Part 18

The persuasion that tuberculosis is not hereditary will do much to encourage patients suffering from the disease to feel that they are not hopelessly doomed. At the present time it is not unusual to find patients so discouraged, when told that they have tuberculosis, that it is almost impossible to secure a favourable reaction to any mode of treatment. They have seen members of families die one after another, or they have heard stories of the inevitable way in which consumption wiped families out of existence, and they give up hope and become quite cast down. Needless to say, while in this condition any treatment is practically hopeless. On the other hand, the conviction that tuberculosis is only an infectious disease, quite curable in the majority of cases if taken in time, is of itself a most important aid in the treatment of the disease, since courage and faith are the principal requirements for successfully combating the affection.

We have had any number of newly invented remedies for consumption in the last twenty-five years. Scarcely a year has passed in which some new form of treatment, often eventually proved to be the resuggestion of an old therapeutic method, has not been heralded as a positive cure for consumption. In every case the first patients treated by the discoverer of the new remedy have rapidly improved under his care. In the hands of others, however, such results have not been obtained, or only for a very short time at the beginning of the treatment. After a time the new remedy failed in its inventor's hands. The true reason for the improvement was then seen to be, not the remedy suggested, but the favourable influence on the mind of consumptives produced by the faith of the inventor in his remedy, and their reaction to this powerful suggestion when they were put under proper conditions of an abundance of fresh air and a plentiful diet.

This shows, too, the reasonableness of the modern treatment of consumption, which consists not in the giving of {91} drugs, but in securing for the patient a plenty of fresh air for many hours a day and the encouragement to consume a liberal amount of nutritious food. Most of the much advertised remedies for consumption are really harmful rather than beneficent. Many of them are ordinary cough mixtures containing considerable opium, which lessens the cough, it is true, but also lessens the appetite and locks up the bowels. Besides, the cough is nature's method of removing material from the lungs which has become disintegrated, and if allowed to remain will certainly bring about the spread of the infection in the pulmonary tissues. Cough is a natural protective reaction to be encouraged, and is not in itself a source of evil needing to be suppressed. If cough is bothering the patient so much at night as to cause loss of sleep, then it is necessary to make a choice between two evils and somewhat to suppress the cough, even though it involves certain other inconvenience to the patient. All these so-called consumption cures contain materials that are almost sure to disturb the appetite and upset the stomach. The fate of a consumptive patient absolutely depends on his stomach; just as little, then, of medicine must be employed as possible. This will indicate the necessity for clergymen rather advising against than in favour of these proprietary medicines which have been definitely known to do so much harm in recent years. Many a patient delays an appeal to medical aid so long, as the result of trusting to such medicines, that a curable case of consumption becomes incurable, or else develops to such a condition as to require years of treatment on the fresh-air, abundant-food plan, where months would have sufficed before.

A very interesting phase of social medicine is the ease and confidence displayed by people, often of more than ordinary intelligence, in recommending various proprietary medicines of which they know nothing except the fact that someone says he, or more often she, was cured of something or other by their use. A chance remark like this to a sufferer becomes a high recommendation. The hardest problem the doctor has before him is to find out what is really the matter with his patients. Not infrequently people having apparently the same set of symptoms are suffering from quite different {92} ailments. A symptom like a sore throat, for instance, may very well be due to any one of at least a half-dozen of causes, most of which require their own peculiar treatment. When the affection under consideration is as indefinite as a tired feeling, or indigestion, or some one of the many ailments included under the term biliousness or kidney trouble, from which people are supposed to suffer, then the diagnosis problem becomes by far the most serious question in the case, and is often very difficult. The trained physician prudently hesitates, but the inexpert in medicine steps in and quite volubly announces what the ailment is in his opinion, and what will probably do it good. A little knowledge is indeed a dangerous thing in medical matters. If it be remembered that there is a very general impression among medical men now, as the result of recent acquisitions of scientific information with regard to the origin, pathological basis, and course of disease, that very probably more harm than good has been done by the administration of medicines in the past, not only the futility of lay (or clerical) prescribing will be manifest, but also somewhat of the amount of harm that may be done.

It is often a matter for painful surprise, then, to find that clergymen and members of religious communities allow their names to be used in the recommendation of remedies of whose composition they know nothing, for a disease of which they know less, if possible. This evil becomes especially poignant when the columns of our reputable religious press are allowed to be used for the purpose of exploiting the public in these matters. The remedies most often recommended are the so-called tonics. These are best represented by the sarsaparillas, and by various cures for catarrh, indigestion, and kindred indefinite ills, of which there are a great many on the market. These are not secret remedies, since their composition is well known by those of the medical profession who care to secure the information. Some six years ago an analysis of most of them was made by the Massachusetts State Board of Health. [Footnote 1]

The principal active agent in all of these remedies was {93} found to be alcohol. In most of them it exists in a proportion about equal to that in which it is supposed to occur in ordinary whiskey. Some of them are even stronger in alcoholic contents than the whiskey usually sold in our large cities. This matter has seemed so important that we give the official figures of the Board of Health.

TABLE

From the Report of the Massachusetts Board of Health

Tonics and Bitters

The following were examined for the purpose of ascertaining the percentage of alcohol in each. Some of them have been recommended as temperance drinks!

Per cent, of Alcohol (by volume).

"Best" Tonic 7.6 Carter's Physical Extract 22.0 Hooker's Wigwam Tonic 20.7 Hoofland's German Tonic 29.3 Hop Tonic 7.0 Howe's Arabian Tonic, "not a rum drink" 13.2 Jackson's Golden Seal Tonic 19.6 Liebig Company's Coca Beef Tonic 23.2 Mensman's Peptonized Beef Tonic 16.5 Parker's Tonic, "purely vegetable," "recommended for inebriates" 41.6 Schenck's Sea Weed Tonic, "entirely harmless" 19.5 Atwood's Quinine Tonic Bitters 29.2 L. T. Atwood's Jaundice Bitters 22.3 Moses Atwood's Jaundice Bitters 17. 1 Baxter's Mandrake Bitters 16.5 Boker's Stomach Bitters 42.6 Brown's Iron Bitters 19.7 Burdock Blood Bitters 25.2 Carter's Scotch Bitters 17.6 Colton's Bitters 27.1 Copp's White Mountain Bitters, "not an alcoholic beverage" 6.0 Drake's Plantation Bitters 33.2 Flint's Quaker Bitters 21.4 Goodhue's Bitters 16.1 Greene's Nervura 17.2 {94} Hartshorn's Bitters 22.2 Hoofland's German Bitters, "entirely vegetable and free from alcoholic stimulant" 25.6

Hop Bitters 12.0 Hostetter's Stomach Bitters 44.3 Kaufmann's Sulphur Bitters, "contains no alcohol." As a matter of fact, it contains 20.5 per cent, of alcohol and no sulphur 20.5

Kingsley's Iron Tonic 14.9 Langley's Bitters 18.1 Liverpool's Mexican Tonic Bitters 22.4 Paine's Celery Compound 21.0 Pierce's Indian Restorative Bitters 6.1 Puritana 22.0 Porter's Stomach Bitters 27.9 Pulmonine 16.0 Rush's Bitters 35.0 Richardson's Concentrated Sherry Wine Bitters 47.5 Secor's Cinchona Bitters 13.1 Shonyo's German Bitters 21.5 Job Sweet's Strengthening Bitters 29.0 Thurston's Old Continental Bitters 11.4 Walker's Vinegar Bitters, "contains no spirit" 6.1 Warner's Safe Tonic Bitters 35.7 Warren's Bilious Bitters 21.5 Wheeler's Tonic Sherry Wine Bitters 18.8 Wheat Bitters 13.6 Faith Whitcomb's Nerve Bitters 20.3 Dr. Williams' Vegetable Jaundice Bitters 18.5 Whiskol, "a non-intoxicating stimulant, whiskey without its sting" 28.2 Colden's Liquid Beef Tonic, "recommended for treatment of the alcoholic habit" 26.5

Ayer's Sarsaparilla 26.2 Thayer's Compound Extract of Sarsaparilla 21.5 Hood's Sarsaparilla 18.8 Allen's Sarsaparilla 13.5 Dana's Sarsaparilla 13.5 Brown's Sarsaparilla 13.5 Corbett's Shaker Sarsaparilla 8.8 Radway's Resolvent 7.9

The dose recommended upon the labels of the foregoing preparations varies from a teaspoonful to a wineglassful, and the frequency also varies from one to four times a day, "increased as needed."

Many so-called tonics not on this list are also known to contain alcohol, {95} though not as yet officially analysed so as to give exact figures. Most of the cure-alls for women's ills contain alcohol in noteworthy amounts, this being in fact usually the only active ingredient in them.

As the analyst of the State Board of Health of Massachusetts is a thoroughly competent chemist, and as these figures have now been before the public for over five years without any contradiction on the part of the manufacturers of these remedies, though it is evident how undesirable the truth of the matter is from an advertising standpoint, there can no longer be any question as to the authoritativeness of the proportions of the alcohol in the remedies as given.

It is rather sad to think of mothers giving these remedies to their children, hopeful of the good they may accomplish, when, as a matter of fact, it would be so much simpler and just the same in the end, to give them, instead of a tablespoonful of the favourite sarsaparilla, whatever it might be, a tablespoonful of dilute whiskey. As was noted in the volumes on the Physiological Aspects of the Liquor Problem published recently by a sub-committee of the Committee of Fifty for the investigation of the liquor problem, not a few prominent total abstinence advocates have put themselves on record as recommending these remedies, though there can be no possible doubt of the great harm likely to arise from their use. There are many physicians who feel sure that some of the alcoholic habits in women, whose origin it has been hard to account for, were really contracted during this secret "tippling" process under the form of a tonic remedy. Everyone knows that any tonic, in order to be effective, has to be gradually increased, so it is not surprising that in many cases physicians have heard of patients taking six to ten tablespoonfuls of some tonic remedy every day. This would be the equivalent, in some cases, of from three to five ounces of whiskey--a rather liberal allowance even for a confirmed whiskey drinker.

As noted by the Massachusetts Board of Health, the dose recommended upon the labels varies considerably, but practically all agree in suggesting that the amount of the remedy taken shall be increased as needed. A simple presentation of this subject will surely be sufficient to arouse clergymen {96} to a proper sense of their duty in this matter. Senators, judges of Supreme Courts, Congressmen, and even university professors and teachers may be so benefited by dilute whiskey, taken early and often, as to be tempted to furnish testimonials for them (for a due consideration usually), but clergymen should at least know something of the consequences of their act before committing themselves.

An almost precisely similar state of affairs obtains with regard to another class of favourite popular remedies. A number of so-called blood-purifying remedies have been recommended at various times, and here, as in other things, it is surprising to find how many intelligent people lend themselves to the exploitation of the public in the interests of the proprietary vender, who cares only to sell, and cares very little what effect his remedies may produce. Most of the sarsaparillas are said to be blood purifiers. It is surprising what vogue this word "sarsaparilla" has obtained. A little more than half a century ago a German chemist and pharmacist announced that the sarsaparilla plant contained certain principles that could be extracted by boiling, and that form excellent remedies for atonic and anaemic conditions. This announcement was received by the medical profession very kindly, and immediate tests as to the efficacy of the new remedy were made. As a result of these tests, within a few years the inefficacy of sarsaparilla became very clear. It is almost entirely without effect upon the human system. In the meantime, however, the word "sarsaparilla" was one to conjure with for the popular mind, and the sarsaparilla remedies began to be manufactured. Millions have been made on them and out of the public. The only active agent as regards tonic qualities which they contain is, as we have said, alcohol. Most of them however, contain at least one other well-known drug likely to be at least as harmful as alcohol. This is iodide of potash. Very few of the so-called sarsaparillas are without a notable proportion of this strong mineral salt, as the Massachusetts Board of Health said.

"With but few exceptions they contain a considerable percentage of a very active and powerful remedy, the iodide of potassium. The sale of such an article in unlimited {97} quantities by druggists, grocers, and others is censurable. More than this, the method of its sale is dishonest, since the unwary purchaser is led to believe that he is purchasing a harmless vegetable remedy, namely, sarsaparilla.

"It may be seriously questioned whether the blood of persons who take iodide of potassium continuously is not decidedly impoverished, instead of being purified, as is claimed by the manufacturers. It is not uncommon to find persons who have used continuously six, eight, or ten pint bottles of one of these preparations.

"Unlike sarsaparilla, the iodide of potassium is classed among poisons by nearly every writer upon toxicology."

Practically all the proprietary remedies have their most potent principle in the supposed mystery of their composition. As a matter of fact, all are simple prescriptions, well known to physicians, and owing their successful treatment of many ills much more to the printer's ink used to secure their sale than to any pharmaceutical ingredient which they contain. No important remedy has ever been put on the market by advertising methods. Exposure of the charlatanry of such methods will not, however, cause an interruption of their sale. Long ago Barnum said that people wish to be humbugged, and there is no doubt that they have been, are, and will be humbugged just to the extent to which they lay themselves open to the alluring methods of the advertiser. It does seem too bad, however, that the influence of the clergymen and of religious as well as charitable visitors--an influence acquired because of the confidential position they occupy and the feeling of good faith their mode of life inspires--should be abused for the encouragement and extension of what is manifestly a great evil.

Alcohol and iodide of potash are not the only drugs likely to do harm that are incorporated in proprietary medicines. Great complaints have recently been made with regard to the spread of the cocaine habit in this country. Not a few of the remedies that are supposed to give immediate relief to colds in the head contain cocaine in dangerous amounts; and there seems no doubt that in many cases the drug habit for this substance has been acquired innocently and {98} unconsciously at first by the use of such preparations. These are only the more notable evils likely to result from the indiscriminate employment of medicines of whose composition there is complete ignorance, and of whose effect there can be only the judgment dependent upon the subjective feelings of the patient. It must not be forgotten that the patient's feelings are for the moment often favourably influenced by some substance that may do no good to the ailment, though making the patient less sensitive to any symptoms from which he was suffering; but in the end doing positive harm, because of the contraction of the alcohol or some drug habit, or because the suppression of symptoms may be the very worst thing for the patients, since it allows the underlying ailment to progress to a serious stage without forcing them to have it treated in radice.

These are only a few examples that show very well the inadvisability of recommending in any way medicines of which one does not know the exact contents. The present writer has had one example of how utterly disingenuous, though one feels much more like calling it rascally, the manufacturers of so-called patent medicines or proprietary remedies may be. One of the remedies widely advertised for the cure of epilepsy, or fits, is announced always as containing no harmful drugs, no bromide of potash. The manufacturer of the remedy was asked how he could say any such thing, since it was very evident even to the taste that the remedy contained bromides. "Oh," he said, "yes, it contains sodium bromide, but not bromide of potash." Almost needless to say, sodium bromide is at least as harmful as potassium bromide, and the advertisement is entirely for purposes of deception.

The poor epileptics have been a source of revenue for quacks and charlatans as long as history runs. At the present time one not infrequently finds testimonials from convents, asylums, reformatories, and the like, asserting the value of some particularly advertised remedy for this disease. All these remedies contain bromides. The treatment of epilepsy is now better understood by physicians and it is generally recognised that the two things that epileptic {99} patients need are outdoor air and as far as possible all freedom from responsibility. Bromides will, for a time, control the number and frequency of the attacks, but if used indiscriminately, and especially if employed without any proper realisation of their possibilities for harm, these salts are almost sure to make the condition of the patient much worse than before, to bring on a state in which mental symptoms predominate over physical, and in which the patient may go into dementia, or some form of mental alienation. Especially is this true with regard to epileptic children. Continuous dosing with drugs of any kind is sure to do them harm rather than good. Care for their diet and rest and the removal of all sources of disturbance of their digestive tract is more important than any other method of treatment.