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•'Wherever there is love of mankind, there 
 
 is love of the medical art." 
 
 — Hippocrates. 
 
PREFACE 
 
 This book is inspired by the belief that the most 
 important knowledge for the individual is that which 
 promotes his physical efficiency and happiness. The 
 knowledge that has the power to contribute the most 
 to these ends is that which helps him to preserve him- 
 self in the best state of health. Good health is the 
 most important prerequisite for physical efficiency 
 and happiness. Vicious heredity, ignorance, or lack 
 of conformity- to the known rules of hygiene, senile 
 decay, and acquired diseases are conditions which 
 militate against good health. All of these are sus- 
 ceptible of amelioration through medical knowledge 
 and education. 
 
 This is the age of scientific methods. All of the 
 knowledge which is important for man is in process 
 of development by some branch of learning. The 
 knowledge concerning human life belongs in the do- 
 main of the medical sciences, a department of the bio- 
 logic sciences. The study of the physical properties 
 of man is called medical for the reason that human 
 interest in this study began in what was really a pre- 
 scientific period, when curing the ills of man was the 
 
 ix 
 
PEEFACE 
 
 first physical study applied to him. Seeking for 
 means to alleviate his diseases, in the crude ages long 
 passed, was the very natural beginning of this branch 
 of biologic interest. Had mankind gone about this 
 study in a truly scientific manner, anatomy, physi- 
 ology, pathology, and hygiene would have been stud- 
 ied first, and then the treatment of diseases built upon 
 these. But in the beginning of enlightened interest 
 in human health scientific methods had not been 
 adopted. An objection to the name, medical, is that 
 it confuses those who are not familiar with scientific 
 nomenclature. The meaning and mission of medical 
 science is often misunderstood. 
 
 ]\Iedicine is the science devoted to the study of the 
 hiology of man : and since health is his best posses- 
 sion, medical science has as its special aim the inves- 
 tigation of those conditions which destroy his health, 
 and the study of their causes, their prevention, and 
 their treatment : and ultimately has for its end to pro- 
 mote his physical efficiency, to relieve pain, and to 
 prolong life. All of the^e are being attained. 
 
 It is evident to the scientific mind that in medicine 
 there can be no schools with fixed creeds, sects, sys- 
 tems, or short cuts to knowledge. There is but one 
 medical science, and that is the science which seeks 
 for the truth. Like all of the sciences, its progress 
 must seem to the impatient to be slow, stumbling, 
 and groping. But three thousand years of research 
 and experience and two hundred and fifty years of 
 
 X 
 
PEEFACE 
 
 scientific methods have brought it to a high degree 
 of perfection. 
 
 This branch of learning concerns deeply individ- 
 uals and the public; but there is still much need of 
 an awakening of the people and of the state to its 
 sociologic significance. Society comes so closely in 
 contact with the individual doctor on his mission of 
 healing and relieving distresses both of a major and 
 minor nature, that, regarding his work, beneficent as 
 it is, as the typical activity of medical science, it has 
 failed to look beyond and grasp the importance of 
 medical knowledge and the medical profession as a 
 whole, of which the individual practitioner is but an 
 isolated, often imperfect, human expression. More- 
 over, the medical profession has failed to place suffi- 
 cient confidence in the public, and has kept itself 
 aloof, and denied the people important knowledge 
 which could be of service to them. This medical 
 aloofness has been prompted by the fear that a little 
 knowledge might do more harm than good, and by 
 the ethical desire not to be misunderstood or charged 
 with self-exploitation. 
 
 It is hoped that this book may help to break down 
 this barrier between the physician and the public, 
 and interest the latter in the work of the former, 
 and the former in the needs of the latter. The plea 
 that goes out to the public from the great heart of 
 the medical profession to-day is that prevention shall 
 take the place of cure. Medical knowledge has 
 
 xi 
 
PREFACE 
 
 reached that point when much of it can be taken by 
 the public and, without medical aid, applied to the 
 end of preventing diseases. Again and again, medi- 
 cine appeals to the people to take the measures nec- 
 essary to stop trv'phoid, tuberculosis, yellow fever, 
 plague, cholera, gonorrhea, syphilis, and the many 
 other destructive diseases which are clearly preventa- 
 ble. The earnestness and practicability of this ap- 
 peal constitute the most important side of medical 
 sociology. 
 
 This book is made up of observations touching upon 
 these sociologic relations of medicine. They are not 
 of sufficient fullness to be dignified by the name of 
 essays. All of them were written in the seclusion of 
 the country, which must serve as the excuse for the 
 meagerness of references. Some of them have already 
 been published in the New York State Journal of 
 Medicine at the time the author was editor of that 
 journal ; others are taken from his addresses, given 
 before both medical and nonmedical audiences ; and 
 many are here published for the first time. There is 
 for this reason little attempt at sequence or continuity 
 of arrangement. Each chapter must be regarded as 
 isolated. 
 
 The book has been divided into two parts : Part I 
 including those chapters dealing with questions of 
 greater interest to the lay reader, and Part II dealing 
 "^*ith questions having special interest for the medical 
 reader. 
 
 xii 
 
PEEFACE 
 
 It is hoped that these observations may help lay- 
 men, students of sociology, teachers and parents to a 
 better understanding of the meaning of medicine and 
 its power to save; and that for the medical reader 
 they may furnish some entertainment and instruc- 
 tion, strengthen his love for his profession, and 
 awaken a fuller appreciation of its possibilities. 
 Some of the chapters are little excursions across the 
 borderlands of medicine, whither we journey aU too 
 little. 
 
 The words of Descartes, " If it be at all possible to 
 ennoble mankind, it will be through medicine," can 
 be understood to-day better than ever before; and it 
 is the belief of the author that this twentieth century 
 is to be characterized by a renewal of interest in 
 health and physical efficiency such as the world has 
 never known, because there is to be inspired in the 
 individual greater concern for his own health and 
 a philanthropic interest in the health of his brother 
 men. 
 
 J. P. W. 
 386 Washington Avenue, 
 
 Bbooklyn, New York, 
 
CONTENTS 
 
 PART I 
 
 THE SOCIOLOGY OF HEALTH 
 
 CHAPTER PAGE 
 
 I. — Public Policy and the Medical Profession 3 
 II. — Federal Interest in the Health of the 
 
 People 7 
 
 III. — A Plea for the Well 23 
 
 IV. — Some Medical Aspects of Civilization . 34 
 
 V. — Healthfulness and Happiness ... 42 
 
 VT. — Exercise and Health 46 
 
 VII. — The Alcohol Question 55 
 
 VIII. — The Venereal Peril 70 
 
 IX. — The Instruction of the Young in Sexual 
 
 Hygiene 86 
 
 X. — Sexual Morality and the State . . . 100 
 
 XI. — Sexual Continence 112 
 
 XII. — Idle Wives, Unmated Men, and the Venereal 
 
 Peril 118 
 
 XIII.— The Social Evil 124 
 
 XIV. — Education and the Health and Efficiency 
 
 OF Girls 128 
 
 XV. — Physical Fitness at the Throttle . . 134 
 
 XVI. — The Accidents of Summer .... 138 
 
 XVII. — Life Insurance Interests .... 144 
 XV 
 
CONTENTS 
 
 CHAPTER PAGE 
 
 XVIII. — Unhygienic Immunity 147 
 
 XIX.— Fresh Air 150 
 
 XX. — Christian Science . . . . . . 169 
 
 XXI. — The Emmanuel Movement and Kindred 
 
 Phenomena 181 
 
 XXII. — Osteopathy 190 
 
 XXIII. — Facts and Theories 194 
 
 XXIV.— The Family Hazard 197 
 
 XXV. — Eating and Talking , 199 
 
 PART II 
 
 medical science and medical art 
 
 I. — The Evolution of Scientific Knowledge . 205 
 
 II. — Bacteriology and Botany .... 211 
 
 III. — Spontaneous Generation 216 
 
 IV. — The Beginnings and Progress of Thera- 
 peutics 221 
 
 V. — The Rationalization of Therapeutics . . 229 
 
 VI. — The Fate of Medicine 240 
 
 VII. — ^The Future Fields op Medical Activity . 245 
 
 VIII. — Medical Science and Human Progress . 251 
 
 IX. — Preventive Medicine 255 
 
 X. — The Diffusion op Medical Knowledge . 259 
 XI. — College Preparation for the Study of 
 
 Medicine 268 
 
 XII. — The Hospital Interneship .... 276 
 XIII. — State and College Medical Examinations . 281 
 XIV, — ^The State License to Practice Medicine . 286 
 XV. — The Practice op Medicine Legally De- 
 fined 290 
 
 XVI. — The Medical Expert Witness .... 292 
 
 xvi 
 
CONTENTS 
 
 CHAPTER 
 
 
 PAGE 
 
 XVII.- 
 
 —The Preceptor 
 
 297 
 
 XVIIL- 
 
 —The General Practitioner and the Clini 
 
 - 
 
 
 CAL Assistant 
 
 299 
 
 XIX.- 
 
 —Work and Play 
 
 303 
 
 XX.- 
 
 —A Well-ordered Life . . . . 
 
 309 
 
 XXI.- 
 
 —The Physician in Politics 
 
 315 
 
 XXII.- 
 
 —Knowledge versus Manners 
 
 320 
 
 XXIII.- 
 
 —Medical Libraries 
 
 325 
 
 XXIV.- 
 
 —The History of Medicine 
 
 330 
 
 XXV.- 
 
 —The Small Medical Society 
 
 333 
 
 XXVI.- 
 
 —Doctors' Sons 
 
 335 
 
 XXVII.- 
 
 —Tuberculosis Preventable . 
 
 337 
 
 XXVIII.- 
 
 —Medieval History 
 
 338 
 
 XXIX.- 
 
 — Societies 
 
 339 
 
 XXX.- 
 
 —Jubilee Membership .... 
 
 340 
 
 XXXI.- 
 
 —Medical Practice in Utopia . 
 
 341 
 
 XXXII.- 
 
 —The Present Day 
 
 342 
 
 XXXIII.- 
 
 —The Borderland of Truth . 
 
 343 
 
 XXXIV.- 
 
 —The Physician's Calling 
 
 344 
 
 XXXV.- 
 
 —The Future of Medicine 
 
 345 
 
 Index . 
 
 
 349 
 
PART I 
 
 THE SOCIOLOGY OF HEALTH 
 
MEDICAL SOCIOLOGY 
 
 PUBLIC POLICY AND THE MEDICAL PEOFESSIOX 
 
 THERE is one important fact whicli the 
 public should understand, and that is 
 that there is no great work in process 
 of development which means more to the peo- 
 ple than the advancement of the medical sci- 
 ences. If society were wise it would render 
 every aid to medical progress. A reflection 
 upon the ability of the people to take care of 
 themselves is the fact that most of the sanitary 
 measures which have been adopted for their 
 protection have been fought for by the medical 
 profession against strong opposition. Medical 
 men have labored to compel the adoption of 
 laws for the prevention of diseases, without 
 which laws our country would be riddled with 
 pestilence. 
 
 Frequently, in this fight which medical sci- 
 3 
 
MEDICAL SOCIOLOGY 
 
 ence is making for the people it loses, and some 
 danger to public health is permitted to enter so- 
 ciety. Bnt ultimately, by the slow process of 
 education, it is often made manifest to the pub- 
 lic that a revision of its action is necessary, 
 and it adopts the policy which medicine ad- 
 vised. This is done sometimes after the lesson 
 has cost a great price. It is not appreciated 
 sufficiently that there is a profession the func- 
 tion of which, as a whole, is for the public con- 
 servation. Individually, physicians often may 
 be inspired by that beneficent self-interest which 
 exists in all men; but as an organized class, 
 what is recommended by the medical profession 
 for the public good has the merit of true philan- 
 thropy which no other profession or avocation 
 approaches. Medicine is not striving for the 
 acceptance of any particular scheme, theory, or 
 doctrine of social betterment ; it is not laboring 
 to fasten upon the people any particular super- 
 stition ; its aim is to learn all that can be learned 
 about the laws of health, and apply them to the 
 end that pain may be lessened, sickness pre- 
 vented, physical efficiency promoted, and death 
 postponed. There are a few pessimistic philos- 
 ophers, of the schools of Schopenhauer and 
 Hartmann, who do not agree that all of these 
 
 4 
 
THE SOCIOLOGY OF HEALTH 
 
 are desirable things, but the majority of peo- 
 ple desire them all. 
 
 Were society wise it would give the men who 
 are striving for these things every help. Un- 
 wisely it does not. Here it makes laws to the 
 prejudice of jDublic health; there it hinders the 
 adoption of policies for the saving of lives. In 
 Vienna recently the mayor of the city made the 
 public statement, in the presence of a smallpox 
 epidemic, that more persons had died from the 
 vaccinations than from the smallpox. Scien- 
 tific men collected data, and showed the mayor 
 that there was not a case of death or serious 
 injury following the vaccinations, and that 
 there had been deaths from smallpox; but the 
 mayor declined to retract his words. The harm 
 which the public often does itself through its 
 chosen representatives is very great. If we 
 go a little farther east, in India, we find 62,000,- 
 000 natives dead from star^^ation and plague, 
 while the English Government sends the grain 
 out of the country to pay for maintaining 
 an enormous military and political show (emp- 
 tying the wealth of the Ganges into the Thames) 
 and fails to heed the plea of her humane medi- 
 cal profession, which would save suffering mil- 
 lions in this afflicted land. While the work of 
 
 5 
 
MEDICAL SOCIOLOGY 
 
 the English medical men in India is most suc- 
 cessful, still their protest always goes up that 
 it is only palliative, and that they cannot secure 
 governmental sanction or help for preventive 
 work. Japan gave heed to medical counsel and 
 saved her people. 
 
 If we return to our own country we find that 
 in every municipality where typhoid fever ex- 
 ists, the medical profession has advised the 
 people what to do to check the disease ; usually 
 it has pleaded with them. Has it advised the 
 people wrongly? No. Has it been unduly san- 
 guine that mortality could be reduced? No. 
 Has the public ever accepted its recommenda- 
 tions without a vast deal of parley and delay 
 while the people kept on dying? No. And is it 
 not a spectacle to be viewed with pity and 
 shame, that in every large community there are 
 people dying who would be well and happy 
 were the recommendations which the medical 
 profession has placed in the hands of the peo- 
 ple acted upon? 
 
II 
 
 FEDEEAL INTEREST IN THE HEALTH OF THE PEOPLE 
 
 "To be a good animal is the first requisite to success in life, 
 and to be a nation of good animals is the first condition to 
 national prosperity." — Herbert Spencer. 
 
 " The public health is the foundation on which reposes the 
 happiness of the people and the power of a country. The care 
 of the public health is the first duty of a statesman." — Lord 
 Beaconsfield. 
 
 THE Cabinet of the President of the 
 United States is made up of the Secre- 
 taries of State, of the Treasury, of War, 
 of the Navy, of the Interior, of Commerce and 
 Labor, and of Agriculture, an Attorney Gen- 
 eral and a Postmaster General. These gentle- 
 men are at the heads of departments which 
 have to do with the economics of government; 
 but only remotely do any of them have to do 
 with the very thing which concerns most closely 
 the happiness, and therefore the prosperity, of 
 the 80,000,000 of people whom they repre- 
 sent — their health. The health of our pigs has 
 representation in the Cabinet, but not our chil- 
 
 7 
 
MEDICAL SOCIOLOGY 
 
 dren. I shall not attempt to say what the title 
 of the officer should be who jDresides over the 
 department the business of which shall be to 
 conserve the most vital interest of the people, 
 but I shall say that such a department could be 
 made the most useful and important of all the 
 departments in the Grovernment, and I except 
 none. If there were a national department of 
 health, or sanitation, with a secretary at its 
 head, it could serve the nation to a degree of 
 efficiency even greater than that with which our 
 municipal departments of health serve our cit- 
 ies or, the State departments of health serve our 
 States. That there should be such a depart- 
 ment is one of the most urgent needs of our 
 country. The centralization of authority is es- 
 sential for a great work. 
 
 At the present time there are private soci- 
 eties all over the land endeavoring as best they 
 can to check the ravages of tuberculosis. Sup- 
 pose the powers of the Government were turned 
 in this direction: it is difficult to imagine the 
 good that would result. Municipalities are 
 struggling, each in its separate way, with the 
 typhoid-fever problem. If only the Govern- 
 ment would come to the aid of all of them with 
 a systematized campaign against typhoid fever, 
 
 8 
 
THE SOCIOLOGY OF HEALTH 
 
 can one imagine the fullness of the beneficent 
 results that would accrue! 
 
 If the solution of the problem lay in educa- 
 tion, think of the facilities of the Government 
 for advancing the cause of education and pub- 
 lic information. The presses at Washington 
 are busy turning out the effusions of Congress- 
 men, and our mails distribute them broadcast 
 over the land. Suppose these forces were em- 
 ployed in the campaign against tuberculosis in- 
 stead of in the interest, say, of private corpora- 
 tions, might not the public money be spent to a 
 better advantage? 
 
 There are now living in this country 8,000,000 
 people who are destined to die of tuberculosis : 
 that is equivalent to all of the people in the State 
 of New York. One hundred and seventy-five 
 thousand people died last year in the United 
 States from that cause. Tuberculosis is a pre- 
 ventable disease. The knowledge sufficient for 
 its extermination is now in the literature of 
 medicine. The State could take this knowledge 
 without further medical assistance and con- 
 summate the work. The fight against tubercu- 
 losis should now be in the hands of the State. 
 Medicine has gone about as far as it can. But 
 in this fight the burden is still made to rest upon 
 
 9 
 
MEDICAL SOCIOLOGY 
 
 the medical profession. The State is not put- 
 ting its hand to the task. The man who has 
 read history correctly knows that ultimately tu- 
 berculosis will be exterminated. How dearly 
 we should prize the saving of some of those who 
 are to be sacrificed upon the altar of delay. 
 Suppose the Government should do its best to 
 preserve some of these 8,000,000 people. Let 
 us say that it saved only 1,000,000 and de- 
 ferred for five years the period of incapacity 
 of another million. The commercial value of 
 that alone would pay all of the expenses of a 
 national health department conducted upon a 
 most elaborate plan. 
 
 During the coming year some 1,800,000 peo- 
 ple are destined to die in the United States. 
 The Government is spending money on the 
 study of infusoria dredged from the bottom of 
 the sea; it is doing all that it can for the pro- 
 tection of the trees and pigs ; and it is devoting 
 large sums of money to study and protect from 
 diseases clams, lobsters, and shad — all of which 
 is most commendable; but while the interests 
 of these things are represented in the Cabinet 
 of the President, our people may sicken and 
 die of diseases which governmental authority 
 might prevent, while the Government, whose 
 
 10 
 
THE SOCIOLOGY OF HEALTH 
 
 function it is to protect us, takes little cogni- 
 zance of our plight. We need protection from 
 disease more than from invading armies; and 
 our infant children need protection more than 
 our infant industries. What shall civilized 
 peoples say of the government which concerns 
 itself more with tuberculosis in cows than in 
 men f In the United States of America a sheep 
 with anthrax receives the attentions of a secre- 
 tary of the Cabinet ; but a whole community of 
 men might have this disease, and there is no 
 secretary to interest himself for them nor to 
 preserve the well. There are scores of scien- 
 tific men in this country of infinite capabilities, 
 perhaps some who might do for us as much as 
 Pasteur did for France. We could have their 
 services at the rate of pay of a colonel of in- 
 fantry. Does anyone believe that it would not 
 be a good investment for the Government to 
 encourage the study of human health and dis- 
 eases? 
 
 According to our last statistics we may calcu- 
 late that during the present year about one for- 
 tieth of our population will be constantly sick, 
 which means that continuously 2,000,000 fam- 
 ilies, representing 10,000,000 persons, will be 
 affected by sickness. What affairs of state are 
 
 11 
 
MEDICAL SOCIOLOGY 
 
 more important to this one eighth of the popu- 
 lation of the country"? What are the many de- 
 partments of the Government doing to reduce 
 this morbidity? 
 
 The thing which is closest to the happiness 
 and prosperity of the people has but meager 
 consideration. The nearest we come to it is in 
 the Public Health and Marine Hospital Service, 
 a small medical department under the control 
 of the Secretary of the Treasury — as though 
 what is done for the public health must be as- 
 sociated with the dollar sign! Common sense 
 and common humanity have prompted the De- 
 partment of Agriculture to undertake much 
 work of a distinctly medical character. The 
 need and opportimities for such work are evi- 
 dent to all observing people. Curiously enough, 
 the Department of Agriculture, according to 
 the provisions of the Pure Food Bill, is called 
 upon to pass judgment upon drugs, medicines, 
 and foods intended only for human use. 
 
 Modern medicine, modern sanitation, has 
 shown what it can do to reduce mortality and 
 improve the health of communities. In its benefi- 
 cent power the Government would have its most 
 potent agent to promote and conserve the pros- 
 perity of the people. Most of the diseases with 
 
 12 
 
THE SOCIOLOGY OF HEALTH 
 
 which these 80,000,000 people suffer are subject 
 to amelioration, and many of them are abso- 
 lutely preventable. Yellow fever, tuberculosis, 
 typhoid fever, malaria, and many other diseases 
 are susceptible to the interpretations of inter- 
 state laws just as well as the railroads are. One 
 State might reach a high degree of efficiency in 
 dealing with them, but failure to do so on the 
 part of neighboring States would negative its 
 work. In one State it is forbidden to empty 
 sewage into streams from which towns below 
 take their water supply, but in the neighboring 
 State sewage is emptied into these very same 
 streams. Lake Champlain is protected from 
 contamination on the New York side, but Ver- 
 mont empties refuse into it. The question of 
 the disposal of the sewage of the cities is be- 
 coming a serious problem. At present it is 
 wasted. The cities are eating up the nitrogen 
 of the country and dumping it into the sea. 
 This will soon be recognized as a waste worthy 
 of national attention. Streams flow, people 
 travel, insects fly, and winds blow, carrying dis- 
 ease from one State into another; and these 
 matters are too big and too vital for each com- 
 munity to try to settle for itself. Eailroad cars 
 are not the only things that may carry trouble 
 
 13 
 
MEDICAL SOCIOLO*GY 
 
 between the States. The milk consumed in New 
 York City comes from at least six different 
 States, all with different laws and different sys- 
 tems of inspection. The milk problem will 
 never be solved satisfactorily until there is fed- 
 eral interest in the country's milk supply. 
 
 Each State might have a laboratory for can- 
 cer research, as New York State has, but a fed- 
 eral laboratory with the power of the Govern- 
 ment behind it would have a greater efficiency. 
 The several States have no relationship or 
 channels of official connection with the coun- 
 tries which are carrying on scientific work, but 
 the Federal Government has. The government 
 which lends aid to foster the industries can af- 
 ford surely to aid the advancement of medical 
 science, the science preservative of its brawn 
 and brain. 
 
 The people of this great country are going to 
 have a national department of health. It may 
 be deferred, but it is ine\atable. The supervi- 
 sion of the foods produced and purveyed to the 
 people, the healthfulness of trades and occupa- 
 tions, the cleanliness of the great waterways, 
 child labor, the safeguarding of the young, the 
 physical fitness of immigrants, the instruction 
 of the people in the care of health, and the keep- 
 
 14 
 
THE SOCIOLOGY OF HEALTH 
 
 ing of vital statistics, are but a few of the gov- 
 ernmental duties which are now neglected for 
 want of a national department of health. Such 
 a department should frame laws for regulating 
 the practice of medicine, and recommend them 
 for adoption to the different States. 
 
 The equalization of medical laws is much 
 needed. The requirements for practice should 
 be the same in every State. It should not be 
 possible for a person who is debarred from 
 practicing in one State to find that he can step 
 over the line and practice in another. 
 
 This country is the most prodigal of all the 
 great nations in its wastefulness of human lives 
 by accident as well as by disease. As an ex- 
 ample of what is going on in the direction of 
 the unnecessary destruction of lives a recent 
 report of Mr. Holmes, chief of the Technical 
 Branch of the Department of the Interior, may 
 be cited. He reports 23,000 lives lost in the 
 United States through mine explosions during 
 a period of less than eighteen years. These 
 disasters, he says, are due to lack of proper 
 regulations, ignorance, and carelessness. Last 
 year 2,000 lives were needlessly sacrificed in 
 our mines, and 10,000 lives were lost on our 
 railroads. The total mortality from accidents 
 3 15 
 
MEDICAL SOCIOLOGY 
 
 to wage-earners in the United States is 35,000 
 annually; tlie non-fatal accidents amount to 
 about 200,0000. 
 
 It is a far cry from the Department of the 
 Interior to the saving of human lives or public 
 health. There is a great profession and a sci- 
 ence devoted to the saving of human lives. 
 Study of this subject has been in progress by 
 this profession since the dawn of civilization, 
 but the Department of the Interior has little or 
 no relation to it. When we have a national de- 
 partment whose specific function is the preser- 
 vation of life we shall be approaching the sensi- 
 ble solution of this question, and not until then. 
 
 "We are deficient in national vital statistics. 
 Without accurately compiled statistics many 
 sanitary calculations become guesswork. The 
 value of such statistics is of especial impor- 
 tance in determining the effects of diseases and 
 other conditions upon the whole population. 
 They furnish a judgment upon large numbers 
 of people, while the best that knowledge other- 
 wise could produce would be upon a few indi- 
 viduals. They also supply the measure of the 
 vital phenomena of a population, the relation of 
 birth rate to death rate, the prevalent diseases, 
 their increase or diminution, their relation to 
 
 16 
 
THE SOCIOLOGY OF HEALTH 
 
 climates and industrial conditions, and many 
 other invaluable helps in safeguarding the well- 
 being of the people. Long before hygiene and 
 sanitary science had attained to any consider- 
 able degree of perfection the value of such sta- 
 tistics was recognized. The several States of 
 the Union are each devoting a certain amount 
 of attention to this matter, but with indifferent 
 cooperation with one another. Some of the 
 States have applied admirable systems in this 
 work, and others have done nothing. Other 
 civilized countries have vital statistics. " In 
 the United States the vital statistics are almost 
 worthless," was said in a recent discussion be- 
 fore the Eoyal Statistical Society of England, 
 and our statisticians know this to be true. A 
 national department of health could remove this 
 reproach. 
 
 European vital statistics show that in the 
 middle of the sixteenth century the average 
 length of human life was twenty years. It has 
 increased, especially during the last fifty years, 
 until it is now forty years. In Sweden, where 
 modem scientific methods are applied most 
 fully, it has risen to fifty-two years, and others 
 of the more highly civilized European countries 
 will soon reach that figure. It is surely of much 
 
 17 
 
MEDICAL SOCIOLOGY 
 
 importance to a new-born babe whether his 
 period of expectancy shall be twenty years or 
 fifty-two. The frightful death rate from pre- 
 ventable diseases in the United States makes it 
 absolutely feasible to add twelve years to the 
 average length of life in this country by means 
 of the simple measures which are already well 
 known and proved. It is not too much to claim 
 that in a hundred years human longevity could 
 be raised to sixty years if the Government 
 would make conserving the health of the peo- 
 ple one of its functions. 
 
 Some day typhoid fever will be as obsolete 
 in civilized communities as cholera or smallpox. 
 We possess all of the information that is nec- 
 essary to make it so now. It is no longer a' 
 great and elusive mystery. The average third- 
 year medical student knows enough about ty- 
 phoid fever to be able to stamp it out if he 
 were endowed with absolute power. Of course, 
 he would have to interfere with the profits of a 
 number of our leading citizens. This is one 
 reason why typhoid is prevalent. At pres- 
 ent it is a matter of barter for human lives. It 
 costs money to convince an influential citizen 
 that the excrement of his tenants should not 
 flow into a municipal water supply ; and it is on 
 
 18 
 
THE SOCIOLOGY OF HEALl'H 
 
 the border of the impossibilities to convince a 
 corporation — for corporations, milike individ- 
 uals, it is understood have no souls. 
 
 If a municipality should grant to its health 
 commissioner all of the authority necessary to 
 this end, he could cut down the typhoid death 
 rate to a minimum, but beyond a certain point 
 he could not go without the aid of the State. 
 He could provide water from the best source, 
 and eliminate most of the avenues of contam- 
 ination ; and he could prohibit the admission of 
 infected foods within his jurisdiction. But if 
 a railroad corporation wished to build a road 
 in another State across one of his water-supply 
 tributary streams his municipal authority 
 would cut but a poor figure in attempting to 
 stop it. 
 
 All over the country railroads cross the 
 streams from which towns take their drinking 
 water, and every coach on every train of cars 
 crossing these streams has a toilet which is 
 used by typhoid convalescents. We possess 
 positive knowledge concerning the railroads as 
 distributors of typhoid. It was once the cus- 
 tom to speak of a certain amount of typhoid as 
 the " normal percentage," but now it is known 
 that the normal percentage of typhoid is zero. 
 
 19 
 
MEDICAL SOCIOLOGY 
 
 Then there are a certain number of cases of 
 typhoid which acquire their infection within 
 the jurisdiction of some other municipality, so 
 no local health authority can stamp out typhoid 
 unless all do, or unless the Federal Government 
 lends a hand. Moreover, we are learning that 
 this disease very commonly is transmitted from 
 person to person ; nurses are particularly prone 
 to contract the disease; and with the dangers 
 inherent in the " typhoid carrier " we are fa- 
 miliar. 
 
 At a certain point the State must come to the 
 aid of the municipality if typhoid is to be eradi- 
 cated. And finally, federal supervision is as 
 essential for the control of the diseuse in a na- 
 tion as municipal supervision is for the control 
 of the disease in a city. There is so much and 
 such rapid transportation of people and of 
 foods, and such an intermingling of the same, 
 that typhoid fever cannot be eradicated by each 
 city or State acting separately and without fed- 
 eral supervision : it is as though each ward in a 
 great city were to attempt to solve its own ty- 
 phoid problem without municipal control. 
 
 Every case of typhoid fever is an evidence 
 of the benighted state of the civilization in 
 which it occurs, and of the inefficiency of the 
 
 20 
 
THE SOCIOLOGY OF HEALTH 
 
 government. Typhoid fever has passed beyond 
 the catalogue of diseases ; it is a crime. 
 
 The wonder is that so much time has elapsed 
 without this country awakening to the appreci- 
 ation of the advantages of a central Depart- 
 ment of Sanitation, presided over by a Sani- 
 tary General or Secretary of Public Health. 
 Why has it not been done? The reasons are 
 various. They are: lack of insistence on the 
 part of the medical profession; lack of knowl- 
 edge of the capabilities of medical science on 
 the part of the public ; and a prevalence of the 
 general notion that the object and function of 
 the doctor is to attempt to cure diseases with 
 medicines more or less noxious, to deliver par- 
 turient women, and to perform the wonders of 
 surgical legerdemain. When the statesman is 
 confronted by a question involving the medical 
 profession, there comes to his mind at once the 
 representative of that profession hastening 
 through the streets on one or another of these 
 errands. This has given him a one-sided view 
 of the meaning of medicine; and it is unfortu- 
 nate that this one-sided view prevails in our 
 legislative halls. Many of the men who draft 
 our laws are of that class which most readily 
 takes up with the therapeutic fads. The ig- 
 
 21 
 
MEDICAL SOCIOLOGY 
 
 norance of the meaning and mission of medi- 
 cine, displayed by our public servants in high 
 places, is notorious and lamentable. 
 
 The remedy lies in education and concerted 
 action on the part of scientific societies and 
 organizations interested in social betterment. 
 Then comes the drafting of a bill for either the 
 organization of such a department, de novo, or 
 the combining into a department of health of 
 the several branches of the present government 
 which now have to do more or less with mat- 
 ters of public health. And then we shall take 
 our place in the world as a great, enlightened 
 people.^ 
 
 * The above was published in the jYcw York State Journal of 
 Medicine in April, 1907. History has been making fast since then. 
 Congress has provided a bureau of public health and an hygienic 
 laboratory, President Roosevelt and President Taft have urged 
 further attention to the necessity for legislation for public health, 
 and both the Republican and Democratic parties, in their 
 national platforms in 1908, declared for further public-health 
 legislation. But none of these is adequate. 
 
Ill 
 
 A PLEA FOR THE WELL 
 
 THE necessity for the family jDhysician 
 and the practitioner of medicine will 
 continue indefinitely to exist. Even 
 as the infective diseases become less and less, 
 there will ever be human ills and accidents, not 
 the least of which are birth and old age with 
 their manifold symptoms. It is not difficult to 
 believe, and surely it is reasonable to hope, that 
 the practitioner of the future in his relation to 
 the individual and the family will be of most 
 service in preventing disease. It is earnestly 
 to be wished that future medical education will 
 give more attention to the study of the simple 
 things now neglected — the general care of the 
 health of the healthy individual. We have been 
 so busy with diseases and the sick that we have 
 neglected the well. The mother who seeks the 
 best information as to what exercise her daugh- 
 ter, about to enter college, shall take, what sort 
 of underclothes she shall wear, when she shall 
 
 23 
 
MEDICAL SOCIOLOGY 
 
 bathe, how she shall ventilate her room, and 
 what she shall eat and drink, will get little sat- 
 isfaction because physicians are not agreed. 
 
 The questions of normal life are not yet suf- 
 ficiently studied. For example, take the nurs- 
 ing babe. To make women give good milk is 
 really more important than to make cows give 
 good milk. Yet the research and the volumes 
 of writing which have been devoted to cow's 
 milk as a food for infants is utterly out of pro- 
 portion to that which has been devoted to wom- 
 an's milk. If the same amount of consideration 
 had been given to making mothers supply good 
 milk as has been given to making farmers 
 supply good milk, the infant-feeding problem 
 would be solved. A large amount of scientific 
 study, laboratories, the microscope, the test 
 tube, sanitary inspectors, the police, the Board 
 of Aldermen, and the Legislature, all are in- 
 voked to improve the supply of cows' milk for 
 sick babies ; but how few of these potent agen- 
 cies are invoked to the simple end that the nat- 
 ural mothers of these infants should supply 
 them with milk ! Might we not wisely give more 
 consideration to the healthy babe before it be- 
 comes a sick babef Are our infants the progeny 
 of the cow that the fons lactis naturalis should 
 
 24 
 
THE SOCIOLOGY OF HEALTH 
 
 be so forgotten? If a mother does not give the 
 milk the matter commonly is dismissed with re- 
 gret, that " she cannot nnrse her child." She 
 may secure a large variety of ineffective advice, 
 varying with the number of consultants whom 
 she employs, but in the end she will not be able 
 to nurse her babe — at least that is the fate of 
 an enormous proportion of the native-bom 
 women in our cities. The only alternative is to 
 " cast the bantling on the rocks, suckle him with 
 the she-wolf's teat," if we may so designate the 
 cold and impersonal extramaternal feeding of 
 infants. This modem instance is cited some- 
 what at length as an example of the devotion of 
 medicine to the art of fighting disease to the 
 neglect of encouraging health, and to the study 
 of pathology to the neglect of physiology. To 
 use a homely expression, we are hell on fits. 
 The doctor has met with wonderful success in 
 the treatment of diseases ; and I have no doubt, 
 when he sets himself to the task, he will with 
 equal success master the science of health. 
 
 Are coarse foods of value in preserving 
 health? Is it true that " four hours of sleep 
 before midnight are worth six after midnight " ? 
 Do we really eat too much, or is the cry but a 
 bugaboo? Is fresh air so necessary for health 
 
 25 
 
MEDICAL SOCIOLOGY 
 
 and conducive to longevity 1 Is the minimum of 
 proteid food the optimum? Is hypermastica- 
 tion of value? Is a daily bath of hygienic vir- 
 tue ? Is it really beneficial to take a cold morn- 
 ing bath? Is exercise essential to perfect 
 health? It is to such simple questions as these 
 that we need to give a scientific answer, and 
 place our knowledge of them on a sure footing. 
 At present they are answered by some in the 
 affirmative, by some in the negative. These are 
 the questions which concern the well, not the 
 sick ; and I shall always insist that, of the two, 
 the well man is of the greater importance and 
 more entitled to the consideration of science. - 
 If as much money and enterprise as have 
 been bestowed upon hospitals were devoted to 
 preventing the diseases which are treated in 
 hospitals, the hospitals would be much less im- 
 portant figures than they are at present. Here 
 lies a woman with her lower abdomen full of 
 pus, intestines matted together, an operation 
 scheduled for to-morrow morning, and eternal 
 invalidism for the rest of her life. A pamphlet 
 on venereal disease costing less than twenty- 
 five cents in the hands of her husband at the 
 proper time, or the proper instruction from a 
 respected source, would have saved all of this. 
 
 26 
 
THE SOCIOLOGY OF HEALTH 
 
 Let not the cynic scoff and say pamphlets and 
 education have been tried and found wanting. 
 Maybe his pamphlets and his education have. 
 But so sure as man is human, just so sure is it 
 true that if there is any information that will 
 save him misery and pain and loss of love and 
 money, that information he wants and will 
 cleave to until death, and if he does not act 
 upon it it is because he has it not. Much infor- 
 mation is given but not received, heard but not 
 heeded, in which case it is not information at 
 all. It is not so much that we should strive to 
 have more skill in letting out pus as in pre- 
 venting suppuration. The Society of Prophy- 
 laxis has more claim to public esteem than the 
 Surgical and Gynecological Society, admirable 
 and valuable as it is. A great man once said 
 that were he omnipotent he would make health, 
 instead of disease, contagious. That omnipo- 
 tence is coming into the hands of the physician 
 now. 
 
 Surgery has perfected the operations for 
 bunions, ingrowing toe nails, and hammer toe, 
 but what scientific interest is given to the ques- 
 tion of shoes for healthy men? That is the 
 more important matter. The army has studied 
 it, but outside of this men are the slaves of 
 
 27 
 
MEDICAL SOCIOLOGY 
 
 foot-disfiguring fashion, and the field for ex- 
 ercising surgical skill upon the distortions in- 
 duced in well men's feet is very large. 
 The treatment of colds keeps the doctor busy 
 through the winter months. If the money and 
 energy expended in compounding, say, simply 
 those cough mixtures which do more harm than 
 good, were devoted to the scientific study and 
 teaching of the cause and prevention of colds 
 the well man would then receive his due. 
 
 We say that scientific attention is given to 
 the matter of ventilation of schoolrooms in our 
 new school buildings by the engineers who con- 
 struct them. Theoretically that is true, but as 
 a practical fact they are poorly ventilated. 
 Well children go into these rooms and come 
 out with headaches, adenoids, and colds — the 
 products of imperfect ventilation. The ventila- 
 tion problem is worked out on paper, but it 
 does not stand the clinical test. What would we 
 think of a medical treatment being applied to 
 the sick which was such a farce as this? 
 
 The medical profession has been instrument- 
 al in inaugurating a great system of tubercu- 
 losis education by means of public lectures, 
 pamphlets, and exhibits. The city dwellers 
 have been most in need of these, and they have 
 
 28 
 
THE SOCIOLOGY OP HEALTH 
 
 been of infinitely greater value to the well than 
 to the sick. But this is only the first step in 
 the campaign against tuberculosis. Knowl- 
 edge becomes sterile if it cannot be applied, and 
 how can the crowded tenement dwellers of the 
 great cities take advantage of this knowledge? 
 How can a balcony be slept upon if there is no 
 balcony? How can windows be opened if there 
 are no windows'? Medicine has started this 
 campaign for the saving of the well ; the State 
 must take it up and continue it, but we know 
 that its ultimate solution is an economic one. 
 When one sixth of the families in one neighbor- 
 hood in New York City live each in a single 
 room, and one third of the families live in two 
 rooms — many of which are dark and squalid — 
 when these miserable quarters cost the occu- 
 pants for rent one third of the wages earned 
 by the men of the families, when these people 
 cannot buy food and fuel economically because 
 they must be bought in very small quantities, 
 then the plea that we make for the well must 
 be also upon an economic basis. It is to this 
 end that our campaign of education must be 
 directed. 
 
 Human health must be regarded as of too 
 great value for the community to permit a 
 
 29 
 
MEDICAL SOCIOLOGY 
 
 landlord to wring out of his tenants for rents 
 twelve per cent on his investment. Coal 
 bought by the pailful, because there are no 
 facilities for storing it, costs from twenty- 
 one to twenty-eight dollars a ton. We have 
 laws against usurious charges for money, but 
 none for usurious charges for tenement houses. 
 Is money so much more precious and worthy of 
 protection than human lives? It is this usuri- 
 ous advantage which can be taken of the poor 
 and ignorant that makes the protection of the 
 well difficult in the crowded cities. The cities 
 are practicing wastefulness in allowing their 
 inhabitants to be rented unhygienic dwellings. 
 Model tenements are an economic necessity. 
 
 No plea for the well is complete unless it calls 
 attention to these economic needs which affect 
 the health of the people. In the first place the 
 whole responsibility for the child should not 
 rest upon the parents alone. The coming into 
 the world of a child is of more importance to 
 the State than is the advent of an immigrant, 
 a criminal, or a lunatic, yet the State gives its 
 serious attention to the last three but leaves 
 the child to the mercy of its parents, who may 
 be ignorant and vicious. These things should 
 ultimately receive the attention of the State: 
 
 30 
 
THE SOCIOLOGY OF HEALTH 
 
 the physically and mentally unfit shall not 
 breed children; and children shall be bom di- 
 rectly into the custody of society, and society 
 shall demand that they receive the attentions 
 necessary to make them healthy and helpful. 
 If the parents cannot or do not provide for 
 them the State shall. If it does not do this it 
 should not have allowed them to be conceived. 
 The most important things for the community 
 to take care of are not the trees or the animals 
 in the park but the human beings. If we find 
 a tree in a public park affected by some disease 
 the people know where to place the responsibil- 
 ity: it rests upon some one whom they ap- 
 pointed ; but a little child may grow straight or 
 crooked, it is at the mercy of parents — they are 
 self-appointed custodians. Whether it is by a 
 pension for mothers, or by an insured stipend 
 for the child, or by State supervision, the re- 
 sponsibility for maintaining the child in health 
 must some day be taken hold of by the people. 
 Diseases and bad conditions will continue to 
 incapacitate the healthy until the well man re- 
 ceives the consideration which his importance 
 and value to the community merits. Some day 
 we shall have scientific studies of human health. 
 Papers before societies on these subjects will 
 4 31 
 
MEDICAL SOCIOLOGY 
 
 be common. Every medical school will teach 
 hygiene (not merely have a nominal chair), and 
 the study of health will be regarded as of 
 greater value than the study of disease. This 
 most important scientific field yet remains un- 
 developed. Biologists are needed to study man 
 to the utmost possibilities of human knowledge. 
 It was once the custom, in a time of medical 
 unenlightenment, for the sick man to ask the 
 advice of some wise layman, but now he seeks 
 the physician. It is now the custom in mat- 
 ters of personal hygiene to take counsel with 
 some layman who exemplifies good hygiene, but 
 the day draws near when medical men will be 
 authorities on health as well as on disease. Just 
 in proportion as the medical profession be- 
 comes proficient and learned in the art of main- 
 taining health, in just that proportion will be 
 increased its power as a force in the public life. 
 The State, the people as a whole, demand in- 
 crease of individual efficiency. And the medical 
 profession has it in its power, to a greater de- 
 gree than any other class of men, to help toward 
 that very thing — increase of the efficiency of the 
 individual. He who preserves the strong is re- 
 membered when he who saves the weak is for- 
 gotten. Those who are looked to only in time 
 
 32 
 
THE SOCIOLOGY OP HEALTH 
 
 of trouble — the old-time doctor, the money 
 lender, the insurance company, the priest, the 
 undertaker — all may be respected, but they are 
 not honored by strong and virile and independ- 
 ent men. The weaker side of the body politic 
 honors them, but public opinion is the opinion 
 of the strong. When the medical profession 
 becomes the champion of the strong man, of 
 the growing youth, and of the lusty babe, as 
 well as it has for countless generations been 
 the champion of the sick and the distressed and 
 the puny, then shall it conduct humanity to vic- 
 tories yet undreamed, then shall the physician 
 be not only helper but he shall be leader also. 
 
IV 
 
 SOME MEDICAL ASPECTS OF CIVILIZATION 
 
 I SHALL not attempt to define civilization 
 — ^it is a rather elusive state — but I shall 
 insist that it implies betterment of per- 
 sonal and social conditions. It must make for 
 happiness, it should help men, or it is not 
 civilization. We must beware of the disposi- 
 tion to regard peoples whose manners and cus- 
 toms are different from our own as being not so 
 civilized as we. These very people may have 
 as good cause to judge us likewise. Civiliza- 
 tion is to the community what culture is to the 
 individual, and since society is an aggregation 
 of persons it all reduces itself to a matter of 
 the individual. 
 
 There is an injustice done this expression in 
 that we are prone to regard as the attributes of 
 civilization the things to which we are accus- 
 tomed. In other words, we think that we are 
 the civilized people, whoever we are. A man 
 who has been li\ing in the woods with the In- 
 
 34 
 
THE SOCIOLOGY OF HEALTH 
 
 dians looks at his moccasins and says : " Well, 
 I shall be glad to get back to Broadway and into 
 a pair of civilized shoes." By that he means ex- 
 changing the comfortable moccasins for a pair 
 of sharp-pointed, stiff patent-leather, foot-de- 
 forming shoes which require to be " broken in." 
 The London girl whom circumstances marooned 
 among the Swiss mountains and clothed in 
 short skirts and a loose bodice, exclaims " I 
 shall be glad to get back home and into civilized 
 clothes again." She means — go up to London 
 and see for yourself! 
 
 We expect these things ; civilization hangs on 
 the edge of savagery. The fact that a society 
 cultivates many of the civilizing virtues hardly 
 justifies it in designating all of its attributes as 
 the qualities of civilization. It happens that 
 the majority stand behind much of the sav- 
 agery and declare that it shall have the name 
 of civilization. This is true of the Broadway 
 shoe and of the London corset. Civilization in 
 the popular acceptance is much a matter of 
 custom rather than of good, of tradition and su- 
 perstition rather than of knowledge and cul- 
 ture. It is illustrated by the mob which de- 
 stroyed the library and apparatus of Joseph 
 Priestly, by the murder of Michael Servetus, 
 
 35 
 
MEDICAL SOCIOLOGY 
 
 and by the little threatening band which waited 
 outside of McDowell's house while he per- 
 formed the first removal of an abdominal 
 tumor. 
 
 An independent citizen of Washington with 
 a good head of healthy hair wears no hat, and 
 he is hooted by the bald-headed, derby-crowned 
 scions of Washington civilization as he passes 
 to and from his daily work. I know a woman 
 who might have a so-called " luxuriant head of 
 hair," but she keeps it cut off at a level with 
 the lower angle of her shoulder blades. That 
 gives her an abundance for coiffure purposes, 
 to pin her hat to, and to look well. Still, in the 
 civilization in which she lives, women take pride 
 in carrjdng about with them as much as pos- 
 sible of this particular excretion. Some carry 
 two or three pounds of it on their heads — 
 weighing ahnost as much as their livers. If a 
 woman can sit on her hair she is proud of it. 
 The more there is of this mass of stuff the more 
 time it requires for its care. It should give 
 about as much satisfaction to have an unwieldy 
 mass of hair as it should to have long and un- 
 wieldy finger nails. It is a part of the agreed- 
 upon concomitants of ci\T.lization. Pekin is not 
 far from New York. 
 
