’ A Doctor s Viewpoint

John Bess ner Huber, A . M . , M . D . h

Editor , The D ietetic an d Hygienic

Gazette ; Author , Co ns umptio n ’ and Civilization ( Lipp incott s ) Fellow o f the American M e dical As sociatio n and o f the New York

f tc A cademy o M edicine , Etc . , E .

GAZETTE PUBLISHING

87 NASSAU STREET, NEW YORK 1 9143 Copyright , , by

HU B E R JOHN B .

Jill is

Qi n , 3 ? 9 5 1 8 TABLE OF CONTENTS

A Twen tieth Century Ep ic The Elimination of Tuberculosis Danger Signals The Prevention of Ca nce r ’ Don t Be a Hermi t Crab The Cowa rd'ice o f Brave Men Woman ’s Seven Ages Let Us Go Ou t Into the Sun shin e Sense Training Eugenics Medical Research and Educ ation Editorial Effu sions How Genius Mani fests Its elf The Humanness of Scien tists Pulicide U n s c i e n t ific Futilitie s Cupid in Psychology Social Exc itement s Psychic Rese a r ch Factors of S a fety Killing and Conserva tion The Ethnic s of In fection Consumption and Civilizatio n Mongrelized Races — A1 1 Anti Vivisectio n Pl ay Spugs and Sp e fs Eutha nasi a The Philosophy of Pr ayer

To L M H . . .

W o uld it w e r e w o r thi e r $

PREFATORY NOTE

A s hort preface ; since nobody ever reads a long l a one . Much of our interest in life ies in how we p ’ — p r e ci a t e one another s ways of looking at i t the way t he - of the counsellor, Sky pilot, the painter, the farmer, the policeman on the fixed post , the steeplej ack, the man on the street , the woman in the wrapper . If this ’ book gets carried in anybody s coat pocket , or se cures place under the evening lamp and besides the armchair it will be because it has been written from a doctor’ s viewpoint of our human relations and of our civilization . Some of the matter in the following pages has ap ’ ear ed T he Amer i c an Revi ew o Revi ews Co lli er s p in f , ’ Weekl Har er s Wee kl T he N ew Yo r k E veni n y, p y, g Po s t Ou t do o r Li e a nd R ec r e a t i o n Kn o wled e S c i en , f , g , ’ t i c Amer i c an Li i n c o t t s M a azin e T he Br i ti s h fi , pp g , e ul i Jo ur n al o f T ub r c o s s and other Journals . To the editors of these publications I make my grateful a o w e d e n t s kn o l gm .

A TWENTIETH CENTUR Y EPIC

Venerable folk can to- day recall how in their child hood t he medieval conception o f di sease still persisted —that the forces evolving pestilence were mi ghtier ul than man co d hope to struggle with, too awful to be defied ; the only escape for humankind lay in p r op i t i at i n g, if possible , those supernatural powers . Hosts must s uccumb when the angel of death spread his wings

on the blast , a cloud passed over a doomed city and from it a retributive hand scattered upon an evil gen e r at i on the seeds of destruction . Such images permeated literature and made it mag ifi t n c en . The poetic temperament may a little regret the extent to which the modern science of preventive medicine has damaged imaginative literature , so that s u such sublime pictures as Milton portrayed, such e r V 1s 10n s p b as Byron and Coleridge saw, cannot now get themselves expressed ; and ( since human interest depends largely on the extent to which events imagined may conceivably enter into human experience) would be little appreciated if they were published . We could

- not to day enj oy , in quite the same way , another “ ” Masque of the Red Death , in which the bubonic “ plague was personified ; nor another such work as The ” Wandering Jew, who personified the cholera that

- stalked spectre like through three continents . The modern idea of warfare against disease w as ex “ pressed by Pasteur : It is within human power to banish all parasitic (infectious ) diseases from the face 9 10 “ A DOCTOR’S VIEWPOINT

” ~ of the earth . Here surely is a more reverent c on c ep t i o n than that medieval one ; fo r it does not hold fl e diseases to be scourges in ict d by a cruel deity . And it is a j uster conception, for it holds most pe stilence

- to be practically man made ; wherefore , and by the same - l token, such pestilences are man preventab e . And we are concluding that man, not God, fixes the death rate . hi s Here, as elsewhere in li fe, it is for man to work out N o r own salvation . does the modern Prometheus defy divinity ; but seeks , how successfully we shall see, by hi s - ul the exercise of God given fac ties , to free his race ’ - ff of aeon long su erings and disasters . Morse s first tele “ ” : gram read What hath God wrought . We are now to consider what God hath wrought thr ough human a e g n cy . PRE V E N TIV E M E D ICIN E

Our modern epic begins , then, with the birth of pre v e n t iv e n medicine, now the most pervasively be ignant li e force in civi zation . Past ur was the accoucheur when b a ct e he demonstrated microscopic parasites ( germs , i c ria , bacill ) to be the essential auses of the infections ; each infection having i t s specific and invariable germ . let mi And us pre se here that , in science at least , great names are landmarks ; and the owners of these names have traversed and gleaned in fields where many a de voted and forgotten laborer had delved and sown and pathetically sweated blood in his altruistic zeal . In science at least n o man works in vain . Full many an one , worthy of an elegy, has given his whole life to establishing a fact o r indeed only an item to a fact ; l ~ his work unrea ized , ridicule and even persecution often hi times s only compensation , throughout perhaps in the meanest destitution ; yet his life and his work have be en absolutely essential to the building o f a mighty A TWENTIETH CENTURY EPIC 1 1

M fabric . artyrs have been many among such, dying of the di seas es from which t hey sought to defend others ;

l ul be . knowing too , fu l well, what their own fate wo d Nor does it in any W1s e detract from the gratitude due the a gre t man , that he has profited by the labors of e an hi s n oth rs , adding what he c of own, scrutinizi g every detail, every datum, permeating and illuminating hi s all with own genius , cementing the mass with his ’ Jen n e r s ul fo r own deductions . Thus did inoc ations , vai n e example, make clear the way for D a and Lister, r Tyndall and Pasteu . i r Upon the foundati—on then, thus la d by Pasteu , did Koch and his c o worker s bring to maturity the hu science of preventive medicine . And what phase of - ? man existence does it not to day influence Personal , s domestic , chool, communal hygiene , as we now under

s . f tand these terms , are derived from it In ants no di longer die by spensations of Providence , but by germ has laden milk . Preventive medicine become adequately filt r a ti o n— equipp ed to deal with housing, sewage , well nigh all problems of rural , civic, State , national , inter a national, world sanitation . V st tracts of hitherto pes tilen t n land , formerly impossible of huma habitation, are now made salubrious and capable of most profitable a agriculture . Only Orient l fatalism stands in the way o f li i - e minat ng those age long plagues , which are still n r ur in u t ed the bosom of Old Mother India , and go forth on their ghastly business from that dreadful i - e progenitor . But now w th ever decr asing frequency ’ l Haflki n e i and viru ence ; for Ross , Manson , , and Sh ga an d their confreres have been and are making tremeu dous progres s in their titanic work against those i n ’ fec t i ons r . Af ica s most dreadful infection, the sleeping sicknes s is als o ei e r , b ng master d , la gely through the 12 A DOCTOR’ S VIEWPOINT

K h work of och, E rlich, and their colleagues . Malaria, that tyrant whi ch only a score of years ago dominated i s ff nl half the world, now su ered o y by the supine .

e Tub rculosis , which since the beginning of the race has been the Captain of the Men of Death, can also , mi if we but will, be eli nated from human experience . i li In commerce , more than in any other phase of c vi za tion, has advantage been taken of the be nefits preven tive medi cine can bestow : such infections as yellow ll fever , sma pox , malaria, typhoid and the dysenteries have been abolished from many entrepots : business in i t has deed, because has been found to pay , succeeded n o t infrequently , where discouraged humani ty has failed . And the wisest statesmanshi p is now c o mprehendi ng that through preventive medi cine disease can be abol i s hed an d , life prolonged , existence made happier . How “ sanely has Lecky observed : The great work of san i tary reform has been perhaps the noblest legislative ff achievement of our age , and, if measured by the su er i n di mi ni g it has shed , has probably done more for the real happiness of mankind t ha n x all the many questions ” that make and unmake ministries . And Dr . Eliot, of

Harvard , is insisting that no religion is worthy the name which does n o t take to its grateful embrace preventive

A MOST SALU TARY IN VASION

A s early a s 184 7 the idea exis ted that mosquitoe s have somehow to do with the spread of yellow fever . 1 81 8 . In Dr Carlos F . Finlay , of Havana , definitely hi set forth the theory, w ch he tried to prove but could n o t beca use he used in his inoculation experiments mos quit o es that had bitten yellow fever patients only withi n five days ; whereas it was later demonstrated that the A TWENTIETH CENTURY EPIC 13 mosquito is harmless until twelve days or longer afte r

1898 Ja When our army occupied Cuba , in , Yellow ck mi mi had been epide c , indeed practically ende c ( that is, constant) in Havana ; and despite all the then- known methods of fighting that infection there were about cases and 23 1 deaths among Am erican officers and men 1 r 900. . in the yea Dr . George M Sternberg, Surgeon

General of the United States Army , appointed four surgeons who were then on duty in Cuba , Walter Reed,

James Carroll, Jesse W . Lazear , and Aristides Agra t r a monte , a board to test the theory of mosquito um mission . Realizing that h an life must be put in lli r e j eopardy , these men were unwi ng to assume the sponsibility of asking others to risk death ; and they agreed to make the first experiments upon themselves .

was . J ( This , by the way , after Dr ohn Guiteras , of 1891 Havana , began in February , , a series of tests to ascertain whether yellow fever could be propagated in a controllable form by means of infected mosquitoes , mm thus securing i unization, as is done by vaccination in ll sma pox . He infected eight volunteers with mosquitoes , di e d i n cludi n — three of whom , g an American nurse (Miss m o s ui Clara D . Maas , of Orange , N . J ) Before the q toes were ready for the tests Reed was ordered to Wash i n gt o n on official duty and was prevented from taking part in the experiments ; and qui te rightly he did not afterward subj ect himself to them . Agramonte was an ff d immune . Carroll was first bitten and su ere a very s evere attack of yellow fever , from which he recovered, An d though for a long time his life was despaired of . hi s premature death was certainly hastened by thi s ex i e - e r n c e . p Next Lazear , while in a yellow fever hos s aw pital, collecting blood from the patients for study, ’ 14s A DOCTOR S VIEWPOIN T

o hi s e a m squito settling on the back of hand . Lik the ancient Roman who thrust his hand in the devouring m fla e , he calmly let the insert remain there till it had e i t s had the satisfi d hunger and inj ected lethal poison . ? Lethal Yes , for five days later this hero o f the ages c m di a e down with yellow fever and ed of it .

