaUties, to which this 
 spurious logic has given rise. Some of these 
 imbecihties, such as blood-letting, persisted 
 throughout ages of time. Hippocrates, several 
 hvmdred years before Christ, performed this 
 operation in the belief that he was removing the 
 evil humors which he believed to be the cause 
 of disease. This nonsense was subsequently 
 practised by physicians, on an always increasing 
 number of ailments, for better than two thou- 
 sand years. Sydenham, a famous English phy- 
 sician, applied this therapy, to some extent, in 
 all of the diseases that he treated. Now, Syden- 
 ham ranks high in the regard of modern physi- 
 cians, who almost imiversally venerate his mem- 
 ory. He is alluded to by medical historians as 
 one of the greatest physicians of all time. Yet 
 he completely lacked the critical spirit that would 
 have caused him to inquire into the soundness 
 
 [76] 
 
OUR MEDICINE MEN 
 
 of the practice of blood-letting. This famous 
 medico entertained many other absurd beliefs as 
 to the efficacy of various other therapeutic pro- 
 cedures. It is, therefore, difficult to discover 
 just what constitutes his greatness, and why he 
 is so venerated by physicians of the present day. 
 Surely not because he had even a trace of the 
 spirit of science, nor because he battled against 
 the error of post hoc, propter hoc. 
 
 The excesses of blood-letting reached heights 
 of absurdity that would cause great merriment 
 to present-day readers, were it not for the fact 
 that this practice has undoubtedly kiUed thou- 
 sands of people who might otherwise have led 
 long and possibly valuable existences. The 
 blood was removed either by the operation of 
 venesection or by the application of leeches. 
 The traffic in these beasts reached stupendous 
 proportions; in one year of the eighteenth cen- 
 tury millions of leeches were imported into 
 France. The persistence of doctors in this 
 foolish procedure is one of the most admirable 
 indices of their progressive, alert, and open- 
 minded spirit. It was undoubtedly due in the 
 
 [76] 
 
THE CURE OF DISEASE 
 
 first place to their credulity, Hippocrates, 
 Galen, and other great physicians had advised 
 their followers of its beneficial effects. Ergo, it 
 must be valuable. Again, it was believed to be 
 of merit for the reason that patients were fre- 
 quently observed to get well after large amoimts 
 of their blood had been removed. It seems never 
 to have entered the heads of even the most 
 learned of healers that the sufferers might have 
 recovered even more rapidly if nothing whatever 
 had been done to them. It is curious, too, that 
 when patients succumbed after this operation 
 they were invariably said by their medical at- 
 tendants to have died despite the application of 
 numerous leeches. 
 
 This ancient and important therapeutic pro- 
 cedure was finally exploded by the Frenchman 
 Louis. Like Harvey, Louis was one of those 
 strange exceptions to the general numskullry 
 that has apparently afflicted the medical cult 
 from time immemorial. For some mysterious 
 reason, he possessed the intelligence to question 
 the value of this universally lauded treatment. 
 He kept accurate coimt of the mortality rate in 
 
 [77] 
 
OUR MEDICINE MEN 
 
 cases of pneumonia which had been treated by 
 bleeding, and in those that were not subjected to 
 this operation. His statistics showed that blood- 
 letting had no appreciable beneficial effect. On 
 the contrary, his carefully compiled data showed 
 that it was actually harmful. 
 
 Many therapies even more bizarre, if not so 
 harmful as this one, received official approbation 
 of medicos for many centuries. The writer 
 knows of no better hvmiorous literature than that 
 to be found in the "Enghsh Pharmacopoeia" of 
 the seventeenth century. One discovers, in this 
 solemn and pretentious volume, that the lungs of 
 foxes are very beneficial to people suffering from 
 asthma. Vigo's Plaster, fabricated from viper's 
 flesh, mixed with live frogs and worms, has a 
 marked therapeutic action on many ailments. 
 Moss from the skull of a victim of violent death 
 is considered by the book to be a meritorious 
 remedy. Human sweat, urine, and the saliva of 
 a fasting man are alleged to possess important 
 healing properties. The annoyances and harass- 
 ments of dysentery are asserted to succumb to 
 
 [78] 
 
THE CURE OF DISEASE 
 
 the ingestion of cat-ointment and oil of puppies, 
 boiled with earthworms. 
 
 Happy to relate, these disgusting stews are 
 no longer recommended in the official handbook 
 of materia medica. They went out of fashion 
 probably for the reason that the growing prud- 
 ery and advances in the estheticism of clients 
 tabooed them. Surely not because physicians 
 proved that their use was not beneficial. None 
 the less, their removal from official sanction is 
 always alluded to by doctors as a great step for- 
 ward in medical "science." They apparently 
 consider that the substitution of myriads of 
 chemical compounds for these wonderful stews 
 is evidence of scientific advance, although it can 
 be safely asserted that only fifteen to twenty 
 groups of drugs in the entire pharmacopoeia are 
 of any perceptible merit. And the majority of 
 these alleviate symptoms, rather than cure dis- 
 ease. 
 
 In the old days, it was the practice of doctors 
 to administer enormous doses of every kind of 
 drug to their imfortunate patients. The latter 
 
 [79] 
 
OUR MEDICINE MEN 
 
 were purged until they were shadows of their 
 former robust selves. Their agonies from the 
 ingestion of copious drafts of emetics surpassed 
 those of the worst sufferings of mal de mer. The 
 gradual reduction of this generous dosage is 
 often ascribed to the teachings of Hahnemann, 
 the father of the homeopathic cult. This credit 
 is frequently accorded to him, even by highly 
 educated physicians, who otherwise sniff at and 
 detest the doctrines of homeopathy. They ad- 
 mit, with an air of broad tolerance, that while the 
 ideas of Hahnemann are immitigated buncombe, 
 still, his notions of the value of minute doses had 
 a beneficent effect upon the scandalous thera- 
 peutic excesses of the accredited physicians of 
 that time. 
 
 It is now admitted by every one of any intelli- 
 gence whatever that the homeopathic doctrines 
 are perfect examples of medieval scholastic flap- 
 dooldle. The value of homeopathic treatment 
 lay in the fact that when patients were given 
 "infinitely diluted" drugs, they were actually 
 given nothing at all. And so nature was allowed 
 to work its own curative effects, without inter- 
 
 [80] 
 
THE CURE OF DISEASE 
 
 ference from the idiotic emetics, or purges to the 
 point of death, that were so greatly rehed upon 
 hy the so-called allopathic physicians. 
 
 It is possible that Hahnemann's absurd doc- 
 trines may have had some importance in the 
 gradual amelioration of the ancient therapeutic 
 asininities of the medical profession. On the 
 other hand, it is likely that the common sense of 
 rare individuals like Louis, and the disregard of 
 drugging by great diagnosticians of the type of 
 Skoda, were more important in the reform. 
 Skoda, a Czechish physician, residing in Vienna, 
 flourished in the first half of the nineteenth cen- 
 tury. His delight was in diagnosis, that is to 
 say, in finding out what ailed his patients. In 
 this art he was a master of the rank of Laennec. 
 But he manifested utter disdain for any kind of 
 healing balsam. The moment he had ascertained 
 the nature of the malady, his interest in the 
 patient abated, and when asked by his underlings 
 to give directions for treatment, he would re- 
 mark brusquely that that made no difference 
 whatever. To him one drug was as good, or as 
 useless, as another. 
 
 [81] 
 
OUR MEDICINE MEN 
 
 This contempt of drugging is called "thera- 
 peutic nihilism" by medical savants. It is still 
 very generally frowned upon by the majority of 
 physicians. In reality, in the hght of what is 
 actually knovm of the curative action of drugs, 
 the nihilists are more nearly right than the in- 
 continent prescribers of herb and clysters. For 
 with the exception of a very few compounds that 
 soothe pain or amehorate symptoms, the entire 
 pharmacopoeia and the whole literature of fa- 
 vorite prescriptions might be consigned to limbo 
 without any effect upon the salubrity of the 
 himian race. 
 
 Despite this fact, our nation is plagued with 
 the existence of large and prosperous drug fac- 
 tories which pretend to be concerned only with 
 the preparation of remedies officially recom- 
 mended by physicians. It is true that these com- 
 mercial organizations perform some service of 
 value in the preparation of drugs such as quinine 
 or digitalis and in the manufacture of biological 
 products like diphtheria antitoxin. On the other 
 hand, a large part of their effort is directed 
 toward the elaboration of nostrums which they 
 
 [82] 
 
THE CURE OF DISEASE 
 
 advertise assiduously, and with which they add 
 to the state of confusion in which physicians 
 already exist in regard to the cure of disease. 
 The American Medical Association attempts 
 to check this torrent of new nostrums. Its 
 council on pharmacy and chemistry conducts a 
 laboratory which examines into the validity of 
 the new preparations. The ones which pass the 
 tests are placed in a sort of appendix to the 
 already hopelessly corpulent "pharmacopoeia." 
 This minor volume is called "New and Non- 
 official Remedies," and is, in reality, a collection 
 of respectable patent medicines. Despite the 
 inhibiting influence of the council, these new 
 concoctions, possessing, it is true, a merit su- 
 perior to Peruna or the ancient oil of puppies, 
 produce an endless unnecessary reduplication of 
 drugs, and only thicken the fogs in which doctors 
 are now groping aimlessly. 
 
 After all, it may be well that this endless 
 drugging be permitted to continue. It may be 
 best that physicians and their clients remain in 
 ignorance of the fallacy of post hoc, propter hoc. 
 For it is a commonplace of observation among 
 
 [83] 
 
OUR MEDICINE MEN 
 
 doctors, some of whom may even be aware of the 
 essential ineffectiveness of most remedies, that 
 patients in general demand the administration of 
 colored liquids or bitter herbs. Any honest ad- 
 mission of impotence in the face of a malady or 
 of skepticism as to the efficacy of drugs would at 
 once lower the medico in the esteem of his 
 clientele. In a word, the majority of physicians 
 believe that they cannot afford to be honest, and 
 in this connection they are indubitably right. 
 For no citizen would be so foolish as to reward 
 a physician with hard-earned gold if he really 
 knew that it was nature that had cured him and 
 that the doctor had been merely a sympathetic 
 onlooker. 
 
 What is more, it has been argued in a preced- 
 ing dissertation that the mere presence of a 
 sympathetic and optimistic physician is of great 
 value to the morale and fighting spirit of the 
 sufferer. And, consequently, if the afflicted one 
 demands that the physician's attendance be ac- 
 companied by the prescription of some nauseous 
 concoction, it is best that this gorgeous hocus- 
 pocus be perpetuated. Hence it must be clearly 
 
 [84] 
 
THE CURE OF DISEASE 
 
 understood that this discussion is in no sense a 
 propaganda for the abandonment of these bogus 
 herbs and simples. It is merely its intention to 
 point out their essentially spurious nature. If it 
 is healthy for our countrymen to be hoaxed, by 
 aU means let the befuddlement go on. At the 
 same time, great respect is due to the honest 
 physicians, always few in number, who war 
 against such quackery by attempting to convince 
 their patients that the battle is really between 
 the body and the disease, and that the aid the 
 doctor gives is to a large extent spiritual. 
 
 The conviction of the majority of persons that 
 even the most ephemeral and innocuous of their 
 aches and pains require active intervention has 
 given rise to elaborate organization of quackery 
 outside the medical profession. This is espe- 
 cially true in America. For our citizens, in ad- 
 dition to being the most gullible of peoples, are 
 also undoubtedly more addicted to hypo- 
 chondrias than are the populations of the ma- 
 jority of European countries. 
 
 Two of the most amusing of these unofficial 
 charlatanisms are those of chiropractic and 
 
 [85] 
 
OUR MEDICINE MEN 
 
 osteopathy. They increase daily in wealth and 
 importance. Their practitioners are allowed to 
 assume the title of doctor. Their theories fly in 
 the face of the fimdamental knowledge that has 
 been gleaned from the study of disease in the last 
 fifty years. Chiropractors, for example, flout 
 the idea that illness may be caused by microbes. 
 They insist that our malaises are, one and aU, 
 due to the pressure of misplaced vertebree on the 
 nerve trunks leaving the spinal column. To cor- 
 rect such dislocations the athletic chiropractor 
 subjects his victim to appalling buffets and 
 maulings. And, since people beheve that the 
 more vigorous the intervention the more certain 
 the therapeutic result, the chiropractor grows in 
 dignity and affluence. The complete imbecUity of 
 doctrines of chiropraxis has no effect whatever 
 upon their popularity. John Smith, who suf- 
 fered from some inconsequential ache, consults 
 the eminent D. C, is terribly thimiped and 
 banged, presently feels better, and logically 
 ascribes his improvement to the rough treatment 
 he has received. And, just as in the case of the 
 M. D., with his tinted water, these rude buffet- 
 
 [86] 
 
THE CURE OF DISEASE 
 
 ings may have had an indirect beneficial effect 
 by aiding the mysterious and altogether obscure 
 power of mind over body. Of this last, science 
 knows nothing. But it apparently exists and is 
 certainly of importance in the battle of the or- 
 ganism against its derangements. 
 
 Accordingly the accredited physician with his 
 syringes and innocuous remedies, the osteopaths 
 and chiropractors with their Dempseyish "rough 
 house," the psychoanalysts with their Freudian 
 gibberish, one and all play some part in the fight 
 against disease. But it is important to remem- 
 ber that nine-tenths of the good they do is accom- 
 plished by a mechanism entirely foreign to their 
 absurd beliefs and windy theories. And, while 
 all of these cults have a modicum of value in 
 certain cases, they also do a great amount of 
 harm. They effect this damage by diverting 
 people from access to a really rational and 
 effective treatment of the small number of dis- 
 eases that can be handled rationally and effec- 
 tively. Thus the chiropractor who treats the 
 child suffering from diphtheria by adjusting its 
 vertebrse prevents the administration of the 
 
 [87] 
 
OUR MEDICINE MEN 
 
 antitoxin which might really have saved its life. 
 The osteopath who ignorantly massages the 
 person suffering from mastoiditis prevents the 
 saving of the life of the patient that the knife of 
 the skilled otologist might accomplish. And 
 the psychoanalyst who, ascribing a persistent 
 and severe belly-ache to a neurosis resulting 
 from a harmful sexual experience in childhood, 
 endeavors to cure it by idiotic Freudian ques- 
 tionings prevents the necessary operation for 
 appendicitis that might actually have removed 
 the cause of the pain. 
 
 To sum up, aU of the cults which flourish 
 among us, faith-healers. Christian Scientists, 
 psychoanalysts, osteopaths, chiropractors, the 
 Corrective Eating Society, exploiters of Man's 
 Divine Inheritance, occasionally may, like the 
 wandering lithotomists and apple-squires of old, 
 accomplish some indirect good. But their merit 
 is enormously exaggerated by our citizens. 
 These charlatans are sniffed at by authentic doc- 
 tors. But it is true that the latter are the in- 
 habitants of glass bungalows, and should have 
 a care in which direction they hurl their destruc- 
 
 [88] 
 
THE CURE OF DISEASE 
 
 tive dornicks. For, in reality, they accomplish 
 the majority of their good in much the same way 
 as the Camorra of quacks and fakers just men- 
 tioned and are only slightly in advance of them 
 in knowledge and ability. This becomes appar- 
 ent to any one willing to tear off the cloak of 
 sacerdotal dignity that the medico almost in- 
 variably wears. 
 
 The mysterious power of mind over body has 
 recently been subjected to a great deal of pre- 
 tentious pseudo-scientific analysis by Europeans, 
 Freud and Jung. Freud, using the methods of 
 psychoanalysis invented by Kraepehn, has pro- 
 pounded windy theories on the nature of hys- 
 teria. These can be nothing but incomprehen- 
 sible twaddle to any one who demands that a 
 generalization rest upon accurately gleaned 
 quantitative data. Yet the doctrines have been 
 eagerly taken up by some physicians alleged to 
 be experts on insanity, and have been widely 
 applauded by many of the intellectuals of 
 America. On the surface, it would seem as- 
 toimding that persons supposed to be brainy 
 should enthusiastically subscribe to this pompous 
 
 [89] 
 
OUR MEDICINE MEN 
 
 nonsense. In reality, its popularity must be due 
 to the importance ascribed by the theory to 
 sexual experiences. One of the most prominent 
 manifestations of American intellectualism is the 
 revolt against the conspiracy of silence in regard 
 to sex that characterized the Victorian period. 
 Intellectuals have reacted with violence against 
 these largely laudable conventions and pruderies 
 which have helped to keep such questions prop- 
 erly romantic and mysterious. They insist upon 
 dragging such subjects into the open. They 
 give everything a sexual basis and sexual impli- 
 cation. The champions of Freud gravely an- 
 nounce themselves to be psychologists, though 
 they know nothing of the quantitative science on 
 which the small body of really valuable experi- 
 mental science actually rests. They confidently 
 apply their theories to those obscure problems of 
 mental derangement which will certainly be the 
 last to be solved by the slow systematic attack 
 of the genuine science of the study of disease. 
 Aside from the grain of truth contained in the 
 ideas of Freud, the contributions to exact knowl- 
 edge made by the promulgators of the Freudian 
 
 [90] 
 
THE CURE OF DISEASE 
 
 cult are virtually nil. And the small amount of 
 fact upon which the doctrine rests has doubtless 
 been known for many years to alienists or even 
 ordinary physicians who possessed common 
 sense and an imderstanding of human nature. 
 
 Up to the time of the investigations of Pas- 
 teur, malaria and syphilis were the two diseases 
 definitely amenable to curative agents. Mer- 
 cury in its various forms was known to have a 
 profound effect upon the manifestations of 
 syphilis. Quinine, the active principle of 
 Peruvian bark, had an undoubted curative action 
 on some kinds of malaria. The treatment of 
 malaria by quinine, though taken up by physi- 
 cians, was in reahty no discovery of theirs. It 
 had been known to be valuable for centuries by 
 South American Indians. Both of these 
 therapies, indeed, rested upon empirical popular 
 experience and were a part of the ancient folk- 
 lore of the people. No ciu-e resting upon the 
 firm basis of the study of disease can be said to 
 have existed before the time of Pasteur and his 
 immediate followers. Following his discoveries, 
 a way to the cure of certain diseases had been 
 
 [91] 
 
OUR MEDICINE MEN 
 
 opened by the investigations of Roux and Yersin 
 and of von Behring and Kitasato. The French- 
 man discovered that the microbe of diphtheria, 
 grown in pure culture, secreted a poison, which, 
 when injected into animals, produced effects 
 analogous to those seen in human cases of the dis- 
 ease. Following this, von Behring and Kitasato 
 demonstrated that animals might be immunized 
 to this poison. They began by injecting minute, 
 non-fatal doses, and were able gradually to in- 
 crease the amount of the harmful substances until, 
 some weeks after the first injection, hundreds of 
 fatal doses could be tolerated by animals immu- 
 nized in this way. They then proved that the 
 immune animals owed their resistance to the 
 presence in their circulating blood of a poison- 
 neutraUzing principle. It was further shown 
 that the blood of such immvme animals could 
 render the poisoji harmless when the two were 
 mixed in a test-tube. 
 
 These investigators, believing that the evil 
 effects observed in human diphtheria were due 
 to the poison, reasoned that they should be able 
 to combat the disease by the injection of the 
 
 [92] 
 
THE CURE OF DISEASE 
 
 blood serum of an inimunized animal. They 
 gave the name of "antitoxin" to this immxme 
 serimi. Their predictions were brilliantly vindi- 
 cated, and it is now known that the mortality 
 in diphtheria has been greatly decreased by the 
 timely injection of antitoxic serum. Here is a 
 definite instance of the conquest of a terrible 
 disease. The terrors of the malady were re- 
 moved, purely as a result of experiments upon 
 animals in the laboratory. Great hopes for the 
 extension of this work to many other infections 
 were dashed by the discovery that the majority 
 of harmful microbes apparently do not secrete 
 soluble poisons of this nature. Up to the pres- 
 ent, antitoxins seem to be therapeutically effec- 
 tive only in diphtheria and in some forms of 
 dysentery, and prophylacticaUy valuable in 
 tetanus. 
 