 36 
 
THE SOCIOLOGY OF HEALTH 
 
 Now let us come a little closer home to the 
 medical profession. There lies before me a 
 medical book by an eminent obstetrician in 
 which I read that " the rapid pace of modem 
 life is more and more rendering the nursing 
 of infants distasteful and even annoying to 
 many mothers, and this is especially so as we 
 ascend the scale of social life." Again, " The 
 advancements of civilization, especially in our 
 cities and among cultivated people, are render- 
 ing child bearing more and more difficult and 
 depriving the infant of maternal interest." 
 These statements are grossly and horribly false. 
 It is true that " the rapid pace of modem life 
 is more and more rendering the nursing of in- 
 fants distasteful and even annoying to many 
 mothers," but that " this is especially so as we 
 ascend the scale of social life " I say, a thou- 
 sand times, No ! Our books on obstetrics and 
 gynecology pass this error along. I wish they 
 would not. The mother who does not love her 
 babe has not ascended the social scale. The 
 women who represent the real civilization, who 
 can justly be said to be high in the social life, 
 are they who keep their bodies in health, who 
 conceive in joy, and who bring forth in glad ex- 
 pectancy their offspring to be cherished and 
 
 37 
 
MEDICAL SOCIOLOGY 
 
 nourished and guided by mother love. Our 
 writers have confused civilization with bridge 
 parties, earrings, high heels, the theater, and 
 feminine fluffiness. Let medical literature at 
 least cease from this error. A group of females 
 bemoaning pregnancy as an " accident " are 
 not even mounted on the social scale. The pug- 
 dog companionship, fingers encrusted with jew- 
 els, idleness and ennui are not the signs of cul- 
 tivation. 
 
 Civilization and social advancement are mak- 
 ing women more healthful, more moral, more 
 happy, more interested in the important things 
 of life; and more useful; if they are not doing 
 this they shall not have that name. They are 
 bringing the pregnant woman out of her " nurs- 
 ery wrapper " and brooding seclusion, and giv- 
 ing her her wonted exercise and open air and 
 healthful occupation. The pregnant woman 
 who fills her soul with fear and secludes herself 
 as an invalid becomes an invalid, but in so 
 doing she is not displaying the attributes of an 
 advancing civilization. 
 
 A few years ago when it was fashionable to 
 be pale and languid a lady from Chicago, as 
 she tied two thicknesses of veils over her face 
 before stepping into the carriage for a drive, 
 
 38 
 
THE SOCIOLOGY OF HEALTH 
 
 said to her weather-browned hostess : " If you 
 went in society you would have to take care of 
 your complexion, too ! " Here are " society " 
 and the " social scale " again ; but the weather- 
 browned woman, who had cast out the artificial 
 from her life, was the higher of the two in this 
 much talked-of " social scale." 
 
 On one of those rare days in the early part 
 of April, when the air is clear and the sun is 
 making the old earth warm again, when nature 
 proclaims the end of winter's slumber, and the 
 buds are swelling with awakening life — on one 
 of those great resurrection days, I saw two 
 women, arrayed with short skirts and stout 
 shoes, set off for the woods with their children, 
 to rejoice in the discoveries of the first signs 
 of life at the glad festival of the awakening of 
 the living things. On that same bright day, I 
 looked into a gorgeous parlor. The shades 
 were drawn to exclude the light of day; arti- 
 ficial illumination threw its pallid pall upon the 
 scene; the air was close and pregnant with 
 infinite migraine possibilities; at a score of 
 tables sat fourscore of women, magnificent be- 
 yond description; their children were in the 
 care of the nurse at home; the bowels of the 
 earth had yielded up the brightest gems to 
 
 39 
 
MEDICAL SOCIOLOGY 
 
 adorn their throats and fingers; precious 
 pearls, filched from the voiceless oyster, nes- 
 tled as though at home against their shell-like 
 ears or hung like tears of protest from the 
 holes that defiled their fair lobes; some dis- 
 played the purchased blush for health that con- 
 cealed the pallid cheek; the richest fabrics of 
 the loom lent to the eye the dazzle of their 
 color and to the ear the faint rustle of their 
 richness ; fourscore of heads were crowned with 
 wondrous and bizarre productions of milliners' 
 ingenuity, made still more glorious by resplen- 
 dent pluniage plucked from the warm bodies 
 of birds of paradise; the air was hushed; 
 this awe-inspiring sight, I was informed, was 
 " bridge " ; and I marveled and wondered if I 
 were now beholding the veritable pons over 
 which sages for all ages had cudgeled their 
 dull asses. Then my mind turned to the two 
 women out under the blue sky, pressing the 
 soft, warm earth beneath their feet, breathing 
 in the precious air of heaven, rejoicing in the 
 miracles of the springtime, with merry chil- 
 dren eager to read the great message written 
 in nature's missal — and I knew the race of man 
 was saved. 
 
 Let us place the right values on things so 
 40 
 
THE SOCIOLOGY OF HEALTH 
 
 that our literature may stand the scrutiny of 
 time. Let us not accept false estimates from 
 the hands of society. Whatever pertains to the 
 health of people is within the jurisdiction of 
 the medical profession, and it is our duty to 
 reconcile with the advancements of civilization 
 whatever makes for healthfulness. 
 
 It also is our bounden duty to declare as un- 
 civilized and uncivilizing the influences which 
 make women less useful and less loving and lov- 
 able as mothers and wives. 
 
V 
 
 HEALTHFULNESS AND HAPPINESS 
 
 HAVE recently had a friend make the 
 statement that he would rather be happy 
 than healthy — this in connection with the 
 harm that tobacco was doing him. He pre- 
 ferred to suffer the physical ills entailed by to- 
 bacco than to sacrifice the pleasure of the fra- 
 grant plant. That is his affair. It is a terse 
 way of saying that it is better to do what one 
 wants to do without considering its healthful- 
 ness or unhealthfulness than it is to do dis- 
 agreeable things for health's sake. This is a 
 perfectly reasonable view. One generally does 
 what he wants to, and that is usually the most 
 sensible thing to do. That is a man's birthright 
 as soon as he is strong enough to enter into the 
 inheritance of his own and take possession. As 
 a child he has to do what some one else thinks 
 he should do — what some one else thinks is 
 good for his health or for their happiness. But 
 when his ego has grown strong there comes into 
 
 42 
 
THE SOCIOLOGY OF HEALTH 
 
 play der Einzige und sein Eigentum. Then, 
 too, there is a disposition to take the gambler's 
 chance. One often violates a law of health hop- 
 ing that the retribution may not be forthcom- 
 ing. Sometimes it is not, and he becomes em- 
 boldened and takes a chance again. 
 
 Shall I take a cold bath on a winter's morn- 
 ing or not"? Shall I walk to the office or ride? 
 Shall I decliae to take a couple of drinks with 
 a convivial friend? Shall I be healthy or shall 
 I be happy? These are the questions often 
 asked. And one naturally decides for happi- 
 ness, for it is that for which we live. The ob- 
 ject of life is happiness, not health. We are not 
 living for the sake of growing healthy, we are 
 living with happiness in \T.ew. The man who 
 makes healthfulness his aim in life might be a 
 fine specimen of a brute, but he would be a 
 pretty poor sort of a man. But just here comes 
 the duty of medicine to humanity; that duty is 
 to make the incentive to happiness and health- 
 fulness grow toward each other until finally 
 they come together and coalesce. Then we shall 
 find happiness in doing what is healthful, and 
 health in happiness. 
 
 This consummation is in process of evolution. 
 One does not go to breakfast without having 
 
 43 
 
MEDICAL SOCIOLOGY 
 
 brushed liis teeth, although it is a time-consum- 
 ing and, in itself, in no wise a pleasurable task. 
 We also bathe and keep our bodies clean. Our 
 ancestors a few generations ago gave little 
 heed to either of these operations. Knowledge 
 of their value to us as individuals makes us 
 perform with happiness tasks which otherwise 
 would be disagreeable. The beautiful men and 
 women of the age of chivalry, of whom the po- 
 ets have sung so wonderfully, were notoriously 
 dirty as to their bodies, although classic art 
 has belied them sweet and clean. Cleanliness in 
 Christendom is a recent conception. The in- 
 fluence of medical science upon human progress 
 is destined to bring into the circle of happiness 
 all those things which make for health, for 
 health is one of the most important prere- 
 quisites of happiness. 
 
 This is just the process which is going on 
 with regard to morality, and has reached a high 
 state of development among the most cultivated 
 people. The old question used to be, Shall I 
 be good or happy? If I am good I shall miss 
 lots of fun. Education has brought morality 
 and happiness so close together that now they 
 touch. The foundation stones of happiness are 
 hewn in the quarry of morality. Happiness is 
 
 44 
 
• THE SOCIOLOGY OF HEALTH 
 
 comparatively little sought for in immorality. 
 Wise men have learned that the best happi- 
 ness must be consistent with morality. Of 
 course the consummation is not yet quite com- 
 pleted ; that would mean, I think, what is called 
 the millennium. 
 
 This development of healthful happiness 
 must go hand in hand with moral happiness. 
 Morals do not thrive well in unhealthy bodies. 
 Solomon and David are horrible examples of 
 retributive morality. The compulsory moral- 
 ity of old men, who are the wrecks of youthful 
 sinners, is not the real thing, although, of 
 course, better than nothing. A man in jail can- 
 not steal, nor can a sexual wreck be a roaring 
 libertine. Desirable morality is of the healthy 
 and vigorous type. The same is true of hap- 
 piness. Healthful happiness — it is that toward 
 which medical science is directed. We are aim- 
 ing toward the state of enlightenment in which, 
 if the walk to the office is the more healthful it 
 will be preferred to the ride, in which the harm- 
 ful tipple will be declined with pleasure, and 
 in which my friend will value his health more 
 than his pipe. Harmless pleasures will take 
 the place of harmful ones, and health and hap- 
 piness will go hand in hand. 
 
 45 
 
VI 
 
 EXERCISE AND HEALTH 
 
 AN Eastern potentate of great age and vig- 
 L^k orous health, who sat watching some 
 -A. J^ Englishmen playing polo, asked if the 
 young men were really so poor that they could 
 not hire people to do that for them. A modern 
 philosopher has observed that work is work if 
 you are paid to do it ; it is play if you pay to be 
 allowed to do it. 
 
 There is much confusion between strength 
 which cati be measured by foot pounds and 
 strength which means vitality and can be meas- 
 ured in resisting disease. The athletic exhibit 
 in the physical culture advertisement whose 
 back looks like a corduroy road, and the plain 
 citizen who prefers arguing with a burglar to 
 tossing him through the window, and who is 
 never sick till he turns seventy, are two very 
 different exhibits of strength. Good health 
 should be the criterion. That is what we are 
 seeking — not lifting power. 
 All men are constituted differently so far as 
 46 
 
THE SOCIOLOGY OF HEALTH 
 
 exercise is concerned. For health's sake a man 
 should take as much exercise as he needs. Most 
 of us need exercise. It is an hereditary neces- 
 sity. Our organism is constituted for exercise, 
 and we must have it or suffer a certain degree 
 of unbalancing of our system. This is neces- 
 sary for the reason that our ancestors for hun- 
 dreds and thousands of years took exercise. 
 Their vocations were acts of toil and manual 
 labor. Huntiag food, fighting off enemies, till- 
 ing land, and building houses are the functions 
 for the performance of which we have inherited 
 muscles. Our good health demands that we 
 shall to a certain degree live up to our inten- 
 tions. It is only since the conditions which 
 make for inequality in social standing have ap- 
 peared that a part of the community labors and 
 another part is exempted from labor. Much of 
 our so-called education is patronized with the 
 view of securing exemption from labor. Our 
 public-school system is defective in this quality : 
 it too often inspires youth with the ambition 
 to escape work. If a man is uneducated he 
 must labor; if he is educated he may earn his 
 livelihood manipulating the products of the la- 
 bor of others. These things will be adjudicated 
 by and by. 
 
 5 47 
 
MEDICAL SOCIOLOGY 
 
 The older civilizations in fertile countries, 
 where food has been abundant and where pros- 
 perity has followed trade, have gradually elim- 
 inated in many instances the necessity for ex- 
 ercise of the bone-moving muscles. We of the 
 Western world are yet too near the soil to do 
 this. Most of us need not go back more than 
 a generation or two to find our ancestors delv- 
 ing with bone and sinew. What is true of the 
 race is true of the individual. It is not good 
 for the health of the brawny blacksmith to quit 
 his anvil and turn bookkeeper. Nor can the 
 children of the toiling lineage live in muscular 
 idleness. Each requires exercise in some sort 
 akin to his hereditary wont. His best physical 
 health demands it. 
 
 But lack of exercise is not the only change 
 made by the man who becomes sufficiently cul- 
 tured to be able to escape physical labor. He 
 also exchanges the free and open air of his an- 
 cestors for the confinement of the office, and he 
 adds the stress and strain of mental competi- 
 tion for livelihood which his ancestors knew 
 not, at least as a necessity, but only incidentally 
 as a pastime. Thus the man who labors not 
 with his hands, if he would follow the tend- 
 encies of his race or family, which must have 
 
 48 
 
THE SOCIOLOGY OF HEALTH 
 
 been salutary because they have produced him, 
 needs exercise, free and open air, and relief 
 from the stress of mental competition. These 
 three things he needs, and he is not wise unless 
 he gives himself the advantage of them regu- 
 larly and systematically. Unless he does, his 
 family line must pay the penalty, and end with 
 him or with his emasculated offspring. 
 
 The city is a trap in which is caught the eagle 
 who has soared the air and dwelt amid the 
 mountain cliffs for countless generations. The 
 free expanse of earth and sky have been his 
 and his fathers. Now he is caged — a mighty 
 specimen. Call him " magnate " or " Napoleon 
 of finance " or " clerk," or what you will, he has 
 in his blood the impetus of a thousand genera- 
 tions and the memories of the free air and sky 
 to give him strength ; but keep him caged in the 
 city, and his breedings will be but barnyard 
 fowl, which will perish and melt away. 
 
 The Anglo-Saxon business man or profes- 
 sional man needs not only some exercise, but he 
 needs it in the open air. I am not sure but that 
 the latter is even more important than the 
 former. It is quite true that much of the bene- 
 fit attributed to exercise belongs to fresh air 
 and forgetfulness of mental competition and 
 
 49 
 
MEDICAL SOCIOLOGY 
 
 business cares. A day's target shooting, lying 
 on the ground, gives results apparently as good 
 as a day at golf. And of all the miserable 
 makeshifts of exercise bowling is the worst, 
 when practiced, as it usually is, in an illy ven- 
 tilated basement in artificial light and dust and 
 smoke. 
 
 This whole matter of exercise and recreation 
 requires orientation. It needs to receive sci- 
 entific study, and to be presented to the peo- 
 ple as a part of their education. Witness the 
 unwholesome struggles for recreation and ex- 
 ercise indulged in by the hordes flocking to the 
 summer amusement places. How deficient in 
 education upon this important subject is this 
 sweating, peanut-eating, gewgaw-besxjangled, 
 beer-consuming throng. The poor man, like the 
 rich man, too often prizes his recreation ac- 
 cording to the cost. The sport which costs 
 money is the thing. 
 
 .1 should like to see the rich's man recreations 
 turned to greater usefulness. There are use- 
 ful recreations which give as good exercise as 
 the nonproductive exercises. A man who plays 
 eighteen holes of golf — even though he indulge 
 in no stronger expletives than " Tush, tush ! " — 
 has used enough energy, if turned into useful 
 
 50 
 
THE SOCIOLOGY OF HEALTH 
 
 chaimels, to cultivate, say, an acre of potatoes 
 or to split enough wood to keep a single fam- 
 ily warm for a month in winter. These are 
 practical and useful employments. To say that 
 a man has taken enough exercise if converted 
 into foot pounds to raise himself 5,000 feet 
 is scientific, but a man does not want to be 
 raised 5,000 feet. But we do need potatoes 
 and fire wood for the winter. Trimming shrub- 
 bery, laying walls, mowing grass, digging ditch- 
 es, making roads, hoeing in the garden, plant- 
 ing seeds, cutting weeds, planting trees are as 
 good exercise as golf ; and all are useful. I am 
 familiar with the satisfaction in winning a close 
 set of tennis ; I know the joy in golf in getting 
 off the long, low drive that goes and keeps on 
 going and contributes to the beating of the 
 bogey ; I know the calm contentment in making 
 bull's-eyes at a thousand yards; I love the ex- 
 hilaration of a dash in the saddle through the 
 still woods or across the plains; I know the 
 joy of holding the tiller to a spanking breeze — 
 but all these are lacking in that quality which 
 craves results — real results, results that help 
 more than the doer alone. And as I contem- 
 plate the efforts which accomplished nothing 
 but pleasure for me alone, as I think of the 
 
 51 
 
MEDICAL SOCIOLOGY 
 
 rides that carried nothing and ended but in 
 turning back to the place whence I came, and 
 then as I contemplate the multitudes of human 
 needs which might be supplied by healthful 
 activities, those who want and to whom the 
 things needed might be carried, the barren 
 fields waiting for the hand to cultivate them, 
 the desolate places crying to be cleansed, all of 
 the faults that can be remedied only by the will- 
 ing hand and strong arm, I am convinced that 
 a waste of muscular energy is as prodigal as a 
 waste of mental energy or of money. When 
 the golf and the tennis, the saddle and the till- 
 er, are forgotten I shall cherish the memory 
 of the real sport in soil turned by the plow, 
 stone fences laid, new land cleared, red apples 
 carried to the market, snow shoveled, wood 
 chopped, and sweet hay stored in the mow. 
 
 The man who can afford to engage in unpro- 
 ductive exercise finds joy in the human weak- 
 ness of prodigality. The spendthrift who lights 
 his cigarette with a twenty-dollar bill has a 
 similar pleasure to that which he finds in knock- 
 ing a rubber ball around a field, consuming 
 time, material, and energy with nothing to 
 show for it; the great majority of mankind can- 
 not afford to do it. What we much need is the 
 
 52 
 
THE SOCIOLOGY OF HEALTH 
 
 competitive spirit and the spirit of joy and play 
 introduced to a greater degree in productive 
 work. It is done to a certain degree ; it can be 
 done more. 
 
 There are sociologists who contend that there 
 is not enough work for those who need it and 
 who must have it in order to live, and they 
 would stay the hand of the rich man from work. 
 This is false doctrine. They have sought for 
 reasons in the wrong place. The whole out-of- 
 doors is crying for the hand of man to cleanse 
 it and to mold it into shapes more useful and 
 beautiful. And so long as there are hungry 
 people and uncultivated fields, so long as there 
 are empty wood-boxes and unchopped wood, 
 so long as there are unsupplied wants, there is 
 work to be done. The man who pours a good 
 can of milk into the sewer should be touched by 
 the same compunctions of prodigality as the 
 unproductive youth who pours a day of good 
 energy into the game of golf. 
 
 I would not discourage the joy of play among 
 children, nor play with them and for them ; nor 
 would I deny such play to the man who works 
 with his brain and cannot secure access to pro- 
 ductive recreation; nor to the man who works 
 with both head and hand indoors and out if he 
 
 53 
 
MEDICAL SOCIOLOGY 
 
 finds joy and help in the relaxation of play; 
 nor would I discourage altogether the athletic 
 sports that encourage health and interest in 
 strong and supple bodies. This is play which is 
 as productive as restful repose is. But I re- 
 turn to the proposition that for most of this 
 play useful outdoor work could be substituted. 
 The play is necessary because of failure to 
 engage in such work. The best kind of labor is 
 useful labor, and the best kind of play is useful 
 play. Such labor becomes play if entered into 
 in the right spirit. Let us turn our faces toward 
 the day when we shall have more of useful rec- 
 reation, and more of joyous and health-giving 
 work. 
 
VII 
 
 THE ALCOHOL QUESTION 
 
 THE alcohol question has been ap- 
 proached and discussed on nearly all 
 of its sides. Ancient and ignorant peo- 
 ple used alcohol because they liked the ef- 
 fect of it, and did not bother to discuss it. 
 Later it was used in religious rites, and for 
 some two thousand years it has always had de- 
 fenders who took the ground that the Creator 
 would not have made it and given His children 
 an appetite for it unless it were good. 
 
 Then came the awakening. It was observed 
 that no agent was contributing so much to the 
 increase of poverty, crime, and destitution as 
 alcohol. It was the agent that was filling the 
 almshouses and prisons. Statistics were com- 
 piled, and the evidence against alcohol was in- 
 controvertible. In the meantime the great tem- 
 perance movement sprang up. No crusade ever 
 had greater righteousness behind it or more 
 earnest men and women enlisted in its cause. 
 
 55 
 
MEDICAL SOCIOLOGY 
 
 The facts which they had at hand, together with 
 the earnestness of the advocates, were sufficient 
 to overwhelm every opposition. Still the re- 
 sults which this great movement has secured, 
 compared with what it has merited, have been 
 but paltry. Two reasons have contributed to 
 this failure. The first is that the temperance 
 advocates quite invariably " slopped over." 
 They were not satisfied with the simple truth 
 alone. It was all they needed, and it was more 
 than sufficient to prove their case. But still 
 they have ever indulged in exaggerations and 
 misstatements. I rarely have heard an hon- 
 est man advocate the cause of temperance from 
 the rostrum. His argument usually has pre- 
 sented the great fundamental truths of his 
 cause, and then interspersed them with so much 
 that was false that, to the eyes of the discern- 
 ing, the whole was but a pretty piece of dra- 
 matic acting. Thus the great cause of temper- 
 ance has been sacrificed to oratory, and to 
 the unfortunate practice of not treating one's 
 auditors honestly and regarding them as intel- 
 ligent beings to whom the truth, and that alone, 
 may be told. This dishonesty has been carried 
 further than the rostrum. The innocent and 
 undisceming child, who above all should have 
 
 56 
 
THE SOCIOLOGY OF HEALTH 
 
 its credulity met with honesty and truth, has 
 been made the dupe of these practices. They 
 have been responsible for having written into 
 text-books on physiology, which were intro- 
 duced into the public schools, a chapter on the 
 effects of alcohol so grossly absurd as to be 
 a travesty. The cause of temperance has been 
 damaged by such methods. The truth is suffi- 
 cient. The more recent text-books, through the 
 influence of the Women's Christian Temperance 
 Union — an organization which has done great 
 good in furthering the propaganda against al- 
 coholism — have corrected these early errors, 
 and we now have many fair and truthful expo- 
 sitions of the effects of alcohol. 
 
 The second reason why the cause of temper- 
 ance has not prospered better is because of the 
 innate liking on the part of a large portion of 
 the population for the effects of alcoholic bev- 
 erages. The debauchee who has been reformed 
 by hysterical demonstrations is not prone to 
 stay reformed. He has the constitutional crav- 
 ing, and I doubt if our statistics on the subject 
 of reformations are worth very much. 
 
 But alcoholism is not altogether an unmiti- 
 gated evil. It is an evidence of a somatic weak- 
 ness or degeneracy. The normal individual de- 
 
 57 
 
MEDICAL SOCIOLOGY 
 
 stroys himself neither with alcohol, tobacco, 
 or sexual excesses. The confirmed drunkard 
 serves humanity by destroying his virility to 
 such a degree that he does not propagate his 
 kind, and if alcohol is the agent to shunt off 
 the degenerate's line of genealogical progres- 
 sion into the cul-de-sac of oblivion I am not sure 
 but that it has served the human race a good 
 turn. On the other hand it is always possible 
 that the touch of instability which leads to 
 drunkenness may, through the agency of a nor- 
 mal mating, propagate offspring through whom 
 the paternal weakness may be made to disap- 
 pear. Happily, this is often the case; and it is, 
 indeed, better that a man should be in a line of 
 progressive improvement than in the line of a 
 decadent family. It is a bad sign when a man 
 given to alcoholic excesses boasts that his 
 father was a moderate drinker, and that his 
 grandfather drank not at all. It augurs bet- 
 ter for the family when a man can say that his 
 grandfather often drank too much, that his 
 father was a moderate drinker, that he drinks 
 but rarely, and hopes his sons will not drink 
 at all. 
 
 It may with some justice be said that no na- 
 tion becomes thoroughly sober until it has been 
 
 58 
 
THE SOCIOLOGY OP HEALTH 
 
 thoroughly drunk, that alcohol alone insures an 
 immunity against alcoholism; and the ravages 
 of alcohol among nations which have never 
 before had it, as our American Indians, and 
 the absence of drimkenness among the South 
 European countries which long ago have passed 
 through the stage of intoxication, may be 
 pointed to as proofs of this proposition. Our 
 knowledge of the principles of evolution and of 
 immunity teaches us that there is much truth in 
 this ; but is it best to secure immunity through 
 this channel? The answer is no. This may be 
 further illustrated. Let syphilis strike a peo- 
 ple whose ancestry is free from syphilis, and its 
 ravages are most horrible. The nations which 
 suffer the least from syphilis are the nations 
 which have been most thoroughly syphilized. 
 Yet, what people would invite syphilis to be- 
 stow upon them such immunity? No longer do 
 we go on the assumption that children must 
 have the exanthematous diseases; we try to 
 protect them from them. It is an immunity 
 bought at too dear a price. 
 
 This question of alcohol and alcoholism has 
 passed through all of these phases of discus- 
 sion, and finally it has come to the last stage; 
 science and common sense have taken hold of it, 
 
 59 
 
MEDICAL SOCIOLOGY 
 
 and here the curse of rum is to meet its defeat. 
 During the last ten years patient and honest 
 men seeking after the truth have investigated 
 with scientific accuracy the effects of alcohol 
 upon the animal organism. A large amount of 
 data has been compiled. Many old theories 
 have been disproven; many have been con- 
 firmed. But we now have the effects of alcohol 
 upon a scientific basis. Its effects upon the vi- 
 tal resistance, upon the phagocytic power of 
 leucocytes, upon heat production, digestion, 
 the heart's action, blood pressure, and upon the 
 nerve centers, have all been carefully studied 
 by many observers, who have arrived at prac- 
 tically the same conclusions. 
 
 Alcohol is a poison and an irritant, although 
 capable of combustion to a certain degree. But 
 this does not make it a food; most of the poi- 
 sons are capable of combustion in the body; 
 they are disintegrated, assimilated, and oxi- 
 dized. Its usefulness in the internal treatment 
 of diseases is very limited. As an antiseptic its 
 value is but small. When taken into the nor- 
 mal human body its effect is harmful, causing 
 a decrease of both muscular and mental effi- 
 ciency in direct ratio to the amount ingested. 
 To say that alcohol gives a man courage to face 
 
 60 
 
THE SOCIOLOGY OF HEALTH 
 
 dangers is as inconsistent as to say that mor- 
 phine gives him courage to face pain. Alcohol 
 paralyzes the centers of volition and the other 
 higher attributes; but first, and for a brief 
 period, it stimulates before it paralyzes. Its 
 reputation for giving strength and courage be- 
 longs to this short initial stage. 
 
 Medicine has learned much of alcohol in re- 
 cent years, but has not given the public the 
 benefit of the knowledge. Physicians have 
 steadily diminished the amount of alcohol used 
 in the hospitals until it has become almost o1)- 
 solete as an internal remedy, but still the pub- 
 lic has continued to judge the medical profes- 
 sion's attitude toward alcohol by the copious 
 prescribing of it in the past and by what it sees 
 of the doctor's habits at his club and at the ban- 
 quet table. So far as the public knows alcohol 
 is still approved by the medical profession. It 
 is time to set the public straight in this matter, 
 and if we have not agreed to cast it out en- 
 tirely much good would come if the public could 
 know that it is now but comparatively little 
 used as a medicine. The practical layman will 
 understand the meaning of the fact when we 
 tell him that in the last twenty-five years the 
 medical use of alcohol has decreased more than 
 
 61 
 
MEDICAL SOCIOLOGY 
 
 seventy-five per cent. A remedy which is 
 being eliminated at this rate is approaching its 
 end. 
 
 If there is any etiological relationship with 
 the certainty of which we are familiar, it is that 
 between alcoholism and epilepsy. We have as 
 good evidence of this as we have of the causa- 
 tive relation subsisting between the bacillus ty- 
 phosus and typhoid fever. The epilepsy of 
 alcoholism presents itself in many phases. The 
 drinker himself becomes an epileptic, but the 
 most important consideration is the relation of 
 drinking on the part of the parent to epilepsy 
 in the child. The epileptic colonies are wit- 
 nesses to the saying of Euripides, that " the 
 gods visit the sins of the fathers upon the chil- 
 dren." All observers of epilepsy report upon 
 alcoholism as a prominent cause of this dis- 
 ease, but there is a large class of cases which, 
 according to our biological theories, would 
 seem almost outside of the influence of hered- 
 ity. These cases are so commonly observed 
 that they represent a distinct and important 
 contribution to the study of heredity. They 
 are the occurrence of epilepsy in offspring 
 conceived while a parent was under the tem- 
 porary influence of alcohol, while offspring 
 
 62 
 
THE SOCIOLOGY OF HEALTH 
 
 born before and after which were conceived 
 while the parent was not using alcohol were 
 free from the disease. The histories of epi- 
 leptics show many cases which can be traced 
 to single instances of transgression in the use of 
 intoxicants. Matthew Woods reports the case 
 of a yonng imbecile girl who was conceived at 
 a time when the father was under the influence 
 of alcohol; four children bom before this 
 period and two bom subsequent to it being per- 
 fectly well. In Caucasus, where wine is very 
 cheap and much used instead of water to quench 
 thirst, the proportion of epileptics is unusually 
 large. Bourneville, of France, observed 2,554 
 children who were admitted to the Bicetre and 
 Fontain Vallee, 2,072 boys and 482 girls, all 
 suffering with idiocy, imbecility, epilepsy, and 
 other neuroses. He found that 1,053 of them 
 were the offspring of drunken parents. Some 
 of these cases are striking commentaries upon 
 the law of compensation — industry and the fru- 
 gal life yielding healthy offspring and opu- 
 lence yielding epileptics. Woods refers to the 
 case of a man who scarcely knew the taste of 
 liquor, and who became the father of four 
 healthy children. Then he became prosperous 
 and famous, organized a wine cellar and be- 
 « 63 
 
MEDICAL SOCIOLOGY 
 
 came a hon vivant. Two more cliildren were 
 bom, both of whom developed epilepsy. 
 
 While medical men are familiar with this 
 etiological relationshiiD the public is not; and 
 it behooves medicine to exert every influence 
 that the public shall understand this much of 
 the etiology of epilepsy, and know that so 
 much of it at least is not an undiscovered 
 mystery. 
 
 Another important social relationship of al- 
 cohol is that of sexual immorality and the ve- 
 nereal diseases. By paralyzing the higher 
 moral centers and irritating the sexual centers 
 it becomes a most potent agent for sexual 
 harm. Alcohol and sexual vice go together. 
 
 The fact that in some of our American col- 
 leges the students are encouraged in the use of 
 beer and the conviviality which it engenders 
 can only be taken as an evidence of the be- 
 nighted state of the education in these institu- 
 tions. The idea was to emulate the practices of 
 the German universities, forgetful of the fact 
 that the latter educate for special work men 
 whose habits are formed, while our colleges are 
 endeavoring to train immature youth in the 
 rudiments of education with which the German 
 university student has long since finished. For 
 
 64 
 
THE SOCIOLOGY OF HEALTH 
 
 an educational institution to encourage youth 
 in the use of alcoholic drinks, or even to coun- 
 tenance their use without protest, is to commit 
 a sin. 
 
 A matter upon which the public needs infor- 
 mation is concerning the effects of alcohol 
 drinking upon the upper air passages. It has 
 long been believed that alcohol is a stimulant, 
 and that in moderation (if there is such a 
 thing) its harmful effect upon the mucous mem- 
 branes is confined to the abdominal organs. 
 Recent studies, showing that alcohol is locally 
 corrosive and generally narcotic, seem to be 
 well founded, but that the effects of alcohol 
 goes further than this and influences mucous 
 membranes remote from its place of absorption 
 has attracted but little attention. 
 
 Students of this subject say that it is excep- 
 tional to find persons who use spirits that do 
 not suffer from catarrh and subacute inflam- 
 mations of the throat and nose. They report 
 that the paralysis of the capillaries caused by 
 repeated doses of alcohol becomes a permanent 
 condition, and find this especially in the respir- 
 atory mucous membranes. We are familiar 
 with the dilated capillaries of the spirit drink- 
 er's face. This is a duplication of what takes 
 
 65 
 
MEDICAL SOCIOLOGY 
 
 place also in the mucous membrane of the nose 
 and throat. 
 
 The voices of singers are very sensitive to 
 alcohol. The changed tone of voice in drink- 
 ers indicates thickening and changes in the 
 vocal cords. Both the bronchial and nasal 
 tones are pronounced in chronic cases, and the 
 carrying property of the voice is lowered. 
 The laryngologists assert that it is compara- 
 tively easy to cure bronchial and nasal in- 
 flammatory conditions in persons who abandon 
 all use of alcohol or narcotics, but unless this is 
 done the disease will continue almost indef- 
 initely. It is also shown that alcohol is a large 
 factor in the production of grip and chronic 
 catarrhs of the throat by deranging the capil- 
 lary circulation and interfering with the vital- 
 ity of the nerve cells. Alcohol is a prominent 
 etiologic factor in pulmonary tuberculosis. But 
 of the two evils, alcohol is a greater national 
 curse than tuberculosis. 
 
 The treatment of chronic alcoholic inebriety 
 should receive more scientific consideration 
 from the medical profession and sociologists. 
 The treatment of poisoning with ptomaines 
 and drugs is well in hand, but the treatment of 
 alcohol poisoning and addiction still receives 
 
 66 
 
THE SOCIOLOGY OF HEALTH 
 
 most of its attention from the mercenary ex- 
 ploiters of " cures." As the insane were, until 
 recently, regarded as outside of the pale of 
 medical attention, so now is the unfortunate 
 alcoholic. Still it is one of the commonest dis- 
 eases, and except among the most enlightened 
 the victim is regarded as being possessed of a 
 vice just as the insane man was once regarded 
 as possessed of a devil. If a man is found on 
 the street suffering with opium poisoning he is 
 conveyed to the hospital and receives scientific 
 and humane treatment. If a man is found in 
 the same place suffering with alcoholic poison- 
 ing he is taken in charge by the police, his am- 
 bulance is a patrol wagon, his hospital bed is the 
 floor of a cell at the police station upon which 
 he is tossed, and in the morning he appears be- 
 fore a judge and is fined for committing a crime. 
 Alcohol poisoning is a bad thing in the eye of 
 the law ; all other poisons are misfortunes. 
 
 Let us put away the mistakes of the past 
 and place ourselves in the attitude toward alco- 
 hol which we should have were it a newly dis- 
 covered chemical compound and had not been 
 used by man since history began. Having 
 learned its effect upon the body we should label 
 it " poison," the same as the other drugs of this 
 
 67 
 
MEDICAL SOCIOLOGY 
 
 class, and instead of being sold by vicious men 
 who offer enticements for its consumption it 
 would be secured only upon a physician's pre- 
 scription. 
 
 The people look to the medical profession for 
 instruction and guidance in matters of health. 
 The time has come when we should take a posi- 
 tive stand on this question. We know the large 
 harm that alcoholic beverages are inflicting 
 upon the people. Its ravages are known as well 
 as those of typhoid. We know them so well 
 that we scarcely need discuss them among our- 
 selves. We know how much weaker the resist- 
 ance to disease is on the part of the man who 
 has habitually taken alcohol than it is in the 
 man who has not. We know the frightful mor- 
 tality in pneumonia and Bright's disease among 
 drinking men. We know the frequency and 
 dangers of delirium tremens occurring, as it 
 often does, in men who have drunk daily but 
 never in amounts to produce intoxication. We 
 know the difficulties experienced by the drink- 
 ing man when he requires a surgical operation. 
 It devolves upon us to instruct the public as 
 to the dangers of alcohol just as it does to in- 
 struct them concerning the dangers of polluted 
 water or bad milk. Alcohol is not a food. It 
 
 68 
 
THE SOCIOLOGY OF HEALTH 
 
 causes one tenth of the deaths in the United 
 States; yet the people spend over two billion 
 dollars yearly for this poison. 
 
 We should have in this country societies ^ 
 under medical influence to promote the study 
 of alcohol and alcoholism, to disseminate infor- 
 mation on the subject, and to use their influence 
 in furthering the cause of temperance. This 
 is distinctly the province of medicine. The 
 medical profession, more than any other class, 
 could have the greatest influence for good in 
 social and professional life, and no other class 
 can be looked to for information so reliable. 
 The time is ripe for a great and sane temper- 
 ance movement, conducted by this profession, 
 telling the public simply the truth about alcohol 
 as we have told it about tuberculosis, dissem- 
 inating knowledge and the incontrovertible 
 facts. The value of such a movement to this 
 country is beyond the power of the most hope- 
 ful to foresee. 
 
 » Germany has become sufficiently aroused in this matter to 
 have a Society of Physicians for the Promotion of Total Absti- 
 nence, which is doing a splendid work. It issues a Korrespon- 
 denz-Blatt, and its influence is making a positive impression upon 
 the medical profession and the public. The American Society 
 for the Study of Alcohol and other Drug Narcotics is a similar 
 organization, and promises to be of great service. 
 
 69 
 
vni 
 
 THE VENEREAL PERIL 
 
 THERE are many conditions threatening 
 society which because of their noxious- 
 ness and tendency to spread are prop- 
 erly designated as perils. Some of these seem 
 inevitable, the remedies for their eradication 
 not having yet been evolved. Others are dis- 
 tinctly remediable, all of the essentials for Ijheir 
 removal being at hand. Given a great social 
 evil, recognized by society as an evil, the rec- 
 ognition backed by a desire to be rid of it, so- 
 ciety will destroy it when two conditions are 
 attained. These conditions are: first, a scien- 
 tific recognition of its nature, and, second, a 
 general education of the public as to its signifi- 
 cance. One of the greatest of social evils ex- 
 ists because only the first of these conditions 
 has been attained. Its nature and harm are un- 
 derstood by a few, but the great mass of society 
 gropes in ignorance. The ignorance of sexual 
 life and sexual hygiene, added to the sexual in- 
 
 70 
 
THE SOCIOLOGY OF HEALTH 
 
 stinct, results in a combination productive of as 
 great evil as any scourge that has afflicted man- 
 kind. Because of these society harbors a plague 
 of disease and a pestilence of immorality which 
 is emasculating the strong, destroying homes, 
 weakening the foundations of society, filling 
 our hospitals and asylums with wrecks of hu- 
 man beings, spreading disease into the sources 
 of life, and deteriorating the race. This is the 
 venereal peril, and it behooves us to cast aside 
 prudishness and, with frankness and clear vi- 
 sion, see what it means. 
 
 The two great venereal diseases are gonor- 
 rhea and syphilis. In this country our statis- 
 tics are incomplete, but in Europe seventy-five 
 per cent of adult males have had gonorrhea, 
 and twelve and a half per cent of adult males 
 have had syphilis. In the United States it is 
 calculated that sixty-five per cent of adult males 
 have had gonorrhea. It is the most prevalent 
 of all diseases next to measles. In this country 
 800,000 males reach maturity annually. Of this 
 number 500,000 become infected with the latter 
 disease. It is stated by Morrow ^ that twenty 
 per cent become infected before the age of 
 
 'Transactions Society of Sanitary and Moral Prophylaxis, 
 1906. 
 
 71 
 
MEDICAL SOCIOLOGY 
 
 twenty-one years, sixty per cent before the age 
 of twenty-five and eighty per cent before the 
 age of thirty. There are 14,000,000 male adults 
 under the age of thirty in the United States, 
 and the most reliable observers calculate that 
 8,000,000 of them have gonorrhea or its sequelse. 
 The trail of physical suffering which follows in 
 the wake of these appalling figures is insignifi- 
 cant when compared with the mental anguish, 
 the broken hearts, and the saddened homes that 
 mark their path. The woman who cohabits 
 with a gonorrheic is doomed to infection, and 
 that such infection is the lot of a vast and grow- 
 ing army of American women is attested by the 
 multiplication of gynecologists and of hospitals 
 for the relief of these unfortunates. Let the 
 layman not think of this as a disease of the 
 vicious. Gonorrhea is a disease of the virtuous 
 wives in our great cities as well as of the prosti- 
 tutes. We have no statistics at hand upon the 
 prevalence of this condition, but the busiest 
 specialty of medicine and surgery is that which 
 deals with these diseases. Gynecologists re- 
 port that more than seventy-five per cent of 
 the operations required for inflammatory dis- 
 eases in women is due to gonorrhea. The ma- 
 jority of abdominal operations upon women are 
 
 72 
 
THE SOCIOLOGY OF HEALTH 
 
 for this cause. This does not take into consid- 
 eration the large number of women who are not 
 operated upon but who drag out a miserable 
 existence. 
 
 Gonorrheal infection is acquired by the in- 
 nocent wife from her husband. In his bach- 
 elor days he got it from an infected woman. 
 He thought he was cured, but there were gon- 
 ococci living still in the deep parts of his urethra 
 which were awakened to activity by the renewal 
 of sexual life. Unhappily, this disease makes 
 little or no impression on a man's general 
 health, and he thinks of it lightly, while but few 
 diseases afflict women that are fraught with 
 greater chronicity and more permanent harm. 
 The reawakening of his old disease and the ap- 
 pearance of the same thing in his bride has 
 prompted many a man to accuse an innocent 
 woman of having been the original purveyor of 
 the malady. A man who has once had gonor- 
 rhea is a dangerous man to marry, and sixty- 
 five to seventy-five per cent of the women who 
 wed are accepting this danger. 
 
 These statements are not matters of surmise ; 
 our knowledge of this condition is woefully 
 complete. It can be recognized with certainty. 
 The gonococcus, the cause of the disease, is one 
 
 73 
 
MEDICAL SOCIOLOGY 
 
 of the most easily identified microorganisms, 
 and there is no disease with which the gyne- 
 cologists are more familiar. 
 
 Childless marriages were once thought to be 
 due to certain incompatibilities, visitations of 
 Providence, and inherent defects on the part of 
 the wife. The wife was once regarded as guilty 
 in the sight of the law if she bore her spouse 
 no children, and could be cast aside for steril- 
 ity. Scientific knowledge has thrown light upon 
 this dark place in the progress of women's 
 emancipation, and the culpability is now placed 
 where it belongs. Gonorrhea is responsible for 
 most of the sterility in childless marriages 
 (seventy-five per cent is a conservative figure). 
 Pretty full statistics are to be had upon this 
 subject. Unfruitfulness in thirty per cent of 
 marriages is due to sterility of the male, caused 
 by gonorrhea having involved the spermatic 
 duct and the epididymis. Active disease in 
 these cases may have subsided, the male not 
 conveying infection, delivering to the female 
 neither gonococci nor spermatozoa, but being 
 apparently potent and healthy. Forty-five per 
 cent of the unfruitfulness in marriages are due 
 to gonorrhea in the woman acquired from the 
 man. The infection, once implanted, progresses 
 
 74 
 
THE SOCIOLOGY OF HEALTH 
 
 upward into the uterus and thence through the 
 Fallopian tubes to the ovaries. It is the married 
 woman's most common disease. Every prosti- 
 tute has it and, fortunately for society, it ren- 
 ders her sterile. It is the bond of sympathy 
 between these two great classes of women sup- 
 plied by the husbands. It exists in every de- 
 gree of severity. In some it produces scarcely 
 a symptom, often not reaching the tubes until 
 after the first and only child has been bom, and 
 then sealing them up against the passage of 
 further ova and producing what the German's 
 have designated as " one-child sterility." In 
 others the fulminating signs are present : acute 
 inflammation of the tubes and ovaries, abscess- 
 es, peritonitis. Between these lie all degrees 
 of pelvic ills, acute and chronic. But ultimately 
 the tubes are sealed and sterility supervenes. 
 This condition is the most prolific cause of ex- 
 tra-uterine pregnancy. Seventy-three per cent 
 of spontaneous abortions in the United States 
 are due to endometritis which is usually due to 
 gonorrhea. The large proportion of sterile 
 marriages and of abortions is not a matter of 
 choice, as is commonly believed, but is due to 
 disease. 
 There are 110,000 blind persons in the United 
 75 
 
MEDICAL SOCIOLOGY 
 
 States. A large part of this blindness is the 
 result of venereal disease. More than eighty 
 per cent of the cases of blindness of the new 
 born are due to gonorrhea, infecting the eyes 
 of the child during the moments of its birth. 
 While this eye disease is easily amenable to 
 treatment still twenty per cent of all blindness 
 at present in the asylums of New York State is 
 due to that cause alone. Syphilis also furnishes 
 its quota. 
 
 Another venereal scourge of childhood is 
 gonorrheal vulvovaginitis — a disease of horri- 
 ble prevalence. The little girl in the clean 
 house contracts it from the hands of the gonor- 
 rheal nurse who gives her her bath. In institu- 
 tions, asylums, and orphanages, it breaks out 
 and passes from child to child, being transmit- 
 ted by clothing, towels, and the bath, until it 
 assumes the character of an epidemic. Its con- 
 sequences for later life are serious, and its 
 chronicity is much to be dreaded. Slow and 
 insidious, often scarcely affecting the general 
 health of the little girl, the infection finds its 
 way to the uterus, tubes, and ovaries producing 
 conditions which result in sterility in later life, 
 and often causing developmental defects in 
 these organs and retardation of their growth. 
 
 76 
 
THE SOCIOLOGY OF HEALTH 
 
 In our great cities acute gonorrhea in little 
 girls, contracted by actual sexual contact with 
 the male, is by no means an uncommon con- 
 dition. 
 
 Concerning syphilis, Pinard, in a study of 
 10,000 consecutive cases of miscarriage in Eu- 
 rope, found forty-two per cent of them associ- 
 ated with this disease. Hereditary syphilis 
 claims a mortality of from sixty to eighty-six 
 per cent. It is one of the most fatal of diseases 
 among the new-born. The most reliable statis- 
 tics to be found in connection with this condi- 
 tion are in France, where 20,000 children die 
 yearly of syphilis, and where the total mor- 
 tality from that disease is seven and a half 
 per cent. This is not because the disease is 
 more prevalent in that country, but because 
 the statistics are more carefully compiled. It 
 is quite as prevalent in England, and in Eus- 
 sia it is so common that whole villages are in- 
 fected, with but few individuals who are not 
 syphilitic. In Zanzibar five sixths of the na- 
 tives are syphilitic. On the Gold Coast thirty 
 per cent of the population has this disease. It 
 was carried to these places by the onward 
 march of what is called civilization. Cook's 
 crew took syphilis to the Sandwich Islands, 
 
 77 
 
MEDICAL SOCIOLOGY 
 
 where it soon became epidemic. Civilization 
 and syphilization : Arcades ambo! Syphilis is 
 the great cause of the destructive diseases of 
 the nervous system. In its inherited form it 
 is the greatest cause of epilepsy. The pro- 
 gressive paralysis of childhood is one of the 
 results of hereditary syphilis. It is the most 
 prevalent cause of paresis and locomotor 
 ataxia. The more thoroughly the histories of 
 the insane have been studied the more has 
 syphilis loomed up as a causative factor. In 
 the United States Army syphilis causes the dis- 
 charge of more men for physical disability than 
 does tuberculosis. Although it is amenable to 
 treatment still it decreases the period of life 
 expectancy by one third. It lowers the general 
 resisting power of the individual and renders 
 him particularly prone to tuberculosis. 
 