HEROIC VOLU N TEERS IN THE WA R AGAIN ST D ISEASE

To establish the length of the perio d when an infected mosquito be came harmful after its biting of a yellow f m fever su ferer , and also the time which ust elapse after the patient had been stricken before the disease can be

i . ee conveyed to the mosquito for transm ssion, Dr R d instituted a second series of experiments in “Lazear ” r Camp nea Quemados , Cuba . General Leonard Wood, s t then military governor of Cuba, gave all pos ible assis ff e ance , and to encourage volunteers for the tests o er d n d hi s a reward of two hundred dollars . A , though call ’ w as issued after Lazear s martyrdom and when the army realized full well in what manner he and Carroll had “ ff A lfi e r i c an su ered , to the everlasting glory of the a o ff e se es soldier, volunteers from the rmy er d them lv for experiment i n plenty and with the utmos t fear ” lessness . The first t o present themselves were t w o young Ohio

K r an J J. . d soldiers , John R issinge ohn Moran ; but only on the condi tion that they should receive n o p c f c un i ar K e o h o y reward . issing r n t ree successive cca nl sions was taken, clad o y in a nightshirt , into a room where infected mosqu itoes wer e confined and lay there quietly until they bit him ; and he was infected with the la fever, from which he recovered . Moran , similarly c d , entered the room containing the mosquitoes , where he m hi s lay for thirty mi nutes . Within two minutes fro A TWENTIETH CENTURY EPIC 1 5

th e entrance he was being bitten about face and hands . On Christmas morning he was also stricken with yellow

an d t . fever, , like Kissinger, fortuna ely recovered There e - hi s ol wer in all twenty two , t rteen of them American s diers , who submitted gloriou ly to the tests . Into the tests to demonstrate that yellow fe ver was not conveyed through fomites ( contact infection through inanimate obj ects , contagion) seven p ersons — entered Dr . Robert P . Cooke , an acting assistant sur geon of the army and six privates of the hospital corps .

In a single room, fourteen by twenty feet , carefully guarded against the entrance of mosquitoes , its temper

- ature maintained at about seventy six degrees , with a f su ficient amount of humidity, supplied with a large l quantity of bed c othing and wearing apparel, taken from the beds and persons of patients who died of hi s yellow fever , Dr . Cooke and men slept for twenty consecutive nights , handling and wearing the contami “ n a t ed n u clothing, although the stench was almost ” bearable . They came out of the ordeal in perfect li health, proving beyond the possibi ty of dispute that the di sease was not contagious and that the mosquito is the sole method of transmission .

YELLOW J AC K VANQUISHED

By such heroisms was it demonstrated that : The m s t e o m i a n osquito known as g y , and o ly that insect , serves as the intermedi ate host for the parasite of yellow fever ; thi s disease is transmitted to the non- immune i n dividual by means of the bite of s t ego myi a that has previously fed on the blood of one sick of this disease ; an interval of twelve days or more after contamination is neces sary before s t ego myia can convey the infection ; the p eriod of incubation ( fr om the bite to the appe ar 16 A DOCTOR’ S VIEWPOINT

ance of symptoms) in yellow fever varies from forty-one a hours to s ixdays ; yellow fever is not conveyed by fo s c lo thm mites , wherefore disinfection of article of g, bed dl ding, or merchandise , suppose y contaminated by con o f tact with those sick this disease , is unnecessary . A house is infected with yellow fever only when there are pres ent within its walls contaminated s t egomyi a capable o f conveying the parasite of this disease ; and while the mode of p ropagation of yellow fever has now been def i ni t el e y determined its specific cause , lik the specific

cause of smallpox , remains to be demonstrated . 1901 In February of , by order of General Wood , - Ma li Surgeon j or Wil am Crawford Gorgas , then chief f e sanitary o ficer of the city , proceeded to liminate yel low fever from human experience in Havana ; and this W in he did ithin a year, although at least one hundred and fifty years that city had never been free of Yellow

Jack . He screened cases of yellow fever , and all sus p e c t ed cases ; destroyed infected insects ; and suppressed s t e i go my a through control of their breeding places . W Later he turned the same trick in Panama , hilst White 1905 banished yellow fever from New Orleans in ,

Liceaga from Vera Cruz , and Oswaldo Cruz from Rio i 1 de Jan e r o in 909 . PANAMA BEFORE 1900 Properly to appreciate what Gorgas and his asso ciates in preventive medicine have done in the Canal Zone one must consider what Panamanian conditions ’ were before the twentieth century . It was one of Keats — finest inspirations surprised Balboa v i ew m g the Pa

c ific from a peak in Darien . Balboa is said to have contemplated a waterway connecting the two vast oceans ; and his Spanish sovereign is historied to have

18 A D OCT OR’S VIEWPOINT

Panama was left ; its site un til the Fre nch o ccupati on w as overgrown by a dense a nd most pestilent tropical t o m a c an i forest . Up the A i occupation th s neck of land bindi ng together t w o continents has been made s h up of mountain and the valleys between t em ; dense , r almost impenetrable unde growth , making a veritable j ungle ; independent and conj oined bodi es of stagnant ml i waters ; swamp areas ; botto ess quagm res , with tor r e n t i al river streams draining i n the persistent rainy seasons the mountain watersheds and deluging the lo w e lands on their way to the Pacific and th Mexican Gulf .

Humboldt, a cen tury ago , after a visit to the Isthmus s t in which he tudied the conditions , gave his belief tha Panama must always be cursed by yellow fever and ma laria ; the former he understood to be caused by the decaying mollusks and marine plants on the be ach at - low tide , the latter by foul emanations from over rank vegetation ; then came the French headed by the grandi 1881 1892 ose De Lesseps , who squandered from to an equivalent of more than o n e dollar for every mi nute s i nc e Balb o a 1513 of time that has elapsed x first , in , set foot on that wonderful and gruesomely fascinating

Isthmus . A reason why Panama has been peculi ar ly pe stilent is t e that , since Balboa , h Is thmus has been the point of crossing between the two oceans in the western hem i spher e ; wherefore there have always been at Panama m n i a y unacclimated European s , who wer e easy vi ct ms to the tropical infections . Gorgas believes that on the average , through four hundred years past , there have been more unacclimat ed Eur opeans i n Panama than in any other tropical city liable to yellow fever . Where fore this re gion had acquired the reputation o f be ing t e h e h un ealthi st know n . A TWENTIETH CENTURY EPIC 19

v t he 1885 Fr onde , who isited West Indies in , wrote “ In all the world there is not , perhaps , now con cen t r at ed in any single spot so much swindling and s hi villainy, so much foul di ease , such a deous dung a heap of mor al and physic l abomination , as in the scene of thi s far- famed undertaking of ni neteenth century

en gineering . The scene of operations is a e s damp , tr opical j ungle , int nsely hot , wet, feveri h, li swar ming with mosquitoes , snakes , al gators , scorpions , d a nd centipe es , the home , even as nature made it , of e i hr yellow f ver, typhus , and dysentery ; and now made measurably more deadly by the multitudes of people ” who crowd thither . Except to note that De Lesseps spent all and had, for that, done but a fraction of the work , we c an touch here o nly on the medical aspects of that Gallic debacle ; the suffering and dying were a veritable

repli ca of the Black Death of the Middle Ages . Behind i “ everyth ng lurked always the grim spectre . Eat , drink ” and be merry for to - morrow yo u di e was everywhere

the ghastly sentiment, either subconsciously felt or

- openly expressed . The strongest to day would be - among the buried to morrow . Y ellow Jack claimed two m out of four, perhap s two of every three victi s among e thos Frenchmen ; and how brave they were , how reck le s s of death $ An instance among many : Claude Mal the h e l at let, t n consu Panama , accompanied a surveying r w -t w o pa ty of t enty to the Upper Chagres . Withi n a a zi week all but Mallet and a Russian engineer , D em bo w ski w ere incapacitated by disease . This Russian a ll t o hi m a sked Ma et advance money, against next p y da ew s y, for a n uit of clothes . On t he afternoon of thei r re tu rn the clothi ng w as bought ; and D ziemb ow ski ’ a cce pted Mallet s invitation to lunch the next day: But 20 A DOCTOR ’S VIEWPOINT the guest di d not come— having died of yellow fever at three that morni ng and having been buried about day i n light those clothes .

Jul di - l l es Dingler , the first rector genera of the cana “ work, had erected for him a residence ; La ” l e Folie Ding er, it was called, because of its excessiv cost and its rather inaccessible location , high on the southern slope of Ancon Hill . Before Dingler could hi s hi s occupy house wife , son, and daughter died of l ye low fever ; and he returned to France soon after, i - e h mself to die , a broken heart d man . Leon Boyer suc c e ede d him and had hardly begun hi s duties when he mi “ ” also was s tten and died . The mysterious malady , “ - wrote Bunau Varilla, a division engineer , defied all pre at cautions , laughed all remedies , and all that the most expert physicians could do for its victims was to ad li ff minister pal atives , the e ect of which was moral rather ” than curative . ' Yet the French did as well as could have been done , considering that the di scovery o f the mosqui to trans f mission o yellow fever disease had not yet been made , whilst the Americans came t o the Isthmus in the full e knowledge of these two discoveri s . The French had admirable hospitals whi ch they ignorantly furni shed with the means of spreadi ng rather than of checking i i d sease . For, in order that their patients m ght not e b annoyed by the ants ubiquitous on the Isthmus , they placed the posts of the hospital bedsteads in bowls of - s t e water . In these bowls , then, the death conveying g o myi a were bred ; whi lst no screens were put in the s dows and doors of hospitals and other buildings , thu permitting the entrance of the malaria- dissemi nating a h n o p eles mosquito . A TWENTIETH CENTURY EPIC 21

GORGAS IN PANAMA

e e Such, then, were conditions in the Canal Zone b for

the Americans took possession . Its sanitary affairs r we e then put in the hands of Colonel Gorgas , who had di so brilliantly applied preventive me cine in Havana . Th o e then military governor of the Zone , Col nel Charles ’ all E . Magoon, assured Gorgas that the government s e hi s resources in that region wer at service . Whereupon the cities of Panama and Colon were renovated, house by house ; sewage systems were installed ; the towns of the Zone were divided into districts for mosquito di - extermination ; buil ngs were rat proofed, to guard against the bubonic plague ; medical inspectors began making daily house- to - house canvasses and to report — ll suspected cases all of which latter were at once , wi y n ill y , segregated in hospitals ; all potable waters were examined and foods inspected weekly, to guard especial l y against typhoid, the principal ingestion infection ; “ ” the typhoid fly was suppressed . The result ? Gorgas and his associates have made this region as infection- free as any in these United

States , and much more salubrious than a great many .