 Efforts were made to obtain immune serums 
 which might depend for their curative effect 
 upon principles active against the microbe itself, 
 rather than against its poisonous products. 
 Some success has attended these efforts, which 
 were indefatigably carried on by large numbers 
 
 [93] 
 
OUR MEDICINE MEN 
 
 of investigators. A serum very effective against 
 bubonic plague has been prepared by Yersin. 
 One of marked curative action upon cerebro- 
 spinal meningitis has been elaborated by Joch- 
 mann and Kruse in Europe, and later by Flex- 
 ner and Jobling in America. More recently a 
 certain type of pneumonia has been treated with 
 some apparent success by the use of an immune 
 serum. There are, in addition, suggestive indi- 
 cations that infectious jaundice and yellow fever 
 may be treated successfully by the same pro- 
 cedure. 
 
 It is true that while the treatment of these 
 diseases with specific immune serums was based 
 upon preliminary animal experiments, at the 
 same time the value of all of these remedies is 
 not proved with the striking conclusiveness of 
 that of diphtheria. This is due to the employ- 
 ment of statistical rather than experimental 
 methods in the study of the effect of these serimis 
 upon human cases of the disease. This method 
 of obtaining exact information, while sometimes 
 of value, is open to many serious objections, 
 especially when the immime serum is not suffi- 
 
 [94] 
 
THE CURE OF DISEASE 
 
 ciently active to reduce the mortality from a 
 disease virtually to zero. In order to be certain 
 of the value of one of these remedial agents it is 
 necessary to resort to experimental methods of 
 the type described in the third chapter. That 
 is to say, rather than depend upon the apparent 
 reduction of mortality from a higher to a lower 
 rate following a given treatment, it would be 
 wiser to divide all available cases into two parts, 
 treating one group and leaving the other to serve 
 as a control, or check. Accuracy demands this 
 procedure for several reasons. One of these is 
 easy to illustrate. The mortahty rate in a series 
 of pneumonia cases might be 30 per cent, when 
 they are subjected to ordinary treatment. It 
 might be found that the rate in a series of cases 
 injected with serum was as low as 10 per cent. 
 From this, it is the custom, especially in Ameri- 
 can medicine, to conclude that the serum had 
 effected an actual decrease in mortahty. This 
 conclusion is in reahty not justified, since the 
 two series of cases either are occurring at differ- 
 ent times or are subjected to varying degrees of 
 general care. It is possible, then, that the mor- 
 
 [96] 
 
OUR MEDICINE MEN 
 
 tality from the second series of cases would have 
 been 10 pef cent., and not 30, even if no serum 
 had been injected. 
 
 It has been pointed out that the application 
 of the experimental method to human cases is 
 httle practised in America, for two reasons. 
 First because the training even of so-called 
 scientific physicians does not demand the rigor- 
 ous accuracy of carefully controlled experiments. 
 Again, a popular hue and cry would certainly be 
 raised against hospitals known to withhold a 
 treatment from patients who might possibly be 
 cured by it. As one great American physician 
 remarked, it would not be justifiable to withhold 
 from any patient a remedy that might be benefi- 
 cial and so save his life. But here, to speak 
 colloquially, is the catch. It is, in the first place, 
 necessary accurately to determine whether or not 
 it is beneficial. For this the experimental 
 method is demanded. This sentimentahsm is 
 short-sighted and foolish, and should be more 
 vigorously combated by physicians, especially 
 those who have pretensions to science. For ac- 
 curate knowledge, based upon quantitative ex- 
 
 [96] 
 
THE CURE OF DISEASE 
 
 perimental data, will be of greater benefit to 
 humanity in the long run than will the muddled 
 ideas that arise from the sentimentality and 
 tender-heartedness of the present quasi- scientific 
 studies. 
 
 When it was discovered that many infectious 
 diseases were not amenable to treatment by 
 serums, scientists in the study of disease cast 
 about for new methods of conquering the enemy. 
 This brought about a curious recrudescence of 
 the ideas of Aureolus Theophrastus Bombastus 
 VOH Hohenheim, who is better but less euphoni- 
 ously known as Paracelsus. This interesting 
 figure of the sixteenth century, part quack and 
 noisy charlatan but with some of the laudable 
 uncompromising iconoclasm of Servetus, as- 
 serted that the purpose of chemistry was the 
 discovery and elaboration of substances that 
 might cure disease. So little was known of dis- 
 ease at that time that his demands went unsatis- 
 fied for himdreds of years. But when the nature 
 of infectious disease began to be elucidated by 
 Pasteur and his followers, a figure arose, in many 
 ways a sort of refined Paracelsus, who renewed 
 
 [97] 
 
OUR MEDICINE MEN 
 
 the demands of the latter. This investigator, 
 named Ehrlich, partly succeeded where his pre- 
 decessor had failed. Ehrlich, who was an 
 enmiciator of largely empty theories and a coiner 
 of pompous names and phrases, at least had the 
 merit of being, in addition, an indefatigable 
 experimenter. 
 
 At the time of the inception of his experi- 
 ments, it was known that many substances such 
 as carbolic acid, corrosive sublimate, formalde- 
 hyde, were destructive to microbic life. But it 
 was impossible to administer these internally in 
 microbic diseases, because they were harmful to 
 the body as well as to the invading germ. 
 EhrMch, realizing this, proceeded to set out in 
 search of drugs which might be comparatively 
 innocuous to the human or animal organism, but 
 might, at the same time, be able to deal fatal 
 blows to disease-producing germs. Following 
 a lead furnished by the work of Breinl and 
 Thomas concerning the effect of an organic 
 compound of arsenic, called "atoxyl," upon 
 trypanosomes, Ehrlich caused numerous variants 
 
 [98] 
 
THE CURE OF DISEASE 
 
 of this drug to be synthesized by chemists. These 
 were then tested, seriatim, upon certain infec- 
 tions caused by trypanosomes and spirochetes. 
 These experiments were, of course, conducted 
 upon laboratory animals. Remarkable results 
 were obtained with some of these drugs, and 
 notably with salvarsan, or 606, now patriotically 
 called "arsphenamin" in America. This drug 
 has a strong therapeutic effect upon syphihs, 
 probably occasionally bringing about its cure. 
 Its action upon the tropical disease of yaws is 
 stiU more devastating. It is furthermore of 
 great value in recurrent fever. 
 
 This branch of the study of disease is called 
 "chemotherapy" and has attracted the efforts 
 of many workers during the last ten years. But 
 aside from the first results of Ehrlich, the num- 
 ber of valuable drugs discovered by this neo- 
 Paracelsianism has been very small up to the 
 present, despite the expenditure of a vast amount 
 of time and great sums of money. This is pos- 
 sibly due to the fact that these labors are pursued 
 almost exclusively by the methods of trial and 
 
 [99] 
 
OUR MEDICINE MEN 
 
 error. They are not so much examples of science 
 as of the activities of our greatly respected and 
 romantic Wizard of Menlo Park in his world- 
 wide search for a material suitable for the fabri- 
 cation of phonograph needles. 
 
 On the other hand, it is certainly possible that 
 curative agents for important microbic diseases 
 will be discovered, even by the expensive method 
 of cut-and-try. The spirit of chemo-therapy is 
 laudable at least to the extent of its insistence 
 upon rigorous animal experimentation. This is 
 a vast improvement over the confused and al- 
 most totally useless balderdash of the old materia 
 medica. 
 
 Medical men can have little part in such ac- 
 tivities. The complex compounds now being in- 
 vestigated require expert chemists for their 
 synthesis. These have then to be tested by the 
 student of disease in the laboratory, who is not 
 in such a continual emotional state of enthusiasm 
 for the recovery of his experimental animals as 
 the physician necessarily must be for that of his 
 patients. When the chemist and the student of 
 disease have obtained suggestive and promising 
 
 [100] 
 
THE CURE OF DISEASE 
 
 results, it is for the physician to attempt their 
 generahzation to human infections. In this 
 attempt he is, of course, a technologist, not a 
 scientist. 
 
 [101] 
 
CHAPTER VI 
 
 PILLS MAKE WAY FOR PREVENTION 
 
 THE purpose of the medical profession is 
 said to be the cure of disease and the pre- 
 vention of its occurrence. It is possible in 
 America, as well as elsewhere, to detect a grow- 
 ing air of sniflBshness toward the pound of cure, 
 together with an increased regard for the ounce 
 of prevention. This is true of progressive phy- 
 sicians and advanced thinkers generally. The 
 present vogue of preventive medicine is chiefly 
 a product of the humanism that has resulted 
 from the advance of physical science and the de- 
 cline of Christianity. Modernism tends to put 
 aside the worship of deity and to substitute for 
 rehgion a supreme arrogance, a confidence that 
 mankind can look out very well for itself and 
 that it has no need of the chaperonage of mystical 
 higher beings. Great publicists of the type of 
 
 [102] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 Wells have set forth eloquently the blasphemous 
 ambitions that the possession of the new weapon 
 of science has raised in the breast of the highest 
 simian. 
 
 The same tone of defiance in the face of the 
 inscrutable terrors and the evident limitations 
 besetting all living things is to be heard in the 
 voices of hygienists and preachers of public 
 health. It is implicit in the later researches of 
 Metschnikoff, who boldly demanded the exten- 
 sion of our bibhcally allotted three score years 
 and ten. It is to be discovered in the ringing 
 appeals of pubhc health orators of the type of 
 V. C. Vaughan. According to perorations of 
 this kind, the purpose of the science of the study 
 of disease is not academic but always utilitarian. 
 Its aim is the conquest of maladies that have 
 terrified man from the beginning of time. It 
 proposes to lengthen the insufficient span of 
 years now accorded to us. It hopes to bring about 
 the production of a new race of healthy, efficient, 
 happy, and upstanding men. Scientists in the 
 study of disease are represented not to be ani- 
 mated by intellectual curiosity, but are supposed 
 
 [103] 
 
OUR MEDICINE MEN 
 
 rather to be driven to their labors by a deep love 
 for suffering mankind. This humanitarian spirit 
 is not confined to the bacteriologist, chemist, 
 epidemiologist, and engineer of the health army, 
 but is ascribed, by some dextrous twist of rhet- 
 oric, to the medical profession as a whole. It is 
 here that the pretensions of the guild rise to the 
 highest pitch of fatuity. For the medical pro- 
 fession is said by certain public health orators to 
 be the only one that works constantly, by its ef- 
 forts in disease prevention, to remove the neces- 
 sity for its own existence! 
 
 There can be no doubt that preventive medi- 
 cine holds out the promise of the conquest of 
 disease. The mortality rate from tuberculosis 
 and typhoid, from yellow fever and Asiatic 
 cholera is being reduced noticeably in many 
 countries by the enthusiastic and untiring efforts 
 of hygienists. The mean length of life is alleged 
 to have been materially extended. Given a little 
 more knowledge, a few more public health ofii- 
 cers, a more efficient hygienic gendarmerie, a 
 slightly more intelligent and docile citizenry, and 
 there is no reason why any one should die from 
 
 [104] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 an infectious disease nor will any obstacle remain 
 in the path of a grand, unparalleled, gorgeous, 
 and stupendous proliferation of .the human race. 
 
 So intimate the shouters for public health. It 
 will be our task in the pages that follow to in- 
 quire whether such an event is desirable, and if 
 so, to find out in whose hands the abolition of 
 disease should be placed. 
 
 Is the widespread and unrestrained practice 
 of preventive medicine desirable? Serious ob- 
 jections arise that would indicate that it is not. 
 The writer brings these forward with consider- 
 able trepidation, reahzing that he will be de- 
 nounced as immoral, unethical, and antisocial by 
 all forward-looking citizens. But the objections 
 are valid and important and had best be faced 
 now, rather than when the evils that they point 
 out wiU have become irremediable. It is best to 
 follow the advice of Huxley, who remarked that 
 "there is no alleyiation of the sufferings of man- 
 kind except veracity of thought and action and 
 the resolute facing of the world as it is, when the 
 garment of make-believe by which pious hands 
 have hidden its uglier features is stripped off." 
 
 [106] 
 
OUR MEDICINE MEN 
 
 The first objection to the continuance of the 
 campaign of disease prevention is concerned with 
 the question of the population of the earth. This 
 has been increasing during past centuries at an 
 astounding rate. Hygienists admit that their 
 fight is aL*eady saving countless thousands of 
 babies and adults who would otherwise die. 
 Each new conquest of disease is heralded with 
 joy and thanksgiving. Each new advance re- 
 sults in donations of further sinews for the war 
 against disease. Additional progress may be 
 looked for in the near future with a resulting 
 augmented rate of increase of a population that 
 is already too dense for comfort. The twin 
 demons of famine and pestilence have been 
 visuahzed as the eternal regulators of the amount 
 of population on the earth's surface. These 
 ogres, whose activities are in the long run benefi- 
 cent, are now sorely beset by socialism on the 
 one hand, and by preventive medicine on the 
 other. 
 
 Humanitarians deprecate the bogy of over- 
 population and hold that collateral advances in 
 the production of the prime necessities of life 
 
 [106] 
 
PILLS MAXE WAY FOR PREVENTION 
 
 will keep pace with the lawless and rapid increase 
 of the genus homo. But there is a limit to raw 
 materials and a maximimi rate of production. 
 It is entirely conceivable that the present aug- 
 mentation of inhabitants may surpass those 
 limits. In consequence, it is only a question of 
 time before there will be great difficulty in sup- 
 plying the necessities of all. What is more, the 
 inordinate and rabbit-like fecimdity of humanity 
 results in other grave evils. The first is that of 
 war. Socialists, pacifists, and hmnanitarians 
 generally would do well to turn from their de- 
 nimciations of emperors, capitalists, and secret 
 diplomacy to an examination of this question. 
 Nations hke the Central Empires hterally burst 
 their bounds because of lusty, constantly growing 
 populations. No arms congresses, no florid ges- 
 tures by Mr. Harding or other great statesmen, 
 no mawkish pretension to human brotherhood 
 can prevail against the overflowing of such ex- 
 cessively philoprogenitive nations. It might be 
 objected that war automatically restrains over- 
 growth. This is not the case, for accurate sta- 
 tistical investigation shows that it does not kill 
 
 [107] 
 
OUR MEDICINE MEN 
 
 enough people to counterbalance the always more 
 densely swarming humanity. Again war, as at 
 present practised, is very objectionable. It is an 
 instigator of Bolshevism, which has frightened 
 the better class of our citizens to the verge of 
 insanity and threatens all of the organizations 
 and institutions that we prize most highly. 
 
 Another evil of overpopulation is the alarming 
 growth of the great municipal agglomerations. 
 As the number of our inhabitants increases, httle 
 dispersion over the land is to be observed. On 
 the contrary, the rural population shows a rela- 
 tive decrease, and the incessant human aggluti- 
 nation into stinking and tawdry cities goes on 
 unrestrained. It is toward the perpetuation of 
 these sweating multitudinous groups that pre- 
 ventive medicine directs its most vigorous efforts. 
 
 It has been remarked that humanitarians and 
 socialists advocate changes in the system of dis- 
 tribution and increase in production to offset the 
 grave problem of overpopulation. Hygienists 
 of a more advanced outlook dare to suggest that 
 the problem may be met by the deliberate limita- 
 tion of offspring. This plan is officially indorsed 
 
 [108] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 and very prevalent in several European coun- 
 tries, but in America the movement still suffers 
 the disfavor of clerics, particularly those of the 
 Romish persuasion. Only recently, the police 
 of New York City, constituting themselves the 
 ex officio minions of their spiritual leader, the 
 venerable and honorable Archbishop Hayes, suc- 
 ceeded in suppressing open meetings of the Birth 
 Control Society. The propaganda receives the 
 indorsement of a very few of the more daring 
 hygienists, but it is still largely in the hands of 
 a band of ladies of both sexes who derive much 
 spiritual benefit and moral pleasure from a thor- 
 ough consideration and never-ending discussion 
 of its interesting and variegated technical 
 methods. 
 
 It is in the discreet and unofficial education in 
 contraception that the medical profession per- 
 forms its most stupendous service to the public 
 health and happiness. The great majority of 
 physicians, when properly approached, offer 
 sound advice in this matter for a comparatively 
 modest honorarium. Thus contraceptive knowl- 
 edge spreads rapidly throughout the upper strata. 
 
 [109] 
 
OUR MEDICINE MEN 
 
 Its technique is discussed in camera by ladies of 
 the better class. It is curious, amusing, and a 
 little pathetic that this highly valuable and im- 
 portant function of doctors is the very one of 
 which none of them boast. It is to be hoped 
 sincerely that the wrath of the clergy will not; 
 intimidate physicians in their prosecution of this 
 great and necessary work. In addition to these 
 hygienic activities, medicos further aid the cause 
 by ex cathedra encouragement and support of 
 those medical specialists who interfere with the 
 life process before birth but after conception. 
 One of these savants, a friend of the writer, in- 
 forms him that a large proportion of his lucrative 
 and useful practice is referred to him by physi- 
 cians in good standing, whose professional and 
 ethical punctilio prevents their personal per- 
 formance of this function. 
 
 It is regrettable in the extreme that it is im- 
 possible to bring about a complete inversion of 
 the practice of limitation of offspring in 
 America. In a word, the middle class and the 
 plutocracy, which constitute the backbone of our 
 
 [110] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 national strength, should really be kept in igno- 
 rance of this technique, so that we might be 
 favored by an increase of such sound and highly 
 desirable stock. The proletariat, on the other 
 hand, whose larvae swarm in myriads on the fetid 
 pavements of our citieSj should be given com- 
 pulsory and accurate instruction in the art of 
 limiting families. 
 
 The second objection to the indiscriminate ex- 
 tension of the practice of preventive medicine is 
 based upon its tendency to bring about the sur- 
 vival and subsequent multiplication of the unfit. 
 The hygienist who organizes the efficient super- 
 vision of the milk supply saves the cretins, 
 morons, and achondroplastic dwarfs, as well as 
 the healthy and well-favored babies of the lusty 
 middle class. This tendency of hygiene to in- 
 hibit the normal purgative methods of nature has 
 been the subject of accurate mathematical analy- 
 sis by the biometrician, Karl Pearson. Pearson 
 concludes that the himianitarian hygienist un- 
 wisely opposes the mechanism of the survival of 
 the fittest, by which natin-e has kept down a too 
 
 [111] 
 
OUR MEDICINE MEN 
 
 great proliferation of undesirables. He con- 
 tends that continued advance in public health may 
 swamp us with a plague of defectives. 
 
 It is difficult to refute the objections of Pear- 
 son, and it is at present infeasible to prevent 
 the multiplication of the unfit. This last could 
 not be accomplished by the passage of marriage 
 laws, since love, or the sexual instinct if you wish, 
 laughs not only at locksmiths but even at legal 
 prohibitions. Restrictive marriage laws would 
 simply result in the replacement of legitimate 
 cretins and imbeciles by illegitimate ones. Ster- 
 ilization of undesirables by vasectomy runs afoul 
 of a formidable and insurmountable wall of sen- 
 timental prejudice. 
 
 Just as the physical and chemical researches 
 of men like Newton, Faraday, Helmholtz, and 
 Van t'Hoff are inspiring events in the dark his- 
 tory of human bigotry and ignorance, so those 
 of Pasteur and Claude Bernard, or Bordet and 
 Loeb in biology and pathology are luminous and 
 instructive. But the first-mentioned investiga- 
 tions, in themselves beautiful, have led to the 
 hideous development of modern industrialism. 
 
 [112]- 
 
PILLS MAKE WAY FOR PREVENTION 
 
 Those of the biologists may result in a final 
 choking of the world by a horde of fifth-rate and 
 undesirable individuals. It becomes a common- 
 place of observation that humanity makes ill use 
 of the achievements of its brilliant sons. It is 
 not yet ready for the boons that science can 
 confer. But it does not follow from this that the 
 science of the study of disease should in any way 
 be inhibited. As weU argue that the study of 
 ballistics in physics, or of the compounds of 
 nitrocellulose or toluene in organic chemistry be 
 suspended on the ground that their investigation 
 promotes war. 
 
 Since the prosecution of science of all kinds is 
 glorious and good but the application of its dis- 
 coveries is at present unwise, it is necessary to 
 concoct some plan that will insure the perpetua- 
 tion of research but suspend for a time its practi- 
 cal application. Preventive medicine might, for 
 example, be put down by drastic laws, and the 
 fimds now expended upon it diverted to the 
 scientific study of disease. The results obtained, 
 instead of being made available to society, should 
 be kept secret, excepting from the qualified indi- 
 
 [113] 
 
OUR MEDICINE MEN 
 
 viduals who are conducting the researches. 
 Then, in case humanity should awake one fine 
 morning to find itself with the ability to check 
 its present irrational philoprogenitiveness, and 
 to devise and execute a plan for the suppression 
 of the breeding of the unfit, the bottled-up 
 knowledge accumulated by the intensive re- 
 searches of the scientific Ku-Klux might be un- 
 corked for the benefit of the emerging super- 
 man. 
 
 It is realized that, while the objections to dis- 
 ease prevention discussed in the preceding pages 
 are sound, it is impossible even to advise that 
 their logical conclusion be put into practice. 
 The race becomes more and more used to com- 
 fort, to physical ease, to the alleviation of illness 
 and amelioration of pain. It can no longer sit 
 resignedly by, contemplating fatalistically its 
 ravishment by fearful plagues. It loses the 
 stoicism, the fortitude, the ignorance, the sense 
 of powerlessness before the scourges of God, so 
 characteristic of the ancients. So we are forced 
 to turn from the logic of the perils of preventive 
 medicine to the faith that the wholesale saving 
 
 [114] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 of life by pubKc health effort is for the highest 
 good. From this point onward, the former point 
 of view will be considered wicked, impossible, 
 unethical, and antisocial. 
 
 This brings us to the second subject of the 
 discussion; namely, to whom is the task of public 
 health to be intrusted? 
 
 The principal role of preventive medicine lies 
 in the control and extermination of infectious 
 diseases. Scientists in the study of disease have 
 dredged up many interesting facts in regard to 
 the characters and habits of the nefarious authors 
 of such malaises. They begin to learn something 
 of the way in which microbes are transferred 
 from diseased to healthy individua,ls. This, to- 
 gether with the study of the individual resistance 
 of individuals to infection, constitutes a branch 
 of knowledge which forward-looking doctors are 
 pleased to call the science of epidemiology. 
 
 American medicine may be proud of the fun- 
 damental contributions of some of its sons to 
 the problems of the eradication of disease. This 
 work was animated by the spirit of self-abnega- 
 tion and passion for truth that led the old Ger- 
 
 [115] 
 
OUR MEDICINE MEN 
 
 man hygienist Pettenkofer to test the validity 
 of Koch's claim of the discovery of the microbe 
 of cholera by swallowing deliberately an active 
 culture of the virulent organisms. This was the 
 spirit of the American Theobald Smith in his 
 researches in Texas fever and tuberculosis; of 
 the army surgeons Reed, Carroll, Agramonte, 
 and Lazear in their dramatic discovery of the 
 mosquito transmission of yellow fever; of Reed, 
 Vaughan, and Shakespeare in the deadly camps 
 of Cuba during the Spanish- American War; of 
 Gorgas in the brilliant sanitary achievement that 
 made possible the construction of the Panama 
 Canal; of Ricketts in his studies of Rocky Moun- 
 tain spotted fever and tabardillo ; of Noguchi in 
 the discovery of the cause of yellow fever; and 
 finally of Park, Williams, and Krumwiede, of 
 the New York health department, who work 
 devotedly and efficiently at the task of control 
 of infectious disease in our metropohs, despite 
 the fact that they have scanty material, are paid 
 miserable stipends, and have to defer to the im- 
 becile whims of the grafting and ignorant New 
 York pohtical magnificos. 
 
 [116] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 It is true that the majority of these workers 
 were trained as physicians, but few of them had 
 anything to do with the actual practice of medi- 
 cine. They had turned from this field to that of 
 the laboratory, to bacteriology and the study of 
 immunity. Public health becomes less and less 
 a thing in which physicians should meddle. It 
 demands, rather, a man of the temperament and 
 clear-headedness of the engineer, who is accus- 
 tomed to think mathematically and who dwells in 
 a region where the land-shdes caused by his 
 errors descend upon his own head. What is 
 desired is a person trained in executive tasks, 
 privy to the compilation and interpretation of 
 statistics, au courant with recent knowledge in 
 sanitary engineering, in epidemiology, in bac- 
 teriology. These requirements are unfortunately 
 not possessed by the vast majority of medical 
 graduates or doctors, for the practice of medi- 
 cine is characterized by lack of intellectual rigor, 
 by an ethic which forbids the denunciation of the 
 blunders of colleagues, by the great value placed 
 on "personaUty," by a blithe readiness to pass 
 the buck and stand from under the avalanches 
 
 [117] 
 
OUR MEDIClJNi: Mii;M 
 
 caused by serious errors. Public health in its 
 administration and technical prosecution is there- 
 fore an aflfair for engineers, bacteriologists, and 
 mathematical statisticians. What remaias for 
 the medico in this field? To him may be in- 
 trusted the subsidiary but still important tasks 
 of instructing the masses in the art. of birth- 
 control, and of diagnosis of the contagious 
 exanthematous diseases. 
 
 The writer does not wish for a moment to 
 imply that doctors of medicine should be ex- 
 cluded from the office of health commissioner. 
 The possession of such a degree by a candidate 
 should do nothing more than cause the commit- 
 tee of intelhgent aldermen in charge of the ap- 
 pointment to examine his abihties with particular 
 closeness. 
 
 Recent years have seen an enormous increase 
 of public health work throughout the nation. 
 The cause is championed by eloquent orators and 
 expounded by able rhetoricians. Cities of the 
 progressive type begin to devote significant por- 
 tions of their budgets to the salaries of health 
 commissioners, and to vie with one another in the 
 
 [118] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 installation of elaborate sewage systems and the 
 construction of efficient water supplies. 
 
 In the early days in large cities, and up to the 
 present in the majority of small ones, the posi- 
 tion of health officer was politically delegated to 
 mediocre physicians, ward-heelers of the locsH 
 Tammany, who needed to eke out their existence 
 by the paltry stipend that was accorded to the 
 occupant of this office. The activities of such 
 officials are devoted to occasional smallpox vac- 
 cinations and to inane fumigations, which are 
 now known to be of little importance. They 
 earn their salaries by the tacking up of red, blue, 
 or yellow placards on dwellings smitten with the 
 various exanthemata that are stiH the necessary 
 experience of almost every child. They make 
 feeble efforts at the sanitation of dairies, whose 
 owners are not sufficiently politically influential 
 to say, "Hands off!" They assert quackishly 
 that an epidemic is under control, when in reality 
 it has burned itself out. Nobody could possibly 
 have been more impotent to check the plague 
 than these muddle-headed gentlemen, who re- 
 semble nothing so much as the Russian Tschi- 
 
 [119] 
 
OUR MEDICINE MEN 
 
 novniks of the days of the Czar. They are clever 
 in creating alarms when there is really no dan- 
 ger, so that they may have the credit of throttling 
 epidemics that fail to appear. 
 
 Their inspections of the sanitation of schools 
 are elaborate pieces of folderol. Since their 
 positions depend upon the favor of powerful 
 political and financial forces, they are seldom un- 
 compromising in enforcing ukases which might 
 interfere with the interests of their masters. 
 Their knowledge of micro-organisms, whose effi- 
 cient foes they are supposed to be, is confined to 
 casual observation of photographs in text-books. 
 They pronounce bacillus "back-siUus." If they 
 have at their disposal a laboratory with a bac- 
 teriologist, they tend to use it perfunctorily or 
 ignorantly, and have not the knowledge ade- 
 quately to supervise its technique and methods. 
 Being practising physicians, they are likely to 
 show deference to the rich and to pay scant at- 
 tention to the less fortunate. 
 
 In short, the typical small city health officer, 
 and to some extent the gentlemen who fill this 
 office in our pretentious agglomeration, are fre- 
 
 [120] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 quently politicians, orators, poltroons, and wind- 
 jammers, whose salaries might better be devoted 
 to municipal displays of fireworks or to monthly 
 barbecues for the poor of the community. Their 
 effect upon the incidence of infectious disease is 
 virtually nil. Progress in replacing the retired or 
 unsuccessful otolaryngologists, ophthalmologists, 
 and obstetricians by sanitary engineers and doc- 
 tors of pubhc health is retarded greatly by the 
 inexplicable theory that the occupant of the office 
 should possess the degree of M. D. It would 
 seem that these formidable letters have a cabahs- 
 tic significance which causes the microbic authors 
 of plagues and pestilences to turn up their toes 
 and die at a wave of the hand of the owner of 
 these magic symbols. 
 
 The intrusting of the health of our communi- 
 ties to physicians of the type just described leads 
 to serious embarrassment and needless economic 
 losses to our citizens. But the ludicrous picture 
 presented by such persons is surpassed by that 
 of oflScials who enthusiastically apply the more 
 or less scientific data of bacteriology to practical 
 epidemiology. Such misapplication is remindful 
 
 [121] 
 
OUR MEDICINE MEN 
 
 of the assininities engaged in by physicians who 
 make their diagnoses exclusively by modern 
 biochemical tests. It is easy to find such in- 
 stances in the field of public health. 
 
 Take, for instance, the problem of the human 
 "carrier" of infectious disease. Bacteriologists 
 have discovered that various diseases, such as 
 typhoid, meningitis, and diphtheria, may be 
 spread by persons who harbor the microbes of 
 these infections but who are not ill themselves. 
 They have either had the infection and recov- 
 ered, or are the fortunate possessors of a natural 
 resistance which makes it impossible for the or- 
 ganisms to invade the body in a manner extensive 
 enough to call out visible symptoms of disease. 
 It will be reahzed that such individuals constitute 
 a menace to communities, since they harbor viru- 
 lent organisms and are discharging these, in one 
 way or another, upon many susceptible persons. 
 The problem of the detection of such carriers is 
 therefore of the first importance in sanitation. 
 
 In the case of the three diseases just mentioned, 
 the detection of carriers is strictly an affair for 
 the bacteriologist of extensive and acciu:ate 
 
 [122] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 training. Of the three diseases, the problem is 
 most adequately met in the case of typhoid fever, 
 the organism of which is comparatively easy of 
 detection. But in the case of cerebrospinal 
 meningitis and diphtheria, the task is not so easy. 
 Let us present an example of the pubhc em- 
 barrassment that might result from ignorant and 
 enthusiastic attention to the carrier problem. 
 
 A small city is stricken with an epidemic of 
 diphtheria. The alert health officer of the town 
 administers prophylactic doses of antitoxin to 
 all school children who prove to have positive 
 Schick reactions, and to such adults as will sub- 
 mit to the test. By some odd chance the fami- 
 lies of the three plumbers of the town have been 
 smitten with the disease. The good doctor swabs 
 the throats of the healthy members of the family 
 and finds by bacteriological examination of this 
 material that all three of the plumbers harbor 
 organisms which have the appearance of diph- 
 theria bacilU, At least, he is so informed by his 
 bacteriologist. The health ofiicer then declares 
 a quarantine of these households and places the 
 plumbers in durance vile until such time as the 
 
 [123] 
 
OUR MEDICINE MEN 
 
 noxious organisms shall disappear from their 
 throats. He makes daily cultm-es. Each time 
 the results are positive. The organisms persist. 
 Meanwhile, the situation of the town becomes 
 first trying, then embarrassing, finally desper- 
 ate. Sinks are stopped up, pipes burst, and the 
 resulting floods cause great damage; one child 
 is scalded to death in its cradle by a flood result- 
 ing from such an accident. Bath-rooms, de- 
 prived of the attentive care of these indispens- 
 able mechanicians, fall into disuse. 
 
 The citizens become frantic. Meetings of 
 protest are held. The release of the plumbers is 
 demanded. But the health ofiicer is firmly 
 backed by the city administration and the polizei, 
 and remains obdurate. Life in the town becomes 
 more diflScult. Sanitation grows impossible. 
 Finally plumbers are imported at great expense 
 from neighboring cities. They attempt, with the 
 promptness and efiiciency so characteristic of 
 the gild, to repair the accxmiulated damage, but 
 it has reached staggering proportions, and small 
 progress is made. Meanwhile, the interruption 
 of sanitation has resulted in the outbreak of 
 
 [124] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 dysentery, typhoid and paratyphoid fevers. The 
 new plvimbers are among the first to succumb. 
 
 The lamentable condition of the town has now 
 been noised abroad. Additional plumbers are 
 sought out, but refuse to come, even when 
 offered princely sums. Life is disorganized. 
 Citizens flee the place by night. Pestilence stalks 
 abroad. Finally, the notoriety of the affair 
 necessitates the intervention of the United States 
 public health service, whose experts find, upon 
 checking up the work of our zealous health offi- 
 cer, that the original plimibers are not carriers of 
 authentic diphtheria baciUi. Their throats har- 
 bor diphtheria-ZzA;e microbes, it is true, but test 
 proves them to be non-toxin-producers, and 
 hence entirely harmless. Such a calamity as the 
 one just described is entirely possible, given a 
 health officer sufficiently enthusiastic, ignorant, 
 and backed by an adequate power for the en- 
 forcement of his dicta. 
 
 Pubhc health activity should, if possible, be 
 freed from the clutches of politicians whose 
 obscenities make our municipal government the 
 laughing stock of the world. The entanglement 
 
 [125] 
 
OUR MEDICINE MEN 
 
 of public health with politics is one of the worst 
 of the influences that retard it. For it is now 
 comparatively easy to find efficient commission- 
 ers of health, since these individuals begin to be 
 graduated in droves from the new schools of 
 hygiene of our universities. But the difficulty in 
 the way of their efficient fimctioning is that of 
 the idiotic change of pohtical power so fre- 
 quently occmring in the majority of American 
 cities. 
 
 The writer has a friend who is a particularly 
 efficient health officer in a rapidly growing 
 Middle Western city. He complains bitterly 
 and with shocking profanity of the vicissitudes 
 that beset him. At present he has rather a free 
 hand in his activities. The majority of the city 
 council and the mayor are in sympathy with his 
 progressive eflForts, He has been accorded a 
 liberal budget, which he uses with breadth of 
 vision and discretion. But he lives constantly 
 in the fear of a return to power of the minority 
 party, which proposes to make "economy" the 
 slogan of its campaign. The Machiavellians, in 
 order to keep at least partly their promises of a 
 
 [126] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 reduction of municipal taxation, threaten to 
 slash mercilessly the budget of our health officer. 
 His plans, the result of jfive years of educational 
 activity, of oratory, of batthng with ignorance, 
 of intrigue, would be irretrievably wrecked if 
 this party should come into power. Even now, 
 in order to hold his hard-won ground, he finds it 
 necessary to make friends with wealthy and in- 
 fluential men. 
 
 It is an interesting fact, which would certainly 
 appear inexplicable to naive persons, that the 
 bitterest opposition to his efforts comes from the 
 rank and file of the physicians of the city. These 
 supposed guardians of our health look askance 
 at his establishment of health centers. He has 
 manned these \vith an efficient corps of young 
 physicians, dentists, and visiting nurses, who 
 give free advice and treatment to thousands of 
 the school children of the city. The good doc- 
 tors evidently fear for the safety of their lucra- 
 tive incomes, and, because of this threat of a 
 reduction of their munificence, are almost with- 
 out exception on the war-path for the scalp of 
 the commissioner. This, my masters, is the pro- 
 
 [127] 
 
OUR MEDICINE MEN 
 
 fession which works constantly for its own ex- 
 termination by its passion for preventive medi- 
 cine ! It is interesting and amusing to observe, on 
 the other hand, that the struggles of this health 
 officer receive the cordial support of the majority 
 of the dentists of the city. Tooth-drawers are 
 frequently sniffed at by doctors as commercial 
 brigands and persons whose craft is only slightly 
 superior to that of carpenters or bricklayers. 
 But, brigands and carpenters or no, it is indis- 
 putable that their understanding and support 
 of prophylactic activities is far more cordial than 
 that of medicos. 
 
 The health conmiissioner in question would 
 long ago have resigned in disgust were it not for 
 his peculiarly warhke and stubborn tempera- 
 ment. In addition to the tenacity of a Gila 
 monster, he possesses marked political sagacity. 
 This he has gained from a realization of its ab- 
 solute necessity to a successful prosecution of his 
 work. Convinced of the value of his cause, he 
 stops at nothing to insure the perpetuation of 
 his efforts. He matches intrigue by counter- 
 intrigue, and has succeeded until now in roUing 
 
 [128] 
 
PILLS MAKE WAY FOR PREVENTION 
 
 logs of a greater weight than those of his op- 
 ponents. He fights fire with fire. 
 
 But the strain of such effort is great. The 
 ordinary duties of work such as his are suffi- 
 ciently burdensome without other anxieties. 
 The combination of these with his necessarily 
 unrelenting conflict with the pack of quacks and 
 commercialists seeking to upset him is wearing 
 him out rapidly. When last seen by the writer, 
 his former serenity was replaced by an evident 
 nervousness and irritability. He looked gaunt 
 and tired. He was ready to search for some 
 place which might allow him to work uninter- 
 ruptedly and remove him from the constant op- 
 position of enhghtened medical colleagues. 
 
 There are, it is sad to relate, lamentably few 
 men of his kind who, combining good training 
 and exact knowledge with the warrior tempera- 
 ment and the uncompromising devotion of a re- 
 hgious zealot, still possess a sufficient modicum 
 of Jesuitical craft. The majority of efficient 
 modem health officers will be quickly defeated 
 in such a struggle. They will seek leisure for 
 work which is divorced from the idiotic whimsies 
 
 [129] 
 
OUR MEDICINE MEN 
 
 of political change in a field which offers eco- 
 nomic security and continuity of effort. They 
 will retire to the laboratory, or to the academic 
 grove, or to foundations of the type of the Inter- 
 national Health Board. 
 
 [130] 
 
CHAPTER VII 
 
 EELIGIO SANITATIS 
 
 IT is evident that preventive medicine does not 
 present the great opportunity for the mythol- 
 ogy so common to the healing art. The practice 
 of pubhc health rests upon the science of the 
 study of disease, and its principal accomplish- 
 ments are direct applications of that science. 
 What is more, investigations which may quite 
 properly be called scientific have been occa- 
 sionally performed by hygienists. The preceding 
 chapter has discussed the distinguished achieve- 
 ments in preventive medicine made by American 
 protagonists of this branch. On the other hand, 
 its entanglement with the obscenities and imbe- 
 ciKties of pohtics, and the opposition of many 
 practicing physicians to it, are influences that 
 have retarded its development. 
 Another and more grave evil threatens to 
 [131] 
 
OUR MEDICINE MEN 
 
 vitiate still further the superb efforts of its Nes- 
 tors. This danger arises from the wave of moral 
 fervor and the spirit of social uplift that is at 
 present one of the salient phenomena of Ameri- 
 can life. This spirit is the manifestation of a 
 new exacerbation of Puritanism. In former 
 days, Puritanism was closely identified with the 
 more violent and fanatical manifestations of 
 Christianity. It has had alternate periods of 
 recrudescence and defervescence, depending 
 upon the vicissitudes of that admirable religion. 
 But now it draws away more and more from its 
 entanglement with the true faith and seeks al- 
 liance with the cause of pubhc health. Its roots 
 are still, as of old, a sullen envy of the "fellow 
 who is having a better time," as pointed out in 
 the penetrating satires of Mencken. But this 
 fellow who has a better time is no longer con* 
 demned as a transgressor of the laws of God: 
 he is looked upon rather as an offender against 
 the new sacred laws of health. 
 
 The neo-Puritan exponents of public health 
 frown upon the bacchanalia that are as old as the 
 life of man. These festivals are without doubt 
 
 [132] 
 
RELIGIO SANITATIS 
 
 expression of his joy in life, and are the symbols 
 of a gay and impudent nose-thumbing at the 
 irrevocable and cruel tragedies of senescence and 
 death, the implacable ironic enemies of human 
 kind. The Messiahs of sanitation forget that 
 such carnivals were very prevalent in the healthy 
 Dionysian periods of Greek civilization. They 
 ignore the mighty achievements and incompar- 
 able salubrity of their Norse, Danish, and Saxon 
 forefathers, who drank lustily all night and 
 fought valorously the next day. They deprecate 
 the importance of the fruit of the vine in the 
 productive and creative activities of old France. 
 They refuse to consider the beer-bibbing that 
 went hand in hand with the Teutonic creation of 
 the priceless treasure of music. So now they 
 attempt to suppress the normal and pleasant 
 worship of Bacchus with the implacable fury of 
 Savonarola. These fanatical activities of the 
 modem apostles of health find an almost exact 
 parallel in the crazy hatred of all things beauti- 
 ful manifested by the priest of Florence. The 
 weapon with which the modem Puritan seeks to 
 slay beauty and destroy gaiety is the same one 
 
 [133] 
 
OUR MEDICINE MEN 
 
 that was so effective in the hands of the insane 
 monk. This implement is the weapon of fear. 
 Savonarola, in the name of Christ, threatened 
 with the eternal fires of hell, all those who wor- 
 shiped Bacchus or winked an eye at the white 
 she-devil. His modern followers, knowing that 
 the belief in an endless roasting goes out of 
 fashion, employ the bogy of sinister maladies 
 which follow various intemperances in this life. 
 It is true that commercial evangehsts hke Dr. 
 Sunday still befuddle simpletons with the slogan 
 "Get right with God," and throw them into a 
 panic with Ixirid pictures of the lake of brimstone. 
 Some Presbyterian, Methodist, and Baptist 
 clerks of God still exist who shriek hell-fire in 
 their jerry-built temples. But the great ma- 
 jority of the reformers, cleric and lay, now use 
 the frightful apparition of disease, calling to 
 their aid an armamentarium of supposedly scien- 
 tific evidence that awes and frightens even rea- 
 sonably inteUigent members of our commimities. 
 The male and female beldames of the new 
 religion of health use, for the advancement of 
 their own aims, the prestige that hygiene has 
 
 [134] 
 
RELIGIO SANITATIS 
 
 earned by really sound achievement. They tell 
 of the conquest of yellow fever and diphtheria, 
 and point out in the next breath that the same 
 knowledge proves the horrors of whisky. This 
 fervor for a health resulting from abstinence 
 from all things gay and pleasant has been erected 
 by them into a Religio Samtatis. Its inspiring 
 figure is the chaste teetotaling American young 
 man, who shuns all evils of the flesh, and who, 
 because of this sobriety, grows hugely successful 
 in his cheesemongery and eventually wins the 
 heart of the beautiful daughter of a rival chap- 
 man. With a missionary spirit common to all 
 successful religions, this American is being held 
 up as a model to the entire world. His emula- 
 tion is being advised to all races, with a naivete 
 and assurance that make us the laughing-stock 
 of civilized peoples. Now that the hquor trajBSc 
 has been dealt a deadly buffet by the Eighteenth 
 Amendment, and since the worship of Aphrodite 
 outside of the familial bungalow has been made 
 perilous by the Mann Act and the house-carls 
 of the vice-squad, the apostles of the faith look 
 for the conquest of these evils in foreign lands. 
 
 [135] 
 
OUR MEDICINE MEN 
 
 We hear the slogan, "A dry universe by 1930." 
 We see sixth-rate evangelists of the stamp of 
 Pussy-foot Johnson impudently meddling in the 
 affairs of England, whose concerns should surely 
 be her own. 
 
 Carnality and alcohol disposed of, the forces 
 of the health crusade gird themselves to war 
 against the sins that remain to us. Large funds 
 are already subscribed toward a campaign to rid 
 our land of the noisome stench of pipe, cigar, 
 and cigarette. The pseudo-scientific evidence 
 used as a weapon in this campaign is still more 
 foolish than that employed in the attack on the 
 other evils. In an important tract against the 
 use of tobacco the penetrating researches of a 
 scientific lady of the South are given a promi- 
 nent place. This femme savcunte ground up a 
 cigarette-paper in water and injected the result- 
 ing suspension into a mouse. The unhappy 
 beast succumbed in a few seconds with violent 
 convulsions, thus proving that cigarettes are 
 harmful to the growth of small boys and de- 
 leterious to the health of our manhood. The 
 discovery of acrolein in cigarette-papers by the 
 
 [136] 
 
RELIGIO SANITATIS 
 
 great scientist Edison, whose name carries with 
 it a papal prestige, is heralded as a definite proof 
 of the noxious efPects of the coffin-nail. The use 
 of such evidence is remindful of an amusing 
 incident that occurred recently in Belgium. The 
 physiologist, Eger, was demonstrating the evil 
 effects of alcohol to the workmen of a great in- 
 dustrial plant. He placed some guinea-pigs be- 
 fore this throng and either fed or injected the 
 little animals with alcohol. They succxmibed in 
 a short time. The scientist, seizing the dramatic 
 
 opportunity, shouted, "And this proves " 
 
 He hesitated, as one of the xmfortunate beasts 
 turned up its toes. "That alcohol is bad for such 
 little animals," interposed a quick-witted work- 
 ing-man. The interruption reduced the demon- 
 stration to absurdity. The seance dissolved in 
 mirth. The workman, though no scientist, had 
 really pointed out an important error inherent in 
 experiments of this kind. For it is a common- 
 place of pharmacologic knowledge that what is 
 poison for the gander is not necessarily harmful 
 to the goose. A substance causing the tragic de- 
 mise of a mouse might have no serious effect 
 
 [137] 
 
OUR MEDICINE MEN 
 
 when subjected to combustion in the snipe of 
 the street urchin. 
 
 The missionaries of health are certain that the 
 tobacco evil will follow that of alcohol into its 
 approaching oblivion. If smoking cannot be 
 exterminated, they mean to see it confined to 
 clandestine practice behind lowered curtains and 
 locked doors. The discreet culture of small 
 tobacco plots will then be added to the fascinat- 
 ing evils of the secret alchemy of the home brew. 
 Portly bourgeois deacons and upright citizens, 
 who now go forth to gather dandelions in the 
 dusk, will add the care of tobacco gardens to 
 their illegal agricultural activities. The sale and 
 smoking of tobacco having been made illegal, 
 householders will gather in secret conclave be- 
 fore fireplaces supphed with forced draft, and 
 carefuUy exhale the forbidden fumes into tall 
 flues, so that they may escape the clutches of the 
 sharp-snifiing yeomanry of the law. 
 
 But there are further crimes against health 
 awaiting the assault of these zealots for the 
 salubrity of their fellow-men. The consumption 
 of tea and coffee will doubtless be made the next 
 
 [138] 
 
RELIGIO SANITATIS 
 
 subject of attack. The rumble of the artillery- 
 preparation for this campaign is already audible. 
 This spring in a health parade of children on 
 Fifth Avenue in New York banners were carried 
 displaying the malignant nature of these bever- 
 ages, and at the same time extolling the virtues 
 and delights of milk. Such is the mad pursuit 
 of perfection now practised by the lunatic fringe 
 of the health army. They will keep from an im- 
 pressionable youth, at all costs, the knowledge 
 that the glorious fighting of their Frankish and 
 Frisian forebears, the adventures of vikings, the 
 grueling work of former centuries, were per- 
 formed with the aid of good ale or mead. Or 
 that the feats of arms and exploration of more 
 modern times have been made possible by sound 
 rum, or strong tea and coffee. For them, away 
 with such dangerous stimulants, and down with 
 the incomparable exhilaration of combat, of ex- 
 ploration, of struggle to the limit of endurance. 
 For them, we have come to the age of modera- 
 tion, to the time when passions of all kinds must 
 be held in leash, to the era of the milksop super- 
 man. The stop-and-go, the safety-first, the 
 
 [139] 
 
OUR MEDICINE MEN 
 
 watch-your step, the keep-off signs of to-day, are 
 raised against every desire and instinct that has 
 given color to life, and that has mitigated a little 
 the essentially tragic lot of mankind. 
 
 The charge has just been made that the horde 
 of fanatical health reformers has called to its aid 
 the supposed facts of hygiene and has im justi- 
 fiably used the alleged scientific data of preven- 
 tive medicine as weapons of fear in the campaign 
 for the crushing of the more sprightly and play- 
 ful aspects of existence. It is necessary to sup- 
 port these charges by suitable examples. The 
 use of alcohol as a beverage is condemned by 
 preachers, evangehsts, Chautauquans, by profes- 
 sional temperance lectures, hygienists, Y.M.C.A. 
 secretaries, by school-ma'ams and Sunday-school 
 superintendents and other housecretes of the vice 
 crusade. The gist of these unending harangues 
 is that its moderate or excessive use causes many 
 serious maladies, and that the progeny of alco- 
 holic parents are defectives, degenerates, epi- 
 leptic, and often insane. 
 
 Their statements rest largely on the erroneous 
 knowledge that results from the employment of 
 
 [140] 
 
RELIGIO SANITATIS 
 
 the method of post hoc, propter hoc, described 
 in a preceding discussion. Thus, a pathologist 
 permits a necropsy upon the body of an indi- 
 vidual who is known to have been a notorious 
 drimkard. The operation of the uncritical and 
 credulous prosector reveals that the unhappy 
 creature had suffered from cirrhosis of the liver. 
 Ergo, concludes the pathologist, the cirrhosis is 
 the result of the unfortunate individual's pota- 
 tions. A whole literature has accumulated, in 
 pathology, around the so-called alcoholic cirrho- 
 ses. A distinguished American pathologist does 
 not hesitate to differentiate between two varie- 
 ties^of the disease, one due to indulgence in gin, 
 the other caused by the guzzling of beer. It is 
 now known by sound investigators in pathology 
 that there is no direct proof that alcohol causes 
 this disease. It is pointed out that the former 
 observations took no account of the many cases of 
 cirrhosis to be found in teetotaling archdeacons, 
 nor of the myriads of hopeless sots whose livers 
 were the very pictures of healthy soimdness. 
 What is more, the investigations of Friedenwald, 
 who endeavored to produce this disease experi- 
 
 [141] 
 
OUR MEDICINE MEN 
 
 mentally by the administration of alcohol, have 
 failed to establish connection between the two. 
 Again, the henchmen of temperance assert that 
 alcohol is the chief cause for the persisting neces- 
 sity of insane asylums. Indeed, it is stated by 
 some that alcohol is the principal cause of in- 
 sanity. These supposedly sound data are culled 
 from the doctrines of uncritical psychiatrists. 
 The latter have been forced to withdraw from 
 their position by the work of Clouston, who finds 
 that people do not become insane because they 
 drink, but engage in excessive bibbing for the 
 reason that they already have a hereditary ten- 
 dency toward insanity and so lack certain inhibi- 
 tory powers common to the ordinary run of in- 
 dividuals. It is insanity, then, that really causes 
 the excesses of alcoholism, rather than the re- 
 verse as the janizaries of health would have us 
 believe. There is no indication that these minions 
 will present the right side of the shield to our 
 view. They have taken it into their heads that 
 people go crazy because of alcohol, and prefer 
 to persist in their false preaching, rather than to 
 yield honestly and gracefully to the undeniable 
 
 [142] 
 
RELIGIO SANITATIS 
 
 facts which cause their case to collapse. The mis- 
 fortunes of every one known to be bibulous are 
 laid at the door of alcohol. They say nothing of 
 the thousands of hearty and hale oldsters, living 
 far beyond their allotted span, and known by 
 every one to have been lifelong sots of the worst 
 variety. 
 
 The writer would be the last to admit that ex- 
 cessive indulgence in spiritus frumenti might not 
 bring certain individuals to grief. Delirium tre- 
 mens is undoubtedly its occasional result. Cer- 
 tain individuals exist to whom alcohol is probably 
 very harmful. On the other hand, innocent 
 young girls have perished horribly from exces- 
 sive indulgence in ripe olives or marshmaUows. 
 It should be valid, then, on these grounds to 
 clamor for the prohibition of such dainties, uni- 
 versally known to be laudable foods when in- 
 dulged in with discretion. It is possible that 
 there are persons with maladies which physicians 
 know to be affected unfavorably by alcohol. Doc- 
 tors wisely advise such sufferers to abstain from 
 its use. But it is well known that diabetics should 
 not indulge in sugar. It would then be rational 
 
 [143] 
 
OUR MEDICINE MEN 
 
 to abolish the sale of sugar, on the ground that 
 these diabetics will undergo an untimely demise 
 in case their craving for the sweet should over- 
 come their powers of self-control. 
 
 The scientific basis for the charge that alco- 
 holics are the parents of degenerate offspring is 
 of a soundness equal to the one asserting that 
 liquor causes numerous diseases. It is a com- 
 mon belief that the children of chronic inebri- 
 ates are often defective. What is more, it is gen- 
 erally supposed that the offspring of parents who 
 were drunk at the time of conception are likely 
 to show various deplorable stigmata of degen- 
 eracy. The second idea is less credible than the 
 first, since, after all, drunkenness may be a very 
 transient condition, which passes off rapidly leav- 
 ing no trace. Yet it is solemnly taught in a cer- 
 tain reputable course in pathology that even a 
 temporary alcoholization of the parents has a 
 deleterious effect upon the germ cells, and so im- 
 doubtedly causes damage to the resulting off- 
 spring. A student who took exception to this 
 doctrine was severely taken to task. Doubtless 
 the good professor considered his questioning 
 
 [14.4] 
 
RELIGIO SANITATIS 
 
 pupil as hopelessly immoral and an enemy to so- 
 ciety. 
 
 In reality, the idea that drunkenness at the 
 time of conception results in degenerate off- 
 spring rests upon no experimental foundation 
 whatever. It will be many years, without doubt, 
 before the race will be prepared for such an ex- 
 periment, at least upon a scale sufficiently large 
 to yield important results. Imagine, if you will, 
 the mixture of levity and horror that such a re- 
 search would arouse, if it were proposed at the 
 present time. Having no experimental basis, the 
 notion actually comes out of the folk-lore of hu- 
 man beliefs and is of a dignity comparable to the 
 ancient credos concerning elves, sprites, and the 
 skilled dwarfs who cunningly fashioned magic 
 armor and forged enchanted swords. Recently 
 Bezzola claimed that the proportion of defective 
 children conceived at the time of universal ine- 
 briety attendant upon the Swiss vintage is far 
 greater than that of degenerates resulting from 
 the conceptions of normal times. This observa- 
 tion would seem to be of value to the orators of 
 prohibition. But they omit to enlarge upon the 
 
 [145] 
 
OUR MEDICINE MEN 
 
 directly contradictory results of Ireland. This 
 investigator compiled similar statistics in regard 
 to the seasonal bacchanalia of Scotland, and 
 found no increase whatever in the proportion of 
 defective children that were the fruit of these 
 festive occasions. 
 
 The notions in regard to degeneracy arising 
 from chronic parental alcoholism rest upon still 
 more flimsy foundations, and, in the light of cer- 
 tain excellent statistical researches, are also to 
 be relegated to the interesting, gay, but inaccu- 
 rate body of human folk-lore. A careful bio- 
 metrical investigation was made in regard to this 
 question by Elderton and Pearson, of the Fran- 
 cis Galton Laboratory of London. So far as 
 can be discovered by discreet inquiry, neither 
 Miss Elderton nor Dr. Pearson are persons of 
 doubtful sobriety, nor do they own shares in dis- 
 tilleries, breweries, or wineries. Yet their elab- 
 orate mathematical investigations clearly show 
 that the proportion of sound children is just as 
 great among the families of chronic alcoholics as 
 in the menages of the most bigoted and blue- 
 nosed teetotaUng dissenters and nonconformists. 
 
 [146] 
 
RELIGIO SANITATIS 
 
 Hygienists, whose business it seems to be to 
 credit any evidence that alcohol is a most harm- 
 ful and noxious substance, pay scant attention to 
 the accurate biometrics of Pearson and his stu- 
 dents. This is not surprising, since the results of 
 these disinterested researches do severe damage 
 to their theories, or, it is more accurate to say, to 
 their religion. The most widely used American 
 text-book of hygiene relegates the Elderton- 
 Pearson report to a foot-note in the 1913 edi- 
 tion, and omits completely to mention it in the 
 1920 edition! 
 
 A considerable amount of work has been de- 
 voted to this subject in the field of animal experi- 
 mentation. Here the results are conflicting. 
 The foe of intemperance may, and usually does, 
 cite one set of results. Doubtless the brewers and 
 distillers are equally fond of using the contra- 
 dictory researches in their arguments. But it is 
 the intention in this discussion always to present 
 both sides in the most impartial and fair-minded 
 manner possible. 
 
 The most prominent of the investigations of 
 this type are those of Stockard and of Pearl. 
 
 [147] 
 
OUR MEDICINE MEN 
 
 Both of these researches appear to be adequately 
 controlled. Stockard used guinea-pigs as his 
 experimental subjects. He found that when 
 adult animals of this species were subjected to 
 long-continued alcoholization and were subse- 
 quently mated, the offspring were fewer in num- 
 ber than those of the sober controls. In addition, 
 the young that were born to the inebriates were 
 subject to a higher post-natal mortality. What 
 is more, those that did survive were prone to be 
 ill-nourished and to suffer from epileptiform at- 
 tacks and other nervous derangements. In brief, 
 the drunken guinea-pigs were the parents of in- 
 ferior and ill-conditioned shoa^ts. These results 
 occasioned applause in the camp of the mission- 
 aries of health, and were, like those of Bezzola, 
 widely used in propaganda. 
 
 Pearl, on the other hand, employed chickens in 
 his research. This investigator, like Stockard* 
 found the number of chicks hatched from the 
 eggs of alcoholics to be fewer than those from 
 normal fowl. But, to the confusion and conster- 
 nation of prohibitionists, the chicks who sur- 
 vived, despite their bibulous ancestry, were ac- 
 
 [148] 
 
RELIGIO SANITATIS 
 
 tually superior to the normal ones in eight out of 
 twelve of the hereditary characters susceptible 
 to Pearl's careful quantitative measurements. 
 This scientist was forced to the conclusion that 
 alcohol undoubtedly had an effect upon the avian 
 germ-plasm. But it was really a salutary one, 
 in that it apparently kills off the weaker germ- 
 cells, allowing the hardier ones to develop and 
 thus give rise to superior hens and roosters. 
 This result was probably gratifying to all intel- 
 ligent wine-venders and saloon-keepers. 
 
 Now, it is evident to those experienced in bi- 
 ological science that neither of these researches 
 can be generalized to human beings. Once more, 
 what is sauce for the gander is not necessarily 
 palatable to his feminine relations. The writer, 
 in discussing this question with a well-known 
 pathologist, was confronted with the fact that 
 guinea-pigs, as mammals, are more closely related 
 to humans than are chickens, who belong to the 
 phylum of birds. This being true, said the sa- 
 vant, it would be more proper to employ the find- 
 ings of Stockard than to cite those of Pearl. But 
 the moral pathologist was baffled upon being 
 
 [149] 
 
Missing Page 
 
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OUR MEDICINE MEN 
 
 The plan that would then be put in operation 
 would be the compulsory alcoholization of all 
 young married people, at least those who con- 
 fessed to philoprogenitive ambitions. The re- 
 sult, possibly, might be the production of fewer 
 babies, but of more bouncing physique and far 
 greater intelligence. If this occurred, and if the 
 plan were kept up, the objections to the practice 
 of preventive medicine discussed at length in the 
 sixth chapter would be immediately nullified. 
 
 The remaining arguments of the opponents of 
 the rum demon are not on hygienic groimds, and 
 it is consequently out of place to subject them 
 to analysis in this discussion. They need only be 
 mentioned with comments which the writer finds 
 it impossible to suppress. One of them concerns 
 the greater efficiency displayed by om- now sober 
 slaves of industry, or, if you please, free Ameri- 
 can working-men. It is a commonplace of ob- 
 servation that an inebriated spoke-setter cannot 
 construct an automobile wheel with the speed 
 and eclat that one admires in his sober colleague. 
 Efficiency is certainly one of the most important 
 deities on the American household of Olympus, 
 
 [162] 
 
RELIGIO SANITATIS 
 
 and his votaries are right in joining the ranks of 
 the antagonists of the corner gin-mill. But effi- 
 ciency is of little moment to those disreputable 
 ones who set high store by lusty and innocent ri- 
 baldries and roysterings and by colorful dreams. 
 Better, say they, a merry and forgetful world, 
 than a hard, bright, efficient one. 
 
 The knights of the health crusade who have 
 followed this immoral argument thus far are 
 probably few. Surely all sound and devout 
 priests of health have dismissed the dissertation 
 in disgust. Let them regret having done so, for 
 the writer admits his capitulation before a last 
 potent stroke, which is delivered, not by the 
 sword brain-biter of preventive medicine, but by 
 the bladder of sentimentality. Alcohol has a 
 brutahzing effect upon the fathers of famihes. 
 It is true that many of these drunken varlets be- 
 labor their faithful spouses dreadfully and often 
 neglect their children. This argument, after all, 
 perhaps justifies an even more vigorous cam- 
 paign than that which rages at present against 
 this evil. Only let it be remembered that the 
 fumes of drink are occasionally of anesthetic 
 
 [153] 
 
OUR MEDICINE MEN 
 
 effect upon the grievous hurts resulting from the 
 thumps of w'ell-diirected roUing-pins, skilfully- 
 wielded in the never-ending war of the sexes. 
 
 Hygiene devotes itself also to the question of 
 sex and the venereal peril with a fervor that just 
 now exceeds that displayed against the evils of 
 rum. Too much is heard of this question on all 
 sides. It is jabbered about voluminously and 
 idiotically in the educational lectures of the Y. 
 M.C.A.; it peeks leeringly out in the plays and 
 novels of Greenwich Village; the pompous the- 
 ories of Freud revolve around it ; it is the leading 
 theme of interest in woman's clubs, sewing- 
 circles, and in the Sunday-schools of advanced 
 and enlightened churches. This blushful subject 
 is discussed with a pretense of scientific learning 
 or as health propaganda. But it is not the sci- 
 ence or the concern for national salubrity that 
 really animates it. Rather it arises from those 
 vicariously sexual impulses of people who, as 
 some one has salaciously remarked, think below 
 the belt. Surely it would be better to return, 
 either to the silences of the period of Victoria 
 the Good, or to the offhand frankness of the fire- 
 CIS*] 
 
RELIGIO SANITATIS 
 
 side conversation of Queen Elizabeth. Or, per- 
 haps, better still to the amiable obscenities of old 
 rran9ois Rabelais, who alluded to the subject 
 frequently but always facetiously, considering it 
 as an apparently essential but certainly jolly as- 
 pect of our fundamental animality, and not as a 
 matter for fearful threats by sex-lecturers or 
 quasi-scientific chattering by Freudians. 
 
 The beldames of the uplift and the amateur 
 sex-hygienists are aided in their educational, co- 
 ercive, and police activities by men of consider- 
 able reputation in the science of the study of dis- 
 ease. One of these persons is a distinguished pro- 
 fessor in one of the leading medical schools of 
 the nation. He lectures the length and breadth 
 of the land. He uses without scruple the weapon 
 of fear. He proposes to suppress the youthful 
 sowing of wild oats by augmenting the phobias 
 that already so greatly inhibit the gaiety and 
 kicking-up of heels that is natural to young 
 people. He paints ghastly pictures of the evils 
 of venereal diseases. His descriptions are vivid, 
 nauseating, horrible. It is common for many of 
 his hearers to faint, and it is said that a band of 
 
 [155] 
 
OUR MEDICINE MEN 
 
 bouncers are held in readiness to remove these 
 unhappy ones. He maintains that pre-marital 
 chastity is the sole alternative to the horrors of 
 venereal infection, but, as if realizing that it is 
 necessary to mitigate such a harsh dictum, he 
 slyly asserts that self-abuse does not have the 
 evil effects that are supposed to attend it. This 
 amounts really to advising young men that it is 
 better to be onanists than to burn, to paraphrase 
 the dictimi of St. Paul! Such scandalous ad- 
 monition is accompanied by a deliberate misstate- 
 ment of the truth : to wit, that venereal prophy- 
 laxis is not to be depended upon. 
 
 This is an utterly false assertion which has been 
 refuted by the experiments of Metschnikoff and 
 Roux, and by the experience of all armies and 
 navies, where prophylaxis is properly applied. 
 The whole sex-hygiene campaign is, to tell the 
 truth, an affair of empty rimable-bumble, carried 
 on by a Camorra of essentially foul-minded Puri- 
 tans. The venereal diseases are undoubtedly 
 fearful plagues, but prophylactic methods exist 
 which, when adequately and promptly used, are 
 of almost perfect efficacy in the hands of per- 
 
 [156] 
 
RELIGIO SANITATIS 
 
 sons of even mediocre intelligence. It is to care- 
 ful instruction in the technique of their applica- 
 tion that hygienists should confine themselves, 
 and not to the peddUng of smutty twaddle that 
 frightens many of our already too docile youth 
 half to death. Let parents, holy clerks, and, 
 best of all, the young man himself, engage in the 
 development of his moral fiber. This is not the 
 province of preventive medicine. Nor is it the 
 function of public health to distort scientific 
 fact for moral ends. 
 
 Such perversion of the true function of 
 preventive medicine by fear-mongers and health- 
 messiahs does much to nullify its otherwise valu- 
 able efforts. Such distortion and misappropria- 
 tion of facts as those just described must inevit- 
 ably shake the confidence that our citizens rightly 
 have in some of its other fimctions. 
 
 [167] 
 
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OUR MEDICINE MEN 
 
 mand of conversational French, so that, when his 
 neighbor at the table remarks, "II fait chaud 
 aujowrd'hm. Monsieur," he will not respond by 
 obsequiously passing the horse-radish. It is evi- 
 dent that the acquisition of such a vast body of 
 irrelevant and unrelated knowledge requires sev- 
 eral years of preliminary college training. 
 
 The apostles of the necessity of broad culture 
 are opposed by educators who are convinced that 
 the basis of medicine is now scientific. They 
 count the ideas of the whoopers for broad cul- 
 ture as amiable bosh, and insist that the three or 
 four years of prehminary training of the medical 
 aspirant be devoted to science, rather than to the 
 acquisition of high-sounding nonsense. In short, 
 he should pursue mathematics at least through 
 elementary courses in the differential and inte- 
 gral calculus, he should have a thorough ground- 
 ing in quantitive, organic, and physical chemis- 
 try. In addition, he should have some schooling 
 in the rudiments of botany and zoology, and 
 should be cognizant of the mysteries of compara- 
 tive anatomy. Of course, ft is clear that the 
 thorough pursuit of such scientific studies would 
 
 [160] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 leave small space for the acquisition of the hu- 
 manities and cultural branches. 
 
 Between these two opposing camps stand those 
 who desire to compromise. These educators wish 
 to combine the study of scientific and cultural 
 subjects in a two-, three-, or four-year pre-medi- 
 cal course. This idea is probably at present in 
 the ascendancy, despite the fact that it is mani- 
 festly impossible to receive thorough training in 
 either of these two fields in so short a time. In 
 fact, the extraordinary development of physics 
 and chemistry in the last decades makes it im- 
 perative to devote at least four years to their 
 study, together with preparation in the mathe- 
 matics necessary to their comprehension. It 
 might be possible, in addition, to allow a smaU 
 amount of time for the acquisition of a suitable 
 amount of scientific French and German. So it 
 is evident that the attempts to teach both culture 
 and science in the few years devoted to a college 
 course are futile and can lead only to a fragmen- 
 tary knowledge of both. 
 
 Finally, there is a decreasing number of prac- 
 tical medical educators who consider the acqui- 
 
 [161] 
 
OUR MEDICINE MEN 
 
 sition of both science and the humanities to be a 
 silly waste of time, and think it better that the 
 eighteen-year-old boy, fresh from high school, 
 plunge at once into the mysteries of anatomy and 
 physiology. These persons no longer voice their 
 ideas publicly, knowing them to be frowned upon 
 almost universally. They concentrate their ef- 
 forts, rather, upon hmiting the pre-medical 
 course to two years, a length of time utterly in- 
 sufficient for the acquisition of more than a smat- 
 tering of any sort of education whatever. 
 
 The method pursued by the majority of promi- 
 nent medical colleges is to require two years of 
 pre-medical, mainly scientific, study, and to make 
 a three or four years preparation to this optional. 
 This system leads to great dissatisfaction, espe- 
 cially among the few students sufficiently en- 
 lightened to have completed a college degree be- 
 fore entering the actual study of medicine. These 
 are faced by two disturbing facts. In the first 
 place, the average youth will not for a moment 
 consider hngering in the academic grove for four 
 years when he can plunge into what he considers 
 the real preparation for his life's work after two 
 
 [162] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 short years of preliminary study. Hence, the 
 more adequately trained man finds himself in 
 the demoralizing position of associating with per- 
 sons who are obviously his inferiors in training, 
 but who suffer no ostensible disadvantage in their 
 actual medical studies. What is worse, he finds 
 himself in the rear of persons who have confined 
 themselves to the minimum requirement of the 
 pre-medical two years in some one-building uni- 
 versity or minor denominational college, and who, 
 as third-year men in medicine, consider them- 
 selves to be infinitely his superiors. 
 
 Another condition, still more disintegrating 
 to the morale, faces the student who comes to 
 the study of medicine after four years of good 
 scientific preparation. This youth, following the 
 advice of those supposed to know, has been con- 
 vinced that the foundations of the intelligent 
 study of medicine he in mathematics, physics, and 
 chemistry. He enters the first medical courses 
 with confidence, aware of his superiority over the 
 majority of his fellows. It is easy, then, to 
 imagine his dismay when he discovers that he 
 knows far more of physics and chemistry than 
 
 [163] 
 
OUR MEDICINE MEN 
 
 any of his medical instructors, so that if he were 
 to ask one of them to explain a biological phe- 
 nomenon in terms, let us say, of physical chem- 
 istry, his question could only result in the hu- 
 miliating confession of the professor's ignorance. 
 Being, let us hope, a young man of tact and dis- 
 cretion, he refrains from so disgracing his men- 
 tors. Instead, he shuts up, and regards with 
 an evil eye the ghb-memoried, poorly prepared 
 young ignoramuses that surround him, who shine 
 in the estimation of their instructors by reason 
 of their parrot-like ability to reel off the enor- 
 mous numbers of unrelated facts which they dili- 
 gently cram out of text-books. The better-pre- 
 pared individual, whom a training in mathe- 
 matics, physics, and chemistry has taught to 
 question and to think, rather than to remember 
 voluminously, idiotically, and indiscriminately, 
 finds himself almost invariably in the rear ranks. 
 He turns with bitterness upon those advisers who 
 had the effrontery to pretend that the basis of 
 medicine is really scientific. 
 
 Now, it is clear that opinion favoring the in- 
 tensive pre-medical study of physics and chem- 
 
 [164] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 istry, while not universal, is at least becoming 
 more and more general. It would be logical, 
 then, to believe that these sciences are not merely 
 contributory to medicine, or separate from it. 
 On the other hand, the only reason for their in- 
 tensive pursuit would seem to lie in the idea that 
 they really are basic to all medical study. This 
 will be evident from a consideration of the views 
 of modern physiologists of the type of Jacques 
 Loeb, who regard all living things as physio- 
 chemical mechanisms. From this point of view, 
 all physiology must concern itself with the study 
 of the phenomena of life in terms of chemistry 
 and physics. And pathology should devote it- 
 self to the consideration of the derangements suf- 
 fered by the physico-chemical mechanisms that 
 constitute the animal body. 
 
 If the studies of the first years of medicine 
 were looked at in this way, it is easy to see that 
 they might be closely unified. Under such a 
 regime the enormous importance now attached 
 to the description of the structures of the body 
 could be greatly minimized. And it follows that 
 the present top-heaviness of the so-called "labora- 
 
 [165] 
 
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OUR MEDICINE MEN 
 
 One might look for a different attitude and 
 method in the teaching of the other first-year 
 branches, such as bacteriology or physiology. 
 But here again one finds excessive stress laid 
 upon morphologic considerations in bacteriology, 
 and upon ancient mechanical ones in physiology. 
 So much attention is given to a study of the ap- 
 pearance of, let us say, the diphtheria bacillus 
 that there is small time for a consideration of its 
 infamous activities in producing derangements 
 in the physicochemical equilibrium of our inter- 
 nal economies. When some enterprising instruc- 
 tor begins to ask students to explain what they 
 see in terms of physical chemistry, he is gener- 
 ally looked upon as an unpractical theoretical 
 high-brow, having little knowledge of the needs 
 of a practising "doc," wishing only to befuddle 
 his pupils with "catch questions." 
 
 The study of disease, that is to say, pathology, 
 is seldom brought into close relationship to the 
 study of the abominable activities of the microbes 
 which produce the majority of our malaises. 
 Nor is it considered in unison with physiology, 
 which attempts to elucidate the admirable and 
 
 [168] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 deKcate physicochemical arrangements that pre- 
 side over the normal functioning of our bodies. 
 On the other hand, the professor of physiology 
 looks askance at the pathologists for assigning 
 lessons of such length that the students find it 
 necessary to slight physiology. The patholo- 
 gist, in turn, attempts cleverly to preempt some 
 of the time he feels to be unfairly devoted to bio- 
 chemistry. The demarcations between each of 
 these closely interdependent branches are kept 
 in sharp definition, and the instructors in each 
 one tend to deprecate the excessive amount of 
 time given to studies other than their own. 
 
 Meanwhile, the student plunges blindly but 
 manfully forward, spending whole mornings in 
 class-rooms, entire afternoons in the laboratory, 
 and, after a hastily snatched dinner, consumes 
 untold kilowatts of electrical power in a diligent 
 but befuddled effort to memorize a sufficient 
 modicum of each of his subjects to make a pre- 
 sentable showing in the class-room next day. 
 He rarely has a moment for the thoughtful con- 
 sideration of disease as a whole, or of the organ- 
 ism as a whole. And at present, after such a 
 
 [169] 
 
Missing Page 
 
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OUR MEDICINE MEN 
 
 bawl hell out of us when we had time to work 
 up only ten?" 
 
 But the old doc in question changes from the 
 grinning fiend of those days to a sort of melan- 
 choly figure, to be cursed gently in sentimental 
 retrospect. The neophytes of the bedside won- 
 der how he can pass his days in his stupid "lab," 
 when glittering fame and mountains of shekels 
 would be his for the asking, were he to transfer 
 his activity from a mere peering through the mi- 
 croscope and a prodding of students to the lucra- 
 tive fields of the consultant or to the dramatic 
 wizardry of the operating-room. 
 
 The gap that the students consciously realize 
 to exist between the laboratory and the hospital 
 work of the medical course is also apparent in 
 the xmderground, and sometimes open, hostility 
 existing between the laboratory and clinical pro- 
 fessors. The former are properly indignant at 
 seeing their efforts flouted by the fledglings who 
 have just taken up hospital work. They resent 
 having to spend hours in preparing materials, in 
 demonstrations, in long laboratory periods, in the 
 routine of hammering facts into the heads of a 
 
 [172] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 heterogeneous assortment of numskulls, only to 
 see these same dunces favor them with nose- 
 thumbings, with grimaces, and with leering smiles 
 of condescension, after arriving at the dubious 
 dignity of hospital study. The professors of the 
 sciences undoubtedly think that part of this 
 mepris is subtly inculcated by the clinical teach- 
 ers. These last, recipients of princely incomes, 
 owners of motor-cars, necromancers of bedside 
 lore, are held in vastly greater respect by the 
 majority of students. 
 
 The clinical professors, on the other hand, gen- 
 erally regard the biochemists, physiologists, 
 pathologists, and anatomists of the laboratories 
 as weU-meaning, learned, but extremely imprac- 
 tical fellows, whom nature has endowed with the 
 patience to spend endless hoiu-s over the micro- 
 scope, before the colorimeter, or among stinking 
 cadavers, but who have not that mysterious utili- 
 tarian penchant, nor the magnetic personality 
 that would qualify them for clinical teaching or 
 for lucrative practices. 
 
 This opposition between laboratory and hos- 
 pital, almost invariably existing as an under- 
 current, at times flares up into open strife, divid- 
 
 [173] 
 
OUR MEDICINE MEN 
 
 mg the cKnicians and the scientists into armed 
 camps, which engage in jousts for ascendancy in 
 the college. Such battles are of a quahty of 
 short-sightedness and nonsensical emptiness that 
 would cause them to be regarded as the caper- 
 ings of buffoons were they not so deleterious to 
 the progress of medical education. They result 
 in a reduction to absurdity of an attempt at the 
 liaison that should exist between the laboratory 
 and the hospital. 
 
 These conflicts are due largely to a confusion 
 of ideals which has been dwelt upon at length in 
 the chapter on "A Misunderstanding of the Role 
 of the Physician." For until medical educators 
 resolutely face the fact there is no such thing as 
 a science of medicine, and that the study of dis- 
 ease is a matter distinctly apart from the art of 
 healing, the existing confusion will only be mul- 
 tiplied. At the present time, the first two years 
 of medical instruction assume that all of the stu- 
 dents are to become investigators of the prob- 
 lems of disease. Each individual is held to the 
 same criteria of excellence, or, to be more accu- 
 rate, of mediocrity. Excepting in institutions 
 
 [174] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 of the tjrpe of the Johns Hopkins and Harvard 
 University medical schools, specialization in the 
 laboratory branches in the earher years is dis- 
 couraged. The teaching is directed at the divine 
 average, lauded by that prophet of democracy, 
 Walt Whitman. Needless to say, the men of in- 
 quiring mind and extraordinary ability must of 
 necessity be held in check to wait upon the rank 
 and file of mediocre persons and the rear-guard 
 of unmitigated dunderheads. What is more, if 
 a student shows extraordinary talent, he is in 
 eflFect asked to apply it alike to subjects that in- 
 terest him and to studies which he considers 
 fatuous and boring. In a word, he is required to 
 strive for a uniform excellence in all of his work. 
 This tends to inhibit his impulse of inquiry in 
 the field for which he feels himself to have a flair. 
 It may be objected that such a student is imma- 
 ture and does not know what study he is really 
 fitted to engage in during his subsequent career. 
 This objection appHes to high school graduates 
 of eighteen and to college sophomores. But such 
 striphngs have in reahty no place in the serious 
 business of medicine. The demand of those who 
 
 [175] 
 
OUR MEDICINE MEN 
 
 favor the college degree as a prerequisite to medi- 
 cal education is undoubtedly justified. 
 
 After the mob of individuals with heterogene- 
 ous talents and aptitudes has been treated for two 
 years as if each one were an embryo scientist, it 
 is subsequently propelled into the field of prac- 
 tical endeavor in the hospital. This kind of 
 work is entirely antithetical to the spirit of sci- 
 ence. Persons who, fired by a spirit of inquiry, 
 might wish to stop and investigate the nature of 
 an interesting case of exophthalmic goiter are 
 hurried by the recitation bell to attend a seance 
 of obstetrics, which they may consider to be 
 empty and inane. The final year of the medical 
 course is devoted to a bewildering profusion of 
 subjects, comprised mainly of various lucrative 
 specialties. These subjects are taught by so- 
 called clinical "professors" of dermatology, of 
 otolaryngology, of ophthalmology, who increase 
 the prestige necessary to their commercial suc- 
 cess by the wearing of academic robes. Thus the 
 callow undergi'aduate of the fourth year, who 
 should occupy all of his time with the arts of 
 clinical and laboratory diagnosis and with the 
 
 [176] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 craft of surgery, controlled by the discipline of 
 the necropsy, is enticed into premature ambitions 
 to specialization. 
 
 Now, to add to the melee, come those who de- 
 mand that this wonderful melange of opathies 
 and ologies be welded into a science of medicine ! 
 This brings about a confusion twice confounded. 
 The clinical professors are right in their resis- 
 tance to the attempt to turn the hospital of the 
 medical school from a place for the teaching of 
 diagnosis and surgery into a glorified rabbit- 
 hutch where the patients are looked upon as ex- 
 perimental animals. 
 
 This critique may be objected to as destruc- 
 tive, and as leading to no solution of the problems 
 that are at present so vexing to medical educa- 
 tors. This is, however, by no means the case. 
 For the moment it is understood that medicine 
 cannot be turned into a science, and that it would 
 on the other hand be a lamentable niillification 
 of its progress to make it entirely practical, the 
 way is open to sweeping changes which would 
 greatly clarify the present murk of cross-purpose 
 and misunderstanding. What is necessary is a 
 
 [177] 
 
Missing Page 
 
Missing Page 
 
OUR MEDICINE MEN 
 
 pital, the importance of intimate contact with 
 the teacher would be insisted upon. In short, 
 there would be a return to the preceptor system 
 in vogue in America in the early part of the nine- 
 teenth century. This system recognized that the 
 lore of medical practice and the craft of surgery 
 are to be learned best by the method of appren- 
 ticeship practiced of old by doctors, and still com- 
 mon in the honorable gilds of plumbers, brewers, 
 and glass-blowers. This would be greatly su- 
 perior to the present alleged bedside teaching, 
 where groups of from six to twenty students si- 
 multaneously endeavor to absorb the wisdom of 
 a single instructor. 
 
 The rudimentary nature of the laboratory in- 
 struction given to the majority of students whose 
 intentions were avowedly practical would leave 
 time for the intensive and elaborate scientific in- 
 struction of the few individuals whose bent really 
 lies in the direction of the study of disease. Such 
 men now and always will constitute an insignifi- 
 cant proportion of any medical class. Conse- 
 quently, they would be enabled to work in inti- 
 mate contact with members of the scientific staff, 
 
 [180] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 who under such a regime would have leisure for 
 uninterrupted investigation, and would not, as 
 at present, have to perform their experiments at 
 lunch-time, between recitation periods, or in the 
 dead of night, a time that should be devoted to 
 rest. The greater part of the time of these in- 
 structors is now given to the hopeless attempt to 
 inculcate the facts and esprit of science into an 
 indiscriminate assortment of youth, all but two or 
 three of whom do not, and never will, know what 
 it is aU about. 
 
 Under the prevailing dispensation, one of two 
 methods is open to the teacher of the laboratory 
 studies. First, he may aim at the diligent ham- 
 mering of his theories and facts into the rank 
 and file of the class, who have little understand- 
 ing and less respect for them. In so doing, he 
 necessarily holds back the students who have a 
 natural aptitude for the subject. This is the 
 democratic method, and is in favor, it is sad to 
 relate, in the great majority of medical schools. 
 Secondly, he may direct his efforts toward the 
 bright and imderstanding ones, and allow the ma- 
 jority to remain frankly in the state o* mystifica- 
 
 [181] 
 
OUR MEDICINE MEN 
 
 tion in which it is natural and inevitable that 
 they should exist. This is the aristocratic method 
 and is generally frowned upon and discouraged. 
 The procedure was greatly admired by the 
 writer in the days, happily long past, when it was 
 his duty to play the task-master to hordes of 
 embryo medicos. He conducted his course at a 
 speed which the apt and interested students could 
 maintain. He left the remainder to struggle 
 along as best they might. He encouraged a few 
 interested and intelhgent individuals to engage 
 in fledgling attempts to swim in the sea of the 
 unknown. He observed the way in which they 
 reacted to the buffets of its storms. These efforts 
 were looked upon with great disfavor by his col- 
 leagues, who accused him of engaging in "grand- 
 stand" research, and of luring the youngsters who 
 had become his satelhtes away from a proper 
 standard of excellence in their other studies. 
 
 As things go at present, encouragement of ex- 
 traordinary ability is not praised. On the other 
 hand, a hot-house rearing of inferiors and num- 
 skulls is considered the acme of pedagogic skill. 
 In brief, it is equalitarianism in education that 
 
 [182] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 is applauded. Now, any one privy to the nature 
 of science knows that it must be understood and 
 advanced by the few. This is completely anti- 
 pathetic to the spirit of democracy, which ab- 
 surdly considers "John Smith to be the equal of 
 his superiors." 
 
 The plan of early sharp division of those wish- 
 ing to be practitioners of medicine from the ones 
 aiming at the scientific study of disease would 
 certainly make it possible for the latter to test 
 their metal in research. What is more, it would 
 release the practical-minded youths of the ma- 
 jority from mystified gropings in a fog of fact 
 and doctrine that must remain for always incom- 
 prehensible to them. 
 
 These ideas are in practice to some extent at 
 medical schools of the type of the Johns Hop- 
 kins and Harvard. These institutions are, how- 
 ever, severely criticized by the majority of medi- 
 cal educators. They are alleged to create a high- 
 brow spirit and to fail to turn out an adequate 
 supply of the "practical doc." The critics pride 
 themselves on being professors in colleges which 
 produce "all-round" physicians. They perhaps 
 
 [183] 
 
OUR MEDICINE MEN 
 
 do not realize that they aid in throttling at birth 
 a number of individuals whose scientific work 
 might have been of great value in the study of 
 disease. Now, it will be clear that under the plan 
 suggested above, all medical schools might pro- 
 duce men capable of becoming good practising 
 physicians or competent surgeons, and at the 
 same time afford facilities for the production of 
 a constant small number of high-brows without 
 whom advance in medicine would be impossible. 
 
 The present strictures made by some medical 
 educators against the high-browism of certain of 
 the great Eastern schools are undoubtedly justi- 
 fied to some extent. And the teachers in the lat- 
 ter are right in accusing the rank and file of medi- 
 cal colleges of suppressing science and, by their 
 Philistinism, reducing their institutions to the 
 level of mere technical schools. 
 
 The plan of returning to the preceptor sys- 
 tem for practical students in the hospitals will 
 be criticized on the ground that the number of 
 youths is too large to make such an idea feasible. 
 As things exist now, only a few endowed insti- 
 tutions are able to limit the number of their en- 
 
 [184] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 trants. The State universities have been founded 
 with the idea of educating all persons whose par- 
 ents have the funds and the social aspiration to 
 send them thither. Any idea of limiting arbi- 
 trarily the number of students in the medical 
 school of such a university is scoffed at as im- 
 practicable and intolerable to the citizens of our 
 democratic conunonwealths. Under present con- 
 ditions, such a medical department is required to 
 accept, as first-year students, a constantly in- 
 creasing number of applicants. All that is asked 
 is that these pass satisfactorily the two years' 
 hodgepodge of pre-medical requirement. This 
 may be accomphshed with a moderate amount of 
 application by any one not in the category of 
 the imbecile. There is not the semblance of an 
 attempt at the selection of prospective medicos 
 on the basis of a predilection for the art of heal- 
 ing, or of a penchant for the study of disease. 
 
 The constantly increasing munificence of the 
 various medical specialties is attracting to the 
 study of medicine an always greater number of 
 undesirables of a greedy acquisitiveness, wdth no 
 notion at all of the essentially religious nature 
 
 [185] 
 
OUR MEDICINE MEN 
 
 of the art of healing, and with no reverence for 
 the high calling of the science of the study of 
 disease. They scoff at disinterestedness. They 
 talk constantly of specialties which will afford 
 them the best incomes. Medical schools are at 
 present thronged with such pests who, having no 
 spirit of disinterestedness to begin with, natur- 
 ally become more materiahstic as they near the 
 goal of their ambitions. It is this species of 
 gouger who drives out the last struggling repre- 
 sentatives of the splendid old type of general 
 practitioner, and who makes a commercial ob- 
 scenity of the pretentious new institution of 
 group medicine. 
 
 The present dissertation is not for a moment 
 to be considered as a polemic against equahtar- 
 ianism, which is doubtless with us to stay. It 
 would be as futile to attempt to put it down by 
 argument as to talk the pyramids of Rameses out 
 of existence. But even the loudest whooper of 
 its excellences cannot presume to praise a sys- 
 tem which permits the entrance of such an indis- 
 criminate rabble into the important function of 
 medical practice or of the study of disease. 
 
 [186] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 It is really entirely possible to limit the number 
 of medical aspirants, even in a State university, 
 without offending too grievously our zealous 
 guardians of equality. This could be effected, 
 not by setting up an arbitrary numerical Hmit, 
 nor by constantly increasing the numbers of years 
 of required pre-medical preparation. The latter 
 scheme has been tried and does little to reduce 
 the number of incompetents and undesirables. 
 But it might be brought about by a rigid system 
 of entrance tests. These examinations could be 
 of two types, the one suitable to college gradu- 
 ates whose aim it is to be practitioners or sur- 
 geons, the other adapted to the training of the 
 graduate in science who enters medicine with the 
 purpose of the study of disease. Such tests, if 
 based upon thinking ability and not devoted to 
 the discovery of the irrelevant encyclopedic 
 knowledge of candidates, would reduce the num- 
 ber of entrants with appalling rapidity. Of 
 course, it is granted that such suggestions are 
 impossible of realization so long as the faculties 
 of medical schools point with pride to classes of 
 one hundred and fifty students. So long as the 
 
 [187] 
 
OUR MEDICINE MEN 
 
 aim of education is the standardized production 
 of intellectual Fords, it is a palpable fatuity to 
 recommend methods which might result in the 
 completion of an occasional Locomobile. 
 
 With a medical education rearranged accord- 
 ing to these suggestions, it might be possible to 
 mitigate the intellectual flabbiness that is ram- 
 pant in the medical profession. This vagueness 
 and lack of mental rigor is notorious in physi- 
 cians. A recent army intelligence test showed 
 doctors from civil life to be 60 per cent, below 
 engineers, distinctly inferior to teamsters and 
 quartermasters, and but little superior to vet- 
 erinarians or dentists. There may be some rea- 
 son to criticize the accuracy of such tests and to 
 assign a large experimental error to them. On 
 the other hand, their results only confirm the 
 opinion long held by close observers of the two 
 professions. 
 
 The cause of the high average competence of 
 engineers and of the intellectual muzziness of 
 most doctors is to be sought in the very nature of 
 their respective callings. The engineer works in 
 constant fear of a catastrophic revelation of any 
 
 [188] 
 
iMIi MUl^iJlJNCJ Ut' THE KAW MATERIAL 
 
 blunders he may make. If he bungles his cal- 
 culations in the construction of a bridge, the 
 structure may collapse under the weight of a 
 train-load of Rotarians, or other prominent and 
 important people. The burden of such an ap- 
 palling disaster will then in all probabihty fall 
 on his shoulders, after having been traced to his 
 error. He is for this reason held up to a high 
 level of intellectual rigor. He must be exact. 
 His bluffs and incertainties and cheatings will 
 return upon him with the accuracy of well-aimed 
 boomerangs. 
 
 Now, it is evident to every one that this is not 
 the case with physicians. A high discipline was 
 practised upon surgeons and other medicos by 
 the ancient Babylonians, who legally punished 
 certain mistakes by cutting off the hands of the 
 bungler, and who rewarded more serious ones by 
 a summary removal of his head. This plan was 
 plainly of merit, and the number of blilffers and 
 shysters among the doctors of Babylon must have 
 been noticeably less than that which is plaguing 
 us at present. Under the existing regime, the 
 bungling doctor is protected by his fellows under 
 
 [189] 
 
OUR MEDICINE MEN 
 
 the conspiracy of silence euphemistically entitled 
 medical ethics. He may insure himself against; 
 malpractice, and large funds are at his disposal 
 to hire clever lawyers who may be able to free 
 him, no matter how glaring his culpability. It 
 is admitted in the gild that many patients are 
 killed through ignorance or downright blunder- 
 ing. It is, however, perfectly easy for physicians 
 to palm off such mistakes on the irony of fate, 
 the cruelties of a just God, or the inexorable and 
 insurmountable whims of nature. It is difficult 
 to deny him when he maintains that the patient 
 has passed away despite his skilful efforts. On 
 the other hand, it is almost invariably the custom 
 for him to claim a cure as his own when nature 
 may in reality have effected it. The patient and 
 family are, for reasons elaborately explained in 
 preceding chapters, prone to accept the interven- 
 tion of physicians as decisive. It is easy to see 
 how these conditions bring about a general esprit 
 of buck-passing on one hand, and a pretension to 
 unreal power on the other. 
 
 Much might be done to saturate the medical 
 neophyte with a different spirit during his medi- 
 
 [190] 
 
THE MOLDING OF THE RAW MATERIAL 
 
 cal course. This might be accomplished, first, 
 by a constant war against the covering up of ig- 
 norance by clever guessing or bluffing. It might 
 be stimulated in the second place by an inces- 
 sant and relentless checking of diagnoses at the 
 necropsy table. This important branch of pathol- 
 ogy should, indeed, be made the pivot aroimd 
 which involves all of the teaching of the aspirant 
 to practical medicine or surgery. A rigid adher- 
 ence to this plan, and a move to institute it 
 throughout the practice of medicine as well, 
 would blow a cold blast of honesty through halls 
 that now stink with bluff and pretense. 
 
 It is true that this plan would necessitate a 
 campaign of education, aiming at the removal of 
 the present superstitions of the masses in regard 
 to the carving of their dead. This might, how- i 
 ever, be accomplished by the tactful reminder 
 that the necropsy is of importance, both in ad- 
 vancing medical knowledge and in checking up 
 competence of physicians. 
 
 [191] 
 
CHAPTER IX 
 
 THE SCIENCE OF THE STUDY OF DISEASE 
 
 ONE of the most praiseworthy of modern 
 American traits is that aptitude for co- 
 operation which has resulted in an organizing 
 genius surpassed only by Germans. This spirit 
 has to a large extent conquered the individual- 
 istic and rapacious tendencies in American indus- 
 try. Our scene becomes less and less a thing of 
 boisterously struggling piratical small commer- 
 cial fry, and more and more one of serene im- 
 pregnable corporations of the type of United 
 States Steel or the Standard Oil. It is well 
 known that these organizations are immensely 
 powerful, and are at times even superior to gov- 
 ernmental authority. It is recognized that the 
 centralization which has resulted in them has 
 brought about a great increase of efficiency. They 
 constitute an enormous improvement in method 
 
 [192] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 of production over the clamorously competitive 
 and undisciplined little manufacturers of for- 
 mer days. They turn out unparalleled quantities 
 of such necessities as gasolene and steel rails. 
 They improve constantly in their consideration 
 of employees. The smoothness of their organi- 
 zations and their paternal regard for their faith- 
 ful house-carls gives the lie to the dark predic- 
 tions of Marx. Radical thought clamors no 
 longer for their destruction by an outraged pro- 
 letariat, but quietly asks instead for their de- 
 mocratization. Their methods were greatly ap- 
 preciated and widely used by European countries 
 during the hostilities just now brought to a par- 
 tial cessation. This appreciation from abroad 
 has greatly enhanced their already formidable 
 prestige. 
 
 In fact, the beauties of organization have so 
 impressed the leaders of all of our activities that 
 attempts are now being made to extend this 
 method to the creations of philosophers, astrono- 
 mers, artists, musicians, and scientists. The 
 products of all of these workers have up to the 
 present been considered to be the result of ex- 
 
 [193] 
 
OUR MEDICINE MEN 
 
 treme individualism. The idea of cooperation 
 has been seized upon in the formation of the Na- 
 tional Research Council, which counts as its 
 members leaders of all of the various branches of 
 science. This body intends to introduce effi- 
 ciency, which has become a necessity to industry, 
 into science, which has until now been a field for 
 intellectual romantics, whose instincts are those 
 of the free-lance and the explorer. The Research 
 Council intends that there shall no longer be any 
 bewildered fumbling and groping in the dark. It 
 plans, instead, to block out precisely the reced- 
 ing territories of the unknown, and to parcel out 
 definite problems to constantly increasing bat- 
 talions of well-disciplined investigators. 
 
 Each one of these soldiers in the scientific host 
 is to have his Uttle problem to work out. The 
 question he is to ask of nature is to be precise, 
 limited, and as nearly as possible amenable to a 
 definite answer. In a, word, he is to invade the 
 unknown in a definite direction and to keep al- 
 ways in touch with his base of supphes. He is to 
 keep in communication with the overlords of 
 
 [194.] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 his science. He is not to poach upon the terri- 
 tories carefully marked out for his fellows. 
 
 He is denied the privilege of wandering forth, 
 equipped only with the rifle of his intelligence, 
 and thus to remain for long periods of lawless 
 and impudent penetration of the forests and 
 jungles of ignorance. Should his supply of grub 
 begin to fail, or his ammunition to run low, he 
 is not to improvise ways and means of subsis- 
 tence which will insure further penetration. 
 Rather it is his duty to return to his base of sup- 
 plies for a replenishment of the recognized prov- 
 ender. Should he be baffled by uncharted 
 marshes or imscalable heights, it is not for him 
 to conquer these by his unaided wit. Instead, 
 he is to return to his director of exploration, who, 
 as the fount of knowledge, will devise a way out 
 of his difficulty. 
 
 The Germans had already to a large extent 
 perfected this orgnization of research before the 
 war. At the beginning of the war, it was sneered 
 at and condemned by Germanophobe scientists 
 in America. But at the termination of the strife, 
 
 [195] 
 
OUR MEDICINE MEN 
 
 the Teutonic origin of cooperative research had 
 been forgotten, and the evil effects of organized 
 science were no longer condemned with the 
 patriotic fervor of former years. On the other 
 hand, the beneficent results of its activities were 
 acclaimed on all sides. Accordingly in Cincin- 
 nati, in 1919, the president of the Federated So- 
 cieties of Experimental Biology eloquently 
 praised the merits of this type of science in the 
 recent conflict. It was difficult to discover, de- 
 spite careful attention, the exact nature of the 
 fundamental discoveries that resulted from it. 
 This, however, is an unimportant detail. It is 
 enough that this stirring speech gave the impres- 
 sion that the benefits of cooperative science were 
 beyond description. 
 
 In the instance of German science, the advan- 
 tage of quantity production of researches is 
 manifest to every one. The annual output of in- 
 vestigations of all kinds is enormous, and fills 
 countless volumes of Zeitschriften, Zentralhlat- 
 ter, and Wochenschriften. These admirably 
 printed periodicals, filled with formidable masses 
 of work in aU conceivable branches of knowledge, 
 
 [196] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 are in some respects to be regarded with aston- 
 ishment and awe. It makes the rapidly growing 
 body of scientific knowledge readily accessible. 
 Ignorance of the more recent advances in any 
 science is inexcusable. A discovery may now 
 be common property on the morrow of the day 
 it is made. It has recently been suggested that 
 the German publicity methods, now enthusi- 
 astically copied in America, be extended still fur- 
 ther. If this takes effect, scientific advances may 
 be heralded by efficient distributing agencies of 
 the type of the Associated Press, which may 
 cause newspapers to publish special editions of 
 the nature of our present indispensable sporting 
 extras. 
 
 But this type of scientific organization in Ger- 
 many, despite its manifest excellences, has 
 brought about some evil tendencies which must 
 fiU the sympathetic observer with dismay and 
 even with disgust. The worst of these is the 
 tone of deference to established reputation and 
 respect for authority that is evident among the 
 younger scientists. The trend is toward the 
 clerical spirit. A scientist makes a discovery of 
 
 [197] 
 
OUR MEDICINE MEN 
 
 some importance, enunciates a ponderous the- 
 ory on its basis, becomes a Geheimrat, and at- 
 tracts a horde of followers, German, Hungarian, 
 English, Japanese, American. These disciples 
 come eagerly to the shrine, and sweat earnestly 
 over an arbeit ettianating from the central great 
 intellect of the Herr Direktor. The research in- 
 volves almost invariably discoveries supporting 
 the central theory. It would be considered a 
 downright impudence for a student even acciden- 
 tally to discover a fact which might be embarrass- 
 ing to the dogma laid down by the presiding 
 priest. Thus, in such organizations, one observes 
 the splendid and inspiring spectacle, celebrated 
 by poets, of "a hundred minds with but a single 
 thought, a himdred hearts that beat as one." 
 
 This growth of the barrack spirit is spreading 
 with rapidity in American science, especially with 
 that concerned with the study of disease. It is 
 antithetical to the spirit of all creative endeavor. 
 For, while esprit de corps is laudable in an armed 
 citizenry or in the production of bath-tubs, motor- 
 tractors, and three-inch guns, it is damnable in 
 adherence to scientific dogma, or in support of a 
 
 [198] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 school of music, literature, or painting. Galileo 
 founded modem experimental physics. He was 
 considered a heretic and an Antichrist by the 
 reactionary clergy of his day. But he privately 
 thumbed his nose at his inquisitors, who then 
 formed the only body of intellectual authority. 
 What is more, he did not attempt to erect his 
 laws of motion into a dogma against the church, 
 or to attract a horde of worshipfuUy slavish ad- 
 herents to his views. The same is true of La- 
 voisier and Faraday and Pasteur. These men 
 were free-lances and innovators, smashers of the 
 contemporary idols of ignorance and supersti- 
 tion. It would have been absurd to ask them to 
 bow to the reigning savants of their day. Their 
 explorations were free and untrammeled. They 
 would have laughed at the idea of a research coun- 
 cil to lay out their problems, or of a director be- 
 fore whom to do obeisance. 
 
 To tell the truth, a genuine piece of scientific 
 investigation is always a highly individualized 
 affair. And real investigators, though they may 
 seek advice and welcome discussion of their prob- 
 lems, will always resent interference from above, 
 
 [199] 
 
OUR MEDICINE MEN 
 
 or attempts of other minds to change the direc- 
 tion of their penetration of the unknown. Origi- 
 nal ideas on how to bolt a cylinder on a Ford 
 motor might throw out of gear the whole laud- 
 able and astounding organization for the produc- 
 tion of that national necessity. Such an inno- 
 vator would be peremptorily and justifiably 
 "fired." On the other hand, it is just as ludi- 
 crous to imagine the director of a laboratory for 
 the scientific study of disease attempting to 
 standardize the thoughts and methods of his 
 scientific henchmen. For it is their very way- 
 wardness of thought and the heresy of their 
 methods that frequently result in important dis- 
 coveries. 
 
 In America it becomes the fashion to ape the 
 Germans, Directors begin to employ disciplined 
 scientists with special penchants, to synthesize 
 researches. This is just as absurd as to imagine 
 a painter having an admirable conception of a 
 beautiful landscape, who would proceed to its 
 creation by employing a corps of specialists, one 
 to paint the trees, another to do the hills, a third 
 to daub in the cows, and a fourth to fashion the 
 
 [200] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 pretty dairymaid who milks them. A great 
 painter has an arrogant belief that he alone is 
 capable of executing each of these details in the 
 proper manner. A great scientist is equally mis- 
 trustful of the experiments and results of his 
 underlings. Despite this, the dernier cri in the 
 American study of disease seems to be that of a 
 great brain, having many splendid ideas, sitting 
 in an attitude of profound abstraction in a se- 
 cluded cabinet, and parceling out the products 
 of his cerebration to awe-struck underlings, who 
 then hurry to their laboratories to prove the 
 validity of the concepts of the master intelhgence. 
 The number of men engaged in the study of 
 disease increases constantly. It may be objected 
 by those who favor the idea of scientific directors 
 that there are many men in the ranks of this 
 rapidly growing army who have not the original- 
 ity necessary for the elaboration of intelligent 
 concepts. The question arises as to the disposi- 
 tion of such individuals, who have faithful and 
 clever hands but wooden heads. The answer is 
 plain. Such persons should not presume to the 
 role of investigators. What, then, is to become 
 
 [201] 
 
OUR MEDICINE MEN 
 
 of the great brain, with its volcanic eruptions of 
 ideas? The answer is clear. Its possessor 
 should work out and test his own concepts. It 
 is true that such a procedure would greatly de- 
 crease the productivity of the active intelligence. 
 On the other hand, he would have the priceless 
 opportunity to see and to do his own experi- 
 ments, and not merely to examine their results 
 with satisfaction or disgust, as the case might be. 
 Most surprising and unexpected turns of events 
 occur in the course of an experiment. These 
 accidental and unforeseen results are frequently 
 ignored by the henchman who has manual clever- 
 ness, but not an alert or questioning mind. The 
 French physiologist, Claude Bernard, insisted 
 that his most important discoveries arose from 
 accidental observations made in experiments, the 
 objectives of which were in an entirely different 
 direction. The same remark has been made by 
 the Belgian immunologist, Bordet. This inves- 
 tigator does all of his experiments himself. He 
 doubtless has a thousand ideas which he has not 
 the time to put to test. But despite this, he 
 
 [202] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 has found time to advance the science of im- 
 munology more than any other living man. 
 
 It follows that the only kind of permissible 
 assistance in the science of the study of disease 
 is the kind that functions under the very eyes of 
 the directing intelligence. This can be procured 
 by the employment of personally trained tech- 
 nicians, or of youngsters just making their bow 
 in the field of research. Such help is far less 
 expensive than that of the unimaginative super- 
 dieners calling themselves scientists, who now so 
 largely infest the laboratories for the study of 
 disease. The abolishment of the idea of a scien- 
 tific directorate would greatly reduce the num- 
 ber of scientific workers. This might be la- 
 mented, but only by those who seek to mitigate 
 the evil of unemployment. For it is certain that 
 fundamental advances in the science of the study 
 of disease are not increasing in proportion to the 
 augmenting numbers of investigators. 
 
 There is really not the slightest hope of such 
 a healthy purgation of the ranks of the students 
 of disease. The institution of the scientific di- 
 [203] 
 
OUR MEDICINE MEN 
 
 rectorate becomes more popular and more firmly 
 established. All that can be hoped for is the 
 occasional accession to power of broad-minded, 
 tolerant overlords, who do not tyrannically ex- 
 ploit the power that is given to them. These 
 lines are not penned as counter-propaganda, 
 which would be fruitless. They are written as 
 a sort of Jeremiad over a system which tends to 
 make the investigators of disease an aggregation 
 of paid house-cretes, subservient to dubious gen- 
 eralissimos, rather than to association of inde- 
 pendent and wide-ranging knights, who prefer 
 to explore alone the dangerous lands and to slay 
 unaided the horrible dragons that plague us. 
 
 The inroads on our valuable forests and the 
 increase in the number of pulp-mills in America 
 arising from the plethora of scientific periodicals 
 on medical subjects are largely due to the great 
 number of persons im justifiably usurping the 
 function of investigator. These realize that the 
 regular appearance of their names in periodicals 
 will increase their prestige and afford them op- 
 portimity for better places with greater emolu- 
 ment. This results in a flooding of such periodi- 
 
 [204] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 cals with inane repetitions of previous work and 
 empty investigations of inferior quality. Such 
 a mass of material makes it a difficult task to 
 keep abreast of real scientific advance. It is not 
 atduous in the sense that all of this piffle de- 
 mands perusal, but rather because the multipli- 
 cation of periodicals has resulted in libraries of 
 labyrinthine complexity. 
 
 Such an avalanche of publications makes it 
 difficult to discriminate between good work and 
 bad. Let a man write in a sufficiently persistent 
 and voluminous manner and he is almost sure to 
 gain a hearing and to be respected. Thus it may 
 happen that the name of a person whose scien- 
 tific product is inferior or even erroneous will 
 be on the hps of every one. Such is the case of a 
 notorious German biochemist. This investigator 
 owes much of his fame to his introduction of a 
 test for pregnancy. It is amusing to relate that 
 by this test men, as well as women, are fre- 
 quently found to be with child. Such a phe- 
 nomenon is, of course, outside all hvrnian expe- 
 rience. The test must be valueless to all who do 
 not believe that the order of nature has been 
 
 [205] 
 
OUR MEDICINE MEN 
 
 upset. Yet the originator of the method is held 
 in great esteem in America as well as in Ger- 
 many. On the other hand, names like that of the 
 American bacteriologist, Elser, are obscure and 
 little known. This savant has published a single 
 magnum opus, which belongs to the classics of 
 his science. Yet it is safe to estimate that the 
 majority of American students of disease are 
 hardly aware of his existence. 
 
 The mania for rapid and profuse publication 
 is not ascribable only to the large number of 
 mediocre individuals who presume to study dis- 
 ease. It is, in addition, the result of the modern 
 love of self-advertisement, in which our country- 
 men are particularly proficient. Like profes- 
 sionals of the advertising art, our more proUx in- 
 vestigators know that it is not necessary that 
 their goods have especial merit. It is needful 
 only, by a constant and variegated repetition, to 
 keep their wares in the public eye. Accordingly 
 a successful year in certain laboratories is often 
 estimated by the number of papers published. 
 A case in point is that of a good clinical profes- 
 sor of great merit and distinction. This person 
 
 [206] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 came one bright morning, his chest protruding 
 with pride, to the laboratory of the writer. After 
 perfunctory and courteous questions in regard to 
 the progress of the investigations there con- 
 ducted, the visitor, no longer able to contain 
 himself, burst out with the information that his 
 laboratory had had a splendid year, since nine 
 scientific papers had gone out from it in the short 
 space of nine months! 
 
 Another cause of this promiscuity of publica- 
 tion is the wild desire for priority. The majority 
 of workers are in a constant state of fear that 
 some colleague will rush into print just ahead i 
 of them. This phobia results in an unnatural 
 strained effort and in a fatuous spirit of compe- 
 tition. Work is done under a pressure which 
 usually results in researches that are incomplete, 
 hurried, and botched. Unhappily, the isolation 
 and parochialism that enabled Leonardo da Vinci 
 to spend more than twelve years on the famous 
 "Cenacolo" are no longer with us. The student of 
 disease works with one eye on his experiment, 
 the other searching anxiously for the publica- 
 tions of those he knows to be laboring in the same 
 
 [207] 
 
OUR MEDICINE MEN 
 
 field. It is rare for any one in medical research 
 to spend years in silence, patiently unraveling 
 the tangled strands of a knotty problem. In- 
 deed, it is customary to shy at questions that 
 cannot be answered in a few months. And it is 
 the rule to consider that an investigator has 
 lapsed into innocuous desuetude when he has 
 failed to publish a paper for a space of two or 
 three years. George Moore asserts that the in- 
 vention of rapid means of communication has 
 resulted in the death of art. His position is 
 probably extreme. But it is certain that the 
 science of the study of disease suffers greatly 
 from the lack of isolation and leisure necessary 
 to strictly original effort and to exquisitely fin- 
 ished work. 
 
 Finally, the abundance of scientific reading 
 matter leads to another serious danger. Many 
 investigators do not go to nature for their prob- 
 lems. They seek them, rather, in the library. 
 Thus, one of America's leading pathologists re- 
 marked in passing that he had read something 
 "while in the library, searching for a problem 
 to work on." This person is generally held in 
 
 [208] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 high esteem. His name is ranked among the 
 ten most prominent investigators in his branch. 
 Yet the remark just quoted must be regarded as 
 an admission of empty-headedness, not to say- 
 imbecility. For it is abnost certain that research 
 starting from a perusal of the work of others 
 holds the danger of preconceived ideas, which are 
 entirely out of place in science. It is impossible 
 to imagine Harvey searching the mystical books 
 of Galen for the inspiration to his work on the 
 circulation of the blood. Or of Pasteur initiating 
 his fundamental researches by a consultation of 
 the inane medical speculation of his time. Or of 
 Bordet turning the strong beam of his lucid in- 
 teUigence on the dark questions of immunity, by 
 perusing previous literature on the subject. On 
 the other hand, these investigators, and other 
 great ones like them, began their researches by 
 the observation of natural phenomena that im- 
 pressed them as important. They formulated 
 hypotheses on the basis of these observations. 
 They then put these hypotheses to test by care- 
 ful experiment. 
 It has been remarked in a previous chapter 
 [209] 
 
OUR MEDICINE MEN 
 
 that the frmtful study of disease really began 
 with the investigations of Pasteur; Before this 
 time, isolated careful observations and a few bril- 
 liant experiments had been made by lonely in- 
 vestigators of the type of Harvey, Leeuwenhoek, 
 Spallanzani, and Magendie. But the seeds 
 of these experiments fell upon unproductive 
 ground. These men were far in advance of their 
 times. They worked in a milieu of superstition, 
 ignorance, and bigotry even more appaUing than 
 the one existing at the present time. Pasteur 
 was a chemist and carried the careful methods of 
 that science into the study of the mysteries of 
 disease. He was laughed at and bitterly opposed 
 by the majority of medical investigators. A 
 few enlightened ones finally realized the impor- 
 tance of his discoveries, and at last a multitude of 
 scientists began to flock to his support and to 
 elaborate his researches. But it is curious to re- 
 late that very few of them consistently used his 
 objective methods, or shared his conviction of 
 the physicochemical nature of the mechanism of 
 all hving processes. Instead, the majority em- 
 
 [210] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 ployed the morphological methods of the Ger- 
 man pathologist, Virchow. This savant had in- 
 sisted upon the importance of microscopic ob- 
 servation and description of changes occurring 
 in the cells of diseased organisms. He cared ht- 
 tle for the elucidation of the mechanism that 
 gave rise to these changes. Such study as that 
 of Virchow is immeasurably simpler than the ex- 
 perimental method of attack, especially when 
 the latter is based upon the methods of physics 
 and chemistry. So it was natural that descrip- 
 tive science should appeal to medical men wish- 
 ing to shine in the field of investigation, but who 
 were innocent of the precision methods neces- 
 sary to the chemist or physicist. It consequently 
 became the mode to describe the appearance of 
 things rather than to investigate their mechan^ 
 ism. This spirit spread rapidly from Europe 
 to America, and by the early nineties of the last 
 century, Americans were vying with Europeans 
 in the discovery of new bacilli, and in admirable 
 and lengthy description of the appearance of 
 diseased tissues. Scant attention seemed to be 
 
 [211] 
 
OUR MEDICINE MEN 
 
 given to the fact that men like Pasteur cared 
 httle for descriptive science but probed always 
 into the mechanism of phenomena. 
 
 The plethora of merely descriptive investiga- 
 tion resulted in the heaping up of an immense 
 literature, comprising scattered and more or less 
 connected fact. In pathology, these data are of 
 value to clinicians in the checking of diagnosis, 
 but have been of little importance in the elucida- 
 tion of the phenomena of life and disease. Such 
 a body of knowledge is to be compared to the 
 careful observations of an explorer who pene- 
 trates an unknown land. The microscopic study 
 of diseased tissues almost invariably necessitates 
 the killing of that portion which it is desired to 
 investigate. During this process, changes in 
 structure may take place which might totally 
 alter the appearance of tissues as they existed in 
 the living state. Therefore, it is usually fatuous 
 to draw sweeping conclusions from the examina- 
 tion of such devitalized tissues. An example 
 of the sterility of this type of effort is to be 
 found in the study of cancer. An enormous 
 amoimt of microscopic investigation has been 
 
 [212] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 devoted to the appearance of cancerous tissues. 
 Clever methods of coloration have been evolved, 
 making the detection of such noxious growths 
 an easy matter to experienced persons. Preten- 
 tious laboratories, erected at great cost, are de- 
 voted to work of this kind. But it is safe to 
 assert that the time and money so expended have 
 done virtually nothing to advance our knowl- 
 edge of the nature and etiology of cancer. The 
 directors of such laboratories now probably 
 realize the sterihty of such effort. But it is dis- 
 gusting to observe that they do not mend their 
 ways. On the contrary, when investigations like 
 those of Murphy begin to throw new light on 
 the problem, these high priests of morphology 
 use the energies of their minions in the attempt 
 to prove that he is wi'ong. 
 
 It was a relatively easy thing to make startling 
 and dramatic discoveries in the days following 
 the investigations of Pasteur. New phenomena 
 were exposed with the greatest ease, in much the 
 same manner as prospectors might uncover rich 
 veins of ore in a new and unexplored territory. 
 Thus it happened that men of no more than 
 [213] 
 
OUR MEDICINE MEN 
 
 mediocre ability became notorious by the attach- 
 ment of their names to a bacillus causing a dis- 
 ease or to some new phenomenon requiring 
 rather simple means for its demonstration. This 
 type of research was largely quahtative in na- 
 ture. It did not demand the meticulous care 
 necessary to accurate physical and chemical ex- 
 periments. It was consequently easy of accom- 
 plishment by persons with the rough training 
 and vague methods of thought current in the 
 medical world. It flourished gorgeously in 
 America, for our nation is notoriously the land 
 of the slap-dash, sloppy type of activity. As a 
 result, the majority of medical research for the 
 first thirty years after the ground-breaking work 
 of the French and Germans is of a nature caus- 
 ing conscientious investigators to blush. 
 
 On the other hand, it is true that a few Ameri- 
 can experimenters deserve to rank with the 
 European Nestors in the study of disease. The 
 most prominent of these are F. G. Novy and 
 Theobald Smith. Both of these men refused to 
 be pushed into that insane fury of competitive 
 effort and indiscriminate production which is 
 
 [214] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 laudable in the manufacture of brass cuspidors 
 but entirely out of place in science. The inves- 
 tigations of Smith in Texas fever and tubercu- 
 losis, and of Novy on relapsing fever and the 
 trypanosomes, belong to the real classics of 
 bacteriology. These men employ the exactness 
 of technique and the painstaking accuracy neces- 
 sary in chemistry. Neither of them wasted his 
 time in propounding idiotic theories or in whoop- 
 ing in support of doctrines enunciated by others. 
 Rather, they concerned themselves with the rev- 
 elations of important and solid facts. Their ex- 
 periments have a preciseness and finish that in- 
 sure their easy verification. Their work stands 
 out in strong contrast to a great mass of incom- 
 plete and hasty investigation, usually imitation 
 or elaboration of European achievement. Ex- 
 periments of the latter kind are frequently 
 notable chiefly for the total absence of controls, 
 and read much like the directions for the prepa- 
 ration of a chowder in the admirable volume of 
 culinary instruction compiled by the noted Mrs. 
 Rorer. 
 The multiplication of descriptive research and 
 [215] 
 
OUR MEDICINE MEN 
 
 surface explanation led to confusion and finally 
 to stagnation. The rapid uncovering of surface 
 phenomena began to slacken. It seemed that 
 the students of disease had advanced to the foot 
 of an unscalable cliff. The cause of this sterility 
 after brilliant beginnings is not far to seek. It 
 was due, without doubt, to the failure to recog- 
 nize thoroughly the necessity of the quantitative 
 methods of physics and chemistry, which involve 
 a patience and relentless rigor foreign to the 
 majority of the students of disease. 
 
 Preposterous theories took the place of pene- 
 trating investigations. These were metaphysi- 
 cal in nature, and are to be called facile visuali- 
 zations or speculations, rather than theories. 
 For a theory, to be valuable, explains all of the 
 facts that appear in the domain that it presumes 
 to elucidate. Also it should be possible to make 
 verifiable predictions on its basis. It should be 
 presentable, if possible, in the form of a mathe- 
 matical expression. Such theories are of the 
 utmost value in science and serve not only to 
 correlate seemingly disparate facts, but make 
 possible the a priori prediction of new ones. 
 
 [216] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 This is not the nature of the so-called theories 
 common to the study of disease. Examples of 
 these are the side-chain theory of Ehrlich and 
 the protein split-product theory of Vaughan. 
 These had no sooner been enunciated than nu- 
 merous facts were discovered which were inex- 
 plicable in their light. The promulgators of 
 these doctrines were then required to evolve 
 elaborate and fantastic subhypotheses in their 
 defense. The battles raging round them ceased 
 to be the conflicts of experimenters and took on 
 the appearance of the vaporings of schoolmen. 
 It was necessary to assume the presence of sub- 
 stances for the existence of which there was not 
 the slightest experimental evidence. What is 
 more, rather than aiding the progress of knowl- 
 edge of disease, they were of evil influence be- 
 cause their facile diagrammatic nature was easy 
 of comprehension by simple intellects and so 
 tended to produce the impression that the prob- 
 lems of immunity and anaphylaxis were ex- 
 plained and settled. In America Ehrlich's 
 theory of immunity was religiously taught and 
 its terminology slavishly employed long after it 
 [217] 
 
OUR MEDICINE MEN 
 
 had been reduced to absurdity by the researches 
 of Bordet and of Arrhenius and Madsen. It is 
 now less popular, but its decadence results, it is 
 sad to relate, rather from patriotic considerations 
 than from intellectual conviction. This has led 
 Bordet to remark sardonically that Marshal 
 Foch is to be thanked for the victory of his ideas. 
 
 It is gratifying to relate that the possibility 
 of an entirely new attitude in the study of disease 
 is beginning to appear in America as well as in 
 Europe. Physical chemists are at last beginning ' 
 to invade the jungle of contradictory facts in 
 which medical investigators wallow. In Europe, 
 the movement began with the quantitative inves- 
 tigations of Arrhenius and Madsen in immunity. 
 The Dane Sorensen and the German Michaehs 
 have made great strides in the field of biochem- 
 istry, and begin to lift that body of knowledge 
 from its cook-book status. 
 
 The American protagonist in the spirit of 
 quantitative physicochemical investigation of life 
 phenomena is Jacques Loeb. Although his work 
 is in the field of general physiology, which seems 
 far removed from that of the problem of disease, 
 
 [218] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 in reality this remoteness is an illusory one. His 
 illuminating researches on the chemistry of pro- 
 teins should be capable of early application to 
 the study of disease. His efforts begin to at- 
 tract followers from the ranks of physical chem- 
 ists. In the field of biochemistry the names of 
 Van Slyke, Folin, Falk, and others are con- 
 nected with quantitative researches with definite 
 application to the problems of disease. 
 
 It is not advisable to clamor impatiently that 
 this new spirit will rapidly solve the obscure 
 problems of disease. For these last are of a 
 baffling complexity and may have to be attacked 
 for a time by the nibbling tactics of Joffre rather 
 than by the penetrating or encircling ones of 
 Foch or Ludendorff. It will be difficult to con- 
 vince the majority of medical investigators that 
 it is futile to continue their researches without 
 fundamental knowledge of the exact sciences. 
 At present there are too many of these persons 
 who learn by rote the delicate methods evolved by 
 chemists, use them with confidence and abandon, 
 and draw idiotic and unjustifiable conclusions 
 from their employment. 
 
 [219] 
 
OUR MEDICINE MEN 
 
 It is necessary to attract physicists and chem- 
 ists to the study of biology and the problems of 
 disease. This will be difficult, since such men 
 are rapidly befogged by the bewildering mass of 
 fact and the still formidable vestigia of medieval 
 medical jargon that it is necessary for them to 
 master. Again, they recognize the great com- 
 plexity of vital phenomena, and do not feel 
 comfortable in the presence of the numerous 
 difficultly controllable variables that are inherent 
 in the mechanism of hving organisms. Accus- 
 tomed to be accurate to the third and fourth 
 decimal place, they naturally shy at experi- 
 mental errors of 5 per cent. Finally, they doubt- 
 less resent the attitude of the majority of emi- 
 nent medical investigators who regard them as 
 mere handmaidens and presume to map out 
 problems that can only be solved by their 
 knowledge and technique. This is, once more, a 
 manifestation of the evil of the medical director 
 of research, who sits in his remote office evolving 
 problems, calling in turn upon physicists, bac- 
 teriologists, and chemists for their solution. 
 
 It follows that any rapprochement between 
 [220] 
 
THE SCIENCE OF THE STUDY OF DISEASE 
 
 genuine scientists, such as physical chemists, and 
 embryo investigators of the type of the majority 
 of students of disease, must be in the nature of a 
 free collaboration. The chemist must have a real 
 interest in biological problems. These are actu- 
 ally rather simple in statement, when the fog of 
 superfluous data and idiotic speculation is re- 
 moved. Until medical educators realize that the 
 prospective students of disease must have a 
 really thorough training in chemistry and 
 physics, and until they are able to teach their 
 subjects from this point of view, it will be futile 
 for medical graduates to attempt unaided inves- 
 tigations of this type. Inadequately trained, 
 they tend to apply the sloppy methods of 
 biological and medical research to the exact 
 science of chemistry, rather than to introduce 
 chemical methods into biology. All that is pos- 
 sible at present would seem to be the collabora- 
 tion alluded to above. 
 
 [221] ' 
 
CHAPTER X 
 
 THE MASTER PHYSICIAN AND THE 
 ANTI-PHYSICIAN 
 
 DESTRUCTIVE criticism is condemned 
 by all public-spirited citizens of our na- 
 tion. They contend that it is not right to tear 
 down institutions and customs unless the critic 
 has something better to substitute for the things 
 he has just demolished. It is doubtful whether 
 the alternative plans proposed by people of 
 synthetic bent are ever of a merit superior to the 
 institutions they replace. This, however, seems 
 to be of minor importance. What is needed is 
 the alternative suggestion. 
 
 Those who have patiently followed the 
 writer's trend of thought through the preceding 
 dissertations may consider him to be charged 
 with the spirit of Dionysus, rather than with the 
 sane, constructive esprit of Apollo. It is true 
 
 [222] 
 
MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 that less thoughtful readers might consider him 
 to be a person of indignation, given to berserker 
 rages, delighting in scenes of demolition and the 
 contemplation of the resulting chaos. He 
 hastens to assure his readers that this is not true. 
 His admiration is all for the synthetic rather 
 than for the analytic aspects of life. He has 
 been led to his criticisms only by the conviction 
 that it is futile to go about the erection of an 
 imposing edifice by superposing it on ramshackle 
 buildings of worm-eaten wood. It seemed neces- 
 sary first to rid the world of these rickety struc- 
 tures and to dig deep foundations as a prelimi- 
 nary to creative activity. 
 
 But civilization is a vast compromise. Noth- 
 ing is done thoroughly, cleanly, and in the grand 
 manner. And so the complete overthrow of the 
 modern practice of medicine would be as im- 
 practicable and impossible as a complete destruc- 
 tion of the whole fabric of society. It is the 
 fashion to erect halls of granite on substructures 
 of flimsy pine. It is customary, when one has 
 criticized, to end on the constructive note. Out 
 of deference to the mode, despite the note of 
 [223] 
 
OUR MEDICINE MEN 
 
 urbane and restrained criticism that has pre- 
 vailed throughout these dissertations, it would 
 seem wise to terminate the argument with a 
 synthesis. One cannot believe with Candide 
 and his modern successor, Pollyarma, that this is 
 the best of all possible worlds. On the other 
 hand, good citizenship demands that one should 
 contribute one's mite toward making it so. 
 
 The following plan for the future organization 
 of the practice of medicine is the result of an 
 anonymous collaboration. 
 
 An acquaintance, who is not a physician, but 
 a man of affairs, of clear vision and of breadth 
 of view, is responsible for the plan about to be 
 suggested. His outline, delivered in clear and 
 concise sentences, showed a complete absence of 
 that formalism, conservatism, and hesitation in 
 the face of difficulties to be observed in members 
 of the medical profession itself. 
 
 The modern advance in knowledge of disease 
 has created a body of learning and technology 
 too vast to be mastered by those persons of aver- 
 age intelligence from whose ranks the general 
 practitioners are drawn. What is more, the 
 
 [224] 
 
MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 strains and complexities of urban civilization are 
 resulting in obscure diseases which the family 
 doctor is incompetent to diagnose or to treat. 
 
 Specialization in medicine is consequently a 
 necessity. Uncontrolled specialization has led 
 to the excesses and imbecilities dwelt upon in 
 foregoing chapters. The present attempts at 
 "group medicine" are groping efforts to coordi- 
 nate the present high differentiation of function 
 in medical practice. But the emphasis in the 
 group is too much on mere technical skill and on 
 economic considerations. The patient represents 
 an object for so-called scientific study and a 
 source of income. More stress should be laid 
 on the fact that he is first of all a human being. 
 
 The elaboration and extension of the group 
 is inevitable and desirable. But its activities 
 should in every case be coordinated by a central 
 directing intelligence, or master physician. This 
 last will be a person of maturity, an able diag- 
 nostician, thoroughly acquainted witli surgery, 
 privy to the importance, in diagnosis and treat- 
 ment, of the science of pathology, bacteriology, 
 and blood chemistry. His primary function 
 [225] 
 
OUR MEDICINE MEN 
 
 would be that of a governor, able to curb the ex- 
 cesses of enthusiasm that each specialist must 
 inevitably feel for his branch. Left to them- 
 selves, speciahst surgeons, neurologists, endo- 
 crinologists, blood chemists, one and all tend to 
 "run wild." Controlled by a real master intelli- 
 gence, their coordinated efforts might become 
 very valuable. Needless to say, the authority of 
 the chief should be autocratic. 
 
 In addition, the master physician would sup- 
 ply the personal touch which is now frequently 
 lacking in the activities of the group. He would 
 realize the immense importance of the patient's 
 morale. He would make as intelligent as pos- 
 sible a use of the still completely empirical 
 knowledge of the power of mind over body. This 
 power, while completely mysterious, undoubt- 
 edly exists, and is made use of by faith-healers, 
 psychoanalysts, and Christian Scientists. These 
 individuals, despite the inanity of their theories 
 and bodies of doctrine, occasionally work mar- 
 velous cures. The master physician would not 
 pooh-pooh at these cults because of the general 
 emptiness of their ideas. Instead, he would 
 
 [226] 
 
MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 make a discriminating use of the methods of all 
 of them. In his hands the present mysterious 
 nature of these phenomena might begin to be- 
 come clear. He would coordinate the present 
 high development of surgical technique and 
 laboratory diagnosis with his own abilitj^ as a 
 general diagnostician and his understanding of 
 the obscure influence of the mind over bodily 
 malaises. 
 
 It would seem, at first glance, that such or- 
 ganization of medical practice on a large scale 
 would demand its nationalization. This, how- 
 ever, would really be infeasible, in the light of 
 the inherent inefficiency of democratic forms of 
 government. It would seem advisable to pre- 
 serve the present organization of medicine along 
 the hnes of private endeavor. Some elaboration i 
 and modification of the idea originated at the i 
 Mayo Clinic would certainly be practicable. 
 That is to say, patients would be charged for the ; 
 services rendered them strictly on a basis of their ' 
 incomes. This would be greatly superior to thej 
 plan recently proposed and put in operation by V 
 the Johns Hopkins authorities, who have de- 
 [227] 
 
OUR MEDICINE MEN 
 
 :ided to limit the fees for operations to a sum not 
 exceeding one thousand dollars. Since the 
 equipment and organization of groups on a large 
 jcale is very costly, it would seem unwise to 
 follow the Johns Hopkins plan. For if our 
 nodern plutocrats were not occasionally made 
 ;o disgorge huge sums for operations, the less 
 'ortunate middle class would find the burden of 
 nedical care still heavier than it is at present. 
 
 The writer greatly admires the splendid pic- 
 ;ure of the possibly glorious renaissance of medi- 
 ;ine painted by his constructively-minded ac- 
 quaintance. He would indorse this plan, fight 
 'or it, preach it from the housetops, die for it, 
 f he believed that it could be put into operation 
 vith the personnel of the medical profession as 
 t exists at present. The lack of intellectual 
 igor and honesty in the medical profession has 
 )een alluded to again and again in preceding 
 ihapters. The causes of this lamentable condi- 
 ion have been pointed out. 
 
 It is possible that master physicians of the 
 ype just visualized might be able to infuse into 
 heir groups a new esprit of honesty, a disdain 
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MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 for the contemptible stand-from-under attitude 
 now so common in medicine. Accordingly, with 
 all possible respect for the plan of medical or- 
 ganization just outlined, the writer wishes to add 
 another qualification to those which the master 
 physician must possess. In a preceding chapter 
 the intellectual discipline noticeable in the engi- 
 neering profession has been compared to that 
 of the medical cult, to the great disparagement 
 of the latter. But it is demanded that the chief 
 of the group be endowed with the spirit of an- 
 other type of citizen, whose metier demands on 
 accuracy of knowledge and rigor of conduct and 
 mental discipline superior to that of any other 
 body of men. This man is the ship-captain. 
 Any one acquainted with the sea knows of the 
 high discipline reigning on shipboard. The skip- 
 per knows, even more than the engineer, that his 
 mistakes will be visited on his own head. Conse- 
 quently, when his ship comes to grief, he prefers 
 to go down with it, rather than meet the dis- 
 grace attending demotion and the entry of his 
 name in the black-book. He is a skipper because 
 he loves the sea and his ship. His disregard of 
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OUR MEDICINE MEN 
 
 great financial reward is notorious. One seldom 
 hears him whine piteously over the small amount 
 of his income as compared to the long years 
 spent in preparation for his calling. He would 
 disdain the frantic wail that went up from 
 medicos, great and small, when the Johns Hop- 
 kins plan for the limitation of emolument was 
 announced. 
 
 As has been mentioned before, the Babylon- 
 ians rewarded the blunders of their doctors by 
 the removal of hands, or heads, according to the 
 severity of the mistake. This plan was full of 
 wisdom and is an evidence of the sagacity of the 
 leaders of that civilization. It is, however, un- 
 suitable to the refined sentiments of our era, 
 which frowns upon all mutilations except those 
 performed en masse in the process of the world's 
 democratization. 
 
 The morale existing among the physicians of 
 the future will have to be akin to that of the 
 shipmaster. It will be the fear of disgrace rather 
 than the fear of capital punishment that will 
 have to animate the master physician. He will 
 
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MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 have to prefer to die rather than kill his patient 
 unnecessarily. And realizing his responsibility, 
 he will be able to hold his subordinate specialists 
 of the group to similarly high level of discipline. 
 It would seem that this spirit could only be 
 brought about by a relentless checking of the 
 doings of physicians. This could only be ac- 
 compUshed by necropsy of all persons dying, and 
 comparison of the necropsy findings with the 
 final diagnosis of the master physician. Nobody 
 complains about the high spirit of discipline and 
 efficiency existing among the masters, officers, 
 and crews of ships. It is on this that the great 
 safety of travel depends. If the population 
 realized that its medical care could be made in- 
 comparably more efficient by compulsory ne- 
 cropsy of all the dead, performed by impartial, 
 intelligent, and accredited pathologists, the 
 present superstitious objection to such procedure 
 would soon disappear. The master physician 
 of the future, in addition to the quality of hu- 
 manity, acunien in psychology, broad training 
 in the technology of medicine and its con- 
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OUR MEDICINE MEN 
 
 tributory sciences, must possess the high feehng 
 of responsibihty that is the outstanding charac- 
 teristic of the shipmaster. 
 
 It remains to supplement this constructive 
 suggestion with another, hardly less valuable. 
 Again, it is necessary to admit that the idea does 
 not really belong to the writer. He has it from 
 a friend whose views are still broader, if less 
 optimistic, than those of the first collaborator. 
 This friend has suffered much at the hands of 
 doctors. He has the misfortune to be a chronic 
 invalid, and has passed a large part of his life as 
 a subject of experiment and financial exploita- 
 tion by physicians, great and small. 
 
 Despite his trials, his attitude toward life is 
 serene and unruffled. He does not curse God; 
 he refrains from excoriating the devil; he hesi- 
 tates to denounce the medicine men who have 
 had such a large share in the multiplication of 
 his troubles. Instead, he regards the medicine 
 men with an eye full of compassion and under- 
 standing. From his remote window on River- 
 side Drive, he gazes on stylish doctors rolling 
 past in expensive limousines, and smiles the 
 
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MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 patient smile of a god who has made a mess of 
 a world, and who regretfully realizes that there 
 is nothing to be done about it. 
 
 His constructive suggestion is fuU of sense, 
 and is born of an experience with doctors that 
 only chronic invalids enjoy. It will appeal to 
 these, and to inteUigent people who are well but 
 who realize that sickness may some day be their 
 lot. It will be particularly attractive to effi- 
 ciency experts, who stand aghast at the tremen- 
 dous wastage that is everywhere apparent in our 
 civilization. 
 
 Chronic invalids, says this friend, are at pres- 
 ent a great burden to society. They devour 
 produce; they take up the time of servants who 
 might otherwise be profitably employed as pro- 
 hibition agents; they engage the attention of 
 nurses who might otherwise function efficiently 
 as manicurists. In return they give nothing to 
 society, save maybe an unending dirge of com- 
 plaint against their bitter lot. They are a 
 nuisance; they are expensive; they are in the 
 way ; they are inefficient. What to do with them? 
 
 The constructively-minded friend suggests 
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OUR MEDICINE MEN 
 
 that invalids would furnish excellent material for 
 a new type of official, operating not with, but 
 against the medical profession. This function- 
 ary would be called the Anti-physician. He 
 would be in the employ of the state or the mu- 
 nicipality, and it would be his duty to advise, 
 free of charge, all persons who feel themselves 
 to be on the verge of sickness or chronic invalid- 
 ism. Advise them in regard to what? In regard, 
 of course, to the doctors that it would be wise 
 for the prospective patient to avoid! 
 
 The chronic invahd has had experience with 
 many doctors. He has gone, almost invariably, 
 from one spiu-ious savior to another. He has 
 clutched at this straw and that. At last he has 
 come to regard with a cold analytical eye all 
 those who pretend to be able to heal him. He 
 knows their foibles, their vanities, their shams, 
 their pretenses. 
 
 Who, then, could be more valuable in the 
 warning of prospective sick ones against the 
 more charlatanish and incompetent of our medi- 
 cine men? It would seem that the institution of 
 the anti-physician would preserve many people 
 
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MASTER PHYSICIAN AND ANTI-PHYSICIAN 
 
 from terrible experience with poor doctors — in 
 .short, with fakers, commercialists, rogues, and 
 bluffers. Such doctors, deprived of their clien- 
 tele by this warning off of their prospective pa- 
 tients, would rapidly disappear from the field of 
 the treatment of disease. 
 
 It is for others to work out the details of this 
 admirable suggestion. Objectors will arise at 
 once to assert that this institution would be very 
 amenable to graft. Doctors would pay the anti- 
 physician to refrain from denouncing them. 
 But it would be possible to prevent this by pay- 
 ing these new functionaries princely salaries, and 
 by giving them life appointments, amid sur- 
 roundings of ease and luxury. What is more, 
 every chronic invalid would not be eligible for 
 this role. The requirement for the office would 
 not be based on any college degrees the candidate 
 has received, nor upon any academic honor or 
 mark of distinction. For it is notoriously true, ^ 
 if rather paradoxical, that the higher education 
 in America increases credulity and dims the judg- 
 ment, rather than the reverse. 
 
 The anti-physician would be chosen from the 
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OUR MEDICINE MEN 
 
 ranks of the incredulous, the cynical, the desetv- 
 chante, the Descartian doubters. His metier 
 might have been that of the peasant, the joiner, 
 the stone-mason, the saloonkeeper. He would 
 almost never be chosen from the ranks of min- 
 isters of the gospel, or lawyers, or doctors, and 
 only rarely from among scientists. For these 
 professional people, strangely enough, are most 
 frequently lacking in the ability to analyze, to 
 pierce shams, to see clearly through pretense. 
 
 Efficiency experts will realize that this plan 
 would give useful employment to thousands of 
 people who are now nothing but burdens on so- 
 ciety. It would abolish untold suffering through 
 inept, unskilful, and dishonest medical atten- 
 tion; it would remove thousands of inept, un- 
 skilful, and dishonest doctors from the practice 
 of their honorable calling. The master physi- 
 cian with his spirit of the shipmaster, contending 
 with the anti-physician with his hatred of fraud, 
 would be a potent force in the renaissance of the 
 medical art, if my two constructively-minded 
 friends are to be believed. 
 
 It is customary, when one has criticized, to end 
 [236] 
 
MASTER PHYSICIAN AND ANTI-PHYSIGIAN 
 
 on the constructive note. Out of deference to 
 the mode, the argument has been terminated with 
 a synthesis. It is the deepest regret of the writer 
 that these suggestions were not his own. He had, 
 perforce, to borrow them from his friends. He 
 was forced to do this because he himself does 
 not beheve it possible to construct halls of granite 
 on substructures of flimsy pine. 
 
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