 These diseases attack not only the young, but 
 slay the child before it is born. They prevent 
 conception. Most of the sterility of women is 
 due to gonorrhea contracted from the male. 
 Fifty per cent of gonorrheal women are sterile. 
 The busy specialists in venereal diseases give 
 us these figures out of the abundance of their 
 experience. Morrow has said that seventy per 
 cent of the women who presented themselves 
 
 78 
 
THE SOCIOLOGY OF HEALTH 
 
 to him for treatment for venereal diseases even 
 at the public hospitals were respectable mar- 
 ried women who had been infected by their hus- 
 bands. In 1901, in New York City, 162,372 
 cases of gonorrhea and syphilis were treated 
 in the private practices of physicians. This 
 represents but a minority of the cases, as the 
 majority are treated in hospitals, in drug stores, 
 in the offices of the advertising quacks, and a 
 large proportion are not treated at all. 
 
 We must beware of distinctions between 
 the guilty and the innocent. If there is such a 
 thing as guilt and innocence the guilt lies with 
 parents and teachers and with the state. Bulk- 
 ley has published a book entitled " Syphilis of 
 the Innocent," in which he reports some 3,000 
 cases of this disease contracted by agencies ex- 
 ternal to venereal congress. It is a scientific 
 recountal of appalling sadness, describing in- 
 fection from the drinking cup, the public towel, 
 the barber's razor, the kiss bestowed upon the 
 helpless child, and through a hundred other 
 avenues of infection. 
 
 The prevalence of these conditions is one of 
 
 the darkest blots upon our civilization. The 
 
 physician knows their horror ; his services, alas, 
 
 are sought when the damage has been done. 
 
 7 79 
 
MEDICAL SOCIOLOGY 
 
 The tragedy of marriage is known to him. The 
 pomp and ceremony, the flowers and ribbons, 
 the music and sweet odors, all too often fade 
 away into the grim presence of blighted hopes, 
 of household joys. Poor man with the invalid 
 wife ! poor childless woman ! We pity you both. 
 It is not your faults ; you would have lived and 
 loved in health and happiness had parents and 
 teachers been true to you ! 
 
 There is much in literature which it behooves 
 us to recognize as prejudicial to sexual moral- 
 ity. It is not the statements of the whole truth 
 which we need object to — there is no naked 
 truth which need not be told, provided all is 
 told, and that in truthful perspective. What 
 makes for ill is the glorification of sexual crime 
 and the heroization of sexual criminals. The 
 public prints which exploit the doings of the 
 violator of the marriage vows, to the neglect 
 of the noble deed of virtue, we know are breed- 
 ing harm. The literature of salaciousness is 
 productive of decided damage. Nor would I 
 exempt from this category the recountals of 
 sexual sins as found in the Bible, and the relig- 
 ious glorification of men whose sexual lives 
 should be spoken of with shame. The exalting 
 of these immoral acts, by surrounding them 
 
 80 
 
THE SOCIOLOGY OF HEALTH 
 
 with the halo of reverence, makes for results 
 which are subversive of morality. 
 
 It is an extraordinary thing that the subject 
 of sexual morality, which is so close to the hap- 
 piness of domestic life, should have been so 
 neglected. When Herbert Spencer asked and 
 answered the question, " AMiat knowledge is of 
 the most worth? " he presented the preeminent 
 importance of a knowledge of the laws of health 
 as the supreme safeguard of the happiness of 
 the individual. But tardily have educators pro- 
 ceeded to apply the great principles which he 
 laid down. AYith studied care this question of 
 sexual health has been ignored by teachers and, 
 sadder still, avoided by parents until finally the 
 child learns it, as learn it he will, from lewd 
 companions ; but truly what he learns is not sex- 
 ual hygiene but sexual immorality. Let us not 
 make the mistake of saying that this is a dirty 
 subject and that we cannot touch it. I have 
 heard this said by those who, while professing 
 to fight evil, confined the fight to nice, genteel 
 evils which are chiefly matters of the imagina- 
 tion and of belief. No, it is a clean and glorious 
 thing to say the word that shall save a young 
 man or woman from invalidism and moral dis- 
 couragement. There are things to be said and 
 
 81 
 
MEDICAL SOCIOLOGY 
 
 things to be done which should be said frankly 
 and done boldly. 
 
 The protection of the innocent demands that 
 the young shall know the sexual biology of man 
 just as he should know of the fertilization and 
 blossoming of flowers. The sexual instinct is 
 the most imjDortant of all the social instincts. 
 It is wrong and false to degrade it by treating 
 it as though it were a shameful thing. The 
 teaching of one of the dominant modern relig- 
 ions that sexual joy is carnal sin and that the 
 death of the body is the great goal is not as 
 sound as that of some of its precursors, which 
 exalted the giving of life. The mental and 
 moral state of " Western civilization " makes it 
 impossible for it to interpret fairly or intelli- 
 gently the real spirit of the old phallic sym- 
 bolism. But when we come to look at these 
 things rightly we shall see, perhaps, as much 
 virtue in the symbol of life as in the symbol of 
 death. One of the most beautiful gifts we have 
 received from nature's hand is the love of man 
 and woman. To say that man is conceived in 
 sin is but one of the dronings of cant. 
 
 Let us speak plainly. The best interests of 
 the individual, of the home, and of society de- 
 mand that man shall cohabit with none but his 
 
 82 
 
THE SOCIOLOGY OF HEALTH 
 
 wife ; if a woman is not his wife lie shall not co- 
 habit with her. This is a simple rule; it will 
 stand the test of analysis, it is easy to remem- 
 ber, and it should be taught, along with the 
 reasons for it, to every boy and girl who reaches 
 puberty. 
 
 Infringement of this rule makes for ill. The 
 penalties and dangers in its violation I should 
 enumerate as follows: — They are: the moral 
 and social degradation of a woman who other- 
 wise would live rightly; the danger of causing 
 disease in such a woman; the encouragement, 
 by example, of a practice which stands preem- 
 inent as the great cause of social unhappiness ; 
 the subtraction of just so much joy and devo- 
 tion from the woman who should or will stand 
 in the proper relation of wife; the possibility 
 of the propagation of illegitimate children; the 
 strong probability of contracting venereal dis- 
 ease; the danger of transmitting physical or 
 moral blight to one's offspring; the develop- 
 ment of vicious habits; the cultivation of im- 
 moral society; the wasting of time and energy 
 in unprofitable company; the social harm to 
 oneself and family; the moral harm which 
 springs from acting in secretiveness and shame ; 
 the contracting of the concomitant vices which 
 
 83 
 
MEDICAL SOCIOLOGY 
 
 go hand in hand with venery for venery's sake; 
 and the postponement of the organization, or 
 the weakening of the strength, of the most po- 
 tent factor in the solidarity of society — the 
 home. These are strong reasons against extra- 
 marital sexual intercourse, and each is suscept- 
 ible of serious consideration. Moreover, to 
 these should be added the fact that sexual inter- 
 course is absolutely not necessary for one's 
 health; the suggestion that it is necessarj'' is 
 only repeated and passed along by the offend- 
 ers who desire an excuse for their own laches, 
 or by those who in ignorance repeat a tradition. 
 
 It is not so much a want of virtue or of mor- 
 als that concerns us as it is a want of knowledge 
 and adequate instruction. The only cure for 
 the lack of virtue which will stand every test is 
 Iniowledge. Evils which cannot be remedied by 
 the cleansing power of truth are beyond the 
 reach of human agencies. If to know all is to 
 forgive all, so also is it true that to know all is 
 to escape the necessity for being forgiven. 
 
 The beginning of the victory over this great 
 social scourge will come when its real charac- 
 ter is known and understood by all men and 
 women; when the penalties for violations of 
 sexual hygiene are as common knowledge as are 
 
 84 
 
THE SOCIOLOGY OF HEALTH 
 
 the penalties for violations of the common law 
 of the state; when the dangers of falls into 
 adultery are understood as well as are the dan- 
 gers of physical falls; and when the tinsel is 
 struck from the shoulders of women of loose 
 sexual practices and the pitiable creature be- 
 neath is exposed. There is little distinction 
 between the innocent and the guilty; all who 
 suffer through unenlightenment are innocent, 
 for no one is so guilty as to elect rmhappiness. 
 At the bottom of these troubles lies the igno- 
 rance which it devolves upon society to remedy. 
 Medical science has accumulated the knowledge 
 which is necessary to correct these evils; 
 it remains for the parent, the teacher, and the 
 guardian of public morals to apply it. 
 
IX 
 
 THE INSTRUCTION OF THE YOUNG IN SEXUAL 
 HYGIENE 
 
 "Learn what is true in order to do what is right." — Huxley. 
 
 THERE are certain accompaniments of 
 civilization which at one time were use- 
 ful, and which, though no longer of serv- 
 ice, still retain their hold and influence by 
 virtue of traditional esteem. There are super- 
 stitions which have been of use to mankind, and 
 which we still permit to linger and enjoy a 
 bounty in the presence of enlightenment long 
 after they should have been dismissed. Among 
 these relics of the past there is one ancient vir- 
 tue, lingering beyond its time, for the entertain- 
 ment of which we pay a mighty price. It is 
 prudishness, and it takes its pay in lives and 
 happiness and in domestic joys and the virtue 
 of our children. In the most important branch 
 of human learning, that which means the pres- 
 ervation of health and physical efficiency, prud- 
 islmess raises its hand and denies enlighten- 
 
 86 
 
THE SOCIOLOGY OF HEALTH 
 
 ment in that knowledge which is precious 
 beyond price. 
 
 The best preparation for moral and useful 
 living is to be found in knowing the truth, and 
 the most imjoortant truths for the individual to 
 know are the truths concerning himself. One 
 of the errors of our time is that we take out 
 of the book of human knowledge a whole chap- 
 ter, write " tabooed " across it, and sequester 
 it from those who need it most. 
 
 Let us be honest, and let us begin our honesty 
 with the child. It would be a boon to humanity 
 if we would be frank and fair with children. 
 Dissembling has wrought much ultimate harm. 
 It is unfortunate that youth is willfully de- 
 ceived by the parent who excuses himself with 
 the self-assurance that the child will learn for 
 himself soon enough what is true. It is not 
 alone in the realm of the religious superstitions 
 in which men no longer believe, nor in the little 
 sentimental, domestic, fairy tales, but it is in 
 the questions of sex life that the great harm of 
 dishonesty springs. 
 
 We are beginning to appreciate the impor- 
 tance of the teaching of the natural sciences. 
 The moral value of such teaching is beginning 
 to be realized, but it must be carried home to 
 
 87 
 
MEDICAL SOCIOLOGY 
 
 the individual to be of the most good. Chil- 
 dren should understand at least as much of 
 their own selves as they do of the starfish or 
 the buttei'fly. When the father calls his son 
 into the library, closes the door, and with awful 
 formality announces, " My son, I wish to talk 
 with you upon a subject which is not touched 
 upon in any of the things which you have as 
 yet studied," we realize that the father is ad- 
 mirable in his intentions, pitiable in his method, 
 and that if the boy had had the simple advan- 
 tages which should have been his by right no 
 such performance as this would have been nec- 
 essary. Moreover, unless this library scene is 
 enacted early the well-meaning parent will have 
 little that is new to offer; juvenile wisdom will 
 have preceded him. The phenomena of nature 
 are so intimately associated with human inter- 
 ests, every branch of knowledge overlaps other 
 branches to such a degree, that we shall do 
 wisely in dealing with the child not to wander 
 away from nature's intimacies, but rather to 
 take advantage of them in driving home the 
 lessons of life. The biological principles which 
 underlie reproduction among the flowers also 
 underlie reproduction among the lower animals 
 and man, and the children should know the sim- 
 
 88 
 
THE SOCIOLOGY OF HEALTH 
 
 pie truths concerning them. If they are not 
 thus taught they will learn to their harm to 
 think of the human sexual relation as some- 
 thing peculiar and mystic. 
 
 We use in our language such words as pudic ' 
 and pudendwn, from piidere (to be ashamed), 
 of which we might well be ashamed, for they 
 are symbols not of virtue, but of lack of virtue. 
 To teach the child that certain parts are vulgar 
 and others not is the beginning of evil. Accord- 
 ing to the older pedagogy the liver is honorable, 
 the kidneys dishonorable; the organs of masti- 
 cation genteel, but those of generation vulgar. 
 We grow up from childhood with these ideas so 
 strongly fixed in our minds that even among 
 the thoughtful and mature it is almost a psy- 
 chological impossibility to think with favor of 
 the ideal state of mind which regards none of 
 them as pudendus — to be ashamed of. Surely, 
 persons having children under their care, in 
 the present state of enlightenment, need not 
 ride roughshod over the usages of the times 
 — that would be social unwisdom — ^but they can 
 refrain from prudishness and dishonesty, and 
 they can approve of the teaching of the natural 
 sciences, and by pointing out their relations to 
 human life and morals they can endorse the 
 
 89 
 
MEDICAL SOCIOLOGY 
 
 sanctity of the human body and the goodness of 
 all that is useful. 
 
 Some of the ancient civilizations of the East 
 have exemplified these things, and accordingly 
 displayed a superior morality. When our mis- 
 sionaries have reported them as being vulgar, 
 and striven to change their ancient customs, it 
 often has been because the missionaries were 
 vulgar and not they. When we have attained 
 to the state of civilization which lies within our 
 reach the pudenda will not be the normal gen- 
 erative parts, but the tuberculous lung, the ty- 
 phoid intestine, decayed teeth, bunions, and idle 
 hands — these are the things of which we shall 
 be ashamed. 
 
 How and what shall the youth be taught con- 
 cerning the sexual questions? This is not dif- 
 ficult to answer if we put aside guile and stand 
 for honesty with the child. Between four and 
 six years of age children are full of curiosity; 
 the world is full of enigmas, and their minds 
 are reaching out for the truth. It is not neces- 
 sary to volunteer information to them, but let 
 their questions be answered truthfully. Boys 
 between eight and ten and girls between eight 
 and twelve should be taught the physiology of 
 human sex. This should be conducted by intel- 
 
 90 
 
THE SOCIOLOGY OF HEALTH 
 
 ligent and discreet teachers, preferably par- 
 ents, not by class-room methods, but by in- 
 formal, close personal talks. The best teacher 
 is an intelligent mother. These talks should 
 have been preceded by the regular studies of 
 the natural sciences. Children of this age 
 should have studied already the elements of 
 botany, zoology, and physiology, the modes of 
 propagation and growth of plants and the lower 
 animals. They should know the meaning of 
 seed, fertilization, and the sexual distinctions, 
 following nature from the simple little truths 
 up to the great things. These are of more im- 
 portance to them from a cultural and practical 
 standpoint than are grammar, history, rhetoric, 
 or algebra. When we come to the sexual rela- 
 tions of men and women it is not advisable to 
 discuss the details of sexual contact. The judg- 
 ment of the teacher will tell how much to teach, 
 but let naught be said that is false or mislead- 
 ing. If there have been the proper preliminary 
 studies of the natural sciences the human physi- 
 ology of sex will unfold itself in a natural se- 
 quence, and the child will learn in a dignified 
 and respected way what most children are now 
 learning in association with the obscene. 
 Boys at this age should be taught the sacred- 
 91 
 
MEDICAL SOCIOLOGY 
 
 ness of their person, the importance of good 
 health and cleanliness. They should be in- 
 structed in the physiological relations between 
 their brains and sexual organs, and the impor- 
 tance of pure thoughts. Inasmuch as practi- 
 cally every boy, sooner or later, between eight 
 and fourteen learns or is taught to masturbate, 
 the harmfulness of this practice should be dealt 
 with. Boys should be instructed not to handle 
 themselves. At fourteen to sixteen the boy 
 should be told more fully of sexual things. He 
 should know his power of fatherhood. Lest he 
 become worried concerning seminal emissions 
 occurring during sleep, he should be informed 
 of their possibilities and harmlessness. Unless 
 he is told this he will inevitably become ner- 
 vously concerned at the advertisements which 
 the quacks, who prey upon the youth, will place 
 in his hands. He should be told the importance 
 of sexual continence as set down in the previous 
 chapter. He should be taught that self-control 
 is a sign of manliness and strength, not of ef- 
 feminacy and weakness. It is the boy of 
 strength and courage who declines his com- 
 rade's challenge to indulge in alcoholics and 
 visit lewd women ; it is the weak boy who cannot 
 decline. He should be taught to have confidence 
 
 92 
 
THE SOCIOLOGY OF HEALTH 
 
 in Ms parents, and when questions come np 
 upon which he desires enlightenment he should 
 feel no restraint in asking advice or informa- 
 tion. He should be told the causes and the 
 nature of the venereal diseases, and at the age 
 of eighteen girls should be taught the same. 
 
 In a general way girls should be taught about 
 the same as boys, but particularly in reference 
 to the things which concern them. Menstrua- 
 tion should be explained. On the whole, they 
 require less instruction in these lines than do 
 boys. The girl at puberty should be taught the 
 sig-nificance of love and sexual feelings. She 
 should know the meaning of the strange emo- 
 tions that fill her mind. The value of this 
 knowledge to red-blooded girls may not be ap- 
 preciated by asexual dames, but it is a matter 
 of vital importance. They should be taught 
 the danger of permitting liberties with their 
 persons. They should know the meaning of the 
 mating instinct and their interest in boys. 
 Could we lay bare the story of the debauching 
 of young girls we should realize into how great 
 a blessing a little knowledge might be turned. 
 
 Youth should be encouraged to have an inter- 
 est m wholesome occupation requiring both 
 physical and mental application. They should 
 
 93 
 
MEDICAL SOCIOLOGY 
 
 be taught to have ideals. The adoration of 
 great and good men is a splendid outlet for a 
 boy's sentiment. After puberty they demand 
 sentiment, and they should have it. Teach 
 boys chivalry. Good female society, games, 
 dances, amateur theatricals, and an occasional 
 love story are all in this line, and help to round 
 the normal youth. Athletics to a moderate de- 
 gree are of benefit, particularly if supervised 
 by a competent instructor. It is a splendid 
 thing for boys to have pride in their physical 
 health, to cast out prudishness, and to be 
 made to strip occasionally for weighing, meas- 
 urements, and inspection. Athletics of this 
 sort make for chastity. " Frisch, frei, f rolich, 
 fromm," the Germans say. Above all, boys 
 should be taught the fallacy of the so-called 
 " sexual necessity," and the danger and absurd- 
 ity of the old idea of " sowing wild oats." The 
 boy should know that there is no more need for 
 him to " sow wild oats " than there is for his 
 sister to do so. 
 
 Both boys and girls should know that there is 
 a bad side to life. It is not true that all is good 
 and beautiful. In due time they should be 
 warned that there are unfortunate women who 
 prey upon men and boys, and that there are 
 
 94 
 
THE SOCIOLOGY OF HEALTH 
 
 men who make girls their victims. Girls should 
 be taught the sacredness of their bodies and the 
 wiles by which advantage is taken of them. 
 Youth should know that the women who lead 
 lives of sexual looseness are not happy in it. 
 Their lives are short and their ends are 
 wretched. 
 
 Above all, teach the youth reverence for his 
 mother. It is one of the greatest powers to 
 hold him to the right. Let him know all that 
 she has meant to him; how that he was once a 
 part of her very body; how she bore him with 
 pains; how she nourished him from her sub- 
 stance; how she was with him through all the 
 dark nights and watched by his bedside; and 
 how that her love is the greatest of all. He will 
 do it for her — live the right life. 
 
 There are superstitions which militate against 
 attaining the best results in teaching sexual hy- 
 giene to the yo-ung. I do not refer to the doc- 
 trine that the body is but a vulgar earthly 
 thing, to be sloughed off in joy, and that we 
 should give no thought of it — this is now but 
 little taught and less believed — but I refer to 
 the doctrine that sins committed against the 
 body of oneself or another can be expunged. 
 Let us teach that sin provides its own punish- 
 8 95 
 
MEDICAL SOCIOLOGY 
 
 ment, and that when once committed it is irre- 
 trievable. We are pmiished by our sins. For- 
 giveness, in the religions sense, is the rock upon 
 which much morality is shattered. Let us not 
 delude the young with the fatuous hope that 
 after the commission of sin there is something 
 that can be done, some one to whom to go who 
 can make it all right and wipe away the past. 
 Such a teaching is immoral. The past cannot 
 be expunged. Let us, instead, teach the young 
 the fear, or rather the respect, for consequences. 
 Teach them that these venereal diseases are not 
 the punishments for depravity, but that they 
 are natural consequences. Above all, let us be 
 reasonable— it is the easiest course. Physical 
 morality is the morality we are dealing with. 
 The morality which has not a physical basis 
 does not concern us. It needs no vague and 
 esoteric grounds of appeal when we can teach 
 the youth what is best for him and his happi- 
 ness. A noble expediency is that which teaches 
 the child to be mindful of what is best for 
 himself. 
 
 The lines of teaching that will help the child 
 must be practical and reasonable. The Church 
 has asked that children be taught the religious 
 superstitions. They have been tried and they 
 
 96 
 
THE SOCIOLOGY OF HEALTH 
 
 have failed egregiously. If the Church desires 
 to teach the things that will help the child, let 
 it desist from the imnatural and unintelligible ; 
 let it cease in its glorification of the doings of 
 an obscure, unprogressive, and uncultured na- 
 tion — long since gone down to extinction — with 
 its wars and killings and intrigues and shame- 
 ful superstitions ; and if it wants to teach about 
 God, let it be of the great God of nature, and 
 not of the wrathful Jehovah whose delight was 
 in the slaying of the innocent and in holding 
 personal communications with lustful men. 
 There is more enlightenment, culture, and won- 
 derment in reading the message written in 
 the swirling planets, in the sprouting seeds, in 
 the unfolding petals, in the growing egg, in the 
 flight of birds, in the tiger's skin, and in the 
 mother's love, than there is in the fanciful writ- 
 ings of interested and superstitious men who 
 have made credulous humanity believe that they 
 were handing down a message. If we want the 
 child to have the word of God, let him be taught 
 to read it himself at first hand; and let him 
 study the lives of men and women who were 
 really wise, practical, and good, and whose ex- 
 amples it would be both possible and wise for 
 him to follow. 
 
 97 
 
MEDICAL SOCIOLOGY 
 
 Let us. furtliermore. bear in mind that it is 
 knowledge of the real things that is to save our 
 youth and not prudery. I have known boys and 
 girls eager for information, with the simple 
 hearts of children, to have their questions evad- 
 ed by their parents — denied the knowledge that 
 might have saved them lives of misery — put off 
 with platitudes. Ignorance is not innocence. A 
 father brought his only son, eighteen years old, 
 to a boarding schooL He said: "My son has 
 always had a private tutor. He is as innocent 
 as when he was a babe. I have brought him 
 here because you have no bad boys. I want him 
 keiDt pure." 
 
 The following are the facts about the boy: 
 At the time these words were spoken he had 
 been practicing onanism for three years. On 
 his return home for his summer vacation he 
 took with him an attack of gonorrhea acquired 
 from a lewd woman. Eight years later, having 
 graduated from college, he was married to a 
 beautiful girl full of hope and joy in the prom- 
 ises of life. She was operated upon for gonor- 
 rheal salpingitis within a year after a gorgeous 
 wedding. Ten years have now elapsed; she is 
 still a semi-invalid. The father has said that 
 it was a shame that his son had made such a 
 
 98 
 
THE SOCIOLOGY OF HEALTH 
 
 mistake and married a sickly, sterile wife; 
 and the law makes it a crime for the physician 
 to tell this silly old man the truth because it 
 would be violating the professional confidence 
 of the patient. Why should not this young 
 man have been given the simple knowledge 
 necessary to save his home and happiness! 
 He should, and the girl, too. Youth should 
 know the meaning of the sexual craving in or- 
 der to know best how to protect itself from mis- 
 takes. The average boy is sensible and appre- 
 ciates what is good for him if he is given a 
 fair chance. The average man wants to do 
 right. He does not want venereal disease, nor 
 does he want to transmit it to another. He does 
 not want a sick wife. He would not be prone to 
 fall into sexual errors did he but understand. 
 In dealing with the young, let us give rea- 
 sons. The boy's mind is a man's mind and it 
 demands reasons. Arbitrary dicta belong to 
 the field and camp, but not to the home and the 
 school. Let us deny the child no truth that can 
 serve him. Not legislation, nor fairy tales, but 
 education is the solution of this problem. Vio- 
 lations of the health of the body are moral sins 
 in which no remedy is so effective as the simple 
 knowledge of the truth. 
 
 99 
 
SEXUAL MOEALITY AND THE STATE 
 
 THE widespread existence of venereal 
 diseases as results of sexual immoral- 
 ity, and their importance as factors 
 affecting the homes and the physical efficiency 
 of citizens, together with their importance as 
 factors productive of classes which become a 
 burden upon the community, all make these con- 
 ditions of economic significance to the state. 
 The state recognizes the necessity for the con- 
 trol and supervision of measles, scarlet fever, 
 and smallpox. Children with these diseases are 
 debarred from school and forbidden contact 
 with others. The state lends its aid in the fight 
 against tuberculosis, but the venereal diseases 
 in most communities are not recognized by the 
 law notwithstanding that their destructive ef- 
 fects are greater than all of these other diseases 
 combined. 
 
 In the United States one factor receives offi- 
 cial attention — that is, the prostitute. She is 
 
 100 
 
THE SOCIOLOGY OF HEALTH 
 
 segregated, taxed, regulated, forbidden, arrest- 
 ed, fined, imprisoned, scorned, and cursed. 
 Who is she and what has she done that she 
 should be visited by the contumely of society? 
 She has gratified men. Still there is many an 
 honorable wife who has no higher function in 
 the world than this. What brought her to her 
 lowly occupation? Several causes, the most 
 important of which are the following: She 
 loved a man who pretended that he loved her; 
 he extorted from her all that she had to offer 
 and cast her aside; society spurned her; she 
 knew but one way to earn a living and in her 
 desperation she turned to it. Another was 
 forced to it, as a last resort, by poverty to sup- 
 port herself or her family. Another was driven 
 to it by parents, husband, or guardian. An- 
 other was made intoxicated and debauched, and 
 discovered that from that day on the compan- 
 ionship of good women was denied her. An- 
 other was made the victim of a systematically 
 laid trap; she was caught, and ever after re- 
 garded herself as unclean. Another coveted 
 fine raiment and jewels; she envied the rich 
 who had them; she read each day in the great 
 daily papers of the sexual irregularities of 
 those who wore these fine things; the two be- 
 
 101 
 
MEDICAL SOCIOLOGY 
 
 came inseparably associated in her mind; tlie 
 opportunity to combine them was offered to 
 her; she accepted it. Another fell because the 
 great passion welled through her being so that 
 she could not control it; she loved the imita- 
 tions of love; no one had ever told her their 
 significance. Another inherited an unbalanced 
 nervous organism ; the strange conditions which 
 men call by the name of degeneracy were be- 
 queathed to her ; she was lacking in moral per- 
 spective and appreciation of values. 
 
 When any of the above conditions exist, it 
 is made easy for a woman to fall. The down- 
 ward path seems the only one, for on every side 
 she is hemmed in by men — men everywhere, 
 who beckon her on and, leaving her, push her 
 farther on her way. She cannot escape them. 
 They have demanded her, surrounded her, and 
 made her what she is. 
 
 Every one of these women is the victim of 
 defective education. Had most of them known 
 the simple truths concerning sexual physiology 
 and hygiene, the meaning of sexual passion, the 
 dangers of venereal diseases, and been taught 
 the real interests of life, society would have 
 been saved their loss. This is personally true 
 of all but the degenerate, and in her case the 
 
 102 
 
THE SOCIOLOGY OF HEALTH 
 
 same lessons should have been tanght her for- 
 bears. There are ten thousand prostitutes in 
 New York now who came from respectable 
 homes, who are the daughters of loving moth- 
 ers, and there are ten thousand little girls now 
 happily playing with their dolls by their moth- 
 ers' sides who are to grow up and take the 
 places of these when they have been swallowed 
 up by the great consuming maelstrom of the 
 city. It is not for the ten thousand prostitutes 
 that we need be most concerned — they are lost; 
 but the ten thousand little girls are worth sav- 
 ing. Ask their mothers if they are not. The 
 most important factors for their salvation are 
 education and knowledge. Let its light fall 
 upon the dark places. Ignorance is not better 
 than knowledge. The next important thing is 
 better social and economic conditions. When 
 every one who wants to work shall have work 
 and fair compensation for it ; when every adult, 
 male and female, does his or her quota of work ; 
 when the aim of education is to prepare for 
 life, healthfulness, and efficiency, and not for 
 college, idleness, or death; when every healthy 
 man who wants to marry may marry, — then 
 education will do the rest, and the venereal 
 plague will be overcome. Idle women and bad 
 
 103 
 
MEDICAL SOCIOLOGY 
 
 women are often so through lack of education. 
 Education helps by filling empty brains. Give 
 a woman knowledge of the vital and interest- 
 ing things about her and she is not apt to de- 
 generate. 
 
 Two interesting features of this subject 
 should not be overlooked: One is the fact that 
 while the laws regulate the prostitute, the male 
 offender, who is her cause, her patron, and the 
 vehicle by which her diseases are conveyed to 
 the innocent — the male offender may go his 
 way, and the law wishes him Godspeed. It is as 
 though we should regulate the plague by shut- 
 ting up the women and allowing the men to go 
 free. Another important feature of this ques- 
 tion is that the chief patron of the house of 
 prostitution is the married man. This fact 
 takes us back to the social and economic con- 
 ditions of the home, which must be remedied be- 
 fore these matters of the sexes can ever be 
 adjudicated. 
 
 Another matter which the state has in its 
 power to regulate is the alcohol question. Al- 
 cohol is the seducer's ally. It has the power 
 to paralyze the inhibitive centers; it causes a 
 blunting of the moral sense and of the willful 
 control of conduct ; it subjugates the higher fac- 
 
 104 
 
THE SOCIOLOGY OF HEALTH 
 
 iilties and leaves the animal passions to follow 
 their iincurbed inclinations. Of all the active, 
 extrinsic agencies, it is the greatest for sexual 
 harm. The dance hall is a public necessity, but 
 introduce alcohol and it becomes the antecham- 
 ber of the brothel. When the public comes to 
 understand the relations of alcohol to the sex- 
 ual sins, a long step will have been taken toward 
 the overcoming of both of these evils. 
 
 The evil influences of the theater, where sex- 
 ual immoralities are presented in an artistic 
 and attractive setting, is a matter with which 
 the municipalities are failing to cope. The 
 moving-picture shows have become a positive 
 menace in most cities in America. They at- 
 tract children and the young. Many of the ex- 
 hibitions are degrading, showing every variety 
 of sexual vice. Young boys and girls are wit- 
 nessing moving pictures showing men and 
 women in the act of sexual intercourse. Chi- 
 cago has just caused these lewd exhibits to be 
 stopped, but they opened business in a neigh- 
 boring city. It was observed that the school- 
 boys in one neighborhood in New York fre- 
 quented these cheap shows on Saturdays. The 
 gymnasium and playgrounds of one of the 
 schools which had always been closed on that 
 
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MEDICAL SOCIOLOGY 
 
 day were thrown open, with the result that the 
 boys patronized the school grounds instead of 
 the shows. Playgrounds and breathing places 
 where youth can work off its energy are essen- 
 tial for good results. 
 
 Venereal diseases place an enormous bur- 
 den upon the state. Blindness, insanity, deaf- 
 mutism, epilepsy, idiocy, degeneracy, and crime 
 follow in their path. At least one fourth of 
 our public institutions for caring for defectives 
 is made necessary by venereal diseases. 
 
 These diseases play an important role as a 
 cause of divorce. The statistics show " incom- 
 patibility," " cruelty," " nonsupport," and other 
 more genteel causes, when behind it all lies the 
 real cause — venereal disease which has ren- 
 dered the wife unattractive, or which has be- 
 trayed the infidelity of the husband. 
 
 One of the most important steps in the eman- 
 cipation of woman is to relieve her from the 
 position of subjection to man. When public sen- 
 timent overcomes the fallacy of the " double 
 standard " of sexual morals, and makes it as 
 much of a reproach for the man to bring gon- 
 orrhea into the home as for the woman, and 
 when women have an intelligent attitude toward 
 these matters, based on knowledge, and are not 
 
 106 
 
THE SOCIOLOGY OF HEALTH 
 
 simply supposed to be dependents to take what- 
 ever the husband gives them — then we shall be 
 approaching the ideals of civilization. 
 
 The monogamous household must be recog- 
 nized as the greatest civilizing influence. Men 
 have created the standard of special masculine 
 privileges because they had the power to create 
 it. Now they are going to relinquish it because 
 they have the chivalry, honor, and good sense 
 to see that it is both unfair and dangerous. 
 
 A word concerning literature in its relation 
 to this subject. The freedom of the press costs 
 us a great price. One of the New York dailies 
 was recently forbidden entry into the mails 
 for maintaining a so-called personal column 
 which was but a thinly veiled advertisement of 
 schemes for the debauching of women. The 
 advertising columns of the daily papers of 
 many of our cities are a disgrace to these com- 
 munities. They carry the advertisements of 
 that great class of criminals who prey upon the 
 misfortunes which they seek to create. Young 
 men find no small encouragement in the re- 
 peated announcements of sure cures for the 
 troubles into which their wrongdoings might 
 bring them. The girl pressed to the point when 
 she is about to fall may yield when confronted 
 
 107 
 
MEDICAL SOCIOLOGY 
 
 by the advertisement vaunting the virtues of 
 the preventer of conception. The presence of 
 these immoral and fraudulent things, flaunted 
 daily in the face of the public, is a standing 
 menace and reproach. 
 
 In most countries the time is not yet ripe for 
 compulsory reporting of contagious venereal 
 diseases to the health authorities. It must be 
 preceded by education. No law is effective un- 
 less the people understand it and are in sym- 
 pathy with it. The privileged communication, 
 the interests of the patient, the rights of the 
 individual all stand in the way. While the 
 venereal diseases are more dangerous, and are 
 doing more damage to the human race than 
 leprosy, plague, smallpox, and scarlet fever 
 combined, the fact that they carry with them a 
 stigma makes reporting them difficult. If they 
 were made reportable, many patients would not 
 present themselves to the reputable physician 
 for treatment, but would frequent the quack. 
 Some states have required reporting without 
 giving the name of the patient. This does not 
 accomplish results. Ultimately these diseases 
 must be reported. The state must know how 
 prevalent they are and where they are most 
 prevalent in order to apply remedies. Treat- 
 
 108 
 
THE SOCIOLOGY OF HEALTH 
 
 ment must be made easier. The quacks must 
 be driven out; they breed venereal diseases. 
 Berlin, Dresden, and a few other cities require 
 that prostitutes shall be examined at frequent 
 intervals and sent to the hospital if found with 
 infective disease. This has never been satis- 
 factory, as the women may become infected 
 within an hour after receiving a bill of health; 
 and when we realize that some of these women 
 accommodate ten or twenty men a day, the 
 weakness of the method becomes apparent. 
 
 But one thing the state can do, and now: it 
 can demand a clean bill of health from the man 
 who applies for a marriage license. The inno- 
 cent wife is the one who too often reaps the 
 wild oats sown by the husband. The state owes 
 it to her to see to it that the marriage con- 
 tract, with which it is so much interested, shall 
 carry with it a guarantee of safety. When a 
 woman yields herself up for motherhood, she 
 is rendering the greatest service that anyone 
 can perform for the state, and she above all of 
 a country's charges should be protected. The 
 nations that throw this safeguard about their 
 women are destined to march in the van of 
 human progress. If the state is not ready to 
 take cognizance of every man with gonorrhea 
 
 109 
 
MEDICAL SOCIOLOGY 
 
 or syphilis, as it now does in the case of every 
 man with smallpox or scarlet fever, it at least 
 must be ready to prevent him from deliberately 
 transmitting these diseases to another when he 
 signifies his intention so to do. 
 
 American cities can do little good by licens- 
 ing and hounding the prostitute. ^Miere this 
 has been done the jDolice and politicians have 
 taken her earnings. In New York City are 
 at least 30,000 prostitutes whose earnings are 
 over $60,000,000 a year. The amount of vene- 
 real disease which they diffuse is incalculable. 
 Leckey's view of the prostitute as a necessity 
 must be made obsolete. Municipalities can bet- 
 ter devote their energies to teaching and warn- 
 ing against her than in regulating her business. 
 Education is cheaper and more effective. If 
 men knew as much of her as of the latest mur- 
 der trial her business would forsake her. Let 
 the state turn away from the prostitute and 
 interest itself in her patrons and in the vicious 
 conditions which have produced her — this piti- 
 ful woman of whom Hafiz said, " Bride of a 
 thousand bridegrooms hath she been." 
 
 Prevention of venereal diseases is most need- 
 ed. If any animal industry were afflicted with 
 this scourge, the state would be aroused to 
 
 110 
 
THE SOCIOLOGY OF HEALTH 
 
 strenuous activity, and neither pains nor money 
 would be spared to stamp it out. But this 
 blight affects our sons and daughters, not our 
 sheep and hogs, and the state raises but a 
 feeble voice against it. Norway and Sweden 
 made venereal diseases reportable, circulated 
 pamphlets of instruction, and reduced their 
 prevalence thirty-four per cent. This country 
 must eventually do the same. We should have 
 tangible data. The subject should be discussed 
 — it thrives in darkness and silence. Typhoid 
 and tuberculosis are being overcome by discuss- 
 ing them and by disseminating knowledge con- 
 cerning them. Curative medicine is in the 
 hands of the medical profession, but preventive 
 medicine must be in the hands of the public. 
 The diseases of society cannot be healed with- 
 out publicly speaking of them. These diseases 
 thrive on prudishness, ignorance, and the be- 
 neficent passion by which the race is kept alive. 
 Prudishness must give place to candor and hon- 
 esty; ignorance must be overcome by promul- 
 gating the facts and furthering the teaching of 
 sexual hygiene ; and passion must be guided by 
 knowledge. 
 
XI 
 
 SEXUAL CONTINENCE 
 
 SOMETIME after having discussed the 
 subject of sexual morality, I received 
 the following communication, which is 
 worthy of serving as a text for some further 
 elucidation of this subject. 
 
 " I heartily agree with all that you say con- 
 cerning sexual morality. I do, however, wish 
 to ask a question concerning some points of the 
 subject. May I ask what are you going to say 
 for the unmarried man who has sexual pas- 
 sion and is desirous of leading a decent life — 
 a man to whom every suggestive look from 
 amorous women, every lascivious picture he 
 sees, and the subtle influences that meet him 
 on every side, all conspire to inflame his 
 senses. 
 
 " You may say to the unmarried man to find a 
 wife. There may be good reasons why he should 
 not get one. How shall such a person not be 
 disturbed by vain longings by day and erotic 
 
 112 
 
THE SOCIOLOGY OF HEALTH 
 
 dreams by night ? I grant you that the proper 
 teaching of the child early in life will help to 
 enable him to control his sexual nature, but 
 what about the man who went into the world in 
 ignorance and learned all that he knows of sex- 
 ual things from his companions 1 
 
 "Lots of men do not care enough about 
 sexual matters to be bothered; but there are 
 many who see the error of their habits, who 
 desire to reform, and to whom this means 
 the fight of their lives. What do you say for 
 them?" 
 
 The conditions represented in this communi- 
 cation are by no means uncommon. They are 
 real conditions, and must be met in a practical 
 way and not vaguely. In the first place, let it 
 be understood that the best interests of the in- 
 dividual demand that man shall cohabit with 
 none but his wife. If a woman is not his wife 
 he shall not cohabit with her. Infringement 
 of this rule is fraught with dangers, which 
 have been enumerated in the preceding chap- 
 ter. One very important thing is that the 
 minds of these men must be disabused of the 
 fallacy of the sexual necessity. The exercising 
 of the sexual functions is absolutely not neces- 
 sary for a man's health. Continent men as well 
 
 113 
 
MEDICAL SOCIOLOGY 
 
 as physicians know this. Moreover, the best 
 preparation for continence is continence. The 
 sexual glands do not weaken from disuse any 
 more than do the tear glands. Good general 
 health is the most important means of preserv- 
 ing sexual vigor. Excessive sexual activity de- 
 stroys it. 
 
 Concerning the specific case in question — the 
 man who yields to what he knows is wrong and 
 harmful — there is just one thing for him to do, 
 and that is to stop. If he desires to correct his 
 habits, but does not, and is much in a state of 
 sexual excitement, then I should say that one or 
 more of three things is the trouble : he is either 
 suffering from idleness, the prime promoter of 
 vice ; his education and knowledge of the simple 
 things are defective; or he has a mental defect 
 which should receive consideration from the 
 neurologists. 
 
 A man who has a serious hold on the essen- 
 tials of life, and who is busy with useful 
 work, as every man should be, whose mind is 
 occupied with thoughts of wholesome interests, 
 or whose time is consumed by his vocation, 
 does not suffer the sexual dangers inherent in 
 idleness. 
 
 Every man should have a knowledge of the 
 114 
 
THE SOCIOLOGY OF HEALTH 
 
 anatomy and physiology of the sexual organs, 
 and he should be familiar with the meaning and 
 dangers of venereal disease, and also with the 
 objections to extramarital venery. If he is not, 
 his education in the simple essentials is defec- 
 tive. The prudishness which deprives young 
 men of this knowledge is decidedly immoral in 
 its results. The Japanese, among whom men 
 and women innocently bathe in the same pool, 
 are free from prudishness and from the vulgar 
 sense of suggestiveness at the sight of feminine 
 curves, which characterize the ogling Occiden- 
 tals. For the same reason a boy brought up 
 among sisters has less of this pernicious pru- 
 dishness which covets the sight of hidden 
 charms. Carlyle has said that the beginning of 
 wisdom is to look on clothes till they become 
 transparent. The person to whose eye they 
 cover a great and elusive mystery is not well 
 educated. 
 
 To answer the question, What is this man 
 going to do about it? is as easy as answering 
 the question. What is the kleptomaniac who 
 wants to stop stealing going to do about if? He 
 should stop; and if he does not, he should re- 
 ceive the attentions which a mental defective 
 merits. 
 
 115 
 
MEDICAL SOCIOLOGY 
 
 As to the healthy man, let such a man, first, 
 be busy; and, second, let him resolve upon the 
 course which he desires to pursue. With fixed 
 determination, a sane man can do about what 
 he pleases. I know an unmarried man who has 
 said to himself, " I shall marry some day ; some- 
 where in the world a woman is keeping her 
 chastity inviolate for me; and I shall do the 
 same for her." With this philosophy he dis- 
 misses the subject from his mind; the matter 
 is disposed of ; he does not bother his head with 
 sexual debates; the question is settled; it can- 
 not come up for reconsideration; and he gives 
 himself and his energies entirely to other mat- 
 ters. It is a splendid thing for a man to pro- 
 nounce a final settlement upon an important 
 question which otherwise might constantly re- 
 cur and harass his mind. The man with a de- 
 termined principle has clear sailing. A course 
 of conduct then becomes easy. It is the unfor- 
 tunate weakling who has not decided his ques- 
 tions, and the man who does not want to decide 
 them, who keep themselves in hot water. 
 
 Let these men in question make themselves 
 healthy, live hygienically, discard vicious and 
 harmful habits, and they will have taken the 
 first step toward eliminating the physical 
 
 116 
 
THE SOCIOLOGY OF HEALTH 
 
 sources of vice ; let them have an understanding 
 of the causes and effects; then let them purge 
 their minds of lust, and establish in its place 
 thoughts of better things and clearly defined 
 principles ; and the victory is won. 
 
XII 
 
 IDLE WIVES, UNMATED MEN, AND THE 
 VENEREAL PERIL 
 
 THE question of sexual immorality and 
 the venereal peril is by no means a 
 simple one ; and because of its complex- 
 ity the remedy can be said to lie in no single 
 expedient. There is the one great cause which 
 we cannot change, nor would we if we could — 
 the sexual instinct. There are certain social con- 
 ditions, however, which may properly be re- 
 garded in the light of contributing causes, the 
 elimination of which would constitute a long 
 step in the direction of sexual purity. To one 
 of these alone I desire to call attention. It is 
 not wine, nor idleness, nor the absence of 
 proper instruction in childhood, nor lewd com- 
 panions, nor the easy accessibility and preva- 
 lence of women of moral perversity, nor the 
 waning influence of the Church — all of which 
 have been held accountable — ^but it is the social 
 condition which postpones normal marriage. 
 
 118 
 
THE SOCIOLOGY OF HEALTH 
 
 Here again we encounter complex sociologic- 
 al problems. Among these the most important 
 are the increasing complications and concomi- 
 tant expenses of domestic life. Men have 
 drifted away from the happy old habit of think- 
 ing of the wife as an helpmeet to the habit of 
 treating her as a luxury, to be maintained at a 
 certain necessary expense, just as one's yacht 
 must be maintained. In the larger towns this 
 condition is so prevalent that in many commu- 
 nities the most useful women are the unmarried 
 ones, and for a woman to marry is to retire into 
 the seraglio of pampered luxuries. There are 
 whole blocks in our great cities in which the 
 women are essentially useless creatures, outside 
 of contributing to the joy of their husbands. 
 They do not even have the elevating responsibil- 
 ity of caring for their own hair or feet, let alone 
 the care of their children or households. The 
 morning bath, the novel, the luncheon, the drive, 
 cards, the theater — the home cannot thrive by 
 these. Idleness in women is the beginning of 
 trouble. It is just as bad for their morals as 
 it is for men's — perhaps a little worse. 
 
 Every young business man who would lead 
 the normal life has before him the goal of his 
 aspirations in business success, which is high 
 
 119 
 
MEDICAL SOCIOLOGY 
 
 and attained by few ; and also the domestic out- 
 fit which goes with it, which usually remains 
 beyond his reach ; and marriage is postponed. 
 
 The household is not upon a normal basis un- 
 less the woman works and helps the man main- 
 tain it. She must be more than an object of 
 ornamental furniture. She should be engaged 
 in useful occupation within the limits of her 
 strength. Employment which is not useful is 
 idleness. If her husband can afford to keep her 
 in idleness, it is to insult her to demand that she 
 should live so. The woman who is idle degen- 
 erates; and her household, her children, the 
 community, and her husband all suffer for it. 
 He would treat his horse better than to demand 
 idleness from it. And yet this is the state in 
 which many young men think a wife wants to 
 live, and few young men can afford to main- 
 tain a luxurious appurtenance of this sort, at 
 least not until they have frittered away the 
 most precious years of their lives making 
 money and in discovering the dangers and in- 
 completeness of bachelorhood. 
 
 I know a cultivated woman in one of our great 
 cities who in her home puts in as many hours of 
 work as she requires of her servants. She joy- 
 ously labors with them, doing real acts of phys- 
 
 120 
 
THE SOCIOLOGY OF HEALTH 
 
 ical toiL She is the companion of her children, 
 who receive from her those attentions which a 
 mother best can give. Still usefulness does not 
 deprive her of the pleasure of the opera, or of 
 a participation in the organized works for social 
 and civic betterment ; and when she is heard in 
 the discussion of social questions she speaks 
 from real knowledge. But here is the interest- 
 ing thing: When the heavens pour forth a del- 
 uge of snow, and with her ruddy boys she sal- 
 lies forth, shovel in hand, to clear the paths, at 
 the neighboring windows appear the faces of 
 the idle women, beholding with amazement, sur- 
 passing their comprehension, the extraordinary 
 spectacle of a lady of social station engaged in 
 useful manual labor! It is not this particular 
 woman who points the moral, but it is the other 
 women for whom we are concerned. It is the 
 fact that by education and training and by the 
 usages of their social environment they are out 
 of touch and sympathy with useful labor among 
 women who might avoid it. "With them it is a 
 thing to be escaped — escaped through the 
 agency of marriage or inheritance. And in 
 this, society is just as cruel to them as organ- 
 ized labor has been to condemned prisoners — 
 it will not let them work. The idle wives of 
 
 121 
 
MEDICAL SOCIOLOGY 
 
 society are as expensive as are the idle prison- 
 ers of the state; and they degenerate just as 
 fast, and in direct ratio to the degree of their 
 idleness. 
 
 This condition is most prevalent in the large 
 cities. In the country, a larger proportion of 
 the women are useful, and for that reason mar- 
 riage is less expensive. But in the city, the 
 prevalence of the practice of marrying a woman 
 to support her in idleness deters the young man 
 from organizing a home ; and marriage is post- 
 poned, with evil consequences. 
 
 This evil will not be overcome until the rush 
 to the cities subsides and the country becomes 
 economically and socially attractive. The hud- 
 dled life of the city is not well adapted for 
 man's advancement. A better prosperity is 
 possible in the less crowded communities. The 
 city works a hardship to both men and women. 
 Its allurements deplete the country of the 
 flower of its young manhood. I should not 
 blame the spinsters of New England if they 
 should organize and en masse march upon Bos- 
 ton, whence the boys of their childhood have 
 gone, with banners bearing the slogan, " We de- 
 mand our birthright ; we demand to be loved ! " 
 
 But before this desperate expedient is re- 
 122 
 
THE SOCIOLOGY OF HEALTH 
 
 sorted to, the growing improvements in commu- 
 nication and transportation will have removed 
 from the country its objection of remoteness, 
 and civilizing education will have made its ad- 
 vantages take the place of the disadvantages of 
 the city. Then there shall be a larger propor- 
 tion of productive members in the community; 
 more productive labor for those who are now 
 idle; more profitable leisure for those who now 
 labor; more simple life; less wastefulness; and 
 a better appreciation of the things that are 
 worth while. The normal life should then be 
 more prevalent. The social conditions of the 
 city also should improve. It should be easier 
 for married women to be useful. The financial 
 burdens of the home should be reduced. The 
 roaming about of unmated men, seeking who 
 may devour them, should be less prevalent ; and 
 a great cause of the venereal peril overcome. 
 
xni 
 
 THE SOCIAL EVIL 
 
 THE discussion of sexual morality has 
 been a much-avoided subject until very 
 recent times. The alarming prevalence 
 of venereal diseases called attention to the ne- 
 cessity for discussion. Then it was found that 
 the people knew really little of sexual hygiene. 
 It is to the credit of the medical profession that 
 this question is beginning to receive the atten- 
 tion which its importance merits. Neglected by 
 the Church, posing as the guardian of public 
 and individual morality ; ignored by the school, 
 from which the child should receive the instruc- 
 tion which best fits him for happiness and use- 
 fulness ; and avoided with prudish cowardice by 
 the parent, whose obligation it is to point out 
 the path by which the child should walk — this 
 question of sexual morality has been left for 
 elucidation to the gamins of the street and the 
 habitues of the brothel. The first that most 
 children learn of it is from the most vulgar of 
 
 124 
 
THE SOCIOLOGY OF HEALTH 
 
 their playmates. This most important subject 
 is first taught by the most immoral teachers. It 
 is to be hoped that the attention now being given 
 it may increase in power and in results, to the 
 end that the neglect which it has suffered may 
 be atoned for. 
 
 The movement to educate the public upon 
 sexual hygiene and save youth from the pitfalls 
 of ignorance had its beginning in the study of 
 venereal diseases and their direful conse- 
 quences ; and the injuries inflicted by these dis- 
 eases upon the innocent have aroused the sym- 
 pathies of students of this class of maladies. 
 The committees of medical societies and the 
 societies for sanitary and moral prophylaxis 
 which are engaged upon these questions have 
 before them a work of greater importance than 
 that of the organizations for the elimination of 
 tuberculosis. 
 
 The matter has been taken up by medical 
 bodies and societies under medical guidance. 
 The simple truth is all that is needed. That 
 will make us free from the ignorance which has 
 lain at the root of sexual sias. Sexual physiol- 
 ogy and psychology should be taught, not 
 vaguely and covertly hinted at. The fallacy of 
 sexual necessity, promulgated by the sexual 
 
 125 
 
MEDICAL SOCIOLOGY 
 
 sinner, should be replaced by the knowledge 
 that the exercise of the sexual organs is not 
 necessary for health. The prevalence and the 
 direful results of venereal diseases should be 
 known, and especially their consequences to the 
 innocent. And, finally, the meaning of normal 
 marriage should be made clear to all young men 
 and women. Marriage can be founded neither 
 upon sexual feeling nor platonic affection; it 
 must combine mental and animal harmony in 
 the divine passion of love in a man and woman, 
 each inspired by the spirit of mutual helpful- 
 ness and a desire to bring out and develop the 
 best qualities in the other. 
 
 The teaching of the things which are neces- 
 sary for the happiness and usefulness of the 
 child should begin at home. The responsibility 
 rests upon the parent. This instruction should 
 be continued in the school ; and the Church and 
 other organizations for moral instruction can 
 well afford to devote some attention to the 
 teaching of these helpful truths. Education is 
 the solution of this problem. 
 
 Seduction and promiscuous sexual inter- 
 course were not only not frowned upon, but 
 were matters of parlor conversation as recently 
 as the time of Addison and the Spectator. 
 
 126 
 
THE SOCIOLOGY OF HEALTH 
 
 Drunkenness did not exclude a man from good 
 society as recently as the Civil "War period. 
 Tight lacing, unhealthy pallor, and piercing the 
 ears for the purpose of hanging jewels upon 
 them have only within the memory of the young 
 become unpopular among cultured people. 
 The advances of civilization have eliminated 
 these. The period now dawning is to be charac- 
 terized by the promotion of happiness through 
 the care and perfection of the human body. We 
 are to recover from the two thousand years of 
 neglect of the flesh. And, in the interest of 
 sexual health and morality, it is surely not too 
 much to hope that public opinion will, during 
 this twentieth century, place its stamp of disap- 
 proval upon the inequality of sexual privilege 
 now prevalent, and demand from the man the 
 same measure of virtue as it does from the 
 woman. 
 
 10 
 
XIV 
 
 EDUCATION AND THE HEALTH AND EFFICIENCY 
 OF GIRLS 
 
 MANY girls return from school or col- 
 lege in a bad state of health and in 
 need of vacation. Many girls grow 
 robust while in school. The former is all too 
 common; the latter, too seldom. Education, if 
 it is worth being called education, conduces to 
 good health. This is not yet freely admitted, 
 but some day it will be. There was never a time 
 when learning things that have been written 
 was better than being well. 
 
 Our systems of feminine education have not 
 yet reached a point in their development when 
 they have much to offer beyond a smattering 
 knowledge of certain more or less useful, or 
 useless, facts and theories. If a girl belongs 
 to that class of young women engaged in pre- 
 paring for college, she is made to consume some 
 of the most precious years of her life memoriz- 
 ing much that will never be of use to her or 
 
 128 
 
THE SOCIOLOGY OF HEALTH 
 
 ever again called for after she has passed her 
 entrance examinations. It really has not been 
 history and mathematics that she has been cul- 
 tivating, but her memory. These girls are neg- 
 lecting to study the things that will prepare 
 them for life. Not life, but the college seems 
 their goal. In college the girl studies more 
 thoughtfully, but she is taught to give little at- 
 tention to the things of real importance to her. 
 The educating process to which the modem 
 college girl is subjected is not so much directed 
 to make her efficient, observant, original, re- 
 sourceful, self-reliant, and thoughtful, as it is 
 to make others think that she is. And while she 
 is learning the merits of " Paradise Lost," the 
 intrigues of the English kings, the names of the 
 several members of the family of Stuart, the 
 ramifications of the Greek verbs, the distinc- 
 tions between the Elizabethan and the Lake 
 School of poetry, and the psychology of im- 
 pulses, often the roses of her cheeks are per- 
 ishing and her eyes are taking on the dreamy, 
 far-away look of neurotic culture. 
 
 Herbert Spencer wisely suggested that 
 should we suddenly become an extinct race, and 
 should some future investigator find our school- 
 books, he would think that he had discovered a 
 
 129 
 
MEDICAL SOCIOLOGY 
 
 race of celibates who were interested in every- 
 thing but their own lives, happiness, and per- 
 petuation. The fact that between forty and 
 fifty per cent of the women admitted to the 
 hospitals for the insane in our Eastern States 
 belong to the class which is spoken of as " well 
 educated," cannot in itself be taken as a re- 
 flection upon the work of the schools; but it 
 does indicate that something is wrong with 
 their manner of life to bring them to this un- 
 fortunate state; and while we cannot say that 
 stress of study is an etiological factor, we can 
 say that their education should have been more 
 in the lines of helping them to a state of har- 
 mony with their environment, for want of which 
 they have become deranged, and that they have 
 frittered away precious study days in chasing 
 the silly baubles of classic culture. 
 
 If after leaving school young women indulge 
 in practices which are injurious to health, and 
 therefore to happiness, it is quite evident that 
 they have not learned the best things. The ap- 
 preciation of the best things in life is happily 
 growing ; but imconscionably slowly. The study 
 of expurgated physiology, a few lectures on hy- 
 giene — how to ventilate a room, the harm of 
 tight lacing, the value of sleep, the importance 
 
 130 
 
THE SOCIOLOGY OP HEALTH 
 
 of discretion in diet, and kindred subjects — will 
 not make schoolgirls healthy. Self-preserva- 
 tion and perpetuation is a bigger subject than 
 primary hygiene. It involves all of the func- 
 tions of the mind as well as the body. It in- 
 volves all of the day of work and play and sleep. 
 It is the most important thing for young women 
 to study. But in our schools and colleges it is 
 as yet imperfectly grasped. What is the most 
 important function of a woman? Surely it is 
 to be a wife and mother. What does the school 
 or college teach her that prepares her for these 
 functions? But little. To most so-called cul- 
 tivated girls wifehood and motherhood are sur- 
 rounded by clouds of sentiment and mystery. 
 But the day comes when they resolve them- 
 selves into stem realities. The households are 
 few in which the inadequacies of the wife and 
 mother might not have been remedied by previ- 
 ous education. Few are the daughters who can 
 teach their mothers anything of domestic econ- 
 omy, compared with the many who excel their 
 mothers in knowledge of the doings of Henry 
 VIII. 
 
 When we begin to educate young women in 
 the vital things of life many of the difficult so- 
 cial problems will be answered, and we shall not 
 
 131 
 
MEDICAL SOCIOLOGY 
 
 find so much that is pertinent in the questions, 
 Wliat shall we do with our girls'? Why do 
 American marriages fail? Why do American 
 mothers fail? 
 
 It is a fact that in a large number of our 
 colleges, study of the Bible is compulsory, but 
 the study of biology and the other natural sci- 
 ences is optional. Is it to be wondered at that 
 the great cause of sexual sin is found to be in 
 defective education, and that the most effective 
 remedy is discovered to be the simple teaching 
 of facts? 
 
 It is actually true that girls in our schools lis- 
 ten to instructors prate of the infinite when 
 their grasp of the finite is so meager that if 
 they were cast away on a desert island they 
 would perish of hunger and thirst in the midst 
 of plenty. There is much that answers to the 
 name of education, which, instead of preparing 
 young women for life, is contributing to their 
 undoing. The one line in which they are least 
 learned is that of the natural sciences, which 
 deal with the things that surround us and which 
 are known. The study of the natural sciences 
 is the most profitable and cultivating. It helps 
 the mind and the body; and so long as it con- 
 tinues to be slighted, young women will lack sal- 
 
 132 
 
THE SOCIOLOGY OF HEALTH 
 
 iitary education. It is the one line of study that 
 will save their health and preserve them from 
 the pitfalls of mysticism and the cults of men- 
 tal obliquity. Next to this in importance is the 
 study of the domestic arts and sciences — the 
 homely household things that contribute to the 
 rounding of a wife and mother. Along with 
 these should go training in accuracy and origi- 
 nality, observation and thoughtfulness. 
 
XV 
 
 PHYSICAL FITNESS AT THE THKOTTLE 
 
 A N important matter which might wisely 
 ZJL be under medical supervision is that 
 ^ .^ of the physical fitness of persons en- 
 gaged in occupations in which many lives 
 depend upon the good physical condition of 
 an individual. The Government, for exam- 
 ple, supervises the traffic rates and the finances 
 of railroads, but takes little cognizance of the 
 lives of the people who travel on them. It 
 would seem that money is more important than 
 human lives. The railroads give some atten- 
 tion to the matter, but neither in a scientific or 
 disinterested way: they take the precautions 
 which give a money value return. 
 
 The engineer of a passenger train fell un- 
 conscious at his post and his train collided with 
 a switch engine with disastrous results. An- 
 other engineer was overcome with heat, pre- 
 sumably, and fell unconscious at the throttle, 
 the fireman discovering the accident in time to 
 
 134 
 
THE SOCIOLOGY OF HEALTH 
 
 stop the train. The same week an engineer 
 on a freight train, after convalescence from 
 a sickness, became suddenly insane, and ran 
 his train at a high speed to escape an imag- 
 inary evil pursuer, until he was overpowered 
 by the fireman and a brakeman. These three 
 instances occurred all in one section of the 
 country, and all within a period of three 
 weeks. 
 
 It is well known that in many of the frightful 
 railway wrecks, in which many lives are sacri- 
 ficed, the accident has been due to the physical 
 disability of some important person. The fail- 
 ure to set a switch, to recognize the color of a 
 light, or to fail in some other act on account of 
 physical defect has been responsible. This is 
 too important a matter to be left to the cor- 
 porations, which have only a financial interest : 
 it should be under governmental control. A 
 railroad is violating a law if it is carrying 
 freight for one party for a cent or two less than 
 for another, but it is violating no law if a pa- 
 retic engineer is rushing a train load of people 
 to destruction. 
 
 The same is true of all passenger-carrying 
 enterprises. The physical fitness of officers of 
 steamboats should be supervised by the state, 
 
 135 
 
MEDICAL SOCIOLOGY 
 
 not alone by the corporations. The eyes of 
 motormen are tested in a perfunctory sort 
 of way, but the motorman may have nephri- 
 tis or diabetes or arteriosclerosis and drop 
 down at a critical time. It is a fact that in 
 one of our large cities these positions are 
 being taken by men who have been found 
 physically defective for the police and fire de- 
 partments. 
 
 The automobile rushes through the streets 
 and country in the hands of anyone who puts 
 himself to the task. The number of accidents 
 is appalling. The driver may be half blind, 
 deaf, or paretic — there is no restriction. The 
 large number of fatalities are all in the day's 
 work, so long as we do not know the parties in- 
 volved ; but still we may be the next victims, and 
 then it becomes a different matter. No person 
 who has not been subjected to a physical ex- 
 amination and determined physically fit and 
 free from disease which does or might suddenly 
 incapacitate him should be permitted to run an 
 automobile faster than four miles an hour with- 
 in the town limits. A medical examination 
 should be necessary for a license, and the li- 
 cense should be good for one year. This need 
 not be burdensome or expensive, and it would 
 
 136 
 
THE SOCIOLOGY OF HEALTH 
 
 surely be for the public good. The antipater- 
 nalist might object to such an ordinance, but 
 after he is run into by a cross-eyed paretic he 
 will be convinced of its value, if he survive the 
 experience. 
 
XVI 
 
 THE ACCIDENTS OF SUMMER 
 
 THE newspapers and the medical press 
 are prone to call attention to the " acci- 
 dents of summer," and it is not to be 
 gainsaid that an appalling nnmber of misfor- 
 tunes and fatalities mark the summer holidays. 
 In the cities, each Sunday or holiday has its 
 calamities ; and the country and seashore every 
 day report disasters which have overtaken the 
 seekers after summer rest and recreation. 
 These accidents and deaths are particularly 
 pitiful, and even dramatic, because they occur 
 in the midst of merrymaking and happiness, 
 and not in the presence of grim and dangerous 
 occupations. Many reasons have been assigned 
 in a general way for these misfortunes, but all 
 have been subsidiary. I have never seen the 
 real reason assigned. Possibly, because it is 
 so simple, it has been overlooked. Briefly, the 
 explanation is to be found in the tendency of 
 persons engaged in strenuous business life, 
 
 138 
 
THE SOCIOLOGY OF HEALTH 
 
 when the opportunity for a short vacation pre- 
 sents itself, to seek some diversion which is 
 totally different from their daily occupation, 
 and to apply the same strenuous efforts to 
 " having a good time " as they apply to their 
 everyday vocation. This can never be done 
 with safety. 
 
 A mill hand works for fifty weeks with his 
 dangerous machinery and is not hurt, because 
 he is familiar with it; but when he steps in a 
 catboat and gets mixed up with the tides and 
 weather, trying to have enough fun in two 
 weeks to last him the rest of the year, David 
 Jones is waiting for him. And, on the other 
 hand, the fellow who sails a boat all the year 
 had better keep his fingers out of the wheels of 
 the mill. 
 
 For eleven months the pale-faced bank clerk 
 has grown soft and flabby with his eye on his 
 ledger page. He has had his cocktail before 
 dinner, and at night over his pipe has sat about 
 the grill-room camp fire and dilated upon the 
 merits of smokeless powder, while the hands of 
 the tall clock in the comer have become scarcely 
 visible through the thickening smoke. His oc- 
 ulist adds a diopter or two to his glasses; and 
 in the late fall he packs his paraphernalia and 
 
 139 
 
MEDICAL SOCIOLOGY 
 
 plunges into the woods. He tries to make him- 
 self look like a half-breed, and thinks that he 
 does; but his guide smiles a deep smile that 
 shows not on his placid face. Now, if you look 
 any more like a deer than a well curb does, my 
 advice to you is to keep out of the banker's 
 range, or there may be another of these " ac- 
 cidents of the summer." And the native woods- 
 man would make just as bad a mess at figur- 
 ing discounts. 
 
 The prince of the ballroom and the after- 
 noon tea never really has an opportunity to dis- 
 play his manliness until he gets into his bath- 
 ing suit. The undertow and a breaker or two 
 start in to eat him up, and they get away with 
 him so far that Sylvester's method, for three 
 steady hours, leaves him cold and limp. And 
 the tough old life guard would cut a sorry fig- 
 ure in the cotillion. 
 
 The mistake made by our sunomer vacationist 
 is to plunge into vacation with the confidence 
 of vocation ; and in these strenuous days there 
 is too wide a distance for safety between the 
 two. 
 
 The cheap seaside resorts vie with one an- 
 other to furnish their patrons with new sensa- 
 tions; and the frequenters of these places get 
 
 140 
 
THE SOCIOLOGY OF HEALTH 
 
 so much for a small outlay of money that they 
 find the attractions irresistible. All sorts of 
 death-inviting devices shoot people like cata- 
 pults down grades, up grades, and through the 
 air. The ingenuity that has been expended in 
 contriving machines to give people, in the bloom 
 of health, an opportunity of coming up to the 
 death line, almost to the crossing place, feeling 
 the cool breath of eternity, and then receding 
 in the exhilaration of safety, would solve many 
 a human problem if applied to that end. Un- 
 fortunately, the insanity of amusements of 
 our seaside resorts does not give recreation. 
 Most of the patrons of Coney Island find 
 themselves worse off for it on Monday morn- 
 ing. It involves more nervous strain and ex- 
 citement than exists in their everyday work, 
 and many more dangers, as experience has 
 shown. 
 
 Thousands of employees work hard all the 
 year, and have a vacation of two weeks in July 
 or August. This vacation is an event, and 
 well it should be, for their labors have earned 
 them two weeks many times over. It is pre- 
 pared for and thought about, and a good time 
 must be had at any cost. The " good time " too 
 often consists in endeavoring to crowd into that 
 
 141 
 
MEDICAL SOCIOLOGY 
 
 short space a succession of events which should 
 have been distributed more equably through the 
 year. The vacationist often works more stren- 
 uously at having a good time than he does at 
 earning his livelihood. 
 
 All of these conditions cause an approach to 
 the danger line in vacation time ; and behind it 
 all lies the strenuous life. "While the habits of 
 the people and our social and economic condi- 
 tions are slow to change, it is always to be hoped 
 that society may yet organize itself so that its 
 affairs may move along more smoothly. The 
 labors of the men and women who toil should 
 so be regulated that recreation is intermingled 
 with work in wholesome proportions. No coun- 
 try or people in the world are so deficient in the 
 practice of sensibly interspersing labor with 
 play as the Americans. The average American, 
 who is fighting his way to business success, does 
 not know how to play or to take recreation. The 
 people of the Old World are so superior to us 
 in this that we might wisely sit at their feet and 
 learn how to play and how to relax. The real 
 spirit of the Landpartie, the outing of the Ger- 
 mans, or of the jour de fete of the French has 
 never been developed on American soil. We 
 lack appreciation of restful pleasures. 
 
 142 
 
THE SOCIOLOGY OF HEALTH 
 
 There is little that the law can do. It is not 
 a matter of throwing more safeguards about 
 the people, as is suggested. The defect is mani- 
 festly a fundamental one, and lies in our socio- 
 logic economic conditions. 
 
 11 
 
XVII 
 
 LIFE-INSURANCE INTERESTS 
 
 WHILE we look askance at some of 
 the methods of the life-insurance 
 companies and, indeed, discover 
 that many engage in practices which are in- 
 compatible with high ethical ideals, we can- 
 not lose sight of the immense service which 
 these organizations render to the public. Life 
 insurance is a well-recognized and approved 
 business, without any more philanthropy in 
 it than any other business has ; and we should 
 be glad that as a business it is a success. 
 It is not upon the fact that it provides a 
 means by which we can insure our families 
 against the contingencies of the future that I 
 desire to comment, but it is its indirect service 
 to the whole people in calling attention to the 
 value of good health that should not be lost 
 sight of. 
 
 The life-insurance companies are doing much 
 to interest men in their own lives and in the 
 
 144 
 
THE SOCIOLOGY OF HEALTH 
 
 lives of their families ; and anything which ac- 
 complishes that is of salutary influence. They 
 are a powerful and practical agency for remind- 
 ing people of matters of health and longevity. 
 Men with bad habits and excesses are refused 
 insurance, and such refusals have a good edu- 
 cational effect. Plant in a man's heart a deep 
 regret that he has lived unwisely and he be- 
 comes a torchbearer, often unwittingly, to 
 warn others away from his unwisdom. The in- 
 surance companies also desire as examiners the 
 competent men of the community, the effect of 
 this being that wholesome competition and ex- 
 amination ensue. 
 
 There still remains for these organizations to 
 combine in a concerted action to secure better 
 general health conditions. Just as the fire-in- 
 surance companies combine in the support of 
 the salvage corps, and in watchfulness over the 
 efficiency of the municipal fire departments, so 
 the life-insurance interests have an opportunity 
 as a clear business matter to join hands with 
 the medical profession and sanitarians in the 
 great movements which are in progress for the 
 improvement of the public health. If in in- 
 hibiting the development of epidemics the medi- 
 cal profession is taking bread from itself, 
 
 145 
 
MEDICAL SOCIOLOGY 
 
 this could not be said of the life-insurance 
 interests. They can, as a matter of plain busi- 
 ness policy, give every aid to medicine in its 
 philanthropic efforts. The life-insurance com- 
 panies could wisely take the same interest and 
 lend aid in the work of health departments as 
 the fire-insurance companies do in the work of 
 ,fire departments. No single financial interest 
 should be more deeply concerned for the public 
 health; and none can with greater pecuniary 
 profit engage in the movement to secure the es- 
 tablishment of a national department of health. 
 
XVIII 
 
 UNHYGIENIC IMMUNITY 
 
 IMMUNITY against almost any condition 
 which threatens health may be acquired. 
 There are certain fundamental things 
 which general scientific opinion is agreed upon. 
 It is agreed that pure water and pure air are bet- 
 ter for the health than impure water and impure 
 air ; and the advance of civilization has resulted 
 in the general acceptance of these beliefs. How- 
 ever, an immunity against many of the impuri- 
 ties existing in air and water may be acquired. 
 It is well known that races which live in condi- 
 tions which to us would be squalor, drinking and 
 eating dirty foods, enjoy an immunity from the 
 dangers of filth and thrive under conditions 
 which would be fatal to the more cleanly races. 
 Intestinal infections which give the natives of 
 the tropics little trouble are fatal to the Eng- 
 lish soldiers. The people of some of the south- 
 em countries of Europe eat meat in a state of 
 decay that would prostrate the northern Euro- 
 
 147 
 
MEDICAL SOCIOLOGY 
 
 pean. One can cultivate an immunity for pto- 
 maines as well as for alcohol and tobacco. 
 
 What is true of insults to the gastrointestinal 
 tract is also true of the respiratory tract. The 
 Eskimos in the winter shut themselves in and 
 breathe over and over again the vitiated air 
 from their own lungs, living practically in a 
 state of hibernation; yet this practice has ex- 
 isted so long that they have acquired an immu- 
 nity to their own bad air; but transported to 
 temperate climates and surrounded by condi- 
 tions which seem more hygienic, they are prone 
 to contract consumption and die. It is reported 
 from Panama that the negroes of the West In- 
 dies are suffering a high degree of mortality, 
 although they are compelled to live under ap- 
 parently good conditions. These negroes in 
 their native state live in filth and bad air, yet 
 they perish under the conditions which, theo- 
 retically, should be favorable. 
 
 On the other side we have a still different 
 picture. It is true that the strongest and 
 most healthy persons often are made ill by 
 violations of hygiene which the less robust 
 endure without complaint. I know of persons 
 who live according to the most advanced knowl- 
 edge of hygiene, sleeping in the open air, 
 
 148 
 
THE SOCIOLOGY OF HEALTH 
 
 and living out of doors practically day and 
 night, who suffer from oppression of breath- 
 ing, headache, and even nausea, in the vitiated 
 air of a theater or church, while the weakly 
 shopkeeper or clerk, who spends most of his 
 time in a vitiated atmosphere, is comfortable 
 and blithe. 
 
 Thus, there are penalties for the healthy as 
 well as for the sickly. The human organism 
 suffers temporarily from any sudden change 
 into new conditions from old conditions under 
 which it has thrived, whether it be for better 
 or for worse ; and it is capable of developing an 
 immunity to poisonous materials, either in- 
 haled or ingested, provided that the immuniz- 
 ing process is approached gradually. This 
 power to become immune to the constant as- 
 saults of poisons is a part of the great organic 
 law which has enabled animal life to endure, 
 and which has contributed to the differentiation 
 of species. 
 
XIX 
 
 FRESH AIR 
 
 FEESH air, in distinction from air that 
 is not fresli, is simply the ordinary out- 
 of-door air in contrast with the ordi- 
 nary indoor air. The latter contains less mois- 
 ture; it has had oxygen removed by animal 
 respiration and by combustion; it has had 
 added to it the products of these chemical 
 changes; and there are presumably other 
 changes the nature of which we do not know. 
 Some day the chemist will be able to define the 
 exact differences in the composition and struc- 
 ture of the two airs. At present we do not know 
 much about it from the chemical and physical 
 standpoint; but from the practical and clinical 
 standpoint much has been learned. 
 
 The greatest appreciation of the value of 
 fresh air came through the study of consump- 
 tion. It was observed that for a person who 
 had contracted this disease to live as other 
 people lived meant death. The consumptive 
 
 150 
 
THE SOCIOLOGY OF HEALTH 
 
 does not do well when he continues in the same 
 habits as are followed by all of the candidates 
 for consumption. The observation that people 
 with this disease recovered if they lived in 
 the fresh air and died if they lived in the or- 
 dinary indoor air, has been one of the most im- 
 portant discoveries that man has made. Its 
 importance has not yet been realized; but it is 
 destined to be of great human service. 
 
 The most important food that we consume is 
 air; the next in importance is water, and the 
 next is the product of the grocery shop. Man 
 can live without the latter for three weeks; 
 without the next for one week ; and without the 
 former for three minutes. Air is the cheapest, 
 the most abundant, and the most essential. We 
 have given much attention to pure groceries; 
 and we should be loath to consume over again 
 what some one else has ejected. We have more 
 recently awakened to the importance of pure 
 water; and the harm of ingesting water which 
 some one else has used is well understood. But 
 there is as yet inadequate consideration given 
 to the prevalent practice of taking into our own 
 lungs the sewage of other lungs. The consump- 
 tive has learned that it is not good for him ; the 
 next person who should learn it is the noncon- 
 
 151 
 
MEDICAL SOCIOLOGY 
 
 sumptive. It was not many years ago that only 
 the sickly and delicate were particular about 
 the water they drank. They noticed that sick- 
 ness developed if they took water that was not 
 pure. The robust were ashamed to complain of 
 dirty water. They thought their constitution 
 would stand most anything. But it was learned 
 that dirty water contained materials which had 
 the power of weakening the strong. Now every- 
 body demands clean water. We have learned 
 many of our best lessons from the sick. We 
 first paid heed to their food; we washed them 
 and kept them clean. Then it became the cus- 
 tom for the well to pay attention to their own 
 food, and for the well to wash and keep clean 
 before they became sick. The demand for fresh 
 air is going to grow up in the same way. 
 
 A great many diseases have been found to be 
 caused or encouraged by improper food and un- 
 clean water. It is difficult to determine which 
 was the first. It is a coincidence that consump- 
 tion was the first to be identified as being asso- 
 ciated with bad air. The rest of man's mala- 
 dies will follow. Already tuberculosis of the 
 bones and joints in children is being treated 
 in the open air with beneficial results that 
 promise even to surpass those secured in con- 
 
 152 
 
THE SOCIOLOGY OF HEALTH 
 
 sumption. Hundreds of these children are be- 
 ing cured because the hospitals are taking them 
 out of the wards and putting them on the roofs 
 and balconies. Pneumonia patients are receiv- 
 ing the same beneficent consideration; and the 
 mortality of the disease is being lowered. The 
 mortality in the treatment of typhoid fever was 
 never so low as it was among the soldiers who 
 lay sick in tents during the Spanish- American 
 War. The insane and neurotic recover in the 
 open air, when they used to perish in their 
 cells. The modern sanitarium in a beautiful 
 country which invites the sick out of doors is 
 bound to give results, because the patients are 
 brought from the indoors. Fresh air is not only 
 important for these classes of unfortunates, but 
 it remains to be applied to all illnesses, surgical 
 as well as medical. Then it will be observed 
 that it is no treatment at all. 
 
 Properly speaking, the application of fresh 
 air to tuberculosis of the lungs is not a treat- 
 ment — ^it is simply giving the lungs what they 
 are intended by nature to have. Tuberculosis 
 infection becomes implanted and grows in lungs 
 which are fed upon impure air. Making the 
 patient live out of doors is a return to the nat- 
 ural and normal requirements of the respira- 
 
 153 
 
MEDICAL SOCIOLOGY 
 
 tory apparatus. When one has become ill from 
 impure food, he is cured by giving healthful 
 food. When one is made ill by breathing illu- 
 minating gas, the, first step in the treatment is 
 to give pure air. The first essential in the 
 treatment of a consumptive is to take him out 
 of the house; just the same as the first essen- 
 tial in the treatment of a drowning man is to 
 take him out of the water. When primitive 
 peoples become sufficiently " civilized " to live 
 in houses, the same misfortune overtakes them 
 that overtakes the simian removed from his 
 jungle to the museum: they contract pulmo- 
 nary disease. 
 
 When a fisherman on Cape Cod contracts 
 pneumonia, they often put him in a little bed- 
 room which is nearly as air-tight as though it 
 had been calked. He has been used to wind and 
 weather all his life, and his wife often harbors 
 the notion that that is what brought on his 
 pneumonia. The blinds are closed; and in the 
 sick room you will find an old nurse fanning the 
 patient, and a veritable young stove of a kero- 
 sene lamp eating up the oxygen. 
 
 The mortality from pneumonia among these 
 men is extremely high. When the doctor ar- 
 rives (he has driven five or ten miles through 
 
 154 
 
THE SOCIOLOGY OF HEALTH 
 
 a wind that lias nearly taken his breath away) 
 he goes in the house, and is thankful enough 
 to find a good shelter. It is the most comfort- 
 able place he has been in since he left the last 
 house, an hour before. If he should suggest 
 more air for the patient, his orders would not 
 be carried out. This is what happens to the old 
 fisherman: he dies. 
 
 It is curious enough that a dry-goods clerk 
 would stand a better chance of recovery under 
 these circumstances than the fisherman, for 
 nature bestows a certain measure of immunity 
 against bad air upon those who habitually live 
 in it. By j)ractice the diver can remain longer 
 and longer under water. A man may accustom 
 himself, at the expense of his health, to get 
 along with less oxygen and more carbon diox- 
 ide. This habituation stands him in good stead 
 when he has to be shut up in a room with a 
 quarter or a half of his oxygen-absorbing ap- 
 paratus put out of commission. But our fish- 
 erman, whose bellows has been blown up with 
 wind from every point of the compass, has not 
 had the immunity to bad air which our dry- 
 goods clerk has enjoyed, and when his oxygen 
 is shut off he dies like a rat under a bell- jar. 
 
 Breathing fresh air improves the health and 
 155 
 
MEDICAL SOCIOLOGY 
 
 resistance of anyone who is habitually without 
 it, and that means pretty nearly everybody. 
 Fresh air increases the resistance of those with 
 consumption. It also does the same for those 
 without consumption and for those with other 
 diseases, chief among which is that great symp- 
 tom complex from which most indoor dwellers 
 suffer and which, for want of a better name, 
 we may call stuffiness, due to the breathing of 
 vitiated air. To advise continuous fresh air for 
 the consumptive alone is hardly fair to those 
 who are still doing their full day's work without 
 complaint — they need it, too. Let us not neglect 
 them while they are yet not consumptives. 
 
 Out of this study of consumption is destined 
 to develop, first the appreciation of the value 
 of fresh air to the sick, and then to the well. 
 And when the well grasp the significance of 
 this, humanity will have taken one of its longest 
 strides forward upon the road of hygiene. 
 This is but one of the benefits that consump- 
 tion confers. The gaunt form of the great 
 white plague stalks at the head of the proces- 
 sion, and leads the way to the open air. 
 
 Physicians who have most carefully studied 
 the nature of the ordinary cold tell us that the 
 people who live close to nature are exempt. It 
 
 156 
 
THE SOCIOLOGY OF HEALTH 
 
 is the denizen of the city, surrounded with the 
 luxuries, who suffers the most. Vitiated air 
 and the contrivances that he buys to keep away 
 the cold are responsible for his colds. The 
 woodsman, who lives and works in the open 
 and sleeps in a freezing hut, enjoys immunity. 
 
 The sufferers from colds are those who spend 
 a large part of the winter time in an unnatural 
 atmosphere. The air in offices, stores, theaters, 
 factories, and dwellings in this climate is bad. 
 Its temperature is usually higher than is con- 
 sistent with good health ; each occupant inhales 
 the materials that have come out of some one 
 else's lungs ; and the percentage of moisture in 
 the air is below the normal. These are due to 
 the defects of the modem heating appliances. 
 It is a long step backward, so far as healthful- 
 ness goes, from the fireplace of our ancestors 
 to the steam-heated radiator. 
 
 Of all the iniquitous machinery that has ever 
 been contrived to destroy the weaklings and 
 emasculate the strong, this radiator stands pre- 
 eminent. Here is a thing which can be put in a 
 room, and the more tightly the room is sealed 
 against the inlet and egress of air the more ef- 
 fective it is and the more it is vaunted as a suc- 
 cessful heater. The furnace, which was cast 
 
 157 
 
MEDICAL SOCIOLOGY 
 
 out to give place to this thing, is eminently 
 more rational. Every cubic foot of air from 
 the furnace that enters a room displaces a cubic 
 foot ; it will not work unless there is ventilation. 
 And the old-fashioned stove and the fireplace 
 all demand ventilation; but the radiator works 
 best without it. The ideal heating system to 
 supply fresh air is that by which outdoor air 
 is conducted directly into closed boxes in the 
 basement containing steam radiators and pans 
 exposing a large surface of water for evapora- 
 tion. From these boxes the fresh air, heated 
 by contact with the radiators and carrying the 
 moisture evaporated from the pans of water, 
 is then conducted through large hot-air pipes 
 and delivered to the rooms through registers. 
 
 The intolerable heating iniquities, not to be 
 considered, are the gas stove and the oil stove, 
 which when inclosed in a room consume the 
 oxygen and throw out in its place their noxious 
 products. 
 
 Most modern heating apparatuses, we are 
 shown, possess the disadvantage that they dry 
 the air. Examination of the air of rooms in 
 the winter reveals from five to thirty per cent 
 less moisture than is present in the normal out- 
 door air. Our indoors winter population lives 
 
 158 
 
THE SOCIOLOGY OF HEALTH 
 
 in an atmosphere so far below the point of sat- 
 uration that evaporation is constantly and 
 more rapidly than normal taking place from the 
 skin and respiratory mucous membranes. A re- 
 sult of this evaporation is a sensation of cool- 
 ness. It is not uncommon to find in an office a 
 temperature of seventy or seventy-five degrees, 
 or even higher, and yet a sensation of chilliness 
 when the moisture is low ; whereas in a kitchen, 
 with boiling pots on the stove, a much lower tem- 
 perature imparts a decided sense of warmth to 
 the skin. It has been shown that persons breath- 
 ing abnormally dry warm air have the vital re- 
 sisting power of their respiratory mucous mem- 
 branes decidedly lowered and rendered suscep- 
 tible to the complex of phenomena designated 
 as cold. Thus we find in our modem system 
 for preventing coldness the conditions conduc- 
 ing to colds. 
 
 As heating materials become more expensive, 
 greater economy in conserving the heat in 
 buildings is practiced. This is done by mini- 
 mizing the amount of fresh air which is allowed 
 the tenants. Colds are the result. Colds are 
 prevalent in winter, the best authorities inform 
 us, not directly because of the cold, but because 
 that is the season when people shut themselves 
 13 159 
 
MEDICAL SOCIOLOGY 
 
 in and breathe bad air. Persons who have en- 
 joyed pure air all the summer, habitually re- 
 verse their practice and give themselves pure 
 air in winter only when they are out of doors. 
 As a matter of fact, cold air is better to breathe 
 than warm air, even though equally pure. It is 
 more concentrated. Every inhalation of cold 
 air gives one more oxygen than an inhalation of 
 warm air. 
 
 The lessons which we learn from the consid- 
 eration of these medical teachings are, that we 
 should inure ourselves to the cold of winter, 
 that we should court the fresh air, and that in 
 heating our houses it should be done by means 
 which give ventilation and moisture. Thoreau 
 said that he loved the cold when it chilled his 
 skin; he was like an oak tree — it did him no 
 harm because he was always in the air, be it 
 warm or cold. 
 
 Gould, in discussing the seven deadly sins of 
 civilization, classes the modem house among 
 them. The modern house is probably not so 
 guilty as the way in which we abuse it. It is 
 pretty generally constructed so as to protect 
 the inmates from the weather, but the inmates 
 have perverted it to shutting out the benefits of 
 air and light and to shutting themselves up 
 
 160 
 
THE SOCIOLOGY OF HEALTH 
 
 with, the unwholesome emanations of their 
 own bodies. The house cannot be classed as 
 a great evil, but man's habits in the house can. 
 Information upon this important matter is 
 easily to be had. Let one walk the streets at 
 night and he will be able to recognize the bed- 
 rooms by noting which windows are most 
 tightly closed. In the city whole blocks may be 
 observed in which the bedrooms are easily dis- 
 cernible by closed sashes, blinds, and shades. 
 Sometimes a window will be seen to be open a 
 few inches, but this is exceptional even in 
 spring and fall when the air is not cold. An- 
 other interesting study, this time in psychology, 
 may be made; for, if the dwellers in these 
 rooms are questioned, they will declare that 
 " we are great fresh-air cranks at our house." 
 Bad air is responsible for some remarkable as- 
 saults upon the truth. These people are vic- 
 tims simply of traditions, examples, and habits 
 — all hard things to overcome. 
 
 One of the points in which there is a gross 
 misconception as to the function of the house 
 is that it is to hold air to keep the body warm. 
 The tendency in the winter is to treat the air of 
 the house as though its first use were for its 
 warmth, when really its first use is for breath- 
 
 161 
 
MEDICAL SOCIOLOGY 
 
 ing. The first concern should be that the air is 
 pure; and any warmth that is not consistent 
 with that is not worth having. Clothes and 
 good skin, reaction should be relied upon for the 
 warmth of the surface of the body. The air is 
 for food, and it is too precious to be used for 
 clothing. 
 
 If we have to work indoors, we can at least 
 sleep out of doors during the eight hours that are 
 not required to be sacrificed to society. Some 
 few people who are not sick do it just for the 
 joy of it. They like to awaken in the morning, 
 after eight hours in the open, with an appetite 
 for breakfast, and feeling as though they had 
 just returned from a vacation in the country. 
 Acres of roofs and balconies in the cities are 
 going to waste. Some day they will be utilized 
 and the dwellers in the caverns will come forth 
 and sleep under the canopy of heaven. The 
 day will come when outdoor sleeping facilities 
 will be provided in every house that is built, 
 just as bathing and toilet facilities are now pro- 
 vided. But before that day there is much edu- 
 cational work to be done. Many superstitions 
 and traditions are to be overcome. The buga- 
 boo of " night air " is to be disposed of. People 
 are to be taught that that is the only kind of 
 
 162 
 
THE SOCIOLOGY OF HEALTH 
 
 air there is to breathe at night. The prob- 
 lem of outdoor beds and awnings is simple. 
 It is difficult only in the mind of the inex- 
 perienced. 
 
 Children always excite our sympathy more 
 than adults; and naturally, too, because they 
 are not altogether free. They are both benefi- 
 ciaries and victims. I confess that I know but 
 few that are not the victims of bad air. Here 
 is a little girl who presses her pale face against 
 the pane, but is not allowed out because it is 
 " too cold " or " too damp " or because she has 
 " a cold." She is in the house for one or the 
 other of these reasons most of the winter. In 
 the summer she is out of doors, and conse- 
 quently begins the winter with fair health. She 
 sleeps in a bedroom heated by a radiator. The 
 window is open two inches at the bottom. About 
 her crib is a barrier to protect her from the 
 draughts. The air is so close and warm that she 
 sleeps restlessly. Diseased tonsils and ade- 
 noids have naturally developed. The question 
 is: Where is the culpability? And the answer 
 is : In the education of the parents. Nor would 
 I altogether excuse the medical profession from 
 the blame. There is yet much to learn concern- 
 ing some of these simples of health. 
 
 163 
 
MEDICAL SOCIOLOGY 
 
 The mother whose child perspires at night 
 and cannot be kept covered, and who offers this 
 as the reason for depriving the child of fresh 
 air when the perspiring and restlessness both 
 are due to the withholding of fresh air, may be 
 regarded as an educated woman, but the sort 
 that she possesses should really not pass cur- 
 rent under the holy name of education. Air is 
 to breathe, not to wear ; and the mother who has 
 not the ingenuity to cover her babe at night so 
 that it may have freedom to roll and still re- 
 main covered, should cancel all other engage- 
 ments and roam the world until she finds the 
 mother who can teach her, and then sit at her 
 feet and learn a lesson of more significance 
 than anything that her professor of English lit- 
 erature ever taught her. I know a simple 
 woman, the wife of a laborer, whose babe slept 
 day and night in a clothes basket on the fire 
 escape. A big umbrella from a delivery truck, 
 proclaiming the merits of a brand of soap, kept 
 off the rain and snow. When the babe outgrew 
 this bed, a shallow packing box took its place, 
 protected on the north by a barrier of muslin. 
 This is the only really rugged, happy infant in 
 the apartment. The others get into the fresh 
 air when some one takes the trouble to dress 
 
 164 
 
THE SOCIOLOGY OF HEALTH 
 
 them up and pusli tliem througli the streets in 
 a carriage, which is not often, because it in- 
 volves too much labor and the time of an extra 
 adult. There are women with pallid children 
 who are deeply concerned with " improving the 
 condition of the poor," who might with profit 
 learn from this woman of simple culture much 
 for improving the condition of the rich. One 
 of the most inspiring conditions with which I 
 am familiar is that of a family of six, with chil- 
 dren ranging from one to five years of age, in 
 the heart of a great city, going to bed at night 
 on the roof, in all the seasons of the year. The 
 problem of awnings to keep off the rain, snow, 
 and wind have been simply solved, but usually 
 the starry heaven is their roof. Some interest- 
 ing facts attach to these conditions: The chil- 
 dren in the appearance of healthfulness are so 
 different from the other children of the city 
 that they look like a different strange and 
 rugged race ; they eat simple foods and have no 
 whims of daintiness ; they would regard it as a 
 punishment to be made to sleep indoors; they 
 know something of the stars and moon and have 
 a wider outlook upon the great universe about 
 them; and their mother finds little in common 
 with those who speak of the care of children as 
 
 165 
 
MEDICAL SOCIOLOGY 
 
 a dragging responsibility, for the rearing of 
 children to her is not a care but a joy. There 
 are many groups of children which have the 
 same intelligence applied to their feeding and 
 to all the other conditions of their lives, and 
 still they are a source of much care and 
 anxiety. The one simple thing that makes 
 this difference between care and joy is the 
 open air. 
 
 I do not know that adults who sleep out of 
 doors, aside from their freedom from colds, are 
 much different from other adults, but children 
 are decidedly different. I once heard Judge 
 Lindsey say that a judge in a neighboring State 
 gave up treating with clement consideration 
 youthful offenders against the law, because he 
 had once tried it and the boy had run away. 
 This is about the same attitude as that pos- 
 sessed by the man who said that he once tried 
 sleeping with his windows open and he caught a 
 cold that lasted him all winter. Both of these 
 cases illustrate that a certain amount of intel- 
 ligence must be brought to bear even upon these 
 simple problems. When a mother says that her 
 children, products of the hothouse, cannot sleep 
 out of doors because they are not rugged 
 enough, she confesses that she has not applied 
 
 166 
 
THE SOCIOLOGY OF HEALTH 
 
 the stint of intelligence to the case which its, 
 importance merits. 
 
 For the adult, the best of sleeping under the 
 open sky is really not hygiene. After all, the 
 best thing is just the joy of it. To lie down to 
 sleep at night with ten thousand other worlds 
 in sight, all moving noiselessly and majestically 
 upon their eternal errands, the greatness and 
 peacefulness of it all enters into one's own 
 spirit and shuts out the petty affairs of the 
 little world. One feels that he is clasped more 
 closely in the tender embrace of the great uni- 
 versal mother of all things. Sweet air bathes 
 his lungs; the sounds of the world grow 
 fainter; and to the music of the stars he drops 
 into slumber. Then the sun god comes and 
 paints the objects all about with gold; brown 
 chimneys look like minarets of the temple; 
 the fleecy clouds quicken their flight; the birds 
 are on the wing; and the day has awakened. 
 High in the air the belly of a gull shines 
 like a cuirass of silver, as it beats the air with 
 glistening wings that seem to splash a golden 
 spray. The long, serpentine chain in the sky 
 swiftly moving to the north proclaims the 
 spring prophecy of migrating ducks. It is a 
 great thing for one to feel that he is a part 
 
 167 
 
MEDICAL SOCIOLOGY 
 
 of nature as well as of the busy conununity of 
 selfish men. It broadens him immeasurably. 
 
 Go out into the air ; do not despise it because 
 it is cheap and plentiful ; bathe your body in it ; 
 absorb it into your blood ; and it will bless you 
 with the benediction of health. 
 
CHRISTIAN SCIENCE 
 
 "There is in our mind nothing that has not been in our 
 senses." — Moleschott. 
 
 CHRISTIAN science is performing a dis- 
 tinct function. It is filling with op- 
 timism the hearts of many people who 
 have been racked with imsatisfied longings, dis- 
 appointments, and distress. It has bestowed 
 "upon them a beneficent laissez faire. Nothing 
 matters. Berkeley failed to secure a following 
 because he attempted an appeal to the intellect. 
 The founder of Christian science succeeded be- 
 cause she appealed to the superstitions, and to 
 self-interest. 
 
 This doctrine is not to be feared, because the 
 cultured mind is not susceptible to its influ- 
 ences. Those who adopt it are possessed al- 
 ready of unnatural delusions or are deficient 
 in knowledge of the nature of things. Two con- 
 ditions exclude this dogma : good mental poise, 
 and familiarity with the natural sciences. 
 
 169 
 
MEDICAL SOCIOLOGY 
 
 The peculiarity of Christian science is that 
 it recognizes no evil ; nothing ill can befall one ; 
 all is good and to be greeted benignly and with 
 a smile of approval; whereas the wise man 
 believes that life is a mixture of good and ill. 
 While there is much happiness, there is also 
 much unhappiness. Those who are helping hu- 
 manity are striving to increase the amount of 
 happiness and diminish the amount of unhap- 
 piness; and they are succeeding fairly well. 
 But it is a slow and hard struggle. Reducing 
 infant mortality; diminishing the hazard of 
 childbirth; saving the wounded; making the 
 hazardous occupations more safe; securing 
 more hygienic dwellings for the poor ; lowering 
 the morbidity from tuberculosis, typhoid fever, 
 cholera, and plague; and minimizing by arbi- 
 tration the danger of war — these are a few of 
 the things which occupy humanity. But in 
 these efforts to make life sweeter, in the move- 
 ments which constitute civilization itself, no 
 help can be expected from the unnatural person 
 who denies that there is any evil to fight. The 
 infant may be fed infected food — it is not sick. 
 The woman in labor needs no skilled attention 
 — she will not bleed or become infected. The 
 wounded need not have his wound cleansed — 
 
 170 
 
THE SOCIOLOGY OF HEALTH 
 
 dirt can do him no harm. The miner descend- 
 ing into the earth need not concern himself if 
 the rope is decayed — if it breaks, the fall will 
 not injure him. The poor may live without sun- 
 shine or fresh air in their rooms — all is good. 
 The tuberculous may expectorate where his 
 sputum enters our food — but we shall not con- 
 tract tuberculosis. Sewage may flow into our 
 well — but typhoid will pass us by. The cholera 
 and plague need not be quarantined against — 
 they will not enter our ports. Men may go to 
 war — the enemy will do them no harm. Thus 
 says Christian science. But history and sci- 
 ence and all our senses tell us that by giving 
 heed to these things, lives have been saved and 
 happiness added to man's lot. 
 
 Christian science recognizes all the good in 
 life, and makes the most of it, which is, indeed, 
 most admirable; but I charge this unnatural 
 system with turning its back upon the world's 
 cry of pain. The suffering and distressed we 
 have with us; bodies deformed, diseased, and 
 racked with pain are here; women are being 
 led into lives of shame; tender children are 
 wasting in our mills; the innocent are con- 
 tracting preventable diseases; victims of pes- 
 tilence, disaster, shipwreck, and earthquake are 
 
 171 
 
MEDICAL SOCIOLOGY 
 
 crying for help. The agony of a man with 
 nerves caught in a machine should excite our 
 desire to extricate him; and the agony of one 
 whose nerve is compressed by a minute infec- 
 tion which can be seen only by the microscope 
 should excite our desire to give relief. But the 
 relief of neither of these is by sweet smiles and 
 assurances that there is no pain. We can offer 
 the sufferer something better. 
 
 I charge this unnatural system with cruelty. 
 I have seen the sufferings of the unfortunate 
 dupes of this delusion. I have seen the hand 
 withheld that should have plucked the burning 
 iron from the breast. I have seen them racked 
 with pain till their faces were distorted, while 
 through their tears they feebly murmured, 
 " There is no pain." I have seen them sink into 
 unconsciousness and die; and heard the weep- 
 ing orphans told, " He is not dead." It does not 
 ease suffering or change conditions to stand 
 idly by and say that the conditions do not exist. 
 
 Christian science is a feminine institution 
 and displays the weakest side of woman. The 
 Christian scientist recognizes a hole in the 
 ground, but not the cavity in a tuberculous lung. 
 Tens of thousands of autopsies have shown 
 these cavities, but the Christian scientist has 
 
 172 
 
THE SOCIOLOGY OF HEALTH 
 
 not seen them. If a telephone wire is eaten in 
 two by rust, she will confess that she ceases to 
 hear the voice at the other end of the wire ; but 
 if a diseased condition causes the decay and 
 breaking of the continuity of a nerve, she de- 
 nies that the muscles supplied by that nerve are 
 paralyzed. The Christian scientist has resur- 
 rected the teaching, promulgated nineteen hun- 
 dred years ago, to " Take no thought of your 
 life, what ye shall eat or what ye shall drink, nor 
 yet of your body." However, she is fond of the 
 good things of the table, not oblivious to the 
 bad, and I should not like to try the experiment 
 of administering to her unbeknown either prus- 
 siate of potash or a culture of typhoid bacilli. 
 While she insists that the effects of such things 
 are entirely mental, one of the most instructive 
 experiments that I have ever witnessed was to 
 see a member of this cult empty her stomach in 
 response to an hypodermic injection of one 
 tenth of a grain of apomorphine. Not all is 
 mind ; there is much matter. 
 
 It may be that when the plague swept over 
 Europe in the sixteenth century the twenty mil- 
 lion people who sickened and died had an im- 
 aginary disease. It may be that the flames that 
 leaped up about the victims of the Inquisition 
 
 173 
 
MEDICAL SOCIOLOGY 
 
 did not burn them. It may be that the pock- 
 marked population of England before the days 
 of vaccination had had no disease. It may be 
 that the thousands who died with hospital gan- 
 grene before the time of antiseptic surgery 
 were deluded into thinking that their wounds 
 were infected. It may be that the 200,000 
 who perished in the earthquake in Italy in 
 1909 were deluded into thinking that there 
 was an earthquake. But the well-balanced 
 and the educated mind knows that these things 
 occurred, and that man is an animal subject 
 to physical laws that govern matter. He falls 
 like a stone, responsive to gravity. His albu- 
 minous structures undergo changes and decay 
 like those of a rat. 
 
 Physicians know that the great majority of 
 diseases are self -limiting and self -curing. Natu- 
 ral history teaches this. Were it not so, the race 
 of man would have become extinct. In not one 
 case in ten does an educated physician expect 
 to limit to any very considerable degree the 
 course of a disease. But what he is able to do 
 is to relieve symptoms, make the sufferer com- 
 fortable, aid Nature in the direction that she is 
 taking to cure the malady, thwart Nature when 
 her tendency is toward aggravation of the dis- 
 
 174 y 
 
THE SOCIOLOGY OF HEALTH 
 
 ease, and tlieii in the one case in ten or twenty 
 or more he is able by his ministrations to turn 
 the fatal tendency of a disease toward recovery 
 and save a human life. But this is not the best 
 that the physician is doing. He is studying the 
 nature and effects of the organisms which find 
 entrance into our bodies and produce changes 
 there, just as the arboriculturist studies the 
 parasites of our fruit trees, or the geologist 
 studies the coral islands. He is finding means 
 of combating these parasites. He is learning 
 and teaching how to recognize diseases and how 
 to prevent them. It is an important thing for a 
 person to know whether he has a disease, and 
 what it is. As a result of medical knowledge 
 and medical administration, fewer people are 
 dying. There are thousands of earnest men 
 the world over giving their lives to these ends. 
 Might it not be pertinent to inquire what is this 
 cult of strange people called Christian scien- 
 tists contributing to human knowledge! Are 
 there any laboratories where they are seeking 
 to add a fact to human wisdom? Have they 
 discovered any of the great truths of nature 
 on account of our ignorance of which we suffer ? 
 Man was once so ignorant of natural science 
 that he was persecuted by superstitions day and 
 13 175 
 
MEDICAL SOCIOLOGY 
 
 mght. There is much still to be learned. Are 
 these people helping to gain knowledge of the 
 things that differentiate us from the beasts'? 
 The answer which they give to these questions 
 is that, all is good ; we need not learn anything 
 of the things that harm us, no harm can come 
 if the mind wills it not to come ; there is no sick- 
 ness, pain, or death. They philosophize with 
 wishes instead of with facts. They rise above 
 knowledge, and their attitude toward science is 
 one of supercilious contempt. They say, " A 
 drug cannot of itself go to the brain or affect 
 cerebral conditions in any manner whatever." 
 But what do they know about it? Have they 
 tried the experiment upon men or upon ani- 
 mals? Have they studied experimentally the 
 effects of morphine? With the Christian sci- 
 entists thought is the thing. But they fail to 
 realize that the thoughts which have helped 
 mind to conquer matter have been the thoughts 
 of such men as have produced the steam engine, 
 and harness electricity for our uses, and not the 
 thoughts that emanate from the ignorant or 
 from the easy-chair, and which are concerning 
 the mind and come back to the mind again. 
 The history of the Middle Ages has taught us 
 that the tendency to exalt the soul to the neg- 
 
 176 
 
THE SOCIOLOGY OF HEALTH 
 
 lect of the body is ever fraught with danger. 
 The mental healers' use of the word " thought " 
 is with little idea of its real meaning. Her 
 mind may be stored with vagaries, which she 
 recalls and repeats, but she is not prone to orig- 
 inate a thought. Such mental processes are 
 in nowise comparable to the thoughts of Dar- 
 win, Tyndall, or Edison, who think of facts and 
 things because they have seen them, not simply 
 of mind. 
 
 Persons whose minds are susceptible to these 
 vagaries are still in the childhood stage of men- 
 tal development. They love to talk of the great 
 when they have not yet learned of the small. 
 They like big talk. They discuss God and the 
 infinite when they do not know nature and the 
 finite. They are like the small boy who is Cap- 
 tain Kidd, in command of a great ship, when 
 he should mind his mother and run along and 
 hoe the potatoes. There is too much grop- 
 ing after the great and remote things by minds 
 that have not grasped the simple nearby things. 
 The more ignorant of facts a person is the more 
 prone is he to turn his mind to the infinite and 
 the supernatural; the more deeply one is 
 learned in the natural sciences, the facts of the 
 tangible things, the less time does he spend 
 
 177 
 
MEDICAL SOCIOLOGY 
 
 in consideration of tlie infinite and unnatural. 
 The scientific man is not in danger of taking 
 up with these strange cults. 
 
 The ultimate appeal of the Christian scien- 
 tist, like the patent-medicine man, is to results. 
 We cure, they say. The wise man says, nature 
 cures for you, and you take the money. They 
 point to the good people who have embraced the 
 faith. But it is well known that credulity is 
 often associated with intellect. Persons of in- 
 tellect are not altogether free from the danger 
 of falling into the hands of the charlatan or 
 taking up with strange cults. There are many 
 good and intelligent people who believe that 
 their future happiness depends upon their 
 thinking that woman was made from the rib 
 of a man, that a child was bom of a \drgin, 
 that the sun once stood still in the heavens at 
 the command of a man who desired to make 
 the day longer in order to give him more time 
 to kill his enemies, that five thousand hungry 
 people were once fed to satiety on five loaves 
 and two small fishes. These are not more 
 strange or less unnatural than the beliefs of 
 Christian science. There are spiritualists who 
 are hard-headed business men. Let us not be 
 asked to judge of things by the good people 
 
 178 
 
THE SOCIOLOGY OF HEALTH 
 
 who believe them. Let us go to nature and 
 learn the truth at first hand. 
 
 We are interested in the Christian-science 
 cult because it is new, not because it is unusual ; 
 because of its importance to those who are sick 
 with fatal but curable maladies ; and because of 
 the light it throws upon the imperfections of 
 the miad as a reasoning mechanism. There 
 are few more interesting exhibits of the power 
 of the human mind to becloud a subject with a 
 jumble of unintelligible jargon than can be wit- 
 nessed when one of these people is asked, How 
 is the insane man, whose mind is defectively 
 operative because of a tumor of the brain, to 
 free himself from sickness, pain, and death? 
 How is the new-bom babe, which has neither 
 thought nor language, to free itself from the 
 effects of dirty milk ? How are the lower animals 
 to know that sickness, pain, and death do not 
 exist? How is the poor benighted savage to 
 know that he is not sick and dying when his 
 heart is growing weaker and his eyes more dim, 
 and the vital functions slowly ceasing? Is the 
 absence of sickness, pain, and death a special 
 benison for those who purchase the text-book 
 of Christian science? 
 
 Christian science is one of those interesting 
 179 
 
MEDICAL SOCIOLOGY 
 
 vagaries that liave from time immemorial be- 
 come fastened upon certain susceptible minds. 
 They come and go. Its chief harm is that it 
 discourages the appreciation of the value of 
 knowledge, and denies the observations of the 
 senses. 
 
 We are human creatures, not gods. Our 
 senses are our best guides. It is through them 
 that we know the outside world. If we deny 
 them, we close out the light of day. And in 
 our darkness it matters not whether we imag- 
 ine the chambers of our abode filled with beauty 
 and with light, it is still dark. The blind do 
 not see. It is impossible for light to pass 
 through an opaque lens. 
 
 Let us have charity and kindness for these 
 people, and remember that most of mankind 
 cherish delusions which are contrary to the ex- 
 periences of the senses and to the understand- 
 ing of the intellect. "We have not yet reached 
 that state of mental development when the un- 
 natural can be cast out. 
 
XXI 
 
 THE EMMAITUEL MOVEMENT AND KINDEED 
 PHENOMENA 
 
 THE fact that Christian science is reach- 
 ing a large number of people with psy- 
 chic ailments warrants the belief that 
 there is a middle ground between the people 
 who deny the materiality of things and those 
 who believe only in material things and the 
 natural forces which connect them. There are 
 comparatively few people who have purged 
 their minds of superstition, so that these move- 
 ments have a wide application. Aside from 
 their appeal to unnatural agencies, they have 
 entered a field which is properly medical, but 
 which medicine, busy with its old-fashioned 
 therapy, has failed to develop; that is repre- 
 sented in psychology, the inculcation of hope- 
 fulness, the distracting of the mind from im- 
 aginary ills, and the great power of suggestion. 
 But this is a medical province, and medicine is 
 more capable of developing it than the clergy. 
 
 181 
 
MEDICAL SOCIOLOGY 
 
 The clergymen who originated the Emman- 
 uel movement went about it in a manner which 
 has not invited criticism, and have striven to 
 antagonize scientific medicine in no way. It is 
 an evidence of how the modem dominant su- 
 perstitions can be put in harness with a great 
 psychic principle and made to do service for 
 the mentally deranged. 
 
 This movement now has gotten entirely away 
 from its originators and is fast becoming wide- 
 spread. Its destiny is to add testimony to the 
 value of psychic influence in the treatment of 
 diseases. It does some good and much harm. 
 People who have ills are prompted to appeal 
 to agencies outside of nature, and they recover 
 from their ills. Most would have recovered had 
 they appealed to natural agencies, because most 
 illnesses tend to recovery no matter what is 
 done. But these people already provided with 
 superstition, when they find that they have re- 
 covered, attribute the change to an extranatu- 
 ral power influencing natural phenomena; and 
 the result is that they become more deeply 
 steeped in superstition than before. They con- 
 fuse post hoc with propter hoc. If there is any 
 one thing that has kept humanity in ignorance 
 and degradation it has been the superstitions, 
 
 182 
 
THE SOCIOLOGY OF HEALTH 
 
 not the least of which is that which conditions 
 the existence of a great extranatural power 
 which can be induced by certain means of solici- 
 tation and entreaty to change the natural 
 course of events which, without such solicita- 
 tion and entreaty, would not be changed. This 
 is one of the most degrading of the supersti- 
 tions fostered by some of the systems of re- 
 ligion. Science is making a successful contest 
 against it, and the minds of the people are rid- 
 ding themselves of this incubus and obstacle to 
 moral and intellectual progress. These healing 
 movements of a religious character cannot 
 much interfere with the march of science; but 
 they can strengthen the hold of superstition 
 upon minds which might otherwise have shaken 
 it off and become free to receive enlightening, 
 natural truths. We should have little sympathy 
 with doctrines that are recommended because 
 they have the power to relieve an individual of 
 certain ills, when in so doing they implant a 
 falsehood in his mind, which sooner or later will 
 cause him harm, and also make him the center 
 from which radiates to others the pernicious in- 
 fluences of false testimony. 
 
 So far as the Emmanuel movement goes, it 
 has spread widely over the country, but even 
 
 183 
 
MEDICAL SOCIOLOGY 
 
 now it makes no pretense to keep within tlie 
 bounds of discretion stipulated by the Emman- 
 uel Church. It is doubtful if there is another 
 church in America where it is confined within 
 reasonable limits. An enormous brood of heal- 
 ing systems have been hatched out of it. The 
 text now is, " Christ healed the sick, let us do 
 the same." 
 
 These movements are being seized upon by 
 the Church, in the superstitions of which the 
 people in their enlightened progress are fast 
 losing interest; and, as a practical and tangible 
 means of attracting attention and rendering 
 apparent help to the afflicted, they are destined 
 to be widely exploited. That means the break- 
 ing loose from the plans laid down by the 
 original church in Boston, and the ultimate 
 "healing of the sick" as a priestly function 
 without medical intervention. And it will suc- 
 ceed for the same reason that charlatanism, the 
 patent-medicine business, and Christian science 
 succeed. That reason is, because where ten 
 people are sick nine will recover, irrespective of 
 whether they are treated by the laying on of 
 hands, by the taking of a bottle of colored water, 
 or by appeals for intervention addressed to an 
 extranatural power, or to a graven image. It 
 
 184 
 
THE SOCIOLOGY OF HEALTH 
 
 is a winning game. So long as more than fifty 
 per cent recover it will succeed. If forty-nirie 
 say, it did me no good, and fifty-one say, it 
 helped me, it gains two recruits ; but when the 
 figures become as ten to ninety simply by virtue 
 of the tendencies of nature, we see the enormous 
 advantage nature gives to any system of heal- 
 ing exploiting itself for public support. Eegu- 
 lar medicine, happily, enjoys the same ad- 
 vantage. 
 
 The influence of the mind over the healthy 
 body is very great, but the influence of the mind 
 over diseases of the body is very slight. Morbid 
 processes in the tissues of the body, commonly 
 called diseases, are so distinctly the product of 
 physical causes that takiQg thought of them has 
 little effect one way or the other. This has been 
 pretty thoroughly tried. The Indian medicine 
 man, the voodoo doctor, Lourdes and the saints, 
 have all testified that actual diseases are not 
 much influenced by the mind. History shows 
 that these methods have done more harm than 
 good. A person with a tuberculous joint, who 
 throws away his splint and declares that he is 
 well, eventually pays dearly for his faith; but 
 that is not all: what is still worse he prompts 
 others to do the same. And since these places 
 
 185 
 
MEDICAL SOCIOLOGY 
 
 do not keep statistics and follow up their work 
 after the ordinary scientific methods, the de- 
 luded followers witness only the beginnings of 
 the treatment but not the end. When the tuber- 
 culosis patient has worn his splint until the in- 
 flammation has subsided (and surgical advice 
 is jDrone to be on the safe side and urge its use 
 until after all possibility of disease has passed) 
 and then visits a shrine of the saints, casts 
 aside the splint, and proclaims that he is cured, 
 he will find to his joy that he is cured. Such 
 an one is doubly dangerous, because of the 
 harm of his influence ujDon others. 
 
 On the other hand, the influence of the body 
 upon the mind is very great; and the more 
 medicine is learning of it the more its impor- 
 tance is being realized. Nervous diseases are 
 now most successfully treated by the scientific 
 method which seeks for the physical basis of 
 the disease. The first requisite in the treat- 
 ment of mental derangements is the hygiene of 
 the body. The insane did poorly in former 
 days when it was supposed that they were pos- 
 sessed of evil spirits and devils, and were con- 
 fined in unwholesome cells. They are now re- 
 covering in our modern scientific institutions, 
 where they are put at useful work in the open 
 
 186 
 
THE SOCIOLOGY OP HEALTH 
 
 air on the farms, given wholesome food, and 
 made to keep their bodies clean and their hands 
 occupied. The novelists and story writers pass 
 along the traditions of the heart stopping, the 
 hair suddenly turning gray, and birthmarks 
 being produced by thought ; but the authentica- 
 tion of these things is not to be had. Persons 
 with the so-called imaginary diseases, for which 
 no physical basis can be found, it is safe to as- 
 sume have some slight physical derangement. 
 Time, the great healer, may cure them; medi- 
 cine, to numb the feeling of discomfort while 
 recovery is taking place, will often be given the 
 credit; infusing the mind with the opium of 
 oiDtimism and hope may be assumed to have the 
 curative power; but in ninety -nine per cent of 
 cases life in the fresh air, occupation, clean- 
 liness, simple nourishing food, and hygienic 
 regulation of the bodily functions will give 
 quicker cures than medicines, hypnotism, or 
 prayer. 
 
 The Emmanuel movement will give better re- 
 sults in the long run if it is turned into a fresh- 
 air movement. 
 
 To sit down with an unhappy victim of per- 
 verted notions, or one whose mind has been con- 
 fused by theories and introspection, or one who 
 
 187 
 
MEDICAL SOCIOLOGY 
 
 lias not a sufficient grasp of real facts, and talk 
 common sense to him, is an admirable service. 
 This is the duty of everyone, be he physician, 
 clergyman, or neighbor. But let it not be sup- 
 posed that this is what these " psychic move- 
 ments " do. They have broken away from 
 plain common sense and gone up into the air; 
 and the few men who have tried to treat the 
 matter in a scientific manner have been left 
 forsaken and branded as unspiritual. 
 
 That these movements will foster a system 
 of quackery there can be little doubt. A man 
 who in the name of morality and religion can 
 stand before people and declare for such things 
 as in his heart he does not believe, and which 
 in private conversation he will deny, I think 
 would trade in the credulity of the supersti- 
 tious ; and after the laying on of hands or some 
 other formality, if the patient recovered, as 
 most likely would be the case, he would en- 
 courage the patient in the belief that through 
 his agency an extranatural voluntary power 
 had been induced to interfere with the disease 
 and the patient had been made well. This move- 
 ment cannot be kept in the hands of the discreet 
 and honorable men with whom it originated; 
 it is particularly adapted to the ecclesiastic 
 
 188 
 
THE SOCIOLOGY OF HEALTH 
 
 charlatan, and in his hands it is destined to be- 
 come a refined system of quackery. 
 
 The people best qualified for the treatment of 
 disease are those who are familiar with the 
 anatomy, physiology, and pathology of the hu- 
 man organism. Let the cobbler stick to his last. 
 "When the clergyman, following the lead of the 
 people, ceases from superstitions, before taking 
 up the practice of medicine let him turn to the 
 teaching of morality and ethics and lend a hand 
 in the improvement of social conditions. These 
 are the fields into which he is destined by evo- 
 lution to be directed, and in which he can be of 
 great service to humanity. 
 
o 
 
 XXII 
 
 OSTEOPATHY 
 
 STEOPATHY is defined by the osteo- 
 healing which treats diseases of the 
 paths as " that science or system of 
 human body by manual therapeutics for the 
 stimulation of the remedial forces within the 
 body itself, for the correction of misplaced tis- 
 sue, and the removal of obstructions or interfer- 
 ences with the fluids of the body, all without the 
 internal administration of drugs or medicines." 
 This would be all right were it not for the fact 
 that the osteopath treats all internal diseases 
 and regards them all as being due to these pe- 
 culiar causes which he enumerates. Here is 
 the danger of a general system of treatment 
 which fails to take cognizance of the anatomy 
 of disease. 
 
 It should be well known that the administra- 
 tion of medicines is but a minor part of the 
 science of medicine. Medicine is occupied with 
 discovering the causes and the means of preven- 
 
 190 
 
THE SOCIOLOGY OF HEALTH 
 
 tion of diseases. Hygiene, sanitation, legal 
 medicine, and public health are subjects of its 
 study. It is the science which connects biology 
 with the practical saving of life and the relief 
 of physical suffering. It has made smallpox 
 a rare disease ; it has deprived diphtheria of its 
 power to destroy; it has stopped the spread of 
 contagions; it has reduced the mortality in 
 more than half of the diseases of the human 
 family ; and it now points out to the state how 
 typhoid fever may be eliminated. Legislation, 
 admitting into the practice of medicine persons 
 who lack medical training, lowers the standard 
 of medical practice and recognizes and licenses 
 to practice medicine persons who are not edu- 
 cated or professionally interested in these most 
 important departments of medicine. Such leg- 
 islation allows the so-called osteopath to diag- 
 nose, treat, and have under his consideration 
 cases of contagious disease, when his art is, 
 at the best, a system of massage. It allows him 
 to diagnose, treat, and sign the death certificate 
 in criminal cases of poisoning when he dis- 
 claims an interest in the physiology of drugs 
 and other poisons. 
 
 The practices of value in " osteopathy " have 
 long been known to medicine. It is one of many 
 14 191 
 
MEDICAL SOCIOLOGY 
 
 measures used in the branch of medicine called 
 therapeutics. Therapeutics includes massage, 
 electricity, passive motions, dietetics, medica- 
 tion, hydrotherapy, rest, exercise, heat, cold, 
 poultices, counter irritation, etc. These so- 
 called " displacements of tissues " with which 
 the osteopath concerns himself have little or 
 no basis in the pathology of disease. Diseased 
 tissues have been studied earnestly for many 
 hundreds of years, but the peculiar conditions 
 which the osteopath can feel through the skin 
 have not been revealed by knife or microscope. 
 There are certain slight dislocations of verte- 
 brae which have their own peculiar symptoms. 
 A knowledge of anatomy and physiology eas- 
 ily explains these symptoms. But the osteo- 
 path, without understanding bacteriology or 
 the nature of infections, attributes infectious 
 diseases to these displacements. 
 
 Osteopathy was " discovered " by a Dr. A. T. 
 Still, a physician in Missouri, who, in his biog- 
 raphy, reveals its origin. He says: 
 
 Who discovered osteopathy? Twenty-four years ago, the 22d 
 day of next June, at ten o'clock, I saw a small light on the hori- 
 zon of truth. It was put in my hand, as I understood it, by the 
 God of nature. That light bore on its face the inscription: This 
 is my medical library, surgery and obstetrics. This is my book 
 with all directions, instructions, doses, sizes, and quantities to 
 
 192 
 
THE SOCIOLOGY OF HEALTH 
 
 be used in all cases of sickness and birth, the beginning of man: 
 in childhood, youth and declining days. I am something of 
 what people call "inspired." 
 
 This piece of rhetoric lies at the foundation 
 of osteopathy; and we have seen certain of our 
 legislatures, delegated to safeguard our in- 
 terests, our educational standards, and our 
 health, declare for it and place it upon the cata- 
 logue of educational requirements. 
 
 Such systems as this come and go. History 
 is full of them. And among their followers 
 have always been those whose very standing 
 have helped to give them impetus. This thing 
 will shortly pass into history with the rest and 
 be forgotten. 
 
 That many chronic cases of inflammations, 
 pains, and neurasthenic illnesses have been re- 
 lieved by massage is as true as that many seri- 
 ous and acute conditions have been aggravated 
 by it. Any " system " will prosper if it does 
 not do too much harm, for the natural tendency 
 of diseases is to recover. Therapeutics is but 
 one of the departments of medicine, and to ex- 
 alt one of the many therapeutic measures to 
 the position of the whole science and art of 
 medicine can be designated only as unwise. 
 
XXIII 
 
 FACTS AND THEOKIES 
 
 BEWAEE of theories. My professor of 
 chemistry and physics had a theory that 
 the cost of producing illumination by 
 electricity would make it utterly impracticable 
 for general use ; and, moreover, no electric light 
 would be big enough to read by, anyway. He 
 used to show an electric light to the class to 
 prove it. If his experience with electricity had 
 been well founded, it would have prompted him 
 to say, even before the electric light was spoken 
 of : " Some day this force can be used for pur- 
 poses of illumination remote from the seat of 
 power." I trust that this excellent man may 
 read these lines by the electric light in his libra- 
 ry; and I hope also that he may recall with 
 happiness the theories which he has fostered 
 and which have survived the wearing tests of 
 time and experience. 
 
 Beware of theories. When the steam engine 
 was invented, an Englishman wrote a book in 
 
 194 
 
THE SOCIOLOGY OF HEALTH 
 
 which he set forth his theory that it would be 
 impossible to propel a vessel across the ocean 
 by steam power. The writing was lucid, the 
 reasoning was correct, but the premises were 
 wrong; and the first volume of this excellent 
 work that came to America was brought over 
 in a steamboat, thereby demonstrating that one 
 fact may carry away a volume of theories. 
 
 " Experience teaches," it is said ; but it 
 teaches two things: it teaches that which is 
 right and it teaches that which is wrong. If 
 the experience is based upon correct principles, 
 it will elevate and help; but if it is based on 
 error, and erroneously interpreted, it only 
 serves to drag down. Suppose that a man 
 practices upon a theory to which he is commit- 
 ted dogmatically — he has made up his mind that 
 it is right — if his assumption is an error, his 
 experience may do him more harm than good, 
 for he twists phenomena to fit his preconceived 
 ideas. 
 
 The man who learns, who is capable of learn- 
 ing, holds his theory-engendering and theory- 
 harboring faculty always in abeyance : he keeps 
 it in a state of relaxation and openness. He 
 permits the ever-flowing stream of facts to per- 
 colate through it and wash out any theory that 
 
 195 
 
MEDICAL SOCIOLOGY 
 
 cannot withstand the current. Upon the ability 
 to do this hangs the proposition that experience 
 teaches and helps. Pity the man who does not 
 allow experience to change his mind. 
 
 Happy is he whose theories are well foimded 
 on demonstrated facts and so well tried that 
 he is inspired by the truth of his convictions. 
 The hopeful persistence of Harvey and Sem- 
 melweis in establishing truths in the face of 
 obstacles is an inspiration to every man who 
 believes that he possesses the right idea. 
 
 " The earth shall yet surrender to him and 
 the fates shall do his will, who marches on, 
 though the promised land prove to be but a 
 mirage, and the day of deliverance be canceled. 
 The gods shall yet anoint him and the morning 
 stars shall sing." 
 
XXIV 
 
 THE FAMILY HAZAED 
 
 GIVEN a good doctor and a sick man — 
 , just those two alone — and the latter is 
 to be felicitated upon the situation. 
 When there is introduced the complication of 
 the anxious wife, the solicitous family, and the 
 critical neighbor, Heaven help both doctor and 
 patient, and all of us ! Many an important life 
 has been sacrificed upon the altar of extramedi- 
 cal solicitude, when with the same disease a 
 poor devil without friends would recover. To 
 harrow up the doctor's soul with the anxieties 
 over his responsibility warps judgment, saps 
 vitality, and introduces an extraneous element 
 with which the doctor has no business to deal. 
 His duty to every patient is the same; it is 
 to give his best talent and skill. When the 
 life of the Empress was in danger, Napoleon 
 saw that the physician was embarrassed by his 
 great responsibility. With his extraordinary 
 knowledge of men and his faith in the conscien- 
 
 19Z 
 
MEDICAL SOCIOLOGY 
 
 tious skill of his physician, he said : " She is but 
 a woman; forget that she is the Empress, and 
 treat her as you would the wife of a citizen of 
 the Kue St. Denis." The physician simply did 
 as he thought was best for his patient in peace 
 of mind and confidence, and the Empress re- 
 covered. 
 
 The best results to both doctor and patient 
 accrue if the former can concentrate his atten- 
 tion upon one thing — the proper treatment of 
 the case before him. "When he has to practice 
 feints, and exercise his ingenuity to make his 
 conduct and practice conform to the whims of 
 bystanders ; when the demand for concealments 
 from some and collusions with others are thrust 
 upon him; and when his nervous system is as- 
 saulted by alarms and solicitations, the in- 
 terests of his patient are jeopardized and his 
 own days shortened. 
 
 The wise physician does the best he can for 
 all. The wise friends of patients spare him as 
 much annoyance as possible, and aim to help 
 rather than to hinder him in the work of his 
 lofty calling and in the exercise of his best skill 
 and judgment. 
 
XXV 
 
 EATING AND TALKING 
 
 WE are becoming convinced that thor- 
 ough mastication is highly desir- 
 able. Confirmed dyspeptics are 
 curing themselves of their ailments by giving 
 more attention to the chewing of their food. 
 In fact, of late, this particular physiological 
 function has received much serious attention, 
 to the great advantage of all — to say nothing 
 of the dentists. But as we contemplate this new 
 masticatory era, we hark back and encounter 
 the long-accepted and time-honored dictum, 
 which has never been disputed, that good com- 
 pany and conversation aid digestion. It seems 
 that this ancient decision, born of the round 
 table, the alehouse, and the " merrie companie," 
 must be reversed in the court of the new gas- 
 tronomy. When one is engaged with a mouthful 
 of food, he should be unmolested until it is re- 
 solved into solution. 
 
 Mastication, as a physiological function, has 
 199 
 
MEDICAL SOCIOLOGY 
 
 been too much disturbed by the ancient dictum 
 above referred to. Here is the eater conveying 
 a loaded fork of nourishment to his mouth; at 
 the same moment his table companion pro- 
 pounds a question or utters a statement which 
 demands a response. Witness the gulping 
 down and the responsive sputterings. This is 
 no unusual scene. Of course there is no ob- 
 jection to talking in the intervals of mastica- 
 tion, but this is practically impossible in the 
 atmosphere of so-called table good-fellowship. 
 It is hardly to be expected that your company 
 shall time the working of his mind and conver- 
 sation to the working, so to speak, of your jaw. 
 That is an Utopian dream. It would be strain- 
 ing antiphonal possibilities. The invitation, 
 " Let's go to the Waldorf and hear the newly 
 rich eat ! " bears witness to these contentions. 
 Talking and eating mean often munching and 
 gulping, but not mastication. 
 
 The company of those who understand us, 
 the company of healthy children, and the com- 
 pany of those who do not demand entertain- 
 ment from us, are surely not undesirable at 
 mealtime; but society which is pestiferous and 
 which demands talk is subversive to the best 
 interests of the table. The old dining-hall 
 
 200 
 
THE SOCIOLOGY OF HEALTH 
 
 legend, that conversation aids digestion, is pre- 
 sumably false. The notion that a lull at the 
 table means that the dinner is not a success at 
 that moment, will not bear the scrutiny of mod- 
 ern physiology any more than it will when two 
 or more, gathered together, are engaged in any 
 other physiological function. The most impor- 
 tant thing should have precedence. An ideal 
 conversation at the table would be simple volun- 
 tary contributions of pleasant thought which 
 excite no immediate reply from anyone en- 
 gaged in eating. To ask a chewing guest a 
 question is as rude as to jostle his elbow, x^ 
 appropriate and modern dining-room motto 
 would be, " Let the full mouth be undisturbed." 
 " It is not well for man to eat alone " is true 
 only provided his society is agreeable, intelli- 
 gent, and familiar with the physiological pro- 
 prieties. Otherwise he will do better to conduct 
 himself like the lion, and, while he gnaws his 
 bone, devote himself to that function exclu- 
 sively. "When we eat, let us eat as simple men 
 that are nourished by their food. 
 
PART II 
 
 MEDICAL SCIENCE AND 
 MEDICAL ART 
 
THE EVOLUTION OF SCIENTIFIC KNOWLEDGE 
 
 SOME years ago, at the Marine Biological 
 Laboratory at Woods Hole, a certain 
 biologist was laughed at by the undis- 
 cerning because he spent the summer at the 
 apparently unpractical work of studying the 
 biology of the parasites of fishes' fins. This 
 scientific man devoted himself to the proposi- 
 tion that all information is practical; and to 
 this thesis I dedicate these observations upon 
 the evolution of scientific knowledge. 
 
 The true scientist is searching for knowledge. 
 Whatever it is or wherever it is, he knows that 
 it is one of the links in the chain of the great 
 universal truth ; and eventually, sooner or later, 
 it will be of practical service to mankind. 
 
 There are two classes of investigators : those 
 who are studying for ends of immediate utility 
 and practical application, and those who are 
 at work in the neglected and apparently un- 
 practical fields of research. The first have re- 
 
 205 
 
MEDICAL SOCIOLOGY 
 
 ward and the eclat of applause for tlieir re- 
 sults; the second hand down to posterity some 
 new facts which in their day have found no 
 great utility, while they have enjoyed the ap- 
 proval and appreciation only of the select few 
 who have known of their work. All honor to 
 those whose deeds remain unsung, who have 
 labored in the cause of science without hope of 
 applause. 
 
 While we acknowledge the debt we owe to 
 Finlay, who suggested that the mosquito is the 
 infecting agent in yellow fever; while we erect 
 a monument to Reed, and lay a wreath upon 
 the grave of Lazear, who gave us the proof; 
 let us not forget the pioneer biologists who 
 studied the morphology and physiology of the 
 mosquito, and who were called unpractical. 
 They worked, little thinking of the importance 
 of this insect to human life, but they formulated 
 and made accessible their knowledge, sitting 
 out the hours in the laboratory beside the faith- 
 ful microscope, and dying, never to hear the 
 word "benefactor." Until the bubonic plague 
 was understood, the flea was an unimportant in- 
 sect. But science now takes down the book in 
 which is written the biology of this little ani- 
 mal, and recognizes as human benefactors the 
 
 206 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 men who studied it and who are now gone, nn- 
 thanked for their service. 
 
 Between these two classes of earnest men is 
 still another : those who belong to the first class 
 but have failed. Suppose that courageous little 
 woman upon whom McDowell operated in. the 
 cabin in the backwoods of Kentucky had died 
 — such a result has occurred in less serious 
 cases in the hands of men of even greater skill 
 than he — and the waiting mob had destroyed 
 the surgeon, the name of McDowell would be 
 practically unlaiown to us; and yet the merit 
 of the man should have been as great. Suppose 
 that O'Dwyer, after the years of labor to per- 
 fect his intubation tubes, had found that they 
 failed; he would have been the same meritori- 
 ous O'Dwyer, he would have labored just as 
 earnestly for mankind, he would have sacrificed 
 as much for them — ^yes, more — ^but there would 
 have been no reward, for the goal would not 
 have been attained. If he had lived to this day, 
 he would see the usefulness of his labors almost 
 made null by the invention of antitoxin ; yet the 
 work of O'Dwyer and the motives that inspired 
 him would have been the same. Suppose that 
 Koch's tuberculin had done what he had hoped 
 it would, he would have been acclaimed the 
 15 207 
 
MEDICAL SOCIOLOGY 
 
 greatest benefactor of his time, and honors 
 would have fallen thick and fast upon him. His 
 hopes were not realized, but shall he not have 
 honor for standing upon the threshold where 
 he could not enter in ? The work he did and the 
 hopes he cherished should merit it. 
 
 Pasteur, who stands preeminent and alone — 
 his genius so far transcends all others — is the 
 greatest and most beneficent scientist that con- 
 tinental Europe has produced. (He may be 
 spoken of in the present tense, because if ever 
 there was an immortal man it is Louis Pasteur ; 
 he lives in every laboratory in the world to-day 
 where original biological work is carried on.) 
 His early work was devoted to studying the 
 structure of crystals, and the business mind, 
 which demands immediate results, declared him 
 an "impractical scientist." But the study of 
 the crystals of tartaric acid in wine lead him to 
 the discovery of the cause of fermentation, and 
 thence to the effects of microorganisms upon 
 living things, and thence to bacteria as the 
 causes of diseases, and thence to the nature and 
 prevention of infections and the principles of 
 antitoxins and immunity — the most important 
 discoveries into the nature of disease which it 
 has ever been given to any man to make. Had 
 
 208 
 
MEDICAL SCIEN'CE AND MEDICAL ART 
 
 his researches halted with crystallization, the 
 world would not have acclaimed him with the 
 glorious title of benefactor; but undoubtedly 
 from his beginnings some others ultimately 
 would have carried on the train of thought and 
 investigation as far as he, and his work among 
 the crystals would have counted for just as 
 much. It matters not to humanity, save for 
 pointing an example, whether its great work is 
 done by one man or by ten. Nothing is lost. 
 Who adds a grain of knowledge to human wis- 
 dom is a benefactor. Had Pasteur never 
 reached the goal of glory, still he should have 
 been crowned with wreaths of victory, for he 
 gave his life to the task of wresting Nature's 
 secrets from her. 
 
 All honor to those who seek for knowledge; 
 honor to those who enter into the dark and un- 
 explored realms of Nature ; honor to those who 
 win from her the means of succor for the dying 
 and relief for the suffering ; and honor still to 
 those who strive and strive again and fail ! 
 
 The development of our science and art has 
 been an evolutionary process. There have been 
 no great discoveries de novo, but each has been 
 the culmination of a series of efforts mingled 
 with failures and successes. Many predeces- 
 
 209 
 
MEDICAL SOCIOLOGY 
 
 sors carried the torch before it was handed to 
 him who bore it to the goal and reaped the re- 
 ward of immortality. All honor to him who 
 thought and toiled — say not in vain — and died 
 before the crowning of the end. He might have 
 passed on this message from Strode : " I may 
 never take you farther than I have been myself, 
 but you may press on when I tell you of the 
 vision I beheld. You may never fashion from 
 the thing I wrought, but you may take your 
 reckoning from the rare design where my 
 clumsv hands fell short." 
 
II 
 
 BACTERIOLOGY AND BOTANY 
 
 THE universality of medicine is displayed 
 in the development of bacteriology. 
 Here is a department of human knowl- 
 edge which belongs to botany; but who would 
 think of turning to the botanist for information 
 about the bacteria, the youngest of the known 
 floral It was a chemist, Pasteur, who founded 
 the science of bacteriology; and straightway 
 from his hands it passed to the pathological 
 anatomists of the science of medicine. Medi- 
 cine has developed this wonderful field of 
 knowledge, which ramifies into nearly all of 
 the other physical sciences. The best methods 
 of studying the bacteria, their life history, 
 their classification, the means of cultivating 
 them artificially, of staining and differen- 
 tiating them, of discovering their relations to 
 animals in health and disease, have all been 
 worked out in the medical laboratories; and, 
 finally, to medicine belongs the credit of study- 
 
 211 
 
MEDICAL SOCIOLOGY 
 
 ing and discovering their biology, the char- 
 acter of their excretions, and the measures for 
 their destruction. Medicine developed the sci- 
 ence of bacteriology, and out of it evolved most 
 important knowledge for the saving of lives — 
 the knowledge of antitoxins and immunizing 
 substances. 
 
 Bacteriology has placed upon a scientific 
 basis all that the old-fashioned common sense 
 called cleanliness. It has explained the myster- 
 ies of polluted water. It has defined the dan- 
 gers of dirt. It has elucidated the etiology of 
 most of the human diseases. It has even dis- 
 posed of the superstition of the " bleeding 
 wafer." It has taken man one long step toward 
 the solution of the problems of his life. 
 
 Medicine has not only enjoyed the education 
 of having brought this science to its perfection, 
 but it has had the satisfaction of seeing it taken 
 up by the chemist and the agriculturist, and 
 turned to practical ends in their work. But 
 we should never forget that the bacteriologists, 
 the men who elaborated this subject into a 
 science, have always been of the department 
 of pathology of the science of medicine. Bac- 
 teriology grew up in the laboratories of the 
 schools of medicine. 
 
 212 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 Botany lost a great opportunity. When it 
 was revealed that the bacteria belonged to plant 
 life along with the fungi, botany failed to step 
 in and claim its own. If this ancient science 
 had been as industrious in studying the bi- 
 ology of plants as it has been in cataloguing 
 them, it might have advanced in importance to 
 a point equal to that of zoology. The botanist 
 has failed to interest himself sufficiently in the 
 fundamentals of his science. He has been a 
 catalogist ; he has sacrificed the microscope for 
 the herbarium; he has not been so much inter- 
 ested in the life of plants, in the origin and fate 
 of plants, as in their family trees. The botanist 
 has been too much of a genealogist and too little 
 of a biologist. He has interested himself too 
 much in the names of things, and too little in 
 the things themselves. 
 
 In times long past the doctor of medicine, in 
 the interest of his peculiar therapeutics, was a 
 botanist. Little did botany dream when she 
 let him in at the back door to dabble in her 
 classified herbs and witnessed his interest grow 
 less and less that after a few centuries, when 
 apparently he had become most neglectful, he 
 should boldly open the front door of her an- 
 cient castle and walk away with her fairest 
 
 213 
 
MEDICAL SOCIOLOGY 
 
 flower, which now for a score of years has 
 adorned the gardens of the sons of Sol. 
 
 Bacteriology in twenty-five years has had 
 given to it much patient research, claiming the 
 sole attention of more devoted men than have 
 worked at botany in a hundred years. Most of 
 these men are unknown to the world, but sev- 
 eral hundred of them have contributed equally 
 to the development of this science. Botany had 
 her great lights, some of the greatest men that 
 any science has known. They have been but 
 few, but they were all great men — Aristotle, 
 Pliny, John Ray, Linnaeus, and Asa Gray. 
 
 It is interesting to observe that three of these 
 five botanists were physicians, and two of these 
 physicians were the greatest scientists of their 
 respective centuries. But the greatness of 
 these men was not manifested alone in botany, 
 they were naturalists and pioneers in the field 
 of zoology as well. Had they been living at the 
 time of the birth of bacteriology, it is doubtful 
 if it ever would have departed from botany. 
 
 But the parting came. Bacteriology has 
 grown toward humanity, and has become of in- 
 finite, practical, everyday usefulness to man- 
 kind. Botany is still the aloof, genteel, sBsthetic 
 science. For the bacteriologist the suffering 
 
 214 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 and dying beckon on. For the botanist the 
 flowers in the meadows nod their heads, the 
 pine trees sing softly their lullabies, and the 
 breezes of summer bear upon their wings 
 the odors of the wayside vines. 
 
Ill 
 
 SPONTANEOUS GENERATION 
 
 "Things happening to-day are merely the copy and reflex of 
 things that happened in former times." 
 
 NOW and then some one goes into print 
 with the statement that biology and 
 modem medicine are founded on the 
 thesis that life does not originate spontaneous- 
 ly. It is interesting to encounter the dogmatic 
 statement that modern medicine is founded 
 upon this assumption, and that " not only does 
 no living thing originate except from preceding 
 life, but no portion of any living thing comes 
 into being, except from a living particle of the 
 organism of which it is to form a part." 
 
 If there is any one thing upon which modem 
 biology is agreed, it is that there was a time 
 when there was no life upon the earth, and that 
 life sprang up as the result of the fortuitous 
 conjunction of carbon, hydrogen, oxygen, nitro- 
 gen, sulphur, and phosphorus, together with 
 moisture and heat. Biologists believe that the 
 same natural laws which originally combined 
 
 216 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 these elements into protoplasm, now exist and 
 continue to operate. While no one has suc- 
 ceeded in making protoplasm synthetically, we 
 do know that it was once made in the great lab- 
 oratory of Nature, which is still in operation 
 with its constant and immutable laws. No biol- 
 ogist contends that new bacteria or nucleated 
 cells come into existence spontaneously, but, 
 contrary to the dogmatic assertion above re- 
 ferred to, many do agree that living matter, 
 similar to that from which the bacteria are de- 
 scended through the microphyta and microzoa, 
 originates spontaneously and, indeed, is origi- 
 nating spontaneously all the time. The cell 
 which Virchow dealt with is a complex, highly 
 organized form of life compared with the mo- 
 nera of Haeckel or the protoplasmic slime out 
 of which they spring. 
 
 It is not medicine, but rather theology, that 
 is founded upon the proposition of an early and 
 never-repeated creation. Because plasmogeny 
 is not susceptible of laboratory demonstration, 
 there are still those who, according to F. A. 
 Lange, "love to shelter themselves in those 
 dark comers which science has not yet illu- 
 mined with its rays, and there to hang up their 
 cobwebs to catch sound reason in." 
 
 217 
 
MEDICAL SOCIOLOGY 
 
 The monera of Haeckel and the protoplasmic 
 slime found in the sea, which biologists are 
 more and more agreed represent the simplest 
 known forms of living matter, have never been 
 discovered in process of production, because 
 their generation took place or takes place under 
 conditions with which we are not familiar ; but 
 this does not necessarily hold good for all 
 time. Geologists have never discovered the 
 diamond in process of formation in nature. 
 Artificial chemistry has produced organic com- 
 pounds which had previously been found only 
 as a part of living organisms — urea, alcohol, 
 grape sugar, butyric acid, acetic acid, lactic 
 acid, fat, amyloids, and alkaloids. Chemistry 
 is steadily approaching the production of pro- 
 toplasm, although it will be most difficult to 
 produce artificially the albuminous molecule, 
 which is large and extremely complex in struc- 
 ture, its atoms being held in very unstable com- 
 bination. 
 
 When we speak of spontaneous generation 
 the modem interpretation does not call for 
 complex organisms, but the most primitive 
 plasmogenesis. Other interpretations have 
 long since passed away. Christendom once be- 
 lieved that elephants and all other things 
 
 218 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 were results of a single creative act; Harvey 
 thought mice were generated spontaneously; 
 Pasteur's " infinitely small " were the yeast 
 organisms; Virchow's ultimate organism was 
 the cell ; Haeckel has carried us to the monera ; 
 and a host of modern observers are at work in 
 the border land between living matter and the 
 inorganic world, discovering in crystallization 
 and among the inorganic molecules activities 
 closely akin to those of so-called organized ma- 
 terial. But the fact that the chemist has not 
 yet succeeded in creating protoplasm or be- 
 cause the biologist has not yet identified it in 
 process of creation, is no ground to assert that 
 spontaneous generation is impossible and that 
 the laws of nature, which once produced living 
 material, are no longer operative in that direc- 
 tion. 
 
 The plants are demonstrating the truth of 
 archegony. The chlorophyll cell possesses the 
 synthetic power of plasmodomism or carbon as- 
 similation ; it builds up protoplasm out of inor- 
 ganic materials — water, carbon dioxide, nitric 
 acid, and ammonia. Thus in the laboratory of 
 the plant we behold the construction of the pro- 
 toplasm, which botanists are agreed is purely 
 by virtue of a chemical process. The plant is 
 
 219 
 
MEDICAL SOCIOLOGY 
 
 formed of inorganic matter and can be resolved 
 back into inorganic matter. 
 
 Max Kassowitz, in his " Biologic," calls atten- 
 tion to the necessity for conceiving of the de- 
 velopment of organic from inorganic material 
 as requiring an incalculably long period, and 
 not as a sudden chemical process. But that 
 archegony, or spontaneous plasmogeny, does 
 occur is pointed to by nature and believed by a 
 large number of biologists. 
 
 If in speaking of spontaneous generation one 
 could be so loose in the use of language as to 
 refer to cellular organisms alone, such as bac- 
 teria, then we must say that most agree that 
 bacteria spring from bacteria; but no one fa- 
 miliar with the great principles of evolution 
 would dispute that new and ever-changing va- 
 rieties of bacteria are developing even now as 
 a result of natural selection and the laws which 
 lie beneath the mutations of species. 
 
IV 
 
 THE BEGINNINGS AND PEOGBESS OF THEEAPEUTICS 
 
 WHETHEK we think of man as the 
 low-browed primate, as the warrior 
 clothed in the skins of animals, or 
 as the exalted ruler of creation, he has always 
 sought for remedies to assuage his pains and 
 the ills of his flesh. This has continued to be 
 the main function of the individual practition- 
 ers of medicine, notwithstanding that the phi- 
 losophers of all times have insisted that the 
 highest object to which medicine can attain is 
 the prevention of disease and the prolonging 
 of life. 
 
 The treatment of diseases began long before 
 man knew the nature of disease. Then came 
 the study of anatomy and physiology and path- 
 ology, and the development of the science of 
 medicine ; but therapeutics, the oldest of all the 
 branches of medicine, has always attempted to 
 progress faster than its sister branches and 
 keep in a degree independent from them, thus 
 
 221 
 
MEDICAL SOCIOLOGY 
 
 showing its primitive origin. There always has 
 existed a disposition to try remedies for dis- 
 eases before the nature of the disease had been 
 studied, or, indeed, before the nature of the 
 remedy was known. This constitutes the em- 
 piricism which lies at the base of therapeutics. 
 And somehow or other there crept into the 
 mind of man the unfounded notion that some- 
 where in the world there was a remedy for 
 every symptom of his ailments. To this add 
 the superstitions, begotten of religion and cre- 
 dulity, and we have the picture of the humble 
 origin of our materia medica. The employment 
 of drugs and chemicals in the treatment of dis- 
 ease began too early ; it would have been better 
 had it followed rather than preceded pathology. 
 It commenced wrong. It began at the target, 
 and not at the bow ; it began at the top, and not 
 at the bottom, as all well-founded knowledge 
 should. 
 
 Our modem materia medica is a continuation 
 of fetichism, down through alchemy and em- 
 piricism. Its brother is the amulet. It is but a 
 few steps in human progress from the rust of 
 the sword that killed an unbeliever to Blaud's 
 pills; from the powdered tails of scorpions to 
 the tincture of capsicum ; from the decoction of 
 
 222 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 the shells of the eggs of a dove gathered from 
 the cloister wall to the liquor calcis of the drug 
 store. Drugs with little or no effect gradually 
 gave way to those which had a denionstrable 
 action; and we have our materia medica. This 
 development has been through empiricism. 
 
 After the Middle Ages the science of medicine 
 developed with extraordinary rapidity. Much 
 information was accumulated ; new truths were 
 discovered; but the practical application of 
 these truths to therapeutics was unconscionably 
 slow. Yet much of the best knowledge that we 
 have at the present time for the prevention and 
 treatment of diseases was then in the posses- 
 sion of man. 
 
 The science of medicine is of value to the peo- 
 ple only as it is brought in a practical way to 
 their daily needs, and this administration has 
 rested largely in the hands of its practitioners. 
 Have they applied most wisely and practically 
 the knowledge of human disease which has 
 come down to them as the heritage of time and 
 which the patient labors of thousands of ear- 
 nest men have won! Were it possible for us to 
 project our vision backward into the past for 
 so short a period as a hundred years we should 
 witness in the medical administrations of that 
 16 223 
 
MEDICAL SOCIOLOGY 
 
 day such therapeutics as would convince us that 
 the fetichism of drugs survived still in the very 
 presence of scientific medical knowledge. And 
 what of to-day? Have we any compunctions as 
 to what the historian shall see when he projects 
 his vision backward, a hundred years from 
 now, upon us? I fear we have. What is the 
 present status of our medical therapeutics? 
 
 The young man who graduated during the 
 past century, or I may say during the present, 
 was sent out into the world to practice medicine 
 with the impression that drugs are the main re- 
 liance of therapeutics. His professor of thera- 
 peutics was also professor of materia medica; 
 and his mind was trained so that when the 
 treatment of disease was mentioned he at once 
 thought of the particular drugs that were in- 
 dicated. Text-books upon therapeutics exhibit 
 two different arrangements: one gives the de- 
 scription of the drugs, and then follows this 
 with the diseases in which they are indicated; 
 the other gives diseases or symptom groups, 
 and follows this with the drugs to be used. The 
 combination of drugs with therapy is so close 
 that the student cannot escape it. And yet, be- 
 yond and outside of all of this, lies the great 
 field of therapeutics only just beginning to re- 
 
 224 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 ceive the scientific attention to which its im- 
 portance entitles it. 
 
 The chair of materia medica and therapeutics 
 should be divided. Materia medica should take 
 its place where it belongs in the department of 
 chemistry. The science of the treatment of dis- 
 eases should be put along with the teaching 
 of the pathology and symptomatology, or else 
 made a separate branch of the teaching of the 
 practice of medicine. The teacher of medical, 
 or nonsurgical, therapeutics should become one 
 of the most important adjuncts to the faculty 
 of medicine. He should have to do with the ra- 
 tional treatment of diseases. He should not 
 teach " sectarian medicine," the treatment by 
 drugs alone. He should roam all the fields of 
 every art and science, and take the best they 
 have to offer. His therapeutics should be 
 founded on physiology and pathology, not on 
 chemistry and botany. He should teach the 
 student how to treat a sick person, not what 
 drugs to give in certain diseases. 
 
 The man who knows the history of his race 
 knows that homeopathy, osteopathy. Christian 
 science, and the kindred delusions, would not 
 have secured the following they have unless 
 they had something to offer. If this is anything 
 
 225 
 
MEDICAL SOCIOLOGY 
 
 that can be employed in the treatment of dis- 
 eases, it is the business of the scientific thera- 
 peutist to find it out and let us have it. We 
 have had to learn for ourselves that homeop- 
 athy taught the healing power of nature; our 
 professor of therapeutics did not tell us. The 
 old-time doctor saw patients recover under the 
 administrations of the homeopath without their 
 taking any appreciable medication. There was 
 not much difference between the mortality in 
 his practice and that of his homeopathic neigh- 
 bor. It was a valuable knowledge to acquire, 
 that a sick man might get along pretty well 
 without any drugs; and we have to thank the 
 homeopathic delusion for teaching it. Unfor- 
 tunately, or fortunately, as the case may be, 
 apostasy has overtaken the disciples of this 
 particular cult, and they have become addicted 
 to the administration of drugs to such a degree 
 that we are quite deprived of further opportu- 
 nities of observing in their practice the phe- 
 nomena of the vis medicatrix naturce. 
 
 Christian science, founded upon unreason, 
 teaches us the value of the influence of mind 
 over certain mental illnesses. It has demon- 
 strated this in a practical manner; and the 
 therapeutist who ignores it is not wise. Chris- 
 
 226 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 tian science is a demonstration of the power 
 of optimism. It also teaches that the natural 
 tendency of most diseases is toward recovery. 
 Because the good in it is wrapped in the warp 
 and woof of ignorance and superstition does not 
 make it any the less good or available, any more 
 than morphine or iodine should not be prized 
 because they are found in nature associated 
 with noxious and inert materials. Osteopathy, 
 a combination of massage, ignorance, and char- 
 latanism, is adding further proofs of the healing 
 power of nature and of the value of massage 
 and passive motion in certain chronic dis- 
 eases. Whether these therapeutic fads, which 
 proceed to treatment without knowledge of the 
 pathologic anatomy of diseases, do more harm 
 than good, I shall not now attempt to discuss ; 
 but that they do teach valuable lessons to medi- 
 cine cannot be gainsaid. 
 
 If the therapeutist wished evidences of the 
 natural tendency of diseases to heal themselves, 
 he need not go to these pseudo-sciences and to 
 quackery for proofs. He may find them in the 
 legitimate practice of medicine. He may see 
 the apparent success enjoyed by many a legal- 
 ized practitioner whose knowledge of medicine 
 can scarcely come under the head of knowledge. 
 
 227 
 
MEDICAL SOCIOLOGY 
 
 We have arrived at the threshold of the 
 institution of rational therapeutics. We were 
 not taught it in our student days, but now we 
 are learning that drugs, excepting the antitox- 
 ins and a score of products of the laboratory, 
 have a very subordinate place in the treatment 
 of the diseases in which the mortality is being 
 lowered. In a recent paper, W. M. Barton 
 {Jour. Am. Med. Assoc, vol. lii, No. 20) cites 
 the following instances of pharmacologic fetish- 
 ism : olive-oil and gall-stones, valerian and hys- 
 teria, tannic acid and internal hemorrhage, al- 
 cohol and ether injected in shock, colchicum 
 and gout, potassium iodid and sclerosis, chlorate 
 of potassium and stomatitis, the hypophos- 
 phites and neurasthenia, lithium and uric acid 
 diathesis, and calcium salts and internal hem- 
 orrhage. 
 
 With our professor of materia medica drugs 
 were the first consideration in the intestinal 
 diseases of infancy, in phthisis, typhoid fever, 
 the exanthemata, appendicitis, erysipelas, and 
 pneumonia; and now how small a figure they 
 play in the treatment of these conditions; be- 
 cause rational therapeutics has developed out 
 of the study of their pathology. 
 
THE KATIONALIZATION OF THERAPEUTICS 
 
 OUTSIDE of the drug store are many 
 valuable remedies. More important 
 than drugs in the treatment of diseases 
 are fresh air, smishine, cleanliness, proper 
 clothing, proper eating, proper breathing, good 
 morals, temperance, equanimity, kindness, self- 
 reliance, exercise, rest, occupation, the care of 
 the mind, the training of the child, high ideals, 
 knowledge of hygiene, optimism, and cheerful- 
 ness. It is the absence of these that has caused 
 most ills, and they, instead of drugs, should 
 have the first consideration in the treatment. 
 How little really well-formulated knowledge 
 we have of these vital things compared with 
 our well-formulated knowledge of the uses of 
 drugs. The charlatan often steps in and mas- 
 ters one of these subjects, and scores a triumph 
 over the doctor of medicine. 
 
 I have seen a man dying with pneumonia in 
 a room so close that the nurse had a perpetual 
 
 229 
 
MEDICAL SOCIOLOGY 
 
 headache, but the poor man was taking oxygen 
 from the drug store. Why? Because the use 
 of oxygen from the drug store was taught by 
 the professor of materia medica and therapeu- 
 tics, but not the use of the oxygen of the free 
 and open air which can be secured without the 
 mystic scroll which means recipe. 
 
 The teaching of the patient about his disease 
 so that he may cooperate with the doctor is 
 often necessary for successful treatment. The 
 doctor's life in the future is going to present 
 even more responsibilities than it ever has. The 
 time is approaching when he must give more of 
 his personal attention to the sick. He shall not 
 escape his duty by dashing off a prescription, 
 and leaving the rest to nature and the druggist. 
 He is becoming too useful and too learned a man 
 for such shirking of responsibility. In this 
 work the trained nurse and the assistant to the 
 doctor are destined to play an important role. 
 There are directions to be carried out and in- 
 structions to be given, and an in-touchness with 
 the patient to be maintained, which can best be 
 done through the agency of such assistance. 
 
 The foundation of therapeutics is in pathol- 
 ogy, etiology, and diagnosis. The physician 
 must get at the root and the cause of the mal- 
 
 230 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 ady before he can treat it intelligently. Next, 
 he must eliminate the cause; and when he has 
 done this he has progressed so far in the treat- 
 ment that the cure is usually in sight. There 
 is many a doctor who stands well in his profes- 
 sion, whose waiting room is crowded, and who 
 gives only sufficient attention to each case to 
 ask a few hasty questions, write a prescription, 
 and say, " Take this, and let me see you again 
 one week from to-day." The chances are that 
 the patient will be better, but the wise man 
 knows that this physician has not stood in the 
 proper position in the tableau of doctor and 
 patient. Already the doctor's duty to the man 
 with consumption is no longer ended with a pre- 
 scription for cod-liver oil and creosote. This 
 evolution we have witnessed in the last few 
 years. 
 
 The new therapeutics demands of the physi- 
 cian that when a patient comes complaining of 
 a headache she shall not be dismissed with a 
 prescription for a drug, but that the cause of 
 the complaint shall be determined and the stuffy 
 bedroom in which she sleeps shall be flooded 
 with fresh air day and night. When a patient 
 seeks help for his loss of appetite he shall not 
 be cast aside with a prescription for a bottle 
 
 231 
 
MEDICAL SOCIOLOGY 
 
 of mix and gentian, but the cause shall be dis- 
 covered, and he shall have prescribed for him 
 a walk to his office instead of a ride, instruc- 
 tions in deep breathing, and an omission of the 
 preprandial cocktail. When the doctor is con- 
 sulted for the pain in the leg of a child, he shall 
 not have fulfilled his duty by sending the parent 
 to the drug store for salicylic acid, but he shall 
 learn the cause of the pain, and upon determin- 
 ing that it is coxitis, apply the rational treat- 
 ment. Therapeutics is becoming something 
 more than a few encouraging words and a bot- 
 tle of medicine. 
 
 The old therapeutics kept the children with 
 tuberculosis of bones and joints in the hospital 
 ward where they might not be cold, and de- 
 pended upon treating them with hypophos- 
 phites and cod-liver oil, while abscess after 
 abscess was evacuated. The drugs are now 
 omitted, and the children are put out in the 
 fresh air and sun, anywhere — on the roof, in 
 the garden, on the balcony — and there are fewer 
 abscesses to open. 
 
 Most diseases are preventable, and most dis- 
 eases will subside when the cause is removed. 
 Consumption is a product of a combination of 
 the violations of the laws of natural living 
 
 232 
 
MEDICAL SCIENCE AND MEDICAL AKT 
 
 which we boastfully designate by the name of 
 civilization. The only treatment that is suc- 
 cessful is no treatment at all, for it simply con- 
 sists in taking the patient out of the pernicious 
 and unnatural environment in which he con- 
 tracted the disease and compelling him to live 
 naturally ; that is, in the open air, and on simple 
 and nourishing food. Had he lived this way 
 before, he would not have had consumption. In 
 all the practice of medicine there is no more 
 pitiful sight than that of a doctor who should 
 know better dealing out pills to a patient who 
 needs to be told how to live ; and m all the prac- 
 tice of medicine there is no more glorious sight 
 than that of a doctor, who knows how, prevent- 
 ing the developing of a disease or discovering 
 and removing the cause. 
 
 One of the greatest needs of medicine to-day 
 is a scientific formulation of the old knowledge. 
 Let us formulate and put upon a scientific work- 
 ing basis the important things which involve 
 the everyday life. 
 
 Some children sleep with their windows open 
 summer and winter, or sleep out of doors, and 
 are the ideals of health. Others sleep with their 
 windows closed, and look sickly and often are 
 sick. Which is better? Are these observations 
 
 233 
 
MEDICAL SOCIOLOGY 
 
 only exceptions which have some other explana- 
 tion, or are they worthy to be studied and for- 
 mulated; and should we not be as well agreed 
 upon this subject as we are upon the action and 
 uses of strychnine? 
 
 Treves has emphasized the beneficence of dis- 
 eases, and he has gone so far as to allege that 
 we should all have been dead long ago had it 
 not been for diseases. This is not offered in 
 a spirit of waggery, implying that we live by 
 diseases ; for in this flippant sense it would al- 
 ways have to be left to some one else to do the 
 suffering. That is the idea promulgated by the 
 humorist who said that the best place to have 
 a carbuncle is on the back of the neck of some- 
 body else. What Treves refers to is that the 
 symptoms of disease — the pathologic changes 
 of disease — are but a manifestation of an ef- 
 fort on the part of the body to rid itself of 
 some offending and harmful foreign substance. 
 Whether it is bacteria, ptomaines, or cucumbers 
 that are causing the trouble, the symptoms are 
 but an evidence of a salutary effort of the or- 
 ganism to rid itself of the noxious invader. 
 Peritonitus has saved more lives than " all the 
 drowsy sirups of the East " ; but we should not 
 lose sight of the fact that the drowsy sirups 
 
 234 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 of the East may sometimes be used to supple- 
 ment the salutary action of peritonitis and help 
 save life. 
 
 The effects of drugs fall into the same cate- 
 gory, along with the ptomaines and cucumbers. 
 The so-called physiological actions of drugs are 
 the symptoms of an effort of the system to 
 throw off an offending foreign substance, or 
 they are an e\ddence of the system being over- 
 come by this same substance. They represent 
 reaction to foreign material. Fortunately, many 
 of the drugs can be made to supplement disease 
 in stimulating the activities of the natural 
 forces of the body, and thus have a salutary 
 action in hastening the elimination of the dis- 
 ease. Undigested and irritating material in 
 the intestine is productive of increased peri- 
 stalsis and a flow of serum into the bowel. Cas- 
 tor oil produces similar results, and therefore 
 is useful in aiding Nature in her effort to elimi- 
 nate the cause of the disease. The antitoxins are 
 employed as synergists to the natural healing 
 powers of the body, and accordingly are of 
 much value. The objectionable drugs are the 
 inert drugs, those which do actual harm, and 
 those which detract attention from more im- 
 portant things. 
 
 235 
 
MEDICAL SOCIOLOGY 
 
 The medical profession has fostered it, and 
 upon the medical profession devolves the duty 
 of curing the public of its drug addiction. The 
 physician least learned in the nature of dis- 
 eases is the one most given to the employment 
 of drugs. They are the lazy man's expedient. 
 The educated physician gives drugs often to 
 relieve immediate conditions or to induce com- 
 fort while he corrects the cause, and patiently 
 waits for nature to cure the disease. But when 
 he gives medicine as a placebo he is placing 
 his stamp of approval upon a practice which he 
 knows is wrong. The American public takes 
 $75,000,000 worth of patent medicines yearly. 
 Who taught them that the remedy for illnesses 
 is drugs'? And who but the medical profession 
 indorsed the use of drugs as the sovereign rem- 
 edy for disease ? But now as rational therapeu- 
 tics advances, and we are placing less depend- 
 ence on drugs, the charlatan keeps up with 
 the procession. The medicine quack is being 
 succeeded by the " food expert," the " physical- 
 health instructor," the " breathing expert," and 
 others, all who claim that they, too, have ad- 
 vanced beyond therapy by drugs. 
 
 A journal devoted to the interests of osteop- 
 athy has recently gone through Osier's works 
 
 236 
 
MEDICAL SCIETs^CE AND MEDICAL ART 
 
 and culled out the instances in wMch, in speak- 
 ing of treatment, he has not advised the employ- 
 ment of drugs or has said that there is no 
 known internal remedy that is of service in in- 
 fluencing the course of the disease. The list 
 of diseases is a rather large one ; and the infer- 
 ence is that because Osier does not advise any 
 particular drugs in their treatment, they are- 
 without the pale of medicine. The rational 
 view should be that if honest investigation 
 shows that drugs do not influence these dis- 
 eases so much the worse for the drugs and so 
 much glory for the investigator. Medicine does 
 not live by drugs alone. 
 
 The very name of our profession is an un- 
 fortunate one. It is outgrowing medicine and 
 is taking its place as the science of sanitation, 
 of hygiene, of health. Medicine began by ef- 
 forts to make the sick well: to that it has 
 added its efforts to preserve the well in health. 
 Sanitary science is what modern medicine 
 means, and sanitary science is what it should 
 be called. 
 
 It has been ruled by courts in several in- 
 stances that the practice of medicine consists in 
 administering drugs, and that if no medicine 
 is given it is not the practice of medicine. A 
 
 237 
 
MEDICAL SOCIOLOGY 
 
 broader interpretation has been placed upon 
 this subject by the courts in some States. The 
 law in many States, however, allows an irregu- 
 lar practitioner to see a case of typhoid fever 
 through his disease, and calls him blessed, pro- 
 vided he does not give any medicine ; and yet, 
 cases of typhoid fever are recovering every day 
 in our hospitals without having received a drop 
 of medicine. 
 
 If we could imagine that for fifty years the 
 manufacture and internal medical use of ninety 
 per cent of the drugs now employed were dis- 
 continued, it is conceivable that therapeutics 
 would advance to a position which it now will 
 take more than a century to attain. Therapeu- 
 tic measures and hygiene, now neglected, would 
 be seized upon, and when fifty years had rolled 
 round we should be surprised to find how 
 poorly we prized our old friends of the apothe- 
 cary shop, and how well the practice of medi- 
 cine had prospered without them. If there were 
 no quinine or arsenic for malaria we should ex- 
 ert our energies in a campaign of extermination 
 against the mosquito. While the drugless treat- 
 ment of consumption has accomplished splendid 
 results in reducing the mortality from that dis- 
 ease, still, its greatest value has been in teach- 
 
 238 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 ing people how to live. Its best value is to the 
 nonconsumptive. However, I do not suggest 
 the discontinuance of the use of potent and val- 
 uable remedies ; I make these statements to call 
 attention to the other and more important side 
 of therapeutics. 
 
 I would not be understood to advocate drug 
 nihility, for the plants and the minerals and the 
 laboratory furnish invaluable therapeutic aids ; 
 but I do insist that rational therapeutics begins 
 with pathology and prophylaxis and the res- 
 toration of physiological conditions, and that 
 medicine has too slowly grasped the simple and 
 natural principles of therapeutics. 
 
 The therapeutic aids of the greatest value 
 are the simplest and cheapest and most access- 
 ible. Most of the illnesses against which treat- 
 ment is aimed are due to violations of right liv- 
 ing. To restore the patient to normal living 
 is treatment of double scientific value : it offers 
 cure for the present and prevention for the fu- 
 ture. Let us felicitate ourselves that in our day 
 we have witnessed the dawn of the new thera- 
 peutics and the decadence of the fetichism of 
 drugs. 
 
 17 
 
VI 
 
 THE FATE OF MEDICINE 
 
 THE medical profession is engaged in car- 
 rying on a propaganda of destruction of 
 the necessity for its own existence. It 
 lives by the presence of the diseases which it is 
 striving to make extinct. As a business it puts 
 aside business principles; as a profession it is 
 the most beneficent force at work at the present 
 time for the improving of the condition of 
 human life. If it were a business, it could prop- 
 erly say: "We will make ourselves as compe- 
 tent as possible to heal your diseases if phys- 
 ical misfortune overtakes you or if you are so 
 foolish as to make yourself sick." That would 
 certainly be a laudable enterprise, and the phy- 
 sician would thrive beyond the thrift of the 
 butcher or baker or banker. 
 
 If medicine were a business and the medical 
 profession were a trust, the plague and small- 
 pox and cholera and diphtheria would be rife 
 and feeding fat the doctor's wallet. But one 
 
 240 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 by one medical men have learned the causes of 
 the diseases and applied the means of preven- 
 tion. Much thankless toil and labor this has 
 cost. The medical profession has not only dis- 
 covered the life-saving, preventive measures, 
 but it has begged and pleaded with the people 
 to accept them. It has humiliated itself be- 
 fore legislatures, it has appealed to govern- 
 mental authorities, it has spent its substance 
 in the education of the people, it has labored 
 with the individual for the sake of his own 
 health, it has taught the mother how to save 
 her babies from sickness — and all the while tak- 
 ing the bread from the mouths of its own 
 children. 
 
 Now, more than at any time in history, med- 
 icine is laboring so successfully in the interest 
 of the prevention of diseases, and the great 
 value of this work is becoming so well appre- 
 ciated, that we are confronted with new condi- 
 tions and possibilities of metamorphosis of 
 medical activity. We are at the beginning 
 of the time when preventive medicine shall be 
 something more than an exceptional benison; 
 we have arrived at the time when the actual 
 practice of preventive medicine will be pursued 
 with all the activity which the ancient physi- 
 
 241. 
 
MEDICAL SOCIOLOGY 
 
 cians applied to the so-called healing of dis- 
 eases. 
 
 We may properly ask the question, To what 
 is this leading? MHiat is to be the fate of the 
 medical profession? And the answer is plain 
 to one who has read clearly the history of his 
 race, and who has faith and hojDC in the destiny 
 of man. The tendency of the medical profes- 
 sion is toward its own obliteration. Let ns be 
 thankful that this is true, for this is the spark 
 that vivifies it and makes us know that it is a 
 living thing. All that is in process of evolution 
 upward must lose itself and disappear. All 
 that truly lives must die into something else. 
 The dead rock endures unchanged for ages, but 
 man dissolves himself into mankind and dies. 
 
 "When I speak of the obliteration of the med- 
 ical profession I do not speak with the tongue 
 of the prophet, who sees unto the very end, but 
 rather with the insight which discovers the 
 steady workings of that great evolutionary 
 force which day by day, '^ Ohne Hast, ohne 
 Rast," sees the diminishing necessity for the 
 doctor. This is the reason why he is entitled 
 to the designation Doctor. The true mission of 
 the teacher is to lead his pupil to the goal where 
 he can be independent of him. Emerson has 
 
 242 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 said that the state exists for the purpose of 
 making men wise, and when all men have be- 
 come wise the state, or government, will have 
 no excuse for existence and will cease. 
 
 Medicine is a noble profession because her 
 sons are entitled to this title of Doctor. We 
 should guard it jealously. Doctor means teach- 
 er. It is one of the two great titles. The other 
 is Mother. The Teacher and the Mother have 
 a similar mission. It is to make those who look 
 to them for succor independent of them. Each 
 is working toward the weaning of its charge. 
 The mother duty is to nourish and train and 
 guide the child toward the day when it may be 
 independent, and thrive as well without her. 
 If she fail in this she fails in her highest duty. 
 The function of the teacher is the same. The 
 goal toward which he leads his pupil is to make 
 the pupil possessed of his knowledge and the 
 benefits of his talents. The true teacher with- 
 holds no secret of his profession. He gives all. 
 He strives to make his pupil perfect, even as 
 himself. He makes the pen with which the pu- 
 pil writes his emancipation. If he fail in this 
 he has not taught well. 
 
 As the mother is to the child so is the medi- 
 cal profession to all mankind. It is slowly but 
 
 243 
 
MEDICAL SOCIOLOGY 
 
 inevitably, with beneficent purpose and with 
 lofty aim, abdicating the necessity for its own 
 existence. Whether the complete abdication will 
 ever be attained, no man can say ; the important 
 fact is the goal toward which we aim. 
 
VII 
 
 THE FUTURE FIELDS OF MEDICAL ACTIVITY 
 
 DURINGr the evolutionary progress of 
 medicine there will always be an im- 
 portant mission for the doctor. He 
 will have less and less to do with the care of the 
 sick and more and more with the prevention of 
 sickness. When the relative proportion of doc- 
 tors becomes less, the importance of the individ- 
 ual doctor should become greater. One physi- 
 cian as sanitary commissioner at the head of a 
 community can prevent an epidemic of typhoid 
 fever which would demand the activities of a 
 thousand physicians once it is started. The 
 physician, exercising the preventive function, 
 is to be the important man, not only as the 
 community adviser, but as the family and in- 
 dividual adviser as well. Common sense and 
 the present tendency of scientific work declare 
 that it is better to exercise endeavors to prevent 
 disease than to cure it. It is cheaper to keep 
 one man constantly on guard to prevent the 
 
 245 
 
MEDICAL SOCIOLOGY 
 
 spark from striking the tinder, than to summon 
 a thousand in the hour of distress to save the 
 burning citadel. 
 
 The fields of activity of the medical profes- 
 sion are destined to be, in national and state 
 councils and executive offices, safeguarding the 
 health of the people ; in the more intimate rela- 
 tions with the public in county and municipal 
 health offices; and in the personal relations of 
 teacher, family physician, consultant and spe- 
 cialist. 
 
 And some day the wise man will attach the 
 physician to his family, not to cure diseases but 
 to prevent them. As a business matter it will 
 be more economic. One of our greatest social 
 absurdities is permitting people to become sick 
 and then employing a doctor to get them well. 
 It is the largest of all of the preventable wastes. 
 We are prodigal of nothing to so great a degree 
 as we are of our health. That is our greatest 
 national extravagance. In that we find the chief 
 waste of natural resources. 
 
 Health is too important a thing to be made 
 subject to the rules of trade and commerce. 
 When the average man is taken sick he then 
 employs a doctor to help him recover. The 
 doctor is placed in the unfortunate position of 
 
 246 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 depending upon the morbidity of others for his 
 livelihood, and the patient is placed in the un- 
 fortunate position of having his misfortune be- 
 come the doctor's advantage. This system 
 works hardship to both parties. A better state 
 of civilization will demand that the physician 
 be regarded as a public necessity, and that each 
 community shall have competent medical men, 
 with assured incomes, the same as health offi- 
 cers, paid by the public. The better the state 
 of health the physicians can maintain in their 
 districts, the greater should be their emolument 
 — ^not the less, as it now is. Every person 
 should have easy access to skillful and scien- 
 tific medical services, not as a matter of charity, 
 but as a matter of right. The charlatan would 
 not thrive under such conditions. A policeman 
 is now assigned to a certain district to prevent 
 and correct violations of the law. Health should 
 receive the same consideration as property does. 
 That the people of this great country are to 
 have a national department of health, there is 
 no doubt. Such a branch of the Government, 
 with the support of Congress and the coopera- 
 tion of State boards of health, would have in its 
 power to wipe out typhoid fever, yellow fever, 
 and malaria, and reduce enormously the mor- 
 
 247 
 
MEDICAL SOCIOLOGY 
 
 tality from tuberculosis. It should have, aside 
 from the intrinsic merits of the case, represen- 
 tation upon the Cabinet of the President. The 
 counsel of a wise sanitarian would be of value 
 to every department of the Government. 
 
 In the several States the fields of usefulness 
 open to the departments of health are large. 
 Gradually they are growing up to their oppor- 
 tunities. As they demonstrate what can be 
 done, the people give them more money and a 
 larger scope. Some States have efficient and 
 growing boards of health and accomplish much. 
 Those States which have not yet awakened to 
 the value of such work suffer for their negli- 
 gence. 
 
 The municipal and county departments of 
 health are the most appreciated. That is be- 
 cause they are nearest to the people. All mu- 
 nicipalities are constantly increasing their effi- 
 ciency and the field of their work. The city of 
 New York has added to the work of its health 
 department the function of having inspectors at 
 the farms where the city's milk supply is pro- 
 duced. This is a natural outcome of the work 
 of inspecting milk as it comes into the city. In- 
 asmuch as this milk comes from six different 
 States, which supply several hundred other mu- 
 
 248 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 nicipalities, if each sent inspectors to the 
 sources of supply there would be an overlap- 
 ping of inspectors, which can only be corrected 
 by Federal supervision. The work of these 
 municipal health departments is undergoing a 
 steady evolution. They conduct bureaus of vital 
 statistics; inspect buildings, factories, schools, 
 etc.; supervise case of contagious diseases; 
 conduct hospitals and clinical laboratories 
 for diagnosis; manufacture antitoxins for the 
 poor ; give courses of instruction on health and 
 hygiene; send nurses to care for and instruct 
 the sick; provide food for consumptives; fur- 
 nish medical advice and proper food for infants 
 in summer ; and in a thousand other ways con- 
 tribute to the health and comfort of the people. 
 While the functions of the other governmental 
 departments in our cities remain about fixed, 
 the power and scope of the activities of the de- 
 partment of health in every well-governed and 
 thoughtful community is being augmented. 
 
 One of the needs in our system of medical 
 education is to train men to meet these new con- 
 ditions. No college in our country has a course 
 in hygiene and sanitation worthy of the name. 
 Doctors are to be trained to fill the important 
 positions, arising on every hand, in sanitation 
 
 249 
 
MEDICAL SOCIOLOGY 
 
 — mimicipal, State and national. Preventive 
 medicine is the thing. The need of specially 
 equipped men is becoming urgent. The first 
 school in this country to train men as sanita- 
 rians will mark an epoch.^ 
 
 These signs of an advancing civilization are 
 cited to show the fields of activity and useful- 
 ness ■ which are inevitably developing for the 
 medical man. He is destined to be more and 
 more of a voice and a hand in the multifarious 
 functions of government. 
 
 ' One year after this was written and nine months after it wa3 
 first published, Columbia University announced that it had twelve 
 experts in hygiene and sanitary science at work on a plan for the 
 establishment of a school of preventive medicine. It is pro- 
 posed to train men for the positions of health officers and sanitary 
 inspectors, so that even small towns may be properly safeguarded 
 against conditions that foster and breed disease. The proposed 
 school will seek to prevent tuberculosis, blindness, and alcoholism. 
 A study of foodstuffs and the milk supply will be features of the 
 course. This is the most important announcement that has ever 
 been made by any medical school in this country. 
 
vni 
 
 MEDICAL SCIENCE AND HUMAN PROGEESS 
 
 AS the official and public duties of the 
 physician increase and diseases be- 
 ^ come less, there will continue to be a 
 demand for men who are learned in human biol- 
 ogy — perhaps as great as at this present time 
 when we hear so much of the crowded profes- 
 sion. Certainly there will be less need of the 
 therapeutist, for if there is any one thing that 
 should be regarded as the sign of advancing 
 civilization it is the recession of morbidity. 
 There will be, besides the general practitioners 
 and the specialists, members of the medical pro- 
 fession occupied in the various public medical 
 activities. The field of the sanitary engineer is 
 beginning to be developed. Medical men will 
 be required as educators. All great undertak- 
 ings, involving human lives, will be advanced 
 under medical supervision. The blessing and 
 approval of the priest gives way to the blessing 
 and approval of the doctor. We have witnessed 
 the transformation. The policy as exemplified 
 
 251 
 
MEDICAL SOCIOLOGY 
 
 by tlie armies of the crusaders must give place 
 to the policy as exemplified by the army of 
 Japan which multiplied threefold the number 
 of its medical men and tenfold their authority 
 and took a stand away in the van of human 
 progress. The sanitarian is to take the place 
 of the bearer of the sacred icon. The value of 
 medical supervision is demonstrated at Pana- 
 ma, where two continents are being cut in 
 twain; and where men are learning that the 
 operation to be well done, or, indeed, to be done 
 at all, must be performed with the aid of the 
 physician. 
 
 The most fertile lands on the green earth 
 have not yet been made the abode of man. He 
 has tended to grow away from them and into 
 the cold and uninviting north, because he could 
 eke out a living where bacteria could not; and 
 where bacteria were everywhere, he perished. 
 But medical science is destined to banish the 
 infective diseases from the tropics, and open up 
 for human habitation rich lands where the date 
 and banian now grow unseen by human eyes. 
 It is destined to give to mankind a new world, 
 equal in size to that which he now inhabits, and 
 many times more fertile, where grain will wave 
 and roses bloom the whole year through, and 
 
 252 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 children wax healthy and merry in lands now 
 pregnant with disease. 
 
 It is in making life more livable, in shielding 
 man from the miseen enemies which prey upon 
 his body, in preserving his family, and in com- 
 pleting his mastery over the malignant powers 
 of nature, that the field of medicine lies. The 
 scientific study of diseases has already lent its 
 aid, with importance equal to that of astron- 
 omy, geology, or biology, in purging the mind 
 of man of superstitions which since the begin- 
 ning of history have hampered his moral devel- 
 opment. The current saying that every doctor 
 is an atheist only means that the mind of the 
 doctor is more free from superstition than is 
 the mind of the average man. The ranks of 
 spiritualists and religious fanatics are not 
 recruited from physicians. The doctor has 
 learned to believe in the eternal materiality of 
 things and in the constancy of the forces which 
 connect them; and even though causes may be 
 hidden from his eyes he believes that they exist 
 and he has faith that they can be found. Pas- 
 teur in discovering the relation to disease of 
 the " infinitely small " things did as much as 
 Galileo in the overthrowing of superstitions and 
 the belief in miracles. 
 
 253 
 
MEDICAL SOCIOLOGY 
 
 We see how far-reaching are the influences 
 of our science and art, and how important a role 
 they play as human aids. They touch the bod- 
 ily and spiritual welfare of the individual, of 
 the state and of mankind. Hand in hand with 
 the progress of civilization go the advance- 
 ments of medicine. Medical progress has ever 
 been an index to human advancement. 
 
IX 
 
 PREVENTIVE MEDICINE 
 
 THE highest form of service which the 
 medical profession can perform for 
 mankind is in the prevention of dis- 
 eases. This is a field which is entirely its own. 
 In the other departments of medicine we come 
 within the realm of the other sciences, such as 
 biology, chemistry, and botany, but prophylaxis 
 is distinctly the function of medicine. Medicine 
 can never hope to be of as much value in the 
 treatment of diseases as it can in their preven- 
 tion. Cholera, smallpox, puerperal septicaemia, 
 yellow fever — it is here that humanity owes its 
 greatest debt to medicine. But curiously, treat- 
 ment must precede prophylaxis ; for it is in the 
 long and futile period of treatment that an in- 
 timacy and a familiarity with the disease is 
 bred, out of which grows the knowledge of the 
 disease which makes possible successful proph- 
 ylactic measures. 
 
 It is in the study of the prevention of dis- 
 18 255 
 
MEDICAL SOCIOLOGY 
 
 ease that medicine has no rivals, and is the least 
 apt to be misunderstood. This realm is not in- 
 vaded by the charlatan or the pseudo-scientific 
 sect. The " schools " of medicine have not to 
 do with prophylaxis. They are not interested 
 here. Homeopathy, osteopathy. Christian sci- 
 ence, the Emmanuel movement, vitopathy, and 
 the patent medicine movement, all are zealous 
 in the treatment of disease; but the science of 
 medicine differentiates itself from them in that, 
 while they are concerned for the sick, scientific 
 medicine is searching out the causes of disease 
 and applying preventive measures. Medicine, 
 as an organized profession, is the only great 
 movement having as an aim the reduction of 
 morbidity by preventing the well from becom- 
 ing sick. 
 
 Intelligent and scientific effort in the preven- 
 tion of disease is tangible and can be measured, 
 and is freer from confusion than is treatment. 
 In the treatment of diseases the forces of na- 
 ture are just as kind to the mercenary quack, 
 with his " incomparable elixir," as they are to 
 the conscientious and skilled physician, who 
 hopes only for the health of his patient. The 
 patients of both will recover; and so, too, will 
 the patient who is given some noxious drug. 
 
 256 
 
MEDICAL SCIENCE AN'D MEDICAL ART 
 
 The first two will be done no damage; the last 
 may be either harmed or helped ; but misunder- 
 standing and credit misplaced have been always 
 the accompaniments of the art of treatment. 
 Therapy is the inexact part of medicine. 
 
 What has been done toward the prevention 
 of cholera can be done with typhoid fever. The 
 fifteen thousand persons who died of this latter 
 disease in the United States during the past 
 year are a needless sacrifice, for medicine has 
 developed the knowledge which, if applied, 
 would make typhoid fever an obsolete disease. 
 Politics alone stands in the way. If the medi- 
 cal profession were given carte hlanche power to 
 eliminate typhoid, it would be done. Medicine 
 has perfected the knowledge of this disease and 
 the means for its prevention, and the people 
 want the disease stopped, but the representa- 
 tives of the people are busy with mergers and 
 tariffs and appropriations and jobs, while the 
 pale faces of those fifteen thousand, dying of a 
 preventable disease, are seen only by the pro- 
 fession of medicine. When some community is 
 awakened by an awful epidemic, it arouses it- 
 self, and some petty local measures are applied, 
 always successfully, to prevent the disease ; but 
 what is done for a village should be done for 
 
 257 
 
MEDICAL SOCIOLOGY 
 
 the State, for the country and ultimately for 
 the world — and the disease would end. 
 
 This will be done — it should be done now — 
 and then typhoid will pass into history, a con- 
 quered disease. In the meantime, your son, on 
 the threshold of life's work; and your daughter, 
 with the roses of health in her cheeks; and 
 jour wife, the mother of the laughing babe ; and 
 you, who are now reading these words, may re- 
 turn in the autumn, and lie down on your bed 
 and die ; for the mergers must be put through, 
 and the tariff must have attention, and the ap- 
 propriations must be passed round, and the 
 jobs are meat and drink. 
 
THE DITFUSIOF OF MEDICAL, KNOWLEDGE 
 
 WiEE we to ask ourselves the ques- 
 tion, How can the public appre- 
 ciation of the art and science of 
 medicine be improved? the answer would be, 
 education — ^education of the doctor and of the 
 public — and the means to this end are steadily 
 at work. The past generation has seen the 
 quality of the doctor much improved, and none 
 of the other branches of learning has surpassed 
 medicine in the march of progress. The young 
 men now entering practice represent a degree of 
 culture which gives to our profession the flower 
 of manhood; and the preparation necessary in 
 most of our institutions, and the legal require- 
 ments imposed in most States for a license to 
 practice, are all contributing to place the medi- 
 cal profession of the future upon a higher plane 
 than ever before. 
 
 A unified profession is of the next impor- 
 tance. That means laboring together in har- 
 
 259 
 
MEDICAL SOCIOLOGY 
 
 mony; each giving freely to the others what- 
 ever of advantage he may have to contribute; 
 vying with one another to see who can give the 
 most. Every commmiity should have its medi- 
 cal society for the interchange of ideas and the 
 reporting of experiences. The presence in a 
 community of a medical library is also of much 
 value. It is surprising how one or two high- 
 class men in a locality doing advanced work, act 
 as an inspiration to the rest of the profession, 
 and improve the habits and practices of their 
 colleagues. We find this everywhere. Around 
 every strong man there develops a school. In 
 many small cities and towns are groups of men 
 doing admirable work, sending abroad their in- 
 fluence, and giving a higher tone to their local 
 profession. 
 
 General and special societies help toward 
 the perfection of medical organization. A 
 great national society, such as we have in the 
 American Medical Association, can do much for 
 the advancement of medicine. Aside from its 
 functions as a society, with meetings and dis- 
 cussions, it can encourage the scientific spirit 
 by furthering pure science and offering encour- 
 agement and rewards for scientific work and 
 discoveries. Properly, this is the function of 
 
 260 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 the state, but the state is not yet ready to do 
 this, and only in a few rare instances has it 
 shown recognition to medical discoveries. Our 
 national organization is steadily increasing in 
 influence and usefulness. It has done much in 
 the exposure of frauds in proprietary medi- 
 cines. It stands for high ideals. It has ad- 
 vanced the cause of medicine by endeavoring 
 to secure a national department of health; and 
 it is conducting a scientific propaganda against 
 sexual vice and other products of public ignor- 
 ance. It behooves the profession to take pride 
 in this great association, and make it as per- 
 fect as possible and a fitting representative 
 of its most noble ideals and traditions. Such 
 an organization can be made to serve the best 
 ends of the profession; it can cultivate pro- 
 fessional uniformity and unity, bringing the 
 remote and humble doctor into closer touch 
 with his most advanced and successful col- 
 league. But, above all, the most important 
 work within the reach of such a great associa- 
 tion is that which is directly in line with the 
 essential aims of our art — the advancement of 
 medical knowledge. 
 
 In the relation of the medical profession to 
 the people, a needful step is the education of 
 
 261 
 
MEDICAL SOCIOLOGY 
 
 the public. By that, I mean, awakening in the 
 public mind an appreciation of the function, the 
 aims and the possibilities of medicine. There 
 is an ancient and still prevalent notion that it is 
 unethical to communicate these things to the 
 public, and a certain medical aloofness exists 
 which has left the field largely to that class of 
 pseudo-scientific persons who take upon them- 
 selves to misinform the public. A barrier of 
 secrecy has been encouraged by the doctors of 
 former days; and relics of the superstitions 
 of medicine linger even yet. Happily, the work 
 of breaking down these obstacles to the ad- 
 vancement of medicine is well under way. The 
 publications and circulars issued by state and 
 municipal departments of health are of much 
 value. Popular magazine articles and many 
 books give the public further enlightenment. 
 But still good would accrue if medical men 
 would contribute more upon medical subjects 
 for popular reading. Certain laymen have ren- 
 dered good service in this direction. The phy- 
 sician need not feel that in communicating med- 
 ical knowledge to the public he is laying himself 
 open to the charge of self-exploitation or of 
 invading the field of the charlatan. It is the 
 charlatan who is ever invading his field. The 
 
 262 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 campaign for the health of the people is a cam- 
 paign of education. If health departments are 
 to have their work go smoothly, the people must 
 understand it and be in sympathy with it. No 
 laws for improving public health will be satis- 
 factory if the people are ignorant of their 
 meaning. 
 
 The need in our general system of public edu- 
 cation to-day is the compulsory study and teach- 
 ing of biology, human physiology, and hygiene. 
 The most important thing for the student to 
 know about is himself, and this study should 
 supersede all others. It has taken two thou- 
 sand years to recover from the pernicious 
 teaching that one should give no thought of 
 what he should eat, or of what he should drink, 
 or where he should lay his head, or where withal 
 he should be clothed, or even of the morrow; 
 but now that enlightened people have rejected 
 this doctrine, it may be hoped that the race will 
 return to the joy and interest in its own ani- 
 mal health, and in the perfection of its off- 
 spring once displayed by those sturdy Greeks 
 before they were subjugated by the hosts of 
 asceticism which deprecated the joys of this 
 world. The first essential in the building of 
 character and morality is good health. The 
 
 263 
 
MEDICAL SOCIOLOGY 
 
 morality that is whining and sickly and prays 
 to be " set free " has done the world irretriev- 
 able harm. The joy in life and the joy in the 
 great gifts of nature are for the healthy. The 
 world needs the physically fit. 
 
 The engineer is most competent to keep his 
 engine in a state of efficiency who best knows 
 its construction, its workings, the dangers that 
 threaten it, and how to overcome them. The 
 most important thing that concerns the student 
 is his own body, and the most important thing 
 that concerns the race is its offspring. It is not 
 the part of wisdom to study the things all about 
 us without knowing about the very body for 
 whose benefit we presume to study these things. 
 A student may be able to read in Greek of the 
 prowess of Alexander, but it boots him little if 
 he is nearsighted and unable to ride a horse. 
 The overtrained college athlete has studied to 
 poor advantage when his heart gives out before 
 he is fifty. A man may know the history of all 
 the tribes of Israel, but his life contains a sad 
 failure if he is destined to spend it with a sickly 
 wife, the relic of a healthy sweetheart, whose 
 invalidism and sterility are of his own making 
 because of his ignorance. 
 
 Go into any of the two million homes in this 
 264 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 land now harboring an invalid, and in most of 
 them you can trace without difficulty the dis- 
 ease back to ignorance. Most of these sick are 
 suffering with preventable diseases. In some, 
 the culpability lies with the invalid; in some, 
 with the state ; but in all, the prophylaxis lay in 
 education. Knowledge and more knowledge of 
 ourselves is the need. 
 
 Not infrequently we hear expressed the no- 
 tion that it is best that laymen should not know 
 about their bodies. People are going to have 
 some sort of idea about these things, and it 
 is better that they should know what is true 
 than believe what is false. In a community 
 steeped in misinformation the truth can do no 
 harm. If they are not taught the truth the 
 newspapers and the charlatans will see to it 
 that they get some sort of information. A lay- 
 man who thinks that a pain in the back and a 
 sediment in the urine are signs of kidney dis- 
 ease is not an educated man. Enlighten the 
 public, and we shall have enlightened patients. 
 We need not fear to teach the public the prin- 
 ciples of therapeutics. Nearly every layman 
 has some favorite remedy for something. Let 
 some one be taken sick away from a doctor, and 
 witness the therapeutic suggestions pour in. 
 
 265 
 
MEDICAL SOCIOLOGY 
 
 There are certain fundamental and simple 
 facts in animal pathology which are of more 
 imjDortance for the individual to know than that 
 he should know of the pathology of nations, the 
 decay of djTiasties, or the moral pathology of 
 the French or English court. Yet our children 
 are taught the latter of these in their schools — 
 indeed, it is comjDulsory — but of the former, 
 they know little. 
 
 If the citizen is taught to take pride in the 
 military conquests of his country he should also 
 be taught to take pride in her conquests of dis- 
 ease. Let those be honored who have saved 
 as well as those who have destroyed. There is 
 no war which we should know of, or be taught 
 with greater zeal, than the conquest of small- 
 pox. The battle to save our mothers from puer- 
 peral sepsis, waged by Semmelweis, is of more 
 moment to humankind than is any of the bloody 
 fields of carnage Creasy wrote about. The con- 
 quest of pain by anesthesia ; the victory of asep- 
 sis ; the routing of the bacillus of diphtheria by 
 antitoxin; and the factory over the alimentary 
 infections of infancy, really all concern us more 
 deeply than the history of wars. History 
 should be something more than a narrative of 
 bloodshed and commercial conquests. There 
 
 266 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 have been soldiers whose mission has been to 
 win victory good for all time, victories, the prod- 
 ucts of which can never be wrenched from ns; 
 and the story of these victories should be known 
 to all. 
 
 This teaching should be accomplished by 
 school text-books, by formal history, and by 
 current literature. Medical associations could 
 do the progress of medicine an additional serv- 
 ice by supporting committees on publicity or 
 general enlightenment, whose function it should 
 be to advance the public knowledge and appre- 
 ciation of the medical sciences. 
 
 Some day a Gibbon or a Lecky or a Buckle 
 shall be raised up to write an history in which 
 the discoveries of medicine and the accomplish- 
 ments of sanitation shall be set down in their 
 real relation to the progress and well-being of 
 nations. The latter historian has come very 
 near doing it for England. Until that day it 
 remains for us to make the best material for 
 the historian of the future that lies in our 
 power. Let us make the records clear ; and the 
 historian shall find inspiration and joy in re- 
 cording the services of medicine to humanity. 
 
XI 
 
 COLLEGE PEEPAKATION FOR THE STUDY OP MEDICINE 
 
 THERE is much discussion concerning 
 the education that best fits a man to en- 
 ter upon tlie study and practice of med- 
 icine. There is not only much discussion of this 
 subject but much confusion as well. To say 
 that a man should have a collegiate education 
 before entering upon medical study is confu- 
 sing. It would be better and more simple to 
 say that he should have an adequate education. 
 Education is a glorious institution; it is the 
 next grade in human advancement below cul- 
 ture. It should not be confused with learning, 
 as it often is; nor should it be spoken of as 
 synonymous with a prescribed period of time 
 spent amid certain academic surroundings. 
 These are all different things. The education 
 which every man should have, or at least should 
 strive for, is that which is best calculated to 
 conduce to two things: his usefulness and his 
 happiness. I am much in sympathy with that 
 
 268 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 man wlio said he could not afford to take the 
 time to go to college because he was too busy 
 getting an education, even though this obser- 
 vation unfortunately does imply something of 
 lack of respect for that excellent organized 
 educational institution, the college, which, on 
 the whole, has more to commend it than the 
 haphazard facilities of the extra-collegiate 
 world. 
 
 To demand that matriculates in medicine 
 shall have had a college training, if not unwise, 
 is at least unfair, for the reason that the college 
 training, with all its preliminary requirements, 
 involves an amount of time which postpones 
 too late in life the completion of the medical 
 study necessary for the practice of medicine. 
 To shorten the college course by allowing the 
 last year or two to be applied to the course in 
 medicine, is an admirable step, but it compels 
 the student to study medicine in the same in- 
 stitution, unless reciprocity arrangements are 
 made between the colleges. Otherwise such a 
 course is not possible with the college that has 
 no medical department. 
 
 When the college gives a training that is 
 more practical and helpful and less devoted to 
 the things of minor importance, when it has 
 
 269 
 
MEDICAL SOCIOLOGY 
 
 freed itself of the ancient traditions of culture, 
 then men may be required to have enjoyed its 
 benefits before being allowed to take up medi- 
 cine. The medical school that requires the 
 bachelor's degree for admission excludes many 
 of the positively objectionable men, but it also 
 shuts out the one man, who occasionally comes 
 along, who would rise above all the rest, and 
 who could be of the greatest service to medicine 
 and to humanity. 
 
 Without entering into a discussion of the 
 weaknesses of the educational system to which 
 our American colleges are committed, it may 
 wisely be assumed that the medical student 
 should have some sort of a systematic prelim- 
 inary education, and the nearest approach to 
 what that should be is found in the college. 
 The defect which could be remedied most eas- 
 ily is the defect of attempting too much. The 
 college cannot hope to put the student in pos- 
 session of all human Imowledge. It should 
 help him with that which is most useful, train 
 his mind in habits of observation, logical think- 
 ing, memory and industry, and show him the in- 
 dex catalogue of the good things that life has 
 to offer. 
 
 So far as academic study and information go, 
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MEDICAL SCIENCE AND MEDICAL ART 
 
 the student gets the most important of these 
 before he enters college ; they constitute the en- 
 trance requirements. The principles of math- 
 ematics and the rudiments of the languages and 
 sciences are the things of importance to the 
 medical student, not higher mathematics and 
 the intricacies of tongues which he expects soon 
 to forget. Unfortunately under this prevalent 
 system the very important things, the princi- 
 ples, he studies in the preparatory school, not 
 with an appreciation of their meaning and 
 value, but as a grind, having for its end the 
 unconditioned admission to his favorite college. 
 He has skimmed through the best of his sub- 
 jects, and they dwell in the past as a vague 
 dream. The best results will be secured when 
 the student has more rudimentary teaching in 
 college. Let the requirements for admission be 
 less rigid, so that a man may enter at fifteen 
 and devote the first years of his college life 
 thoughtfully and deliberately to those impor- 
 tant things which the preparatory school now 
 attempts to teach him, but which the college, 
 beckoning him on, compels him to touch but 
 superficially. 
 
 Our one mistake is to combine the college and 
 university. These two should be separate. The 
 19 271 
 
MEDICAL SOCIOLOGY 
 
 boy at college gives much attention to athletics, 
 the fraternity and his chums. This is well and 
 good; but this so-called college life cannot be 
 advantageously combined with the work of the 
 student who is really a university man and en- 
 gaged in the scientific study of subjects for his 
 life work. It is also true that the boy's college 
 studies are not made sufficiently vital to him, 
 as something to help him in life. They do these 
 things better in Germany. There the univer- 
 sity is a university de facto, where the student 
 studies his special subject, and may follow it 
 to the full extent of human knowledge. The 
 gymnasium prejDares him for the university; 
 but the gjTnnasium is also an institution of 
 learning, and has not for its aim and end the 
 quiz compend function of the American pre- 
 paratory school. We have a few preparatory 
 schools which are worthy of a better name, and 
 they might wisely be remodeled, slightly ampli- 
 fied, and send their graduates directly to their 
 special university studies. Our so-called col- 
 leges and universities are something less than 
 universities and more than colleges. They are 
 becoming unwieldy and complex. In the de- 
 partment of arts the contact of pupil with 
 teacher, so valuable in the old-time college, has 
 
 272 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 disappeared. The best thing they have to offer 
 is the contact of student with student under cer- 
 tain regulations and in an atmosphere of cul- 
 ture. Aside from this the student may profit 
 by his opportunities little or much as he pleases, 
 just as he might if he were in any other posi- 
 tion in life. 
 
 I cannot conclude without offering the sug- 
 gestion that the college will attain to its great- 
 est usefulness only when it becomes a less pecu- 
 liar institution. By that I mean, it should 
 approach more closely the conditions of the life 
 for which it is preparing its students. The mo- 
 nastic life, as an educational scheme, is a fail- 
 ure. The period of a man's usefulness is short, 
 and life is too precious for one to step aside 
 from the path of usefulness and isolate himself, 
 professedly for self -improvement, for a period 
 of years, and then hope to come back and im- 
 mediately take up work as a useful member 
 of the community. The best way to prepare 
 for the life that one aims to lead is to live it. 
 The best schooling for usefulness is to be use- 
 ful. When our college system is perfected the 
 student will spend a certain part of each day 
 in some useful occupation — some occupation 
 which in the terms of the world has a com- 
 
 273 
 
MEDICAL SOCIOLOGY 
 
 mercial value. The best way to learn chem- 
 istry is to teach it at the same time; and so 
 the enlightened student will teach those who 
 are less enlightened than he. When a student 
 begins to have a grasp of a subject then he 
 should face about and take some part in teach- 
 ing those who are less proficient. Upper class 
 men should be instructors of lower class men. 
 Then there should be practical work with the 
 hands. Hoeing potatoes is just as good exer- 
 cise as golf, and sawing wood is a splendid 
 preparation for the oarsman, if one does these 
 things in the right spirit. The negroes at 
 Tuskegee have discovered this. Harvard must 
 learn it. 
 
 In medical schools the monastic policy has 
 recently been disposed of. The medical student 
 no longer gains his knowledge by sitting at the 
 feet of the grave and learned teachers, drinking 
 in their words of wisdom and deluding himself 
 that he is securing a medical education. No; 
 he walks the wards, he examines cases, he pre- 
 scribes, he puts on dressings, he takes histories, 
 he makes analyses. In fine, he prepares for 
 practicing medicine by practicing it and seeing 
 it practiced; and this has been found to be the 
 key to medical teaching. If he has good teach- 
 
 274 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 ers lie observes that they, too, are students. 
 The boy is father to the man. He recog- 
 nizes no line of demarcation; and, if he has 
 been well taught, a student he remains al- 
 ways. 
 
xn 
 
 THE HOSPITAL INTERNESHIP 
 
 SOME day no student will be graduated in 
 medicine and licensed to practice unless 
 he has had hospital experience. The 
 hospital will supplant, to a large degree, the 
 lecture hall. Students will be taught more at 
 the bedside. Some day the hospital and the 
 patients will appreciate the advantage of hav- 
 ing students in the wards. But that day is not 
 yet. At present a minority of graduates in 
 medicine have hospital experience. This is se- 
 cured by taking the competitive examination 
 for positions on the resident or interne staff 
 of the hospitals. 
 
 The student about to graduate in medicine, 
 casts his covetous eye about for the hospital 
 whose congenial walls shall receive him and 
 harbor him for some two years, while he pur- 
 sues the work which he hopes will culminate in 
 the making of a doctor. He is fortunate, in- 
 deed, if he rids himself of the idea that he is 
 
 276 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 after a hospital ; lie is wise if he is imbued with 
 the thought that he is seeking knowledge and 
 experience. There will be classmates of his 
 who, without becoming internes, will excel him 
 in both of these. The interneship is but an op- 
 portunity; there are many others. The ear- 
 nestness and the fidelity and the thoroughness 
 that he puts in his study tell the story. He can 
 get out of his cases only the knowledge that he 
 works out of them. There is no easy-chair 
 method. Scientific knowledge must be worked 
 for ; it is never a gratuity. So let the student try 
 for his interneship; he is fortunate if he gets 
 it — fortunate for the opportunities which it af- 
 fords. Happy is he if his college has taught 
 him enough of a subject to whet his appetite 
 for more. 
 
 Let us understand that we are brothers, and 
 always students, in a great confraternity. It is 
 for none to arrogate to himself the title of mas- 
 ter. The interne of yesterday is the attending 
 of to-day; and the knowledge of each is incom- 
 plete. Happy the two if they work together as 
 fellow-students in mutual helpfulness and sym- 
 pathy. That hospital is a blessing in which the 
 attending has a personal delight in the faith- 
 fulness of the house surgeon and the thorough- 
 
 277 
 
MEDICAL SOCIOLOGY 
 
 ness and perspicuity of the historian, and in 
 which the internes observe with pride the diag- 
 nostic acumen and therapeutic skill of the at- 
 tending, which he has developed out of the same 
 opportunities which now are theirs. 
 
 I have heard a house physician boast that he 
 had had entire charge of the service ever since 
 he came on duty. He might have had that any- 
 where in the great outside world of private 
 practice. Here is a house surgeon who tells 
 that he did six abdominal sections in a week, 
 but the chances are that the attending surgeon 
 was either lazy with satiety or indifferent with 
 overwork. 
 
 The hospital interne is better off in the hos- 
 pital where he is associated with thorough, 
 painstaking, and conscientious attendings, who 
 treat him as a fellow-student, working together 
 with them to learn and to improve themselves 
 in their branch of medical knowledge, than he 
 is in an institution where he is given responsi- 
 bilities, and goes it alone without the coopera- 
 tion of those of greater experience, knowledge, 
 and skill. All his life must be one of personal 
 responsibility; in the hospital he should bend 
 his energies to learning from others and with 
 others. 
 
 278 
 
MEDICAL SCIENCE AND MEDICAL AKT 
 
 And here I come to the question of learning. 
 Learning is of value as it has trained the mind 
 and the hand, and as it is available when need- 
 ed. I once saw a case of trichinosis slip through 
 the diagnostic fingers of three men, and be 
 caught by the fourth who had never before seen 
 a case; and the first three could have passed a 
 better examination in trichinosis than the man 
 who caught the pig. The first three had been 
 hospital internes, the last had not. Number 
 four had no more knowledge of the subject than 
 the others, but he had his knowledge formulated 
 and available. He had it in prospective rela- 
 tion to a case of trichinosis; the others had 
 theirs wrapped up and pigeonholed as inde- 
 pendent abstract material. It is the business of 
 the student to run a wire to his knowledge, and 
 keep the line in order. 
 
 Finally, it is not the college, it is not the hos- 
 pital, it is the animus within the man that shall 
 make him superior. If he has the thirst for 
 knowledge, he shall have it ; if he has the long- 
 ing to perfect himself, he shall excel. We have 
 pretty much what we desire; provided always 
 that we are worthy and capable. There is many 
 a country practitioner — who once had the ad- 
 vantages of the help and sympathy of a good 
 
 279 
 
MEDICAL SOCIOLOGY 
 
 preceptor, but never the advantages of a hos- 
 pital interneship — who carefully studies his 
 cases, thinks about them, reads about them, 
 compares them with previous cases, who is 
 above ready-made diagnoses and ready-made 
 prescriptions — ^who is in his art and science a 
 peer, and in his community the well-beloved 
 physician and the noblest type of a well-rounded 
 man. 
 
XIII 
 
 STATE AND COLLEGE MEDICAL EXAMINATIONS 
 
 THE large amount of discussion and the 
 diversity of opinions prevalent upon 
 tlie subject of medical education and 
 medical examinations show a restlessness and 
 a certain degree of dissatisfaction which are 
 salutary. An association of American Medical 
 Colleges has been organized, and its work has 
 resulted in an elevation in the standards of re- 
 quirements for the doctor's degree. While the 
 teaching of medicine has made advances along 
 practical lines, the examination of the student, 
 to test the learning that he has derived from his 
 teaching, has not progressed so far. The old 
 methods of oral and written examinations, 
 chiefly the latter, are still the main reliance of 
 the examiner. We know how imperfectly these 
 examinations test the merits of the student, and 
 we know how important a part is played by the 
 cramming process and the expedients which 
 constitute short cuts to success in examinations. 
 
 281 
 
MEDICAL SOCIOLOGY 
 
 The function of the doctor is a complex one. 
 He has many things to do, all of a practical 
 nature, and he must know many things. A doc- 
 tor must have knowledge which cannot be con- 
 densed in a compend or even in a more preten- 
 tious volume, and which the answering of 
 questions does not test. A student may be able 
 to answer as well as his professor the question, 
 What are the symptoms of scarlatina? but, does 
 he know scarlatina when he sees it? — that is the 
 question. How would you treat a fracture of 
 the lower end of the radius 1 may be glibly and 
 correctly answered by one who is not able to 
 treat correctly a fracture of the lower end of 
 the radius. A practical examination is needed. 
 In many of our medical schools such an exam- 
 ination is conducted in part: the students are 
 marked in their practical and clinical work, and 
 these marks figure in the ultimate result. Many 
 hospital examinations for internes combine the 
 practical and theoretical. These examinations 
 often demonstrate that a man who passes an 
 acceptable written examination is not qualified 
 for the honorable title of doctor. If the state 
 recognizes him as such, his title should be Doc- 
 tus sed non Doctor. The state examinations are 
 written and not practical, still, it would not be 
 
 282 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 difficult to make them practical. If the hospi- 
 tals can do it the state can do it. It is success- 
 fully done in Germany, where the candidate is 
 not granted a license to practice until he has 
 shown actually that he has practical qualifica- 
 tions. He must display his ability to diagnose 
 diseases, to make examinations, and to conduct 
 treatment. 
 
 The horrible imputation used to be made that 
 in certain states a man without medical train- 
 ing, with a good memory and a quiz compend, 
 could pass the state's examination; and if he 
 had the quiz compend in his pocket he need not 
 even have a good memory. We should doubt 
 the correctness of these assertions; but the 
 mere fact that such statements have been made 
 reflects upon the practical character of the ex- 
 aminations. 
 
 One of the blighting influences upon the study 
 and teaching of medicine is the examination 
 system. Its pernicious effects may be seen 
 from the beginning to the end of the modem 
 medical curriculum. Unfortunately, the exam- 
 ination fetich is gaining a stronger hold upon 
 medical education instead of declining. Its in- 
 fluence is detrimental to our true aims. The 
 present methods of conductiag examinations 
 
 283 
 
MEDICAL SOCIOLOGY 
 
 have a demoralizing effect upon both the student 
 and teacher. According to Matthew Arnold, the 
 true aim of education is " to develop the power 
 of our minds and to give us access to vital 
 knowledge." If the modern examination sys- 
 tem does discover the powers of mind or the 
 possession of vital knowledge, then it is good. 
 But does it! Is it possible for an examiner who 
 has never seen the candidate before, by asking 
 a few questions, to discover " the powers of his 
 mind," and determine whether he is educated 
 or no ? By this " external examination," the 
 powers of the mind can be tested only to a very 
 limited degree. One power of the mind is 
 tested, and that is the power of passing exam- 
 inations — the power of quickly recalling things 
 recently learned. Lauriston E. Shaw says that 
 it is just as illogical continually to worry a man, 
 who is trying to develop the higher faculties of 
 his mind, with investigations as to his memory, 
 as it would be periodically to test the lifting 
 power of a man who is learning to play the 
 fiddle. The student is studying medicine to per- 
 fect himself in the observation and treatment of 
 disease, not to cultivate his memory and his 
 self-confidence. 
 " We tell whether a man has been well edu- 
 284 
 
MEDICAL SCIE^TCE AND MEDICAL ART 
 
 cated not by what lie knows but by what he can 
 understand." It is not the answer to questions 
 that examiners should want, but rather knowl- 
 edge of the fitness of the candidate to practice 
 medicine. 
 
XIV 
 
 THE STATE LICENSE TO PEACTICE MEDICINE 
 
 THE present medical laws in most of the 
 States are the best that could be secured 
 at the time of their enactment. They 
 have served an excellent purpose in protecting 
 the people from the worst types of incompe- 
 tence. Their value has been appreciated; and 
 many have been in operation long enough for 
 their weaknesses to have been made manifest. 
 A weakness in some is that they keep alive the 
 so-called " schools of medicine," which are not 
 entitled to be regarded as separate schools and 
 which in reality do not exist. Homeopathic and 
 eclectic medicine have practically disappeared; 
 still, the laws of some states keep alive the de- 
 lusion that they do exist. 
 
 There is decided harm in laws which create 
 two or three separate examining boards. Other 
 " schools " of peculiar therapeutics are de- 
 manding the same special privileges which al- 
 ready have been accorded to the two " schools " 
 
 286 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 now recognized. The same laws, it is insisted, 
 which apply to homeopathy, should apply to os- 
 teopathy, provided each complies with the same 
 requirements; and legislators cannot much 
 longer be made to see it in any other light. 
 When the state recognized one peculiar sect it 
 opened the way to recognize all. 
 
 Before this absurdity has gone any further it 
 should be stopped. There should be a single 
 examining board in each State, whose business 
 it should be to examine into the qualifications 
 of candidates applying for a license to practice 
 the healing art. Some States have adopted this 
 system. This board should determine partic- 
 ularly the candidate's knowledge of the hu- 
 man body and its diseases, their causes, their 
 effects upon the body, their prevention and 
 their treatment. Of treatment, the most that 
 we can demand is that it shall be either rea- 
 sonable or authoritatively sanctioned; and ad- 
 vances of medical science will constantly make 
 this a variable subject. What was authorita- 
 tively sanctioned treatment twenty years ago 
 would not satisfy the demands of a present-day 
 examining board; and we may draw the same 
 odious comparison between some of our modem 
 therapeutics and that of twenty years hence. 
 20 287 
 
MEDICAL SOCIOLOGY 
 
 This board should determine that a candidate 
 has complied with certain educational require- 
 ments, at least as high as are now insisted 
 upon; and, having a satisfactory knowledge of 
 the science of medicine, he should be licensed 
 and allowed much latitude in his choice of treat- 
 ment, A doctor whom the state recognizes 
 should be simply a doctor. The state should 
 know no homeopaths, eclectics, osteopaths, or 
 hydropaths. Therapeutics is but a small part 
 of the science of medicine. It should be the 
 privilege of the licensed doctor to use small 
 doses or large doses, massage or hydrotherapy, 
 or whatever he please, provided he be well 
 grounded in the fundamentals of medical sci- 
 ence. 
 
 While the United States generally have sup- 
 ported high educational standards in the in- 
 terest of the health of the people, it should not 
 be lost sight of that there have been continuous 
 assaults aimed against these high standards. 
 The enactment and maintenance of salutary 
 medical laws have not been altogether without 
 opposition. 
 
 To the medical profession belongs the credit 
 of having created these standards. It has been 
 the medical profession that has served the high- 
 
 288 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 est interests of the people by imposing higher 
 and more difficult requirements upon itself. 
 Behind every act of legislation which has raised 
 the standard of requirements for the practice 
 of medicine has stood the great body of its medi- 
 cal men. They have supported every act of 
 legislation which has aimed to preserve the 
 health of the people, to improve sanitary condi- 
 tions and to minimize sickness. 
 
XV 
 
 THE PRACTICE OF MEDICINE LEGALLY DEFINED 
 
 AN adequate definition of what consti- 
 tutes the practice of medicine has long 
 . been a desideratum whereby to deter- 
 mine compliance with the medical practice law 
 or violation of the same. The Appellate Divi- 
 sion of the Supreme Court of New York State 
 rendered a decision in 1907 which supplies this 
 want. The judgment of the Appellate Court is, 
 that, to confine the definition of the words 
 " practice of medicine " to the mere adminis- 
 tration of drugs or the use of surgical instru- 
 ments would be to eliminate the very comer- 
 stone of successful medical practice — namely, 
 diagnosis. The court holds that such an inter- 
 pretation would rule out of the profession the 
 eminent men whose work is confined to consul- 
 tation and diagnosis. Diagnosis is an integral 
 part of both the study and the practice of medi- 
 cine. The court, citing the instance of consump- 
 tion, which may, if discovered in time, be ar- 
 
 290 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 rested and eradicated by simple hygienic treat- 
 ment, and that in the treatment of this disease 
 drugs have been practically given up, pro- 
 pounded the question, " Would the physician, 
 in such a case, who by his skill discovered the 
 incipient disease, advised the open-air treat- 
 ment and refrained from administering drugs, 
 not be practicing medicine"?" The court re- 
 ferred to the statement of another court in a 
 similar case to the effect that, " the day has 
 passed when it was thought that a physician's 
 advice was of no use unless he ordered a dose 
 of medicine." 
 
 It is held that the purpose of the medical law 
 is to protect the people against charlatanism, 
 ignorance, and quackery, and that it is not the 
 legislative intent to restrict the examination of 
 those desiring to practice medicine solely to 
 that class of the profession who may prescribe 
 drugs. This decision was arrived at after a 
 study of the authorities throughout the country, 
 and from examination into the history and 
 growth of our own public health laws. 
 
XVI 
 
 THE MEDICAL EXPERT WITNESS 
 
 THE medical expert witness often is 
 spoken of in derision. Unfortunately 
 the derisive comments are not confined 
 to the lay press, but the medical press also has 
 not hesitated to cast its calumny upon him. Is 
 this opprobrium justified by the facts? 
 
 Medical men are subject to the same defects 
 of judgment and limitations of insight as be- 
 long to other men. They are not peculiar in 
 freedom from human weaknesses. Medical men 
 can be differentiated from other men in two re- 
 spects : they represent as a whole as high moral 
 qualities as any class, and they possess the 
 greatest knowledge of the human body and its 
 diseases. These two assertions are easy to de- 
 fend. 
 
 If expert medical testimony is required, the 
 best man from whom to get it is a doctor of 
 medicine. Occasions always will arise when 
 such testimony will be desired. It is sought 
 
 292 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 from him, according to Mr. Chief Justice Shaw, 
 " because his professional pursuits, his peculiar 
 skill and knowledge in some department of sci- 
 ence, not common to men in general, enables 
 him to draw an inference, where men of com- 
 mon experience, after all the facts proved, 
 would be left in doubt." 
 
 Why do the apparent discrepancies of testi- 
 mony occur which foster the misconceptions 
 concerning the medical expert witness with 
 which we are so familiar 1 The answer is to be 
 found in the codes of proceedings of the courts, 
 in certain laws of the state which make for in- 
 justice, in the license which the courts place in 
 the hands of the examining counsel, and the 
 limitations to which the witness is confined, and 
 not in the honesty or knowledge of the expert. 
 
 Of all the devices created by the law, which 
 make for the subversion of justice, the hypo- 
 thetical question stands among the preeminent. 
 Give a skillful lawyer the privilege of asking 
 questions, real or hypothetical, to be answered 
 by " yes " or " no," and he can frame them in 
 such a way as to put the answer in the witness' 
 mouth; the lawyer who cannot ask an hypothet- 
 ical question in such a way as to get the answer 
 he desires is not a clever lawyer. It is framed 
 
 293 
 
MEDICAL SOCIOLOGY 
 
 so as to secure in one word the answer to a num- 
 ber of questions ; and few medical experts ever 
 answered such a question without a feeling of 
 resentment at its unfairness, or at least a de- 
 sire to qualify the answer by further explana- 
 tions. The witness is required to give his 
 opinion upon a great collection of supposed 
 facts, but we do not know what his opinion 
 would be if one of these supposed facts were 
 withdrawn or were discovered not to be a fact. 
 He is asked for the truth, and nothing but the 
 truth, and then is not permitted to tell it. 
 
 Another unfortunate side to this question is 
 that the expert witness is made to have a finan- 
 cial interest in one side of the case. A certain 
 opinion is sought and it is to be paid for. No 
 fair or generous man lives who has something 
 to give, the giving of which costs him nothing, 
 and who is to be well paid for it, but will tend 
 unconsciously to give freely what is wanted. 
 It is for this reason that the expert, no matter 
 how honest he is, leans toward the side that 
 employs him. This prejudice will exist until he 
 is made to stand upon neutral ground. Neutral 
 ground can only be secured by requiring the 
 witness to testify as to the nature of the case, 
 being retained by both or by neither side. The 
 
 294 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 court should desire the impartial truth, and in 
 order to secure it the expert witness must l)e 
 in a position to be as impartial as the judge. 
 
 It is, moreover, clearly unfair to ask from a 
 medical man judgment upon a case without his 
 having had an opportunity to examine the pa- 
 tient. Particularly is this so if another medical 
 man, who is to testify " on the other side," has 
 had such an opportunity. It is earnestly to be 
 wished that lawyers might realize that in medi- 
 cine there is no " other side." The truth is all 
 there is. 
 
 If medical witnesses are summoned by the two 
 sides, let them have a fair and equal opportu- 
 nity to examine the patient together, and dis- 
 cuss the case as they would in a consultation, 
 and it will be found pretty generally that they 
 agree. Men who are really experts are all pos- 
 sessed of the best knowledge of their subject. 
 Medicine as a science is not so very inexact. Let 
 these men be called upon the witness stand. Let 
 them not be handed over as automatons to the 
 contending counsels to be bandied about; but, 
 as men of intelligence and knowledge from 
 whom the court desires the truth, let them be 
 allowed to elucidate the question, and it will be 
 found generally that they are of the same opin- 
 
 295 
 
MEDICAL SOCIOLOGY 
 
 ion in the court room as they are in the examin- 
 ing room. 
 
 It is the trick of the lawyer to make the medi- 
 cal expert his tool. It is to the discredit of the 
 courts that this is so. The lawyer's practice 
 is to present one side of a case, the doctor's 
 practice should be to deal squarely with the 
 whole, and to subvert this practice means mis- 
 understandings. 
 
 The hue and cry against the medical expert 
 is virtually a reflection not upon him, but upon 
 the practice of our courts and the laws which 
 govern them, and which are responsible for the 
 injustice which makes him one of its victims. 
 
XVII 
 
 THE PRECEPTOR 
 
 1WISH that we might have restored to us 
 in some way the old relation of preceptor 
 and pupil. Personality is such a strong- 
 factor in teaching, it is a great loss to sacrifice 
 it. Teaching is becoming a composite and com- 
 plicated function — like much of our modem-day 
 processes, it is gaining in efficient machinery 
 but losing in inspiring personality. I would not 
 say that students are not taught better now 
 than ever before, nor would I say that shoes 
 are not made better now than in the olden days ; 
 but the passing of the dear old cobbler, who was 
 my neighbor, and who hoed in his garden after 
 supper, has deprived me of just that much hu- 
 man kinship. The medical student needs to 
 hear the living voice of the master. 
 
 It is of great value to a young man to have a 
 whole man as his ideal. Let me explain: The 
 student now divides his time equally among 
 many teachers. He admires this one's diagnos- 
 
 297 
 
MEDICAL SOCIOLOGY 
 
 tic acumen, that one's painstaking honesty, and 
 the splendid therapeutic technic of another ; but 
 when all are done and he goes to work for him- 
 self his ideal, if he has any, is a composite, not 
 a loved and respected individual; and a com- 
 posite lacks bowels. 
 
 The broad field of medicine will never again 
 be mastered by any single man. Students have 
 long ago ceased to go to Leyden to study with 
 Gaubius. The student now in his college work 
 comes under the influence of a number of teach- 
 ers, each excelling in his special branch. But 
 it is possible for him when he enters into prac- 
 tice to enjoy the advantage of which the modem 
 stress of the times has deprived him. Then if 
 he can, as an assistant or an associate, become 
 attached to some practitioner, whom time and 
 experience have made both wise and venerable, 
 he is, indeed, a fortunate youth. This is one of 
 the reasons why the doctor's son enjoys an es- 
 pecial advantage; he has a preceptor whom he 
 respects and who loves him. We can best have 
 ideals by seeing them in reality. 
 
xvni 
 
 THE GENEKAL PRACTITIONER AND THE CLINICAL 
 ASSISTANT 
 
 THE time was when the practitioner 
 of medicine worked independently and 
 alone, jealous of his own knowledge and 
 skill. The modern practitioner does not harbor 
 this jealousy, but lives and works in an atmos- 
 phere of cooperation. The principles of reci- 
 procity are to be still further amplified among 
 practitioners of medicine. No better fortune 
 can come to the young man, even though he has 
 just finished an interneship, than to begin his 
 practice in close association with a well-edu- 
 cated physician with a good-sized clientele. 
 The younger man should be his senior's assis- 
 tant. His value will be in the finer methods of 
 clinical diagnosis. He also can give his atten- 
 tion to looking up the literature of cases which 
 are being studied and to the investigation of 
 the newest methods of treatment. 
 
 The equipment necessary for applying the 
 modern methods of clinical diagnosis is neither 
 
 299 
 
MEDICAL SOCIOLOGY 
 
 formidable nor out of the reach of the general 
 practitioner. It does not require a complicated 
 laboratory, although a laboratory is desirable. 
 A table for a microscope and its appurtenances 
 is necessary. If there are no rooms adjacent 
 to the consulting room, a small incubating oven 
 may be set up in the kitchen. The apparatuses 
 for blood counting and for determining blood 
 pressure should be added to the clinical ther- 
 mometer and the stethoscope. The important 
 examinations to be made are of the sputum, the 
 urine, stomach contents, feces, the blood, and 
 bacteriological tests of mucous-membrane dis- 
 charges. The young men who are now being 
 sent out to practice medicine have been taught 
 these things, and they should practice them. 
 The best conditions of general practice are 
 served when the busy practitioner associates 
 with him such a man. Their mutual interests 
 will be helped. It is universally true, other 
 things being equal, that, the better work a phy- 
 sician does, the better are his emoluments. 
 
 We must return, in a measure, to the old sys- 
 tem of preceptor and pupil ; the latter, however, 
 being a licensed and scientific physician who 
 gives as much as he receives. He should give 
 his services as an assistant in the lines above 
 
 300 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 referred to. He also may be called upon to do 
 some of the night work, to do dressings, admin- 
 ister anaesthetics, and in many other ways to 
 lighten the burdens of the senior, and in so do- 
 ing help out his own income and lay the founda- 
 tion for his future work. The latter can con- 
 tribute the lessons which experience has taught. 
 He can give his assistant — or, preferably, asso- 
 ciate — the benefit of that combination of knowl- 
 edge, skill, tact, and judgment which the schools 
 cannot teach, and which can only be developed 
 by time, and well-guided experience; it is the 
 atmosphere that surrounds the ideal physician. 
 He can turn over to his associate cases which he 
 prefers not to treat. 
 
 The same younger man may be associated 
 with two or more physicians if one has not suf- 
 ficient work to keep him busy. As the younger 
 man becomes more and more engaged with gen- 
 eral practice he will give less time to the labora- 
 tory, but it is surprising how habits of accuracy 
 in diagnosis cling to a man who has once prac- 
 ticed them. It is also surprising how difficult 
 it is for a man, who starts in practice " by the 
 rule of thumb," to get away from his careless 
 habits. About the worst thing that can happen 
 to a young man is to enter immediately into a 
 
 301 
 
MEDICAL SOCIOLOGY 
 
 large and driving general practice before he 
 has had a chance to get himself squarely ori- 
 ented with regard to general medical work. 
 The best results are to be secured by gradually 
 growing out of the clinical laboratory and the 
 deliberate and leisurely study of cases into gen- 
 eral practice. 
 
XIX 
 
 WORK AND PLAY 
 
 LET it be laid down as a rule of life that 
 a man should not be addicted too much 
 ^ to any one thing. The wisdom of a 
 wholesome variety and the mixing of play with 
 work should drive the busy man afield in cer- 
 tain seasons of the year in search of change and 
 recreation. To none do these observations ap- 
 ply more than to the dweller in the city, and to 
 no dweller in the city more than to the doctor 
 of medicine. He lives and works in an atmos- 
 phere of stress, and he cannot help himself be- 
 ing influenced by it. He is surrounded by the 
 rush for gain and power, which he cannot help 
 from entering into his blood. About him is the 
 strenuous business life, 
 
 Where with like haste, thro' diff'rent ways they run, 
 Some to undo, and some to be undone. 
 
 The city life is an unnatural life. It lacks 
 the recreation to be found in manual toil. The 
 31 303 
 
MEDICAL SOCIOLOGY 
 
 surgeon uses his hands, to be sure, but his work 
 is associated with so much personal responsi- 
 bility and nervous strain that the real hygienic 
 advantage to the worker is neutralized. The 
 average city business or professional man, if 
 he is wise and fortunate for a season turns his 
 back upon this scene of artificial life, and seeks 
 the places which men have not defiled. Let 
 him go where he will look up to the blue sky — 
 I shall not say can, for he can look up to it in 
 town if he only would — and let him roam the 
 fields or woods or sea; and he will be a better 
 doctor for it, and his patients will receive bet- 
 ter advice when he returns. 
 
 There are many diversions which are helpful 
 to the practice of medicine — riding, driving, 
 walking, the outdoor games, and working with 
 the hands. They are all there, waiting for the 
 man who will let them take hold of him and 
 help him. As to fishing, the best way to fish is, 
 Tityruslike, to lie beneath the shadow of the 
 branches of a widespreading beech, and read 
 the " Complete Angler." Walking has much 
 to recommend it. It is an ancient pastime. 
 Among our primitive ancestors it was culti- 
 vated as the most approved means of travel. 
 To those of the equipage and the motor car, I 
 
 304 
 
MEDICAL SCIENCE AND MEDICAL AET 
 
 commend it. Take with you the society in 
 which, of all the world, you find the greatest 
 joy, and walk the fields, breathe deeply, inhale 
 the breath of flowers, behold the pictures na- 
 ture has made, listen to the songs of birds ; and 
 when you return to work you will radiate joy 
 just in the proportion that you have absorbed 
 it out of the great world of beauty in which you 
 have sojourned. 
 
 The country practitioner leads a more round- 
 ed life. He is less apt to be addicted too much 
 to any one thing. He has his wholesome diver- 
 sions. Some of these diversions his city 
 brother, by taste and education, or want of 
 education, would not undertake; but they will 
 lengthen his days. Let the man who puts out 
 his own horse and trims his hedge after the 
 day's work is done not envy him who drops 
 into the great upholstered chair at the club 
 around the corner from his of&ce and fills the 
 circumambient air with rings of fragrant smoke 
 at the close of the day. The city has always 
 been the destroyer of men and of families. 
 Urhs edax rerum. No city would long endure 
 were it not replenished with brawn and brains 
 from the fields and mountains. 
 
 Still, the country practitioner would profit 
 305 
 
MEDICAL SOCIOLOGY 
 
 much by certain relaxations which he too rarely 
 takes. He needs the inspiration of the contact 
 with his fellows. He needs the meetings of his 
 medical societies more than his city brother 
 does. At such meetings he exchanges ideas 
 with men of larger experience and wider ob- 
 servation than he. He needs to have his faith 
 in certain things corroborated and his doubts in 
 others confirmed. The pleasure in his work 
 can be much increased by finding the ideas 
 which he has gained from one case agreeing 
 with the experiences in a hundred others. What 
 has been in his mind as an unsettled theory be- 
 comes a solid working fact through the results 
 of others' observations ; and he goes back to his 
 work with new inspirations and a firmer hold 
 upon the essentials of his art. 
 
 As the practice of medicine goes, most practi- 
 tioners devote themselves so assiduously and 
 self-sacrificingly to their work that some form 
 of sporadic relaxation does good and helps 
 their minds and bodies; and in many cases 
 it becomes a necessity. Properly viewed, this 
 is true, unfortunately. The necessity for a va- 
 cation is an acknowledgment that something is 
 wrong; and as a matter of fact something is 
 wrong. Few men are doing their work under 
 
 306 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 the best conditions. This is true because there 
 are few men who do not need a vacation, or who 
 are not benefited by one. 
 
 There is a Sabbatic tradition that has come 
 down to us from remote times. This tradition 
 has become a part of our religion and entered 
 into the laws of the state. But it is not well 
 founded. It is unnatural that a man should 
 conduct himself for six days in such a manner 
 that at the end of that time he needs a day's 
 rest from his doings of the other six. Still, 
 most of us do. How much better it would be 
 if we might live so that on Tuesday morning 
 we should begin work as much refreshed as on 
 Monday, and Saturday should find us as ready 
 for labor and play as Wednesday had, and that 
 our services and thoughts might be as holy on 
 each day of the seven as we could make them. 
 This would be the equable life, which we have 
 not yet learned to live. 
 
 The average professional and business man 
 must have his summer vacation ; he shortens his 
 life without it. Essentially, it is not the sum- 
 mer vacation that is so good, it is the preceding 
 months of work that are so bad. He has vio- 
 lated the laws of health: the vacation is the 
 therapy; he takes it as a cure to save his life. 
 
 307 
 
MEDICAL SOCIOLOGY 
 
 Better that he should not need the cure ; proph- 
 ylaxis is the thing. 
 
 Let us hope that we may attain to that state 
 in which work and play and prayer and medi- 
 tation shall be so harmoniously combined and 
 progress together so smoothly and naturally 
 that a surcease from our method of life need 
 never be a necessity. Then shall each day of 
 the seven have its Sabbath hours, each day of 
 the summer and winter, too, its portion of va- 
 cation; and so in all the days and seasons of 
 the year, the stream of life shall flow smoothly 
 on toward the great sea of eternity. 
 
 And, furthermore, let it be provided always 
 that no useful man shall envy the man who has 
 a great stock of health and nothing more. 
 
A WELL-OEDERED LIFE 
 
 WHEN a man is found who orders his 
 life pretty close to the ideal it is 
 well to take cognizance of him. I 
 know a man, a practitioner of medicine, yomig 
 and strong at sixty-two, who lives the normal 
 life — at least as nearly as it is possible for a 
 practitioner of medicine to live it surrounded 
 by a community of violators of the code of na- 
 ture's ethics. He sees as many patients each 
 day as time will permit, giving each one as 
 much attention as though he were the only case 
 he had. He saves time by choosing his friends 
 among the most congenial, not among his pa- 
 tients. He never makes a companion of a pa- 
 tient for policy's sake. He " sits around " nei- 
 ther in the sick room nor in the drug store. He 
 prefers not to be called where he is expected to 
 entertain the family or consult with the grand- 
 mothers. He chooses his companions among 
 the well. He is one of the best-posted men that 
 
 309 
 
MEDICAL SOCIOLOGY 
 
 I know; and his judgment and learning make 
 him sought by many a colleague who desires 
 to get at the heart of a case. His library is 
 well stocked with the best current medical liter- 
 ature and books of reference. Usually he has 
 a young practitioner associated with him. In 
 a small laboratory connected with his office the 
 finer details of diagnosis receive attention. He 
 has the newest apparatuses of accuracy, but 
 whenever possible he prefers to depend upon 
 the old and tried blunt methods. He can hear 
 almost as much with his naked ear as with the 
 stethoscope. Still he keeps his associate pretty 
 busy making microscopic examinations. 
 
 This man received much of his early medical 
 education under the masters of Europe thirty- 
 five years ago, yet he attempts no specialty; 
 even minor surgery he delegates to some one 
 else. He keeps well posted upon the advances in 
 the specialties, and hnoivs what they can do for 
 his patients. He sees a comparatively large 
 number of patients each day, and possesses a 
 wonderful store of formulated knowledge based 
 on experience. He is a regular attendant at his 
 medical societies, where his discussions are al- 
 ways models of clearness and scientific thought. 
 He thoroughly enjoys his work, and still finds 
 
 310 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 as much pleasure in getting at a diagnosis as 
 he ever did in his student days. He still re- 
 gards himself in every sense a student. 
 
 So much for this man at work: he is not so 
 very different from many of our high-class 
 practitioners ; but at play he is, for I know no 
 man who brings such a happy philosophy into 
 all the hours of the day. He is one of the sweet- 
 est, most courteous, and fragrant characters; 
 and in every sense a gentleman. Above all, he 
 is original. He insists that his family, and even 
 himself, are a part of the community which is 
 entitled to his best thought and attention, as 
 well as the sick. The sick summon him because 
 they regard him as the best doctor to get them 
 well; but his own call him because they love 
 him. For certain hours during the day this 
 good man devotes himself to the well, I know 
 that he himself practically prepared one of 
 his sons and a daughter for college; and 
 they all thought it was play. At the present 
 time he has a class in biology and natural his- 
 tory, and the two oldest pupils are himself and 
 his grandson, aged eight. I met them coming 
 in from the suburbs one morning before break- 
 fast with a can of tadpoles and half a dozen 
 frogs in an old medicine bag. I do not know 
 
 311 
 
MEDICAL SOCIOLOGY 
 
 where he got them, but he said that he was 
 taking them to his Sunday school. 
 
 He loves his children and grandchildren. He 
 recognizes children as our best teachers. The 
 responsibilities which they bring make us bet- 
 ter. They teach us self-denial and considera- 
 tion for others. He says that children are the 
 real missionaries that are redeeming the world. 
 
 He is one of the boys with the boys. I saw 
 him once with three grandchildren on his back, 
 playing in the very middle of the day, and his 
 wife threatened with apoplexy from laughter; 
 and I happened to know that at that time there 
 were four peo]Dle trying to find him. When he 
 is not in his office his servants know that he is 
 not in ; and when he is occupied with his family 
 he is just as occupied as though he were with 
 the sick. He recognizes his duty to them and 
 to himself, and he claims that it makes him a 
 better doctor. By doing well by the well he is 
 better able to do so by the sick. He has a gar- 
 den full of flowers, a house full of happiness, 
 and a heart full of love for all the things in 
 nature. The curious part of it is that each day 
 in the seven is the same, and he has never taken 
 a vacation because he needed it. 
 
 The work of this good man is among all 
 312 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 classes of people — from the very rich to the 
 very poor. To whomever he goes he gives his 
 best thought, and faithful and conscientious 
 service, whether paid in money or in some bet- 
 ter currency. He is loved by all of these, and 
 respected and honored by his profession. Grad- 
 ually an undesirable class of patients has be- 
 come estranged from him — those who want to 
 take medicine — for he is one of the few men 
 in his community who often see a case through 
 an illness without resorting to the drug store 
 at all. Sometimes his advice to patients dis- 
 plays so sharp an insight into their characters 
 and habits that they seek some other adviser 
 who will be more impersonal. This, together 
 with his disinclination to spend time over the 
 trivialities with unprofitable people, has kept 
 his practice down to a comfortable working 
 basis. Most of the men who were his contem- 
 poraries in early practice have passed away, 
 and during their last few years many of them 
 were inefficient from overwork. This man is a 
 better doctor to-day than he ever was. He is 
 like an oak which buffets the storms and basks 
 in the sun, and is the same from day to day. 
 He has no ups and downs, because he is always 
 up. In the community he is a public-spirited 
 
 313 
 
MEDICAL SOCIOLOGY 
 
 citizen, taking an active share in politics and 
 devoting mucli time to educational work. He 
 is a member of the local school board, and has 
 been instrumental in the inauguration of school 
 methods that have attracted wide attention. 
 
 Now for the strangest thing of all. The one 
 class of people who profess love and charity 
 shrug their shoulders when asked about this 
 man, and many have no good word for him, ex- 
 cept that they hear he is a good doctor. Good 
 doctor, forsooth! What better can be said of 
 any man? He is, indeed, a good doctor; his re- 
 wards he reaps each day; and he is paving a 
 path to immortality strewn with flowers of 
 sweetest perfume and echoing with the music 
 of the voices of children. 
 
XXI 
 
 THE PHYSICIAN IN POLITICS 
 
 EVEEY physician has been advised to 
 keep out of politics. This advice cannot 
 be escaped. The Commencement-day 
 orator delivers it to the graduating class, the 
 old physician cautions the young man against 
 " mixing in politics," the literature of medicine 
 perpetuates the admonition, and medical circles 
 have a perennial sneer for the " political doc- 
 tor." It is to be wished that there might be less 
 of this sentiment. It is neither fair to the state 
 nor to the medical profession: it deprives the 
 former of the interest of one of its best class of 
 citizens, and the latter of the advantages of 
 availing itself of the opportunities of self-gov- 
 ernment. To advise any class of citizens to ab- 
 stain from politics is to advise self-disfran- 
 chisement. 
 
 Politics is the science and practice of gov- 
 ernment. It is " clean " or " dirty," as the peo- 
 
 315 
 
MEDICAL SOCIOLOGY 
 
 pie who participate are clean or dirty. No 
 class-day orators are advising the dive-keeper 
 or the man who preys upon the lives and prop- 
 erty of the people to keep out of politics; as a 
 matter of fact he is thoroughly in it, and has 
 more legislation influenced in his interest, and 
 places more of his friends in office in one year 
 than the medical profession does in ten years. 
 This is partly due to class-day oratory, and to 
 the superior attitude and aloofness of our pro- 
 fession. 
 
 The science of medicine has brought about 
 as far as it can the solution of the tuberculosis 
 problem and the typhoid fever problem and a 
 host of other similar problems which are as 
 vital to the people as are the lives of their chil- 
 dren. Medicine has shown how these diseases 
 may be exterminated. Now these matters are 
 up to the state. That means their further de- 
 velopment is in the hands of politics. And shall 
 our profession, after having hunted down the 
 monster of typhoid, and gotten it at bay in its 
 lair, cowed and at our mercy, desist from giving 
 the coup de grace because the stroke must be 
 applied with the lance of politics! We need 
 more doctors in our legislative chambers and in 
 our executive offices. Medicine has long ago 
 
 316 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 grown past tlie function of administering to 
 those who perchance have fallen sick. It has 
 become the most salutary field of activity in the 
 commonwealth, and we are not raising up men 
 fast enough to administer its offices. We may 
 justly be accused of slothfulness in our duty to 
 the people. 
 
 There are a large number of cities in this 
 country in which the best-administered office is 
 the department of health under medical super- 
 vision, but in many municipalities this impor- 
 tant department is handicapped by an absence 
 of medical influence in the bodies to which it is 
 answerable. In legislative matters the medical 
 man can be counted on to be on the right side 
 of the great questions concerning the health of 
 the people, and he is the only legislator of whom 
 this can be said. We strive for wise medical 
 laws, we are confronted by the urgent need of 
 a national department of health, but in order 
 to secure these benefits for the people we have 
 to appear as suppliants before the legislative 
 bodies, which are often without sympathy or ap- 
 preciation of the meaning of these things. The 
 few physicians in these bodies are of great help. 
 But the United States Congress, made up of 476 
 members, contains only four physicians; that 
 
 317 
 
MEDICAL SOCIOLOGY 
 
 is, one physician to represent every 22,000,000 
 of inhabitants, including 130,000 educated phy- 
 sicians. 
 
 In the minor municipal offices we find phy- 
 sicians. Usually these men are selected by the 
 civil-service system. They represent a high 
 grade of culture in the municipal service, and 
 the city is fortunate in having them. The num- 
 ber of offices which can be filled only by medi- 
 cal men is constantly increasing and will con- 
 tinue to increase. Medicine is destined to play 
 a role in politics which it is not difficult to fore- 
 see, and it behooves us to prepare for it, and 
 not hold aloof from the duties and opportuni- 
 ties which the future has in store. 
 
 If the medical man can afford to give some 
 of his time or substance to charity or philan- 
 thropy, as all physicians do, he can employ his 
 energies in no better channel than in labor for 
 the common good, for social and civic better- 
 ment, through the agency of politics. Govern- 
 ment is not in the hands of the people — it is in 
 the hands of the people who take it into their 
 hands. In Germany, France, and England, 
 physicians take a prominent part in political 
 matters and in the general interests of the com- 
 munity. In the early period of this country 
 
 318 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 medical men were active in the affairs of gov- 
 ernment. We may name with pride Benjamin 
 Ensh, Josiah Barttall, Oliver Wolcott, Lyman 
 Hall, Matthew Thornton, Edward Hand, Wil- 
 liam Irvine, Jonathan Arnold, Cadwallader 
 Golden, John Brooks, William Eustis, Nathan- 
 iel Freeman, Joseph Warren, and Hugh Mer- 
 cer — physicians who made their impression 
 upon the politics of their time. Among the 
 finest features of the history of medicine in 
 this country are the signatures of the doctors of 
 medicine to the Declaration of Independence. 
 Of them we should be proud. Political doctors, 
 they! 
 
 22 
 
XXII 
 
 KNOWLEDGE VERSUS MANNERS 
 
 THERE is no substitute for knowledge. 
 There is no imitation knowledge. 
 Knowledge is either the real thing or it 
 is not knowledge. 
 
 I should like to see this proposition impressed 
 upon every student early in his career. Com- 
 mencement addresses are prone to exalt the 
 manners of the phj^sician. Cultivate an ele- 
 gant, hopeful and gracious sick-room manner, it 
 will do more than all your medical knowledge, 
 they say. Maybe it will ; but if that is the case, 
 the patient does not need a doctor. 
 
 I have heard this so often and seen so much 
 of the pernicious effects of this teaching that I 
 am convinced that a voice should be raised in 
 the defense of sick-room knowledge against 
 sick-room manners. There are two things 
 which the doctor should take with him to the 
 sick room: the spirit of the scientist and the 
 spirit of the gentleman, relatively important in 
 
 320 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 the order named. The art of medicine is a com- 
 bination of these two. If a man is truly imbued 
 with the former, the latter follows as a neces- 
 sary result. A man may be a successful engi- 
 neer or electrician and not a gentleman ; but the 
 medical man touches human life too closely not 
 to be a gentleman if he is to be successful. The 
 physician who applies his science to the best 
 purpose, to the end of curing his patient, cannot 
 deport himself in any manner derogatory to the 
 interests of his patient. It is not a scientific 
 application of medicine for the physician to be 
 brusque and unmannerly in the presence of a 
 sensitive sick person whom he essays to help. 
 The scientific spirit in therapeutics, knowledge 
 of the effects of external influences upon the 
 disease, is what the physician should take with 
 him into the chamber of the sick. These are 
 the essentials. 
 
 I have endeavored to define the essentials of 
 our art, as contrasted with the outward graces 
 which certain practitioners exalt above them. 
 Happily among regular practitioners the culti- 
 vation of the manner is rarely at the expense of 
 the essentials, but among certain physicians it 
 is carried, unfortunately, to an extreme degree. 
 The clanking, silver-trimmed harness, or the 
 
 321 
 
]\rEDICAL SOCIOLOGY 
 
 limousine, the rose in the button-hole, dia- 
 monds, the patent-leather ties, the elegant and 
 imposing manner in the sick room, with the 
 well-turned and flattering allusions, may be all 
 delightful and helpful and good, but pity the 
 patient if they be at the expense of the scien- 
 tific medical essentials if the patient be really 
 sick. The man who would refrain from listen- 
 ing to a patient's chest sounds because it cannot 
 be done in a dignified way, or who is thinking of 
 his own manners when he should be thinking of 
 the patient, has no place in medicine. 
 
 Many a young man, after admonitions on 
 manners from some wise head, is prompted to 
 have his trousers pressed, invest in an orchid, 
 and cultivate a pink-tea smirk to carry with him 
 into the sick room ; when it would be better for 
 his patient did he but render his trousers baggy 
 with his knees under his microscope, and wear 
 upon his face into the sick room the simple ex- 
 pression of intelligent interest and hope bom of 
 knowledge and confidence. 
 
 Much is said of the physician inspiring con- 
 fidence. To a certain degree it is a good thing. 
 It is not necessarily the badge of the competent 
 doctor, but it is the stock in trade of the char- 
 latan. The latter is always full of confidence. 
 
 322 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 He assures his patient that he will cure him. 
 His income depends upon inspiring confidence. 
 He is the beau ideal confidence man. The phy- 
 sician who inspires confidence usually inspires 
 it because his patient is a strong man or is not 
 profoundly sick. But after all, the best confi- 
 dence in the sick room is the confidence in the 
 ability of the doctor, in his interest in the case, 
 and in the belief that he will do all that he can 
 for the patient. 
 
 " There," said the doctor, as he flicked the 
 powder upon the patient's tongue. It was the 
 " there " that did the patient more good than 
 the powder, was it? So much the worse for the 
 powder, so much the better for the patient ; the 
 powder was not much good or the patient was 
 not much sick, one or the other or both. This 
 matter of manners is exalted because most pa- 
 tients would get along pretty well without medi- 
 cal attention, and the beneficent manners of 
 which we hear so much would become any one 
 better than they do the doctor. It is because 
 his work is to so large an extent among those 
 who do not need him for his medical attain- 
 ments that the notion has become current. Its 
 positive harm comes when habit has prompted 
 him to cultivate manners and when he permits 
 
 323 
 
MEDICAL SOCIOLOGY 
 
 them to interfere with the essentials in a case 
 which needs the best his brains and his science 
 can give. Then we realize the meaning of the 
 true doctor. Then we appreciate the man who 
 has piled up as much knowledge as he can, who 
 brings it to the bedside, who applies the scru- 
 tiny of the well-trained mind, who goes at his 
 case with method, whose aim is first to discover 
 the nature of the disease and then apply the 
 treatment with recovery as the goal, and who 
 adds to these qualities the simple attributes of 
 an honest and gentle man. 
 
XXIII 
 
 MEDICAL LIBRAKIES 
 
 A MEDICAL community with a medical 
 society is invariably progressive; but 
 if it adds to this a good medical li- 
 brary, it adds to its progressiveness stability. 
 
 A hospital, a laboratory or a society is often 
 the nucleus of interest about which a medical 
 community gathers, but none of these can ap- 
 peal so strongly to the largest number of the 
 substantial element of the profession as does a 
 medical library. One of the reasons for this is 
 that a medical library is not possible in a com- 
 munity which is not sufficiently advanced to 
 have a successful medical society. The hospital 
 and the laboratory in a given community do not 
 offer like opportunities to all, and the voice in 
 their management and work comes from but a 
 few. 
 
 A society is influenced by the indescribable 
 " spirit of the hive " or by some dominant char- 
 acter, and its interests rise and fall, unless it be 
 
 325 
 
MEDICAL SOCIOLOGY 
 
 a great organization or has property interests 
 or vested rights affecting its members. But a 
 medical library in Trhich all members have a 
 right and which depends for its existence upon 
 the interest of all, when once established and 
 appreciated, becomes a center of common sym- 
 pathy and the strongest of bonds for holding a 
 medical organization in harmony. 
 
 A society with such a library possesses co- 
 hesive power. Men who are advanced enough 
 to maintain a society will often rally about the 
 interests of a library when but passive in other 
 things. They may have their differences in the 
 hospital and in the society, but they will be 
 found united for the library. Such a library 
 becomes their pride. They know its worth. 
 Their common interests crystallize about it. It 
 diffuses through the whole society high ideals, a 
 respect for that which is scholarly and worthy 
 of reverence, and a love for the noble traditions 
 of their profession. 
 
 Asa library develops and grows it should add 
 in the order named the following classes of lit- 
 erature: First, the current periodicals; second, 
 the newer books; third, the completed sets of 
 periodicals and reports; and fourth, the older 
 works — the writings of the fathers — in which 
 
 326 
 
MEDICAL SCIEJs^CE AND MEDICAL AET 
 
 glimmer the begimiings of the art and science 
 of medicine. Every medical community should 
 have a library begun and developed on these 
 lines. 
 
 It would be possible for every county society 
 or other county organization, to which all phy- 
 sicians are eligible, to have its medical library. 
 In sparsely settled coimties the library-sup- 
 porting organization might be geographically 
 larger. Physicians are learning the value of 
 community of interests. There is no need of 
 five doctors in a single village all having a com- 
 plete set of the same reference work when none 
 of them has some other thing which is of just 
 as much importance. It would be wiser if they 
 pooled their interests ; and then, with the same 
 amount of money, they could have five different 
 things instead of one. The next step is short: 
 it is the establishment of a central place where 
 these things shall be available to all. "When 
 that step is taken the development of a library 
 with its beneficent influence is begun. A little 
 attention keeps it alive, and the forces of nature 
 feed it. 
 
 It only requires a word, here and there, to 
 turn into it the library of a deceased physi- 
 cian, which otherwise would be dissipated and 
 
 327 
 
MEDICAL SOCIOLOGY 
 
 ultimately find its way to the junk shop. A 
 little cooperation with a neighboring library 
 exchanges duplicates for things needed. The 
 American Association of Medical Librarians 
 conducts a clearing house for just this purpose. 
 Time is the all-important factor in the growth 
 of a library. A library which is kept sound is 
 as sure to grow as an oak sapling. It is hard 
 to stop it. One of the greatest libraries in this 
 country, that of the College of Physicians of 
 Philadelphia, organized when Philadelphia was 
 a village, can be pointed to as a product of time. 
 For nearly two centuries medical books have 
 gravitated to it, until now it is a veritable treas- 
 ure-house of medical literature. Time does it. 
 The community which contemplates organizing 
 a library is squandering its best capital in delay. 
 
 The important factor in the beginning of such 
 an undertaking is that every available person 
 shall have an interest and shall contribute some- 
 thing. A library in a small community to which 
 everybody contributes two dollars a year is 
 worth twice as much as one in which the same 
 total sum is contributed by one or a few indi- 
 viduals. " Our Library " is the talisman of 
 success. 
 
 It is to be hoped that the smaller cities and 
 328 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 rural districts will establish libraries among 
 which the spirit of cooperation may move, mitil 
 the country is dotted with these storehouses of 
 medical learning, and each community becomes 
 a permanent custodian of the literature of med- 
 icine. 
 
XXIV 
 
 THE HISTORY OF MEDICINE 
 
 THAT doctor is best qualified to practice 
 his profession in whom, other things 
 being equal, is found a knowledge of the 
 history of his art. There is no better inspira- 
 tion to good work than the study of the lives 
 of the pioneers of medicine who labored on to 
 success and whose names live in the annals of 
 our science. There is no better help for avoid- 
 ing the pitfalls of error than an appreciation of 
 the struggle of scientific medicine against the 
 obstacles of mysticism, superstition, charlatan- 
 ism, and credulity. The physician who is not 
 familiar with the history of medicine labors un- 
 der a decided disadvantage. How much we hear 
 and how much we read that would not have been 
 uttered but for a deficiency in this knowledge! 
 The medical man who is learned in medical his- 
 tory knows the origin of many modern pseudo- 
 medical sects, and he knows their fate, and is 
 best qualified to discover the good in them. 
 
 330 
 
MEDICAL SCIENCE AND MEDICAL ART 
 
 Our own country is so young that we have not 
 yet awakened to an appreciation of the impor- 
 tance of medical history. Still, we are old 
 enough to have made some history of our own 
 with which every medical man should be fa- 
 miliar. In Europe more attention is given to 
 this subject. It is taught in the universities and 
 a large amount of literature has accumulated. 
 In the United States there are but few medical 
 schools which give their students even an ink- 
 ling that medicine has a history. Much honor 
 is due to the pioneer institutions with high 
 enough ideals to give lectures or instruction in 
 this field. 
 
 Especially noteworthy are the medical his- 
 torical societies. In such organizations we may 
 be sure to find men who represent the best med- 
 ical culture of their communities. American 
 medical literature may take pride in the fact 
 that the first periodical devoted to medical his- 
 tory was established in this country.^ Another 
 of the advances which mark an epoch in medi- 
 cal culture is the action taken by the University 
 of London in 1905 requiring an examination in 
 the history of medicine as essential for the de- 
 
 1 The Medical Library and Historical Journal (now the ^scula- 
 pian), instituted in 1903. 
 
 331 
 
MEDICAL SOCIOLOGY 
 
 gree of Doctor of Medicine. These are all signs 
 of the times pointing to the cultural growth of 
 medical knowledge. 
 
 " The foundation stones of the whole modern 
 structure of human wisdom have all been laid 
 by the architects of yesterday. Thrice wise is 
 he who knows the quarries and builders of by- 
 gone ages and is able to differentiate the stones 
 which have been rejected from those which have 
 been utilized." 
 
XXV 
 
 THE SMALL MEDICAL SOCIETY 
 
 "I hold every man a debtor to his profession; 
 He should be a help and ornament thereto." — Bacon. 
 
 SOME of the best inspiration that medical 
 men have ever received has come from 
 the little coteries of brother practition- 
 ers who make np a medical society. The large 
 societies serve their purpose and are necessary, 
 but the small societies, made up of the select 
 few, often supply inspiration for the members 
 which could be created in no other way. The 
 element of mutual admiration, engendered by 
 compactness of organization, is the important 
 thing. As a matter of fact no man really does 
 good work unless he belongs to a mutual admi- 
 ration society of some kind; it may have only 
 two members ; but the best work we do is done 
 for the approval of some one else. 
 
 The small size of a medical society is no re- 
 proach. If it has sufficient compactness, that is 
 closeness and harmony, its good cannot be meas- 
 
 333 
 
MEDICAL SOCIOLOGY 
 
 ured by its size. The fact of the existence of a 
 small society implies that it is successful. Its 
 members are so close that if there is lack of 
 sympathy or profit from its meetings it falls 
 apart and is no more. All small societies are 
 good societies. To designate such with the ap- 
 pellation of " mutual admiration society," is a 
 high compliment to its members. If our great 
 societies were tinctured more with mutual ad- 
 miration it would be good. One of the best 
 spirits that can come among medical men is that 
 of mutual admiration, and the little societies 
 often contain it to an admirable degree. 
 
XXVI 
 
 DOCTOKS' SONS 
 
 DOCTORS' sons pretty generally make 
 good doctors; that is, if they decide to 
 study medicine and be doctors at all, 
 they succeed. When you hear a physician say 
 that the practice of medicine is a dog's life, and 
 that if he had it to do over again he would never 
 study medicine, that patients are ungrateful and 
 give him little thanks or pay, you may be pretty 
 sure that his son will not study medicine; and 
 if perchance he should, he is terribly handi- 
 capped by a lot of bad medical traditions. The 
 unsuccessful doctor does not let his son study 
 medicine. The doctor's son who does study 
 medicine is quite invariably the son of the man 
 who was successful enough to find joy in his 
 work, and who could wish his son nothing bet- 
 ter than to enter into the calling which had 
 meant so much to him. And the boy sees in his 
 father's life something that excites his admira- 
 tion to emulate and covet. As a matter of fact 
 23 335 
 
MEDICAL SOCIOLOGY 
 
 and observation the son of the really successful 
 doctor commonly does study medicine; and I 
 could name a number of such men who attained 
 to even greater success than their fathers. 
 
 However, the decision as to whether a man is 
 successful or not does not rest with you or me 
 — the decision is with him — he is the only one 
 who knows. 
 
XXVII 
 
 TUBERCULOSIS PREVENTABLE 
 
 IF tuberculosis is preventable, why then is it 
 not prevented? Are not the thousands who 
 are to perish during the coming year worth 
 the saving? If we knew that we should be 
 among the number, should we not think it a ter- 
 rible thing? If the treatment is simply hygiene, 
 is it not strange that we are not willing to live 
 hygienically until after we have contracted the 
 disease? If 200,000 people die annually of tu- 
 berculosis in the United States, and an equal 
 number are annually cured of the disease by 
 sleeping and living in the open air, why would 
 it not have been better for them to have slept 
 and lived in the open air before they were sick, 
 instead of after they were sick, and thus have 
 avoided the disease? If sleeping and living in 
 the open air is good for the sick why is it not 
 good also for the well? Is it not better to stay 
 well than to be cured of tuberculosis? 
 
XXVIII 
 
 MEDIEVAL HISTORY 
 
 IT is said by some medical historians that we 
 must remember that what little Western 
 learning survived through the dark ages 
 was stored and guarded in monastic vaults and 
 clerical libraries — wealth imrevealed and un- 
 known even to the custodians, but still in some 
 fashion preserved for the enlightenment of 
 wiser generations — as though this were to the 
 credit of the Church. It made a waste of Eu- 
 rope, and out of the fertilizing piles of decom- 
 posing humanity grew its resplendent flowers — 
 the mighty edifices, which have astonished the 
 world. It suppressed natural scientific truth, 
 for natural science was contrary to its doc- 
 trines. If anything was permitted to survive, 
 it was because it was emasculated of such truths 
 as refuted its dogmas; and for this reason we 
 have had preserved for us much silly rubbish, 
 while oblivion has been the fate of much of the 
 real learning of that unhappy period, when the 
 Church was dominant. 
 
 338 
 
XXIX 
 
 SOCIETIES 
 
 IT is good for men with, common aims and in- 
 terests to unite for their mutual improve- 
 ment. The worker in any field of science 
 who has not society affiliation is handicapped 
 by the want of it. Sympathy, cooperation and 
 help are what everyone needs, and to deprive 
 one's self of them is not independence but lack 
 of wisdom. A medical community in which the 
 members are united in a good society, in the 
 success of which they take pride, is more pro- 
 gressive than the community in which each one 
 is pulling alone. 
 
 The doctor who needs the help and sympathy 
 of his fellows requires a medical society; and 
 the independent worker, whose originality and 
 success make him independent, owes it to his 
 fellows to affiliate himself with them; and each 
 will find that there is something for him to give 
 and something for him to receive. 
 
XXX 
 
 JUBILEE MEMBEESHIP 
 
 THE British medical societies have a hap- 
 py Custom of celebrating what they call 
 " Jubilee Membership." When one has 
 been a member of a society for fifty years, some 
 further cognizance is taken of this fiftieth anni- 
 versary than simply sending him a bill for his 
 annual dues as had been done on forty-nine pre- 
 vious occasions. Fifty years is a long time for 
 a man to have served his profession and the 
 public; and our British brethren observe this 
 by pausing for a few moments in their scientific 
 work while the president of the society presents 
 a resolution congratulating the member upon 
 the attainment of his " jubilee membership." 
 This resolution embodies congratulations, a 
 brief resume of the member's professional serv- 
 ices, and expressions of hope that he may long 
 be spared to the society in the intellectual en- 
 joyments of a ripe age. Such attentions as this 
 make for kindness, and sweeten the atmosphere 
 through which we all must walk. 
 
 340 
 
XXXI 
 
 MEDICAL PRACTICE IN UTOPIA 
 
 MEDICINE is the most important of all, 
 and yet, because of its inaccuracies, 
 it has never taken its well deserved 
 place among the sciences. Medicine is the most 
 beneficent of all, and yet, because its votaries 
 must secure their livelihood by its practice, it 
 has never taken its well deserved place among 
 the philanthropies. Some day it will, but there 
 is to be much education for both doctor and 
 public before these conditions may be realized. 
 Medical practice in Utopia is different. Here 
 it is untrammeled by the necessities of the dol- 
 lar. Here the doctor perfects himself in his sci- 
 ence and art, and, with the spirit of true philan- 
 thropy, advises his patient just what is best for 
 him, nothing more nothing less ; that is the only 
 consideration; and his reward is measured by 
 the conscientious devotion, intelligence, and 
 skill which he puts into the task. We have some 
 eminent practitioners in Utopia, but many more 
 are needed. 
 
 341 
 
XXXII 
 
 THE PRESENT DAY 
 
 SOME practitioners of medicine labor un- 
 ceasingly with little diversion in their 
 work, looking forward to the time when 
 they shall slacken their pace and enjoy surcease 
 from toil. They forget that the present only 
 is surely ours, that the past has gone, and the 
 future may never come. He lives most wisely 
 who lives the equable life, and finds his joys as 
 he lives each day. Let us not build a great man- 
 sion to occupy when we are too worn out to 
 enjoy it; but instead, shall we not do more 
 wisely to abide awhile each day in the little 
 wayside cottage of contentment, where the 
 morning glories creep over the doorway, and 
 the birds sing, and children play merrily be- 
 neath the boughs? 
 
XXXIII 
 
 THE BOKDEKLAND OF TKUTH 
 
 IT is interesting to observe that in many of 
 the diseases in which scientific investiga- 
 tion has shown a positive relation between 
 certain causes and effects, the discovery was 
 preceded for a long time by a general but uncon- 
 firmed surmise that such a relation existed. 
 There is no belief or superstition but has some 
 foundation for its existence, and many of our 
 most important discoveries have been made by 
 following crude surmises. 
 
XXXIV 
 
 THE physician's CALLING 
 
 IF there is any joy which man should prize, 
 it is the joy of relieving distress. There is 
 but one greater, and that is the joy of pre- 
 venting distress. The life of the physician is 
 spent in the midst of both of these, and he 
 should be the most blessed of men. 
 
XXXV 
 
 THE FUTURE OF MEDICINE 
 
 IT requires no extraordinary insight to peer 
 into the future and behold the position of 
 exalted importance which medicine is des- 
 tined to occupy. None of the avocations of men 
 shall be more honored. Its administrations 
 shall be more kind and its results more benefi- 
 cent than philanthropy itself. It shall stand be- 
 tween the living and the dead, and men shall 
 call its mission holy. 
 
 THE END 
 
INDEX 
 
INDEX 
 
 Accidents of Summer, 138. 
 
 Addison, seduction in time of, 
 126. 
 
 iEsculapian, the, 331. 
 
 Air, Fresh, 150. 
 
 Alcohol, a poison, 60. 
 and college students, 64. 
 and consumption, 65. 
 and respiratory diseases, 65. 
 and sexual vice, 64, 104. 
 in medicine, 61. 
 
 Alcohol Question, The, 55. 
 
 Alcoholic inebriety, 66. 
 
 Alcoholism not an unmitigated 
 evil, 57. 
 
 American Association of Medi- 
 cal Librarians, 328. 
 
 American Medical Association, 
 260. 
 
 Aristotle, 214. 
 
 Army, United States, syphilis 
 in, 78. 
 
 Arnold, Jonathan, 319. 
 
 Arnold, Mathew, 284. 
 
 Assistant, Clinical, The Prac- 
 titioner and the, 299. 
 
 Association of American Medi- 
 cal Colleges, 281. 
 
 Automobile accidents, 136. 
 
 Bacon, Francis, 333. 
 
 Bacteriology and Botany, 211. 
 
 Barton, W. M., 228. 
 
 Barttell, Josiah, 319. 
 
 Beaconsfield, Lord, 7. 
 
 Bedroom ventilation, 161. 
 
 Beginnings and Progress of 
 Therapeutics, 221. 
 
 Berkeley, George, 169. 
 
 Berlin, prostitution in, 109. 
 
 Bible, glorification of sexual 
 sins in, 80. 
 study of, compulsory, 132. 
 
 Biology, teaching of, 88, 132, 
 263. 
 
 Blaud's pills, 222. 
 
 Blindness due to venereal dis- 
 eases, 75. 
 
 Borderland of Truth, 343. 
 
 Botany, Bacteriology and, 211. 
 
 Bourneville, 63. 
 
 Bridge party, 39. 
 
 Brooks, John, 219. 
 
 Buckle, Henry Thomas, 267. 
 
 Bulkley on syphilis of the inno- 
 cent, 79. 
 
 Cabinet of the President, 7. 
 Calling, The Physician's, 344. 
 
 349 
 
index; 
 
 Cancer research, 14. 
 
 Cape Cod, pneumonia on, 154. 
 
 Carlyle, Thomas, 115. 
 
 Child, responsibility for, 30. 
 
 Christ, teaching of, 173. 
 
 Christian delusions, 178. 
 
 Christian Science, 169, 226. 
 
 Christian teaching, obsolete, 
 263. 
 
 Church, destructive of medical 
 history, 338. 
 should teach helpful truths, 
 
 126. 
 teaching of, 96. 
 waning interest in the super- 
 stitions of, 184. 
 
 Cities breed idle women, 119. 
 
 City, a trap, 49. 
 
 the destroyer of men, 305. 
 
 City practitioner, 305. 
 
 Civilization, Some Medical 
 Aspects of, 34. 
 
 Clinical Assistant, The General 
 Practitioner and the, 
 299. 
 
 Colden, Cadwallader, 319. 
 
 Colds and fresh air, 157. 
 
 College life and girls' educa- 
 tion, 129. 
 
 College of Physicians of Phila- 
 delphia, library of, 328. 
 
 College Preparation for Study 
 of Medicine, 268. 
 
 Colleges, American, 270. 
 
 Columbia University and teach- 
 ing of sanitation, 250. 
 
 Complete Angler, The, 304. 
 
 Coney Island amusements, 141. 
 
 Confidence in the physician, 
 
 322. 
 Congress of physicians in 
 
 United States, 317. 
 Consumption, cure of, 232. 
 
 value of, 238. 
 Continence, Sexual, 112. 
 Country life preferable to city, 
 
 122. 
 Country practitioner, 305. 
 Courts defining practice of 
 
 medicine, 237. 
 Creasy's Battles, 266. 
 Culture, neurotic, 129. 
 
 Darwin, Charles, 177. 
 
 David, 45. 
 
 Day, The Present, 342. 
 
 Declaration of Independence, 
 medical signers of, 319. 
 
 Definition of practice of medi- 
 cine, 290. 
 
 Delusions, Christian, 178. 
 
 Department of the Interior, 15. 
 
 Diffusion of Medical Knowl- 
 edge, 259. 
 
 Disease and ignorance, 264. 
 
 Diseases, salutary, 234. 
 self-limitation of, 174. 
 
 Divorce and sexual vice, 106. 
 
 Doctors' Sons, 335. 
 
 Doctor's work in the future, 
 230. 
 
 Doctus sed non Doctor, 282. 
 
 Double standard of sexual 
 morals, 106. 
 
 Dresden, prostitutes in, 109. 
 
 Drug nihiUty, 239. 
 
 350 
 
INDEX 
 
 Drugs, action of, 235. 
 becoming obsolete, 228. 
 
 Eating and Talking, 199. 
 
 Eclectic medicine, 286. 
 
 Edison, Thomas, 177. 
 
 Education and the Health and 
 Efficiency of Girls, 128. 
 
 Education of the public, 261. 
 
 Emerson, R. W., 242. 
 
 Emmanuel movement and 
 Kindred Phenomena, 
 181. 
 
 Epilepsy and alcohol, 63. 
 
 Euripides, 62. 
 
 Eustis, William, 319. 
 
 Evil, The Social, 124. 
 
 Evolution of Scientific Knowl- 
 edge, 205. 
 
 Examinations, State and Col- 
 lege Medical, 281. 
 
 Exercise and Health, 46. 
 
 Expert medical witness, 292. 
 
 Facts and Theories, 194. 
 
 Family Hazard, 197. 
 
 Fate of Medicine, 240. 
 
 Federal Interest in the Health 
 of the People; 7. 
 
 Federal supervision of milk 
 production, 249. 
 
 Fetichism and medicine, 222, 
 228. 
 
 Fitness, Physical, at the Throt- 
 tle, 134. 
 
 Freeman, Nathaniel, 319. 
 
 Fresh Air, 150. 
 
 and tubercvdosis, 153. 
 
 Future Fields of ^ledical Activ- 
 ity, 245. 
 Future of Medicine, 345. 
 
 General Practitioner and the 
 Clinical Assistant, 299. 
 
 Generation, Spontaneous, 216. 
 
 Gibbon, Edward, 267. 
 
 Girls, health and efficiency of, 
 128. 
 teaching of, 93. 
 
 God, The Word of, 97. 
 
 Gonorrhea, 71. 
 
 Gould, George M., 160. 
 
 Gray, Asa, 214. 
 
 Gymnasium, German, 272. 
 
 Haeckel, Ernst, 217, 218, 219. 
 
 Hair, superfluous, 36. 
 
 Hall, Lyman, 319. 
 
 Hand, Edward, 319. 
 
 Happiness, Healthfulness and, 
 42. 
 
 Harvard and Tuskegee, 274. 
 
 Harvey, Wilham, 196. 
 
 Hazard, The Family, 197. 
 
 Health, efficiency of girls and, 
 128. 
 more important than prop- 
 erty, 246. 
 national department of, 14. 
 
 Health, Exercise and, 46. 
 
 Health of the People, Federal 
 Interest in, 7. 
 
 Healthfulness and Happiness, 
 42. 
 
 Heating devices, 157. 
 
 Henry VIH, 131. 
 
 24 
 
 351 
 
INDEX 
 
 History, Medieval, 338. 
 Historj'' of ]\Iedicine, 330. 
 Homeopathy, 225, 286. 
 Hospital Interneship, 276. 
 Human Progress, Medical 
 
 Science and, 251. 
 Huxley, Thomas H., 86. 
 Hypothetical question, 295. 
 
 Idle Wives, Unmated Men, and 
 the Venereal Peril, 118. 
 
 Ignorance and disease, 264. 
 
 Immunity, Unhygienic, 147. 
 
 India, starvation in, 5. 
 
 Infant feeding, 24. 
 
 Innocent, protection of the, 82. 
 
 Instruction of the Young in 
 Sexual Hygiene, 86. 
 
 Interneship, The Hospital, 276. 
 
 Irvine, William, 319. 
 
 Japan and medical council, 6. 
 exaltation of medicine in, 
 
 252. 
 Japanese, absence of prudish- 
 
 ness in, 115. 
 Jubilee Membership, 340. 
 
 Kassowitz, Max, 220. 
 
 Knowledge, Evolution of Scien- 
 tific, 205. 
 
 Knowledge versus Manners, 
 320. 
 
 Labor, joyful, 53. 
 Lake Champlain, 13. 
 Lange, F. A., 217. 
 Law defining practice of medi- 
 cine, 237. 
 Lazere, Jesse W., 206. 
 
 Learning, available, 279. 
 Lecky, W. E. H., 110, 267. 
 Libraries, i\Iedical, 325. 
 License to practice medicine, 
 
 286. 
 Life, A Well-ordered, 309. 
 Life Insurance Interests, 144. 
 Lindsey, Judge B. B., 166. 
 Linnseus, 214. 
 
 Lives, human, destruction of , 15. 
 Longevity increasing, 17. 
 
 Malaria, 238. 
 
 Manners, Knowledge versus, 
 320. 
 
 Materia medica and thera- 
 peutics, 224. 
 
 McDowell, Ephraim, 207. 
 
 Medical Activity, The Future 
 Fields of, 245. 
 
 Medical education to meet the 
 new conditions, 249. 
 
 Medical Expert Witness, 292. 
 
 Medical Ivnowledge, The Diffu- 
 sion of, 259. 
 
 Medical Libraries, 325. 
 
 Medical Library and Historical 
 Journal, 331. 
 
 Medical Practice in Utopia, 341. 
 
 Medical Science and Human 
 Progress, 251. 
 
 Medical society. The Small, 333. 
 
 Medical temperance movement, 
 69. 
 
 Medicine, History of, 330. 
 
 Medicine not a business, 240. 
 
 Medicine, Practice of. Legally 
 Defined, 290. 
 
 352 
 
INDEX 
 
 Medicine, preparation for study O'Dwyer, Joseph, 207 
 
 of, 268. 
 Medicine, Preventive, 255. 
 Medicine, The Fate of, 240. 
 Medicine, The Future of, 345. 
 Medicine the sanitary science, 
 
 237. 
 Medieval History, 338. 
 Membership, Jubilee, 340. 
 Mental competition, 48. 
 Mercer, Hugh, 319. 
 Milk supply, 14. 
 Mind, influence of body over, 
 
 186. 
 Mind, influence of, over the 
 
 body, 185. 
 Monogamous household, 107. 
 Morality and happiness, 44. 
 
 sexual, 100. 
 Morrow, Prince A., 71. 
 Mortality in the United States, 
 
 10. 
 Mother, reverence for, 95. 
 
 the best teacher, 91. 
 Motherhood and wifehood, 131. 
 Municipal departments of 
 
 health, 248. 
 
 Napoleon and the Empress, 
 
 197. 
 Natural sciences, teaching of 
 
 the, 87, 132. 
 New York City department of 
 
 health, 248. 
 Norway and venereal diseases, 
 
 111. 
 Nursing of infants distasteful, 
 
 37. 
 
 Old knowledge, need of formu- 
 lation of, 233. 
 Osier, William, 236. 
 Osteopathy, 190, 225, 227. 
 Out-door sleeping, 162. 
 Oxygen in pneumonia, 229. 
 
 Pasteur, Louis, 11,208,'211,219. 
 
 Patent medicines, 235. 
 
 Peril, The Venereal, 70. 
 
 Phallic symbolism, 82. 
 
 Pharmaceutical fetichism, 228. 
 
 Physical Fitness at the Throt- 
 tle, 134. 
 
 Physician's CaUing, The, 344. 
 
 Physician in Politics, The, 315. 
 
 Pinard on syphilis, 77. 
 
 Play, Work and, 305. 
 
 Pliny, 214. 
 
 Politics, The Physician in, 315. 
 
 Poor, sanitation among the, 29. 
 
 Practice, Medical, in Utopia, 
 341. 
 
 Practice of Medicine Legally 
 Defined, 290. 
 
 Practice of medicine, state 
 licensure for, 286. 
 
 Practitioner, The General, and 
 the Clinical Assistant, 
 299. 
 
 Preceptor, The, 297. 
 
 Preparation for study of medi- 
 cine, 268. 
 
 Preparatory schools, 271. 
 
 Present Day, The, 342. 
 
 President, Cabinet of the, 7. 
 
 Press and sexual vice, 107. 
 
 353 
 
INDEX 
 
 Prevention of disease, 26, 246. 
 
 of tuberculosis, 337. 
 Preventive Medicine, 255. 
 Profession, a united, 259. 
 Prostitute, the, 100. 
 Prostitution, warning against, 
 
 110. 
 Prudishness, 89. 
 Ptomains and cucumbers, 235. 
 Public health and Marine 
 
 Hospital Service, 12. 
 Public life, physicians in, 318. 
 Public Pohcy and the Medical 
 
 Profession, 3. 
 Pure food bill, 12. 
 
 Quiz compend, 283. 
 
 Radiator, the hot air, 157. 
 
 Railroad wrecks, 135. 
 
 Rationalization of Therapeu- 
 tics, 229. 
 
 Ray, John, 214. 
 
 Reed, Walter, 206. 
 
 Religious superstitions, 96. 
 
 Reporting of venereal diseases, 
 108. 
 
 Roosevelt, President, 22. 
 
 Rules for sexual conduct, 82. 
 
 Rush, Benjamin, 319. 
 
 Sabbatic traditions, 307. 
 Sanatarian taking place of 
 
 priest, 251. 
 School rooms, ventilation of, 28. 
 "Schools" of medicine, 256. 
 Scientific ICnowledge, The 
 
 Evolution of, 205. 
 Sectarian medicine, 256. 
 
 Semmelweis, Ignatz P., 196, 
 266. 
 
 Sexual Continence, 112. 
 
 Sexual Hygiene, Instruction of 
 the Young in, 86. 
 
 Sexual morality and the State, 
 100. 
 
 Sexual wrecks, 45. 
 
 Shaw, Chief Justice, 293. 
 
 Shaw, Lauriston E., 284. 
 
 Signers of Declaration of In- 
 dependence, 319. 
 
 Single medical examining 
 board, 287. 
 
 Sleeping out of doors, 167. 
 
 Social Evil, The, 124. 
 
 Social scale, The, 37. 
 
 Societies, medical, 260, 339. 
 
 Society, The Small Medical, 
 333. 
 
 Solomon, 45. 
 
 Sons, Doctors', 335. 
 
 Spencer, Herbert, 7, 81, 129. 
 
 Spontaneous Generation, 216. 
 
 State and College Medical 
 Examinations, 281. 
 
 State departments of health, 
 248. 
 
 State License to Practice Medi- 
 cine, 286. 
 
 State and Sexual Morality, The, 
 100. 
 
 Statistics, xntal, 16. 
 
 Sterihty, 74. 
 
 StiU, A. T., 192. 
 
 Strode, Muriel, 210. 
 
 Study of medicine, preparation 
 for, 268. 
 
 354 
 
INDEX 
 
 Summer, Accidents of, 138. 
 Superstitions, pernicious, 95. 
 Sweden, venereal diseases in, 
 
 111. 
 Syphilis, 71. 
 
 Taft, President, 22. 
 Talking, Eating and, 199. 
 Teaching of girls, 93. 
 Teaching public medical sub- 
 jects, 266. 
 Temperance movement, 55. 
 Tenements, model, 30. 
 Theaters and sexual \'ice, 
 
 105. 
 Theories and facts, 194. 
 Therapeutics, new, 231. 
 Therapeutics, Rationalization 
 
 of, 229. 
 Therapeutics, The Beginnings 
 
 and Progress of, 221. 
 Thornton, Mathew, 319. 
 Throttle, Physical Fitness at 
 
 the, 134. 
 Tobacco smoking, 42. 
 Tonsils and adenoids, 163. 
 Treves, Sir Frederick, 234. 
 Trichinosis, diagnosis of, 279. 
 Tropics to be made habitable, 
 
 252. 
 Truth, The Borderland of, 
 
 343. 
 Tuberculosis mortality, 9. 
 Tuberculosis preventable, 337. 
 Tuskegee Institute, 274. 
 Tyndall, John, 177. 
 Typhoid, economics of, 18. 
 in the United States, 257. 
 
 Unhygienic Immunity, 147. 
 University and coUege, 271. 
 University of London, history 
 
 of medicine in, 331. 
 Useful recreation, 50. 
 Utopia, Medical Practice in, 
 
 341. 
 
 Vacation and vocation, 140. 
 Venereal disease in New York 
 
 City, 79. 
 Venereal peril, idle wives and 
 
 the, 118. 
 Venereal Peril, The, 70. 
 Violations of chastity, 83. 
 Virchow, RudoK, 217, 219. 
 Vulvo-vaginitis in children, 76. 
 
 Warren, Joseph, 319. 
 
 Well, A Plea for the, 23. 
 
 Well-ordered Life, A, 309. 
 
 Wifehood and motherhood, 131. 
 
 Wild oats unnecessary', 94. 
 
 Witness, Medical Expert, 292. 
 
 Wives, idle, and the venereal 
 peril, 118. 
 
 Wolcott, Oliver, 319. 
 
 Woman's Christian Temper- 
 ance L'nion, 57. 
 
 Woods Hole, Marine Biological 
 Laboratory at, 205. 
 
 Woods, Matthew, 63. 
 
 Work and Play, 303. 
 
 Work for wives, 120. 
 
 Work, manual, in college. 273. 
 
 Young, Instruction of, in Sex- 
 ual Hygiene, 86. 
 
 355 
 
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