Panama now rivals Palm Beach as a health resort . Yellow Jack has been absolutely bani shed from the Zone 1906 1907 since . During Gorgas did not have a single 50 case of bubonic plague to deal with ; he had per cent . 1906 reduction from in malaria, typhoid , dysentery, pneumonia, and other grave diseases . His death rate

3 0 . 190 1 06 was more than per cent lower in 7 than in 9 . In the region over which he has had jurisdiction ( the — Canal Zone and the cities of Panama and Colon a 4 4 8 territory of square miles , extending five miles on

either side the canal route) , he has had in his keeping the health of many thousands of men from widely di f 22 A DOCTOR’ S VIEWPOINT

fe r e t n parts of the earth, engaged in digging thr ough the sw amp land of the erstwhile deadliest region in 1 s existence . In March , 907, he had employee 122 o f 1 0 under observation , with deaths ; in March 9 8 4 5 he supervised men, with only deaths . The mortality rate of the Canal Zone for March o f that , ' o f year was less than that the City of New York, which s o r i o is among the lowe t , rural urban, in civil zati n . During 1906-7 he had deaths among em p loye es during 1912-3 he had 483 deaths among employees .

men The French, with an average force o f , lost during their construction period the Amer i c a the ns , with an average force of during about same length of time , had die . 15 00 In modern warfare, by the way , it costs about $ , d

‘ to kill a man . In the Boer row this item came as high as The Balkan mix- up with Turkey was con ducted more reasonably burned up in making al one man food for powder . Gorgas , in the Can Zone , at t he has been saving human life x actual cost of

the individual . Sanitation in the Isthmus under Gorgas o f l has cost just five per cent . the tota canal building ex es penditur . ’ the m l n t l When, then , Pana a Cana is ope o the wor d s vessels let no o n e have to be reminded that thi s epic work c ould never have be en accomplished had not de s inl t o voted and zealou men, from F ay Gorgas , so mag nific e n tl m s ff y , and with so much altruis , u ering and martyrdom led up to and applied the discoveries an d e di e r sources of me cal science to the colossal en terpri s .

GonGA s AN D M AL AmA

An d what Gorgas did against malaria in the Is thmus A TWENTIETH CENTURY EPIC 23

l m and e sewhere deserves a section by itself. It is ore difi c ult w t ih to cope malaria than with yellow fever, although the latter is far the more fatal di sease ; be s s t e o m i a li cau e g y breeds about human dwel ngs , whilst h es an op el loves to roam afield and in rural waterways .

- Wherefore , to sketch the anti malarial work were , as

honest Cassio might observe , even a more excellent song

thanthe other .

1m r t a c e And the consideration is of uni versal p o n , because the climatic and geographical conditions for the breeding of an op heles are ideal in the tropics all the year around . It was Ronald Reed, an English Army 1 898 surgeon, who discovered in that the malarial germ, the p la s mo dium (which Laveran had demonstrated) is conveyed to man only by the bite of this particular l species of mosquito . Nowhere else on the globe cou d

The Lady Anopheline , who alone transfers the plasmo di um (being here , as elsewhere in the cosmos , deadlier than the male ) flourish so luxuriantly as in Panama , were not its breeding frustrated by sanitary science ade l r ac t i uat e . q y applied When malaria , then, can be p

cally extinguished from the Isthmus , the like can be i ach eved pretty much anywhere else, if the inhabitants of the given region have but the acumen and the back ’ bone to go abo ut the work . Here , then, is Gorgas

1 an heles . The habitat of op during the larval stage hi is destroyed wit n a hundred yards of dwellings . The larv ae ui n of this mosq to live o ly as a rule in clear , fresh water that is plentifully supplied with grass and algae . Drains are the most effective and economical plan ; once put down they requi re no more attention ; no water be ing x t e posed to the surface , there is no breeding place lef for the mosquitoes ; by means of a horse -m ower o r 24 A DOCTOR’ S VIEWPOINT

be scythe the grass over the drain can cut . Failing

tiles , an open concreted ditch may be put down ; but li the first cost here is nearly as much as for ti ng, and the concrete ditch must constantly be kept cleared of hi obstructions in w ch breeding pools may be formed . i ff Open d tches are the least e ective and most expensive . 2 All . protection for the adult mosquito must be de

stroyed . The adult is weak on the wing , not generally flying far and needing plenty of grass and brush for protection against the wind . Brush and grass are therefore cleared for a hundred yards around dwellings ; where the locality is to be occupied for a year or more s it is best graded and gra sed, the latter kept well mowed . There is no obj ection to a little shrubbery or a few n 3 ll . All trees about a dwe i g . habitations are

ff . screened, but e ectively Screens as ordinarily put up , without expert supervision , are of little use . Good wire should last three years ; there is plenty of screen s 4 ing on the market that will not last six month . . i Where breeding places cannot be destroyed by drain ng, a larv are destroyed by means of crude petroleum ,

Phi n o t a s . oil , and sulphate of copper The first of these c n s t r u c is used in temporary pools , caused by bad o

tion , or at temporary camps where it would not be im r a c economical to drain , and wherever drainage is p t i c able ; the last two are used for killing the larva in a e the alg and grass along the dge of a lake , a stream

or a swamp .

For those interested in the health of industrial camps , Gorgas makes exceedingly pregnant observations : In and about the Canal Zone laborers and their a 500 f milies have been scattered over square miles , though they have been collected principally in some forty camps or villages along the line of the canal ;

26 A DOCTOR’ S VIEWPOINT

Kafli r o f days for many a poor , who will otherwise e have died untimely and most pathetically . Colon l Gorgas has gone with the cons ent and approval of a a our W r Dep artment . The workers in the R nd gold mines are reported to be dying o ff in great n umbers hi of pneumonia, epidemics of w ch infection have been

rapidly succeedi ng one another . And the invitation came because Colonel Gorgas has s olved in Panama most b en efic en tly this problem of pneumonia preven tion, along with the others we have considered .

As in the Canal Zone , Gorgas believes that the pneu di ar be monia con tions e part of the grippe problem, cause almost all cases of the former follow upon attacks mi r o fit of the grippe . People all over the world ght p ni ably consider this . Grippe and pneumo a , like the the other diseases we have dwelt on, can be abolished if e people concerned but choose ; nor , as we have se n, would the cost be beyond the r es ou r c s of any com munity , state or nation . With regard to grippe there is the erroneous impression that it is too trivial a mat

‘ ter to bother about . Well, the Dutch have put up a proverb in the house where 1 ~Peter the Great studi ed “ ” shipbuilding . Den Grooten Man is niets te klein to the great man there 1s nothing too trivial ; and that is why the world may be confident that Gorgas will clean up that pneumoni a j ob in the Rand and the grippe j ob along with it THE KILL IN GUAYAQUIL

Consider , by way of contrast , the graphic presenta tion of fourteenth- century conditions in a twentieth T h century town made , under the above caption , by e S o u t h Ame r i c an 1 1914 of February , . Guayaquil , ’ Ecuador s principal seaport , is one of the unhealthiest A TWENTIETH CENTURY EPIC

s pots in the world . It has a first mortgage on most of the malarial fevers in existence and yellow fever ” a might almost be said to be an industry . Occ sionally ff r ff e orts , mo e gruesomely diverting than e ective , have

been made to fight infection . For example , at a time when t here were a sco re of yellow fever cases in the Guayaquil hospital and the communi ty w as li terally

germ saturated , the local health authorities refused a p arty from the North desiring to go to Quito , permis s ion to land on the ground that some of its members i might bring in that d sease . And many Northern papers were deceived to the extent that they praised ’ efi e c t iv e . the measures taken in Guayaquil Again, there was an absurd plan providing for a large quantity of 1 es o ff v drain p p to carry the excessi e rainfall ; this , it

seems , was because somebody had an option on a supply f o pipe .

il . The bubonic plague appearing in Guayaqu , Dr a Lloyd, the Americ n Marine Hospital physician, then

on duty in that place , was employed by the municipal i hi s ity . But as the epidem c , by reason of zeal , grad uall y lessened and cases became sporadic , the port “ . again be came normal in its unh ealthi ness and one di dl more sease, and that the dea iest , was added to the ” l s i t .

But there is now hope of Guayaquil , because the rigid quarantine maintained at Panama by Gorgas i s hi ni nl setting a standard w ch no other commu ty , certai y

none on the Mexican Gulf or the Caribbean Sea , can n f ig ore . For no vessels coming rom such ports or having touched there would be permitted to enter the Canal without exhaustive scrutiny and unendurable

de lay . During tw o years pas t our own Government has be en 28 A DOCTOR’S VIEWPOINT quietly persuading the Ecuadorean Government t o cle ar l A n d e up the Guayaqui situation . at the r quest of the latter, Gorgas , heading a commission of experts , vis i t ed Guayaquil, made a thorough scientific investigation n mi hi of co ditions , and sub tted an elaborate report , w ch expressed no doubt as to the ability of real live , con s c i en ti ous men to establish and maintain a clean , healthy port . The cost would be some about half 9 the total commerce of Ecuador, approximately 0 per

. l r cent , of which passes through Guayaqui . Not p o hi biti v e , obviously

F R OM LITTLE REBEL TO SURGEON-GENERAL “ ” There is a fine billboard displayed in the m e t r o p olis intended for the wholesome influence of our youth . The ascendi ng steps in the career of General Grant from the hardest conditions in life to the Presidency “ : are presented, underneath all being the legend What will be your career with much better chances in your ? ” li favor Colonel Gorgas , in an address de vered in 1 12 n s June , 9 , at the commencement exercises of Joh : Hopkins University , in Baltimore , said “ I am bound to the Baltimore of a former generation by the closest ties of gratitude and friendship . I first — came to Baltimore about forty- fiv e years ago a rag ll ged , barefoot little rebel, with empty pockets and sti s h more empty stomach . My father had gone outh wit ’ hm Lee s army . At the fall and destruction of Ric ond , ’ s he h ad my mother s house, with all that , was burned , leaving her stranded with six small children . She came to Baltimore and was there ass isted and cared for by friends . These memories are vivid with me and can ” n f ever be ef aced . How beautifully rounded out , then, “ ” w s hi s um n d J i age a t h a ocument , when ohns Hopk ns g A TWENTIETH CENTURY EPIC 29

to Colonel Gorgas its honorary degree of doctor of

In s . . . laws . conferring thi Dr Wm H Welch extolled ’ hi s Gorgas Signal service to his profession, to coun hi s try , and to the world by conquests of pestilential “ hi mi ni dis ea ses . With gh ad strative capacity and with full command of the resources of sanitary science Colo nel Gorgas has given to the world the most complete and impressive demonstration in medi cal hi story of the accuracy and life- saving power of a knowledge con cerni ng the causation and mode of spread of certain

i i . dreaded epidem c and endem c diseases He it is who , in spite of obstacles and embarrassments , has made the construction of the isthmian canal possible With out serious loss of life or incapacity from diseas e a triumph of preventive medicine not surpassed in im portance and significance , in the conquest of science s over disea e , in the saving of untold thousands of hu man lives and human treasure , in the protection of our shores from the once ever- threateni ng scourge of yellow ili fever, in the reclamation to civ zation of tropical lands — i n results such as these are to be found the monu ments of our laureate , his victories of peace , to whi ch this university now pays tribute by such honor as it ” ca n bestow .

Many other just honors , many encomiums from every

s . civilized nation, have come to thi great benefactor The latest is President Wilson’ s nomi nation of Gorgas (who had in 1903 been made Colonel by special act of Congress in recogni tion of hi s di stingui shed services) to be Surgeon- General of the Army of the Uni ted — he o ur States , with the rank of Brigadier General . T J n al of t he Amer i c an M edi c al A s s o c i a t i on has well o h served “ For his masterly ability as an organizer a nd ad 3 0 A DOCTOR’S VIEWPOINT

ni s t o l l e s mi strator, highest prai e is due Co one Go thal , and any reward whi ch Congress o r the President may see fit to confer on him will be well des erved ; but the mechanical construction of the Panama Canal differs 1n 1 from other engineering feats only s ze . The work o f the Sanitary Department under Colonel Gorgas has not only been the greatest task of sanitation that has

ever been undertaken, but it is also unique and epoch n making . For the first time in human history a regio i ha s which, since the earliest traditions of c vilization, been regarded as a plague spot in which it was imp o s man e sible for civilized to live and work, has be n con verted into a place fitted for enj oyable habitation and labor , with a death rate below that of the most mod ” ern cities . The unique value o f the work of Colonel Gorgas lies in his practical demonstration that regions of the earth hi therto closed to the whi te man can be made as hab s ec i t able as any portion of our own country . Any tion of the earth can now be made open to civilization . Nor can civilized man now recede to his own position o f ff s fatalism, resignation , or indi erence , to the ravage i of epidem c disease . r This , then, has been the career of Colonel Go gas . It is characteristic of the man and of both the pro fessions of healing and of soldi ery which he s o nobly represents that no reward in the form of great wealth hi s has ever been , nor would it have ever been con s ide r ed or accepted . The satisfaction of work well done for the good of humanity is the modest di stinction worthy of him and of his monumental work . h ul T ere sho d , finally , be a Department of Public a i l He lth in Wash ngton , with a Secretary of Pub ic ’ i n i li ns o f Health the President s Cabinet . Ninety m l o A TWENTIETH CENTURY EPIC 3 1

e e ~ p ople would be vastly benefited, in the most r la t i o n s of life , by the appointment , with his acceptance, e - - of Brigadi r General Gorgas to this pre eminence . THE ELIMINATION OF TUBERCULOSIS

l n t he My friend and colleague , and noble champ o in

- anti tuberculosis fight, Dr . Mary E . Lapham, in a fine N e w Y r k E v en i n Po s t article in the a g , quoted from my ’ paper in Harp er s Weekly that the tube rcle bacillus is the essential, specific cause of tuberculosis and that, if all sorts and conditions of men and women would combine to help the doctor in preventing the spread of this germ we could eliminate the disease ( con s ump l tion ) from human experience . I had written a so that “ ’ ff i r Tuberculosis is not only a doctor s a a , but is also the most tremendous economic and social degeneration ” in existence . Dr . Lapham considered these ideas of mi s o i ne pretty far fetched ; , in extenuat on of them, I wrote in T he E ven i ng Po s t the followi ng : i . o Dr Lapham and I , however d vergent in ur ideas of getting there , have our eyes on the same goal. The tubercle bacillus is indeed t he specific cause o f tuber c ulo s i s ; there is no tuberculosis where the germ e s s e n t i al as ar e t w o to the dise e does not exist . But there elements in the evoluti on of consumption ; the specific — cause , the germ ; and the pre disposition , the state of the hi b e c ome s a body by w ch it soil for the bacillus . The tubercle bacillus ( I refer to the human type) cannot multiply outside the human body except under labora t ory conditions . It is not ( in the large aspects we ar e considering) a notable danger to humankind when con t ai n ed in human excreta ; the danger is mostly from

human sputum .

3 4 A DOCTOR’S VIEWPOINT

“ s it i s be pr evented, having clearly hown the way, up ” t o the rest o f civili zation to work with the doctors in f the altogether practicable , though epically di ficult, business of vanquishi ng once and for all the Captai n o f the Men o f Death . Why difficult ? Here are some reas ons why

WHERE T HE TARIFF COMES IN

Think o f a tariff that put an aver age tax o f 42 p e r

i o f li . cent . on the necessit es fe Consider what Dean “ H : enry Wade Rogers has written We all know that , no matter what may be the profits whi ch come into the treasury of a Trust, the wage paid is the prevail in f g rate , the market price . The tarif has made the “ Pittsburg millionaire” and it has also made the Pitts ’ Pi t t s burg laborer . What the latter s condition is the bur g Su r vey discloses . The consideration show n to the workingman is seen in the provisions of the Payne

A ff he a 75 . ldrich Tari . By that act is t xed per cent 12 o n 1 on his woolen suit , per cent . his shoes , 7 per 5 o n 0 . cent . his stockings and underwear, per cent on hi s 8 o n cotto n shirt, 7 per cent . his woolen hat and x l he c ar r ie s 4 gloves . The dinner pai is taxed 5 per hi s cent . The stove in home and the pots and kettles r 5 hi s a e taxed 4 per cent . The common crockery on

t 55 . k 5 able is taxed per cent , his knife and for 0 per

4 5 . w cent . , and his spoon per cent The windo glass i n 62 . a e his house is taxed per cent , nd ther is a tax on the lumber or the brick with which the building is con

structed , and on the paint and the wall paper used in hi s its finishing . The food with whi ch he makes frugal m 54 eal is taxed , the sugar he uses being taxed per ” cent . We doctors tell the poor that in order to get well ELIMINATION OF TUBERCULOSIS 3 5 of thei r cons umption they have to eat abundantly of hi al pur e n utritious food, part of w ch must be h f a dozen fre sh eggs a day $ What brute has ever been so vile as the human be ing who corners the food market ; as those selling fowl p ut r ifie d from storage several years ba ck $ Think of millions of eggs being held up for top “ ” prices while the poor are sold rots and spots ( rotten eggs passed through sieves so that chi ck embryos three quarters of an inch long shall not get into the stenchi ng m ’ li ess) . And, when Christ s poor are treated ke that , people have the Olympian nerve to speak of ours as a Christian civilization $ Then there is the ghastly inhumanity of gauging hu — man labor by a law of supply and demand a law nat l ural on y in so far a—s it is evolved out of human greed and human meanness o f valuing labor as one does lum e r b or pork or j unk . Tuberculosis is neither a heredita ry nor a family dis e — di eas but a house sease , contracted chiefly in n u healthful tenements and workshops . A decade ago , when the idea of model tenements for the poor was launched doctors working among the tuberculous rej oiced ; for here , it was felt , would be a most potent agency against

- the diseas e . But the model tenement of to day is not for — hi the poor not in New York nor in C cago ; and Mr . . e s s i s n ot James Bryc ay it for the poor in London .

Nearly ten years ago , with what strength and clarity ther e was in me, I set forth such things as these i n “ m ” my book , Consu p tion and Civilization ; things my um —all colleague , in your col ns , gives the impression most unwittingly—that I have never considered $

A e l i r o pr acher , on Tubercu os s Day a year ago , p “ ” p ounded the question Does God Fix the Death Rate ; an d he e e n o t fix nobly answer d hims lf, that God does 3 6 A DOCTOR’S VIEWPOINT

o d the death rate . His God was not that kind of a g ;

hi s Providence no such providence . Man fixes the death o r rate by the war ( industrial with ordnance ) , the fami ne and the pestilence he makes ; and by the same hi - token, these unholy t ngs are man preventable .

O X T HE -R ? WH , THEN , FI ES DEATH ATE

- ? Who , then, does fix the death rate i n n um Those theologians , now happily diminishing

ber, who ignore the demonstrated facts of preventable disease and seek to perpetuate the m e di a v al superstition ’ that infections are the Alm ighty s merited scourges ; those laymen who consider they are not their brother’ s keeper and who disparage a tuberculosis propaganda as of no p e r s On al concern to them ; legislatures whi ch ’ give milli ons of the people s money for schemes that s o l frequently turn out crooked, when they wi l not give a u tho sand to health departments , for fighting a com — mun al disease that destroys lives a year 27 a day in one city alone ; venders of patent medicines

(mostly alcohol) and consumption cures , nostrum fakers who fleece their victims until the latter have passed far beyond the incipient stage in whi ch phy “ s i c i an s could have helped them ; a league for medi cal ” freedom , organized to prevent the wise centralization and c o -ordination of health activities ; those who over work women and children in factories and are r e s p o n sible for sweat- shop atrocities ; those employers who requi re men to work at dangerous trades under i n t ole r able conditions ( some industries hold a consumption - 8 - death rate above 0 per cent . ) those faith healers and miracle- mongers who would blind the sick to the facts di a of sease until no cure can be done . Here is n army ,

having no conscience and owning no religion, that fix the ELIMINATION OF TUBERCULOSIS 3 7

- s a n a t o r i a n s death rate, which competent physicians , , and humanitarians are trying— against such titanic — Odds to lower . I hereby earnestly implore the laity to be hence forth o n the side of those forces that are bringing down the death- rate instead of traini ng with malign battalions that are in the business of sending it up .

Dr . Latham is right . Our civilization has been most perversely leaving the br ink of a frightful precipice hi unguarded w le at the bottom are we doctors , Dr .

Latham and the rest of us , helping to restore what few we can among the hosts that have fallen into the depths below . And though thousands have been helped ul and many f ly restored, every third or fourth adult white and every other adult negro among u s could not be helped and has succumbed entirely . ll ’ We , what s to do ; are we going to keep on standing for all thi s ? Goethe was told that a certain situation “must be — s o there was an immense authority and custom in — favor of its being s o i t had been held to be s o for a “ : thousand years . To which he answered But i s it so ; is it so for me ?

Lister, as a student in surgery, was told that putre faction i n wounds was due to the oxygen in the atmos phe r e ; and there was no other way but that people had di e to most horribly of gangrene , in fetid hospitals . all But this did not suit Lister ; it was not so for him . And by his initiativ e humankind was freed of such con dit i o n s i t . w r m that Dr Wrench , in g about them , warns the squeami sh reader to leave o ff with the beginning of the description and go on to the next chapter of his O - — a book on Li ster . T day short generation after 3 8 A DOCTOR ’ S VIEWPOINT we are amazed and di sgusted at a civili zation that would placidly endure such c o n dtii o n s . al d me The Panama Canal, of which B boa rea d , and o f i l l wh ch Charles V was prescient , cou d never be bui t , declared Humboldt and Froude , because the isthmus was about the rottenest pest- hole o n the globe ; and De Les seps ’ honorable failure was in large measure due to di d that fact . But all this not daunt Gorgas ; it was hi not so for m . And he forthwith made a canal pos — sible b e assured it could never otherwise have be en — built by transforming that r egion into a veritable h nl ealth resort , with a mortality rate o y two or three A ni i merican commu ties can get under, and wh ch is the f despair o most others .

TUBER CULOSIS CA N BE CON QU ERED Tuberculosis can be eliminated from human exp eri ence ; all we have to do i s to determine not to stand for it . A century ago he who would have said such a thi ng about smallpox would have been declared fit only for a l madhouse . For sma lpox was decimating cities and an dx v i e wiping out whole towns llag s . The smallpo x conditions of those days di d not s atisfy Jenner ; so he e A n d went to work to get rid of that pestilenc . they w . A n d. r ac called him mad, and a lot orse yet how p tically obsolete is s mallpox to - day ; in 1 912 j ust two smallpox deaths among some five million people $ And the method of getting rid of tuberculosis is simpler dl ni ( though in practice the task is confesse y tita c ) , ’ We because don t even know the germ of smallpox , while we have the altogether adequate knowledge of the germ of tuberculosis I have outlined , and know precisely how to cope with it . Is then the prophecy unre ason able that our posterity E LIMINATION OF $ TUBERCULOSIS 3 9

~ a century hence will read with contempt and abhor s t ultified r ence of a civilization so that , having the clear preventive knowledge , it continued to be con tent with so loathsome a thing as consumption ? i d ui Much has been done adm rably by in ividual altr sts , by societies , and by Governments , against tuberculosis . But the kind of work that has thus far been done will di never completely eradicate the sease , because it does not deal adequately with the basic evils by whi ch the

Captain of the Men of Death does his gleaning . n And yet We ar e getting on . Co ditions are not nearly so bad as they wer e a decade ago . Whi le the rots and l e o n ev e r t he spots man sti l remains abov gr und, we have less ( a t last there is some real sta tesmanshi p in Wash i n gt o n ) got the detes table t a riff r educe d from an aver

4 2 26 . age o f per cent . to an average of per cent ; for all that it is still the mi s e r able s t laurel ever set on ’ Mammon s brow . And we are somehow coping too with the Captain of Industries who blo o ds w ea t s his i o mlli ns out of the poor , by demanding, and pro

r es s iv el n . g y getting, the livi g wage And if we could but unload our selves of the charity n a n d broker , the charity politicia , the philanthropist “ ” “ ” r n who talks about human de elicts and u desirables , we might be able to house the poor , the really poor, in — wholesome tenements a hundred model tenements for every one such now existing— and all conducted on a frankly business basis . One must see how the tuberculosis problem is be ginning to engage the consideration of discerni ng states men, who grasp the idea that all good government exists the primarily for maintenance of the home . And where is the home , what the human relation , what phase of our x af infinitely comple civilization, that is not wretchedly A DOCTOR ’ S VIE WPOIN T

fli c t e d h ? s by the Great W ite Plague Di raeli , Lecky , — Goldwin Smith , Hughes such men have and do com p rehend this . Why , indeed , wait for future generations ? - a to act To day the end m y begin to be fought for if, ab r j uring the tutelage of private enterp isers , and under the Presidency o f o ur grea test sta tesman since Lin u r l s s coln, o people wil but determine to po ess in them selves the sovereignty for whi ch Washington and our fa thers fought . hi Another fine t ng about Go ethe . A man came to him with a tremendously difficult tas k and feared he “ ” could not get away with it . Ach , answered Goethe , “ ” all you have to do i s t o blow on your hands $ $ Go to it , brother

4 2 A DOCTOR’ S VIEWPOINT

Well as for consultation whenever anything is wrong in ’ “ ” n o e s innards .

E V E RY B OD Y L OV E S A F A T MAN

and A great many of us are born with body habits , others of us j ust naturally acquire them after birth ; doctors call these habits temperaments , o r , tendencies , di or pre spositions . To be born with them does not necessarily mean that we are born with the dise ases they l ead to or represent . In fact , abnormal heredity ’ n e a r l as d doesn t count nowadays for y i much as it use to ; we are seldom born with the diseases themselves , bu t rather with tendencies to them . And these latter may manifest themselves as the real thing sometimes l very late in life . And it behooves the wise man to recal anything of that sort in his family history ; and then to guard especially against the disease to which it may lead . Here are some of these body habits i a l Tall thin specimens , with sl ght sm l bones , slender ribs , and long narrow chests ( that you can run your knuckles along a s on a z ylo p h o n e or a washboard) had j ust a s well take a little in terest in the present anti tuberculosis crusade— especially if those with that kind -u of make p have oval faces , a romantic expression , bright eyes , delicate skin and coloring , and run to art or poetry . Some people are born with a tendency to obesity these are by far the best- natured among our fellow z citi ens . Let such a one never hope to be lithe and willowy throughout his life on this mundane sphere e he that is , if he is born with the obese temp rament ; t i “ ” n . star part Patience is not for him Or, if a lady “ ” t e n de n c i e d s thus reads thi , let her not hope to curl “ ” up in a buttercup , like the Fairy Queen in Iolanthe . D AN GE R SIGNALS 43

Those who acquire “ heft in life are oftentimes ” ff wi l reduced e ectively enough , if they l only have the will power to stay s o by keeping away from the fle s h ? pots . And why should the fat man want to bant “ ” $ Nobody loves a fat man . Nonsense Everybody lli loves a fat man . Jo ty, eupepticism, oleaginous geni ality constan tly ooze from him to bless and permeate ’ civilization . The fat man is optimism s best asset ; how t cheerless we would be wi hout him . The tendency to is a obesity lmost never successfully combated ; and yet , seriously , there are some diseases of later life which depend on fat deposition in various organs , and against which it were well for the stout individual to guard when he turns forty .

’ How s YOU R LIVER ? h The s ort man, with the chest wide and round and o large , must not aspire to play the tr mbone , or to march in a band tooting that huge instrument which encircles t he body ; and such occupations as glass blow ing must be eschewed by such a one . For he has a che s t edn e s s tendency to wheeziness , to barrel , and to hi e short windedness , w ch is lik ly to grow on him later in — “ ” life as with the undertaker in David Copperfield .

Then there is the gouty temperament , which from v a time to time , according to the medical fashions of

rions eras , has been called the arthritic , or the rheu

- a . matic , or the uric acid or the lithemic h bit Such a r e people apt to be pretty good livers , generally robust l ( seemingly so at any rate ) , we l developed as to body , hi r the face florid , the hair t ck ( and sometimes iron g ay

quite early in life) , good teeth , the appetite hearty, i hi - good d gestion , and a strong heart with gh pressure r —i n e a te ries . A century ago the days of the thre ’ 4 4s A DOCTOR S VIEWPOINT — bo ttle men people of the gouty habit were prone to - s o wine , especially port ; to day the trouble is not much with drinking as with too much eating . ( Pretty nearly all of us do that . ) So the gouty have to prepare them a a selves against arteri l and heart ch nges , kidney and

- liver trouble and apoplexy . It is quite as true to day as r when the dictum fi st appeared some twenty years ago , that a man is j ust as old as his arteries . With these physiologic al hose pipes (which deliver blood instead of water) sound , elastic , and unrupturable , their owner is young at seventy ; he who h a s them of poor material “ ” is like to be old at fifty . And that venerable Punch j oke— “ Is life worth living ? it depends on the liver” is fraught with wisdom , as are almost all really good j okes . RIC KETS V E RSU S EUGENICS

On the other hand , there is the lymphatic tempera — ment those who have been born rachitic , weak of body , poor blooded , not well developed, prone to catarrhs ; they have little power of resistance and are constantly in danger of contracting some serious disease . Such ’ people have in times past b een among the wo rld s

greatest benefactors . It seems as if Providence , by way a h a d of compens tion for their bodily handicaps , given ll them noble souls , triumphant over their bodily i s l by their indomitable wil s , masterful men as to their ni brains , ge uses in literature and the arts and in world f enriching sciences . The human race cannot af ord to let such inspiriting examples as these pass away u n

timely ; nor should there be occasion for that . Almost all these fellow mortals can be bui lt up and made virile

- and able bodied , as fit physically as mentally ; and can , i an with proper care and guidance , l ve as long as y

of us . DANGER SIGNALS 4 5

Then there is the neuropathi c temperament ; and this IS a hard proposition : because there is so much innate

, cussedness in these very trying though often most [ lov

able specimens . And here it must be emphasized that there is no inherited tendency which cannot be success — i fully fought and downed except possibly alcohol sm, especially when it i s bequeathed by both parents . But

even thus handicapped , one can win out if he can hi o ff keep from the Great W te Way , go on a ranch or i to Patagonia , or anywhere outside of civil zation, with a mentor able to help him control his addictions and — a ul o c his perversities dominant mentor, who co d on

casion, if need be , hand over a good, healthy, corrective wallop .

EVEN NEUR OTICS CURABLE

A n d as to the s in of the father which was visited e i unto the third and fourth g neration , modern med cal l science has proved that , a one and uncomplicated, it — seldom endures beyond the second generation often ,

indeed, is not transmitted at all, although the Men

delians seem now to have something to say as to that . And yet it is an awful thi ng to have acquired ; if you ’ ’ “ don t believe me , go and see Ibsen s Ghosts , a play

perfectly well founded on scientific fact . The drug failings also are likely to be mani fest in

people of the neurotic temperament . And yet there — 'o r is no drug addiction cocaine, opium , absinthe , any other—whi ch cannot be triumphed over if only the

right kind of fight is put up . Just a parenthesis here about the acquired habit - i of taking the coal tar drugs , acetan lide , and so forth ,

for headache and for that feeling the morning after . It is dr eadful how prone young people are to thes e 4 6 A DOCTOR ’ S VIEWPOIN T

hi t ngs . I recall how, at lunch one day , our maid appeared with the face of a corpse , and with lips as blue as the ink I am now using . We sent her at once to bed , and upon investigation , this was the cause of her appearance : That morning I had r e c ei v ed - an advertisement of a coal tar product , with tablets to try on my patients ; as usual I promptly chucked the whole into the wastebasket . The maid ni wi in the mor ng found these tablets in the box , th the

, legend on it that they were good for headaches . She took not one but several, with the result narrated . l Had I not restored her, she might have been fata ly poisoned ; nor would her s have been t he first case of this kind , by any means .

: Well , to return to the neurotic temperament this can be triumphed over and brought to normal , but in most cases only after the bitterest kind of struggle . Remember that the three modern fates which govern i m ll. human destinies are heredity , environ ent , and w When the heredity is bad we have to offset it by a hi combination of environment and will , each of w ch is at least as powerful as heredi t y . So let the neurotic eu get into the outdoor world , which is his best v i r o n m e n t ; and let him gloriously exercise the divine human will . Then, believe me , he can triumph over the demon that would otherwise destroy him body and

soul.

THE PACE THAT KILLS

and And now a word about infection , heart disease ,

the pace that kills . In England it has been found that one- thi rd of all the deaths between fift y-fiv e and sixty fiv e come about through damaged hearts ; in the United States there has been during the last decade a c on DANGER SIGNALS 4 7

f s tan tl c o is e . y in reasing percentage , deaths from th caus All doctors know that this is largely by reason of the u worry , the h rry , the strain, and the dreadfully high i i ressure of modern commercial sm, and s ocial d stino p — a n d m hi tions , the ania for wealth factors w ch tend to und ue wear and tear of the p recious organ which

- must supply the body with its life sustaining fluid . The s all e nervou system, which is basic for xistence, and which especially controls the circulation , is in one who feels that he has to cope with and be in and of the m ul adding crowd, in constant stim ation . But apart ff from the nervous system is the fact that men of a airs , who have come down with pneumonia, grippe , or a like infection ( the toxins or poisons in which are drea dfully disintegrative of the vital organs ) can simply not be made to take the prolonged rest which is imperative for convalescence from these infections . Many of these — — patients and elderly men t o o ar e in their offices “ s when they should mo t decidedly be in their beds . Such ” “ a fussy lot , those doctors , declared one such ; besides , ” an old horse that once lies down never gets up . He put on his overcoat , went to business , returned that afternoon in collapse , and died next day . Another, a grippe convalescent , concluding he never felt better in hi s life , told his doctor to go hang, went downtown , and died in the evening . Another , a pneumonia convalescent , sits up to play cards with his wife , and drops back l lifeless upon his pi low .

The fault is not here with the doctors , to whom it is n ot given to command the manners and customs of the age ; they can but warn against fast living and against business habits conducive to such tension as must i n evitably lead to an untimely break- up ; they can but i n di c at e d s the fever , the weak and uncertain pulse , the y p 4 8 A DOCTOR ’ S VIEWPOINT

nea , the blue lips , the cold finger tips , the ashy face , the distended veins in the neck— and tell the dire meaning o f these danger signals . And now a s to the tendency to cancer : Many deaths from this disease occur after forty- fiv e years ; an d most - i deaths between sixty and sixty four are due to it . Wh le consumption destroys humankind from adolescence to ’ a r life s prime , cancer cl ims the greater numbe of victims a n d n in the afternoon eve ing of life . And it is a curious a c o n s u m phase of the law of compens tion , that while p tion, the Captain of the Men of Death , destroys mostly ’ — civilization s submerged strata the poor , the starved , and the exhausted— cancer on the other hand does the lar ger part of i t s gleaning rathe r among t h e well- to - do

l . in ife , those who have never felt the stress of poverty Patrician can c er ha s a p r edilection for the h omes of the — ll p rosperous . Cancer loves a shining mark the i us n r trio s , those of g eat worldly importance , those whom

' n e c an ill a commu iti s sp re , those who have , through m a a w any years of superb ctivity , f irly earned ease ith r t e dignity in a serene and espec ed old a g . Nor is there a any disease so insidious as c nc er . Therefore let the h n a man after forty , especially wit ca cer in the f mily a history ( though there is very little in c ncer heredity) , wh o s i n notices any inflamm ation in the mouth , or who e s li i n e x digestion are not easily re eved, or who has plicable pain in the abdomen ; or the wom an whose func tions natural t o her sex seem abnorm al le t such suf fe r e r s frequently consult medical advisers of tried skill and reputation .

DO NOT W ORRY

An d finally about those factors of s a fe ty ; they ar e e our reserve forces , which avail us in time of undu

50 DOCTOR ’ S VIEWPOINT

s accidents , and other untoward circumstance to humankind is constantly subj ected . n ot r i So do worry ; but do heed a dange s gn al, es pe c i ally when it lights up after forty $ THE PREVENTION OF CANCER

Cancer is one of the few problems remaini ng for i s medical science to solve . Its essential nature not yet i s t he fully determined . But the study of it intense ; il - e n civ ization wide field has , for a generation past, b e

entered by so many able and experienced delvers , all in generous rivalry to be the first to bestow upon their kind the epic boon ; so abundant are the material r e sources whi ch the sympathetic rich have put to the service of these workers ; so noble and so di stributed are the cancer research institutions ( j ustifying the claim of Harvard’s President Emeritus that no religion can be valid which does not recognize the b en e fic en c e pro c e e di n g from their walls) so loyal is the c o - operation of governments—that the unraveling of the cancer s mystery cannot surely now be longer delayed . I hall advert to t he prevalence of cancer ; how it invades the — human organism in its prime the world worker upon whom huma n progress depends , the mother to whom humankind must look for its life ; how practically i n curable is cancer when once established ; and other most momentous considerations : but my emphasis will be laid on the possibili ty of preventing half our cancer “ cases by prompt and adequate action in the p r e c an ” “ cerous stage . What cannot be cured must be e n ” all dured is an excellent dictum, satisfactory, like hi i p losoph c reflections , to those who have not , nor need fear the incurable thing ; but neither the cancer sufferer no r A his physician can get much comfort from it . nd 51 52 A DOCTOR’ S VIEWPOINT

D octor Parker Syms , in an address on cancer under the a i auspices of the New York St te Med cal Society, “ ha s given us a better saying , that what can not be cured ” ma y be prevented .

THE PREVALEN CE OF CANCER

i s Cancer considered to be very much on the increase , although this may be only apparent and by reason that our modern statistics are better prepared and based m on more accurate knowledge and observation . For y t ‘ part I mus believe that there is an increase . Because, ’ u hi ff l s b nlike tuberculosis , w ch a ects main y mankind s u m s — - erged trata the starved, the ill clothed , the devi t ali z ed— a cancer has had comp ratively , by no means always , a patrician predilection ; its tendency , except e s i n for the sup rficial cancer , which result mostly from u n j uries is for those after forty , in whom eupepticism as relieved by exercise in this motor car age has left , it mi li were , unburned or unassi lated k nkers to clog and i d . corrode the bo ly machinery Then , too , twentieth cen tury preventive medicine has been wonderfully i n s t r u mental in preserving the lives many who would for “ of merly have died in infancy an d youth ; and certain of these survivors have probably later on contracted can$ cer and added to the percentage of its incidence .

However these things may be , cancer is known to affect humankind exceptionally before the twentieth l year , rare y before the thirtieth , whilst most of its vic b tims are etween thirty and old age , the maj ority being - fi e - fiv e between forty v and sixty . The disease is con s ide r ably more than half as prevalent as tuberculosis . J The latter , The Captain of the Men of Death (in ohn ’ Bunyan s tremendous phras e) has been destroying every third or fourth adult white life and every other negr o T HE PREVENTION OF CANCER 53

life be tween adolescence and fifty . Cancer is nearly six i tenths as prevalent as heart d sease . It is nearly as l hi preva ent as pneumonia , w ch in certain times and i ul places has had as h gh an incidence as tuberc osis . In the United States there are now nearly eighty thou r sand cance deaths annually . In England one woman t e n in dies of cancer and one man in eleven . The di sease prevails mo r e am ong women than among men because in most women it at tacks the o r ga n s peculi arly fem hi i m n e . a Ap rt from t s , cancer prevails more among a n d a men, especially that of the lips stom ch .

WHAT IS KNOWN ABOUT CANCER

Cancer is a malignant growth , malignant because its tendency is to increase and ramify into pr eviously r r T h e healthy pa ts of the body , until it dest oys life . word me an s crab ; and by it som e Gr e ek man y cen tur ie s a ago , with the genius of his race for trenchant ch r a c t e r i z a t i o n e n le —l , expressed the insidious , t tic ike reach ing out fr om the sini ster growth until ascen dancy h a s e a n be n g i ed over the sufferer . One sees her e also why r a t n i ff r ope io must not be delayed unt l the o shoots , eve y m i n one of which must for a cure be entirely re oved, a e e v de r gions oft n remote from the original seat , and which the surgeon cannot safely reach . For, if any a r c ncerous tissure remain, there will , with ve y rare ex c e t i o n s r p , be recurrence months or years afte ward , with practically no hope of permanent or positive cure in the present state of medical knowledge and experience . Complete removal by the knife of a strictly localized ll cancer , before it begins to ramify , wi give a cure

nl . r the o y assured cure But a cancer , at fi st a purely localized disease , is like in time to have portions of the primary tumor conveyed elsewhere through lymph and 54 A DOCTOR’ S VIEWPOINT blood cha nnels ; and when such secondary growths o h tain science has no remedy to give . t It were hardly well , except in the medical press , o ’ amplify such considerations ; the physician s consulta tion should bring them out . But certain things are appropriate to be stated here . There is little if any reason to believe cancer to be hereditary ; nor that it is a communicable , infectious disease ; nor that it pro duces in the sufferer a future immuni ty in the way that he who has , for example , an attack of smallpox need never again fear that disease ; nor is there at present a specific cure for cancer , by drugs or chem i als m c , of seru s or vaccines , although some superficial cancers appear to have been cured by the use of radium and other such means .

THE PR ECANCER OUS PERIOD We know this most important thing about cancer that there are certain bodily conditions and certain ail ments predisposing to its development , and which con e s t i t u t the precancerous state or stage . Except after blows or other inj uries cancer will not develop in normal i s tissues . It by recognizing this stage in time that forty thousand of our people can annually be saved i from death by this ap all n g affliction . How is this to be done ? Nearly half the cancers have a precancerous stage that ought to have been de “ ” - t e c t ed . Benign tumors , not in themselves death deal ing ; prolonged irritation ; disturbances of function

through years ; chronic ulcerations , especially of the i n fl am at i o n s stomach ; m ; injuries , abnormal tissue , as scars or stumps from old operations— such are con it i n s d o which must be feared as leading to cancer . wi Every benign tumor, however innocent to begin th , THE PREVENTION OF CANCER 55

“ ” ul r e is a potential cancer ; if operable , it sho d be fi l . moved, lest cancerous in tration take place in it Thus may not only a defini te and permanent cure be vouch safed ; but also such a relatively slight and s h o c kle s s

operation give the least disfigurement or mutilation . Certain kinds of moles ( birth marks ) may take on malignancy ; if these were removed in the precancerous stage there would most likely be no recurrence and no internal mi grations of the cancer cells to other and r e b e mote parts of the body . When these moles have come definitely cancerous they are exceptionally seri ous . li “ Cancer is always a tumor, a swel ng, a lump as many people say . The laity are apt to think of a n tumor as necessarily meani g a cancer . But to the doctor any kind of a swelling (and there are at least a score of them ) is a tumor . Also there are several di ff kinds of cancer, ering in the degree of their malig nancy and in their course . Superficial cancers , as those

of the face or lip , are reasonably recognizable by sight

and touch and by a microscopic examination . Imme di a t ely such a thing appears medi cal consultation must

be . had Of course , such a thing may not be cancerous ; further description is withheld in order not to arouse

- pathophobia . Deep seated cancers are much more dif fi c ult to detect ; oftentimes the only indication of them is a functional disturbance of the organ or tiss ue i n

volved or perhaps also of other and associated organs . o Wherefore those after f rty , especially women, and cer t ai nly those after forty who find their health not as it ha s bee n should go without delay for a medical ex i am nation . Irritation prolonged through months and years all too often leads to a cancer at the site of the irrita 56 A DOCTOR ’ S VIEWPOINT

i s — tion . Thus there the clay pipe cancer ; there used ’ to be the chimney sweep s cancer ; there is that of the tongue from the j agged edge of an untreated tooth ;

the laryngeal cancer, from the inveterate smoking o f — strong tobacco ; the cancer from X ray burns ( how long the list o f medical martyrs who have suffered thus ) the cancer from prolonged exposure to the s un ; that from insect bites or intestinal parasites ; that from betel- nut chewing in India ; from eating very hot rice hi kank r i in C na ; the cancer in Thibet . ( The natives ni ka r i carry in their tu cs a pocket stove , the nk , the constant u s e o f whi ch i s followed by can cer at the

site of the burn . ) Prolonged di sturbance o f function n ot amenable t o ordi nary treatment should excite suspicion that h as im p e r a t i v e ly to be dissipated ; especially i s thi s s o of the digestive apparatus . Function and structure are as inseparable a s mind and matter abnormal function di ing must inevitably lead to seased structure . Anemia, a di nause , in gestion, loss of appetite , of weight , strength i and stam na , j aundice , bleeding from the stomach , un s easiness , pain and tendernes on pressing below the — breastplate such things should exite apprehension that i i has to be d ssipated . Gastric pain has been c o n s d ered to indi cate cancer and its absence to remove the occasion of fear ; but here were a broken reed to rely i on , for even advanced cancers have g ven no pain . These warnings must be emphasized for men after forty alch oli c s who have been or habitual eaters of irritating,

- indi ges tible and super abundant food . And the most heartrending cancer cases are those of women who have neglected the warnings given by discomfort and func t i o n al disturbances .

58 A DOCTOR ’ S VIEWPOINT

i s . remarkablylittle risk of life entailed Why , bless you ; the operating table is almos t the safest place in existence ; though later operations are confessedly ex

tensive, severe and dangerous , operation for the early cure o f cancer has a mortality o f n o more than one hi f o . per cent . And t nk the rest one gets A fortnight al or so of absolute relaxation in bed , a rest such as o r s ul most every man woman among us , ick or well, wo d o ff ul be the better for . How much better indeed , wo d the whole country be if such felicity ( as they say in i u the m nstrel shows) sho ld eventuate . ’ n ow er cen . Don t delay . Even as things are sixty p t o f of superficial cancers and nearly forty per cent . e thos deep seated are operable , with very fair pros e pe ts of cure . By earlier operation pr oportionately

better success would be attained . ’ N r li on i r l o rely on pal atives ; nor faith, m nd o hea er s “ ul cures ( How wo d the Master, with His if thine eye ”

ff . o end thee , cut it out abhor such unholiness ) And has finally the cancer got beyond remedy ? Then must philosophy and reli gion bring their consolation ( this they did in other eras— why should they not in ours) c whilst the physician, though he annot give euthanasia can nevert heless assuage the suffering and make it e u durable . And St . Paul could give help too . For when “ he besought that his incurable disease , his thorn in ” i the flesh might be made to depart from him, and t did not , despite his prayers ( for there was no miracle , even fo r one so worthy) he was comforted by the divine “ e i as sur an ce My grac i s s uffic ent unto you. DON ’T BE A HERMIT CRAB

“ “ I have read somewhere , observed the doctor , how s if a naturali t, studying the d ficulty a butterfly had i n

breaking from its chrysalis , determined to help along ’ — the little creature s will to- live by cutting through some i mpediments that bound it , so that it could the more — easily free itself . And what had that tender hearted scientist accomplished by his helping ? Instead of com

ing out strong and beautiful, the butterfly was a frail

thing indeed . The struggle of which the mistaken kind ness had relieved it was the very source of the strength of the body and the i r r ide s c e n c e of wing it should have

begun life with . “ n It is the same way , I understa d, with ducklings f that are helped from their shells . They dif er from those that j ust have to stru ggle out in being stunted

any puny, if indeed they do not have to die at once , or soon after the too - kindly hand has helped them out of

the egg shell stage of their development . “ The other day I visited the aquarium at the Battery

in the metropolis . In that most absorbing panorama of

fish life , from the ingratiating seal down to the tiny

- — sea horse a specimen of which that profound though ‘ ’ untutored psychologist Barnum worked o ff on the easy m A erican of his day as a mermaid, a horse on the public as — i n it were that aquarium are two adj acent tanks ,

one containing the real crab , the other a deplorably ff poor relation of his , the hermit crab . The di erence hi s is decidedly worth considering . The real crab, in 59 60 A DOCTOR’ S VIEWPOINT

native waters , leads a rough and perilous life , among a s j agged rocks . He is d hed about by every wave , whilst hi on all sides s piscine enemies attack him . So his i t s has kind , throughout struggle for existence , through crab- aeons developed a strong and serviceable coat of — nl mail a hard shell . Certai y the real crab is entitled to admi ration ; and he has businesslike appendages that - - t r excite a n o li me an ge e sort of respect . “ But not so the hermit crab , whose forefathers long ago imagined they had hit on a good idea , when they stole into the well- built homes that had been developed and then abandoned by other mollusks . And what has - ? been the result of such house free policy Why , gen e r a t i o n hi l after generation t s foo ish kind of crab , dwell i t s ing in stolen tenements , has ceased to bother itself about ques tions of safety or of any struggle for exist ence , such as ennobles all forms of life that enter into it .

Consequently , nature has written this sin against evo lut i o n - , this semi parasitism , most plainly upon the her ’ mit crab s organization , for any one to read and to be hi - disgusted over . T s miserable , shabby genteel sem ff t blance of a crab , has su ered in its ana omy precisely to the degree that it has ignobly borrowed or filc h e d from his neighbors . Not now a lusty, perfect , com — mendable , high class crustacean, its body is sadly weak ened, several of its vital organs are partly or wholly e l — all r shrivelled up , and its sph re of ife with the glo y — and satisfaction there gl o uld be in that has become

a ~ c he a pathetically limited . Having by p and unworthy h a s expedient secured safety , it in consequence fatally m compro ised its independence . Not now needing to construct its own coat of mail , a vital inducement to a life of dignified and vigilant exercise of its own powers i s correspondingly withdrawn . A number of bodily ’ ° DON T BE A HERMIT CRAB 1

func tions have struck work ; by a stern law of e v o lu tion— that an unused organ must atrophy— the hermit Onl has not y lost all power in certain parts , but also i those parts themselves . Instead of the thick, ch tinous shell of t he self- respecting crab the her mi t can now sho w only a membrane absurdly thi n and deli cate ; thi s half-naked and woebegone hobo of the seas presents l di imbs now ru mentary , or so small and frail as to be bu t nl laughable excuses for limbs . And the o y com p e n s a t i o n for all this degeneracy is that such additional tail development as will permit it to hold on to its stolen ’ ff retreat has been acquired through nature s su rance .

Obviously , in the near biological future the hermit spe i cies of crab will , by reason of its racial sen lity , become extinct . “ There is an enormous amount of semi - parasitism and parasitism in the cosmos , so far as our ken goes . — There are many forms of life the dodder, the mistle o n — t h e u toe , and so that will not take tro ble to find

their own food , but borrow or steal it from the more industrious ; here is oftentimes an acquired habit and a very bad one , for which nature invariably exacts a Alm ni dreadful penalty . ost every a mal is a living ’ i a zz a r o m poorhouse , harboring , supplying them gratis , n e not only with a permanent home , but with all the

c e s s it i e s and in deed all the luxuries of life . The animal ' is thus an unwilling host , to its own prodigious dis

comfort ; and often indeed to its death, by such rela t i s hi o n . p It is a most debatable philosophy , that of ‘ fl David Harum , that a moderate amount of eas is — ’ ’ good for a dog it keeps hi m from b r o o di n on bein ’ a dog . “ Now the point of all this lies in its application to

the human parasites , of whom there are a vast number 62 A DOCTOR’ S VIEWPOINT

subsisting on the rest of us ; this hurts us considerable , but it harms them a great deal more . In the biologic s cheme the genus homo is conditioned as to his life a s p rocesses , precisely is every other creature in the cosmos . Man is most perversely stupid to imagine the universe to be anthropocentric s o far as willi ng is con cerned . In the presence of the eternal verities he is as helplessly pliable as any other sentient thing ; the mod — — ern fates heredity , environment and function master him as did those of mythology ; and he cannot evade their shaping of him any more than can the dodder and the hermit crab . ff li They who eschew e ort , and are unwil ng for strug ff gle and su ering are lost . And , whilst going through - de s t ami n i z a t i o n a process of self , the indolent and the selfish inflict a most grievous phlebotomy upon the virile and the self- respecting portions of our really sub : lime race . The evil is obvious in various ways for example , the charity that helps the individual to help himself is altogether laudable ; but indiscriminate alms giving is a cruel wrong both to the recipient and to his ‘ community . Consider also the paternalism which j ust ’ now is rather rife ; when will the body- politic come to appreciate that what its government bestows upon some of its people must inevitably— there can be no other — source b e abstracted from the remainder of the citi nl — —b zens . The o y way there can be no other y which the government can be humane and generous is by tax ing you and me and Jones and Brown and Smith and ” Robinson . “ ” I am inclined to believe , observed the evolutionist , “ i that all manner of charity is futile ; and mistaken , n ’ e that it seeks , in violation of nature s laws , to preserv the unfit . Were it not after all better for the race in DON ’T BE A HERMIT CRAB 63

o ff— general if its weaklings were left to die humanely, ff of course ; are not , for instance , e orts on the part of you doctors to save the lives of consumptives , espe i all ul e c y of tuberc ous infants , really misdirect d, in that they violate the Darwini an law of the survival of the fittest ? Is not the continued existence of the weak an ad i t i o n al d , an unfair and a useless burden upon the strong and a handi cap upon the development and the progress of the fit ? Were not the Spartans wiser than we in throwing their unhealthy born infants to the wolves though of course I would not stand for any such thing as that , but only for a kind of blissful euthanasia , by which our unfit might be helped toward their oblivion . — — Anyway they considered did the Spar tans that the claims of the individual and of the race involved in

these respects a contradiction that , could be sensibly adjusted in but one way : they would not save a sickly ul infant , because to do that wo d be contrary to com mun al o hygiene , which would have for its ultimate h ” j e c t the improvement of the race . “ r And yet they were most deplo ably mistaken, those ”— materiali stic Spar tans here wa rmly broke in the hu m an it a r i an as history proved ; for they were ev e n t u ally overcome by the brainier though less brawny Athen l ans . “ You err , continued the humanitarian , in consider ing this tenet of the survival of the fittest to have only a physical, a materialistic phase ; whereas if it is to have li the s ghtest value in philosophy , it has got to be indica tive of evolution in all its aspects . Evolution, to be a

- philosophy worthy the name, has got to be an all com prehending system , upon which consistent living c an be based ; it has go t to consider not only the purely 64 A DOCTOR’ S VIEWPOINT

ll— physical, but all other aspects of life as we the men — an e v o lu tal, the moral, the emotional, the spiritual u a tion inclusive of the h m nities . For no doctrine in hi p losophy is surer than that the physical , moral , men a ll o e n a r e i n tal , spiritual and ther phases of exist ce separable and mutually a ffecting and affected parts of n — the i dividual being monistic , in short . The most practical Gradgrind, the coldest political economist , the most austere Statesmen , will grant this , as well as — the most susceptible to the emotion al a t least they will if they be men experienced in de a ling practically n a with human conditions . On such basis the , a symp ff thy for the weak and the a licted , and a helpful solution for their return to health and strength is altogether logical ; otherwise the conclusion is inevitable that wille s um u t en r civilization , the g , altruism, and of cou se i s t i a n t hr . C y, have been and are now colossal mistakes “ ” “ If, continued the humanitarian , this broad view of evolution be accepted, who would dare take it on himself to discriminate or to select from among his ‘ ’ fellows the fit t e s t for survival ? There are just now some very well disposed p e o p le i w h o s e presumptio n in making these premises is making them ridiculous and even intolerable ; and are the eliminators and e uge n i z e r s themselves so immaculate that they need no attention in the premises ? Who is to manage their business fo r them ? “ Many a useful man who has given substantial com hi h i s fort to others , has been unhealt ly born and has had infant life hanging month by month by a thread until e xi s t e n c ew a r d ul the scale has been turned , with res ts most beneficial to his kind . The biographical diction n aries furnish the ames of many a weakling who , having

66 A DOCTOR’ S VIEWPOINT

— ms me di c a t r im n a tu r ae ery —the , I believe the phrase runs i n most cases of sickness ? And has it not been obs erved among physicians that weakly parents not ” infrequently be get strong children ? The doctor nodded appreciatively ; for the humani

tarian was a man after his own heart . After all is

said about the sordid, stolid and vivisecting medical

profession , the doctor and the humanitarian are twin

br others . “ Yes ; for example there are tuberculous parents l w who have had born to them virile chi dren , hose a ch nces against consumption , oddly enough , have been

rather better than those of untainted parents . Before adolescence there are comparatively few deaths from tuberculosis ; the period when this disease manifests itself most and during which most deaths occur from it being between fifteen and fifty years . So there is a hi - e n long period of latency when , if the c ld be well vi r o n e d and nurtured, he will be likely to overcome such s t untoward tendencies a he may have begun life wi h . Here surely are evidences of an unright and honorable

offer on the part of nature to remedy her defects . She

surely is entitled to have us emulate her . We ought to help some ourselves and not expect either her or t he

Deity to do everythi ng . “ But to return to human parasitism . Obviously how to be both humane a n d wise is one of the most tremeu ‘ an dous problems of civili zation . It might well make ’ ” K u . other story , as ipling wo ld say THE COWARDICE OF BRAVE MEN

m ello w m The dinner had been delicious , the wines g,

the table setting exquisite , the flowers subtly fragrant , i the l ghts soft and varicolored, the gowns of the ladies most symphoni ously blended ; the ladies indeed had been

adorably charming and gracious , whilst none of them , s o thank goodness , had been rapturously beautiful as to ’ disturb the eveni ng s harmonious relations ; all betok

ened the truest kind of hospitality, such as a eupeptic bishop once extolled . The ladies having left for the drawing room the gentlemen lit up . “ ” ’ s b an mv an t I have been reading , ob erved the , sip hi n b e at ific all ping his liqueur , w lst his eyes tur ed y to ward Aurora (with her attendant maidens) o u the i — I ceil ng have been reading of a Frenchman who , ff whilst visiting New York , was so a licted with germi phobia that he abruptly cut short hi s visit and suddenly returned to that dear Paris , where in his belief germs are fewer or anyway more amenable to restriction than ” in the rampant New York atmosphere . “ ” Fear is indeed a curious thing, said the member “ t of the opera club . I remember that at the ime of the earthquake in San Francisco the Metropolitan

Opera House singers were visiting that city . Among b a s s o r o un do them was a j ustly famed p f , several inches over six feet, of physical architecture superbly propor t i o n ed to his height , and of noble , indeed most martial bearing . In the course of his operatic engagements his roles fr equently called for feats of desperate hero 68 A DOCTOR ’ S VIEWPOINT

a s l ism ; such inviting, in stentorian tones , the who e e n m a s s e male chorus to spit themselves , in turn on ( as hi to this he was indifferent ) upon s naked blade . And ’ e r t o d his organ o p p e the whole orchestra , including the brasses , the kettledrums and all the rest thrown in . My soul is thrilled and wholly satisfied in the r e c o lle c r n tion how this epitome of valorous ages did these tu s . On such occasions I invariably felt I had the worth of i my money and more , even without the gargl ng soprano h i fe r s and the r i n o c o u tenor thrown in . Then came that earthquake , which wrought a most melancholy change ull- in our f throated cavalier ; the shock , it seems , com . — ’ p le t ely di sorgani z ed his psychism I think that s what those psychologists call it . For many weeks he was , like the Hibernian about to propose , all of a thrimble ; the scene of his erstwhile spectacular heroism knew l him not ; and when fina ly he did reappear , it was as — a the peace adj uring, ltogether innocuous monk in ”

R o m e o an d Ju li e t .

“ ” “ ’ Well, observed the scientific guest , it wasn t the basso ’ s fault if he was a less courageous man after than ’ before the earthquake . Some might consider he hadn t

i a ll mim e t i c all been of heroic mold at , only y brave ; but i n I am not , for one , at all of that mind . I consider , deed , that there being so much of him , his proportions a being so huge , he must have experienced a rel tively

greater shock , and have shown its consequences more

than would a slight and wiry party . And what is shock ? It is a profound disturbance of the normal e u interaction of the great nerve centr s , and conseq ently hi of all the organs and tissues , w ch the nervous system

controls and regulates . The cause of the shock will

generally come from without . And overwrought emo tions are very conducive to fear ; how often have t he THE COWARDICE OF BRAVE “ M EN 69

a e c t i n s $ o ne a fl o unmanned men Again, dreads an n i at e d ti c p event , such as having to make a speech ; the fear of which i s dissipated immediately the action is begun ; the trouble is then to stop such a man, who in the halcyon realization there was nothing t o fear after i n n i t um ad . all, is like to keep on fi Or the danger may be reasoned out ; and the fear may lie in the assumed ” inability to cope with it . “ ” “ Consider, too , said the doctor, that all healthy living is the right adjustment of the body ’ s functions to its external relations . And it is not to be wondered at that disorganization will follow upon so irregular and unexpected a thing as an earthquake buttin g into

the customary environment . Then there is also the physical condition of the individual, his being perhaps i e below par , at the time of the h therto inexperienc d disturbance . “ “ That is so , said the West Pointer . Men strong,

- virile, well fed, associated in companies and in daylight , a each with his intern l relations in good working order , will not so easily fear as those who are exhausted after - hi long marches , starved , the body mac ne not well fueled,

isolated and at night . Yes , there have been glorious

instances to the contrary , as at Valley Forge . Every ’ o f body knows , course , about the two o clock in the n morning courage ; any man brave then, whe the body

is weakest , is indeed a wonder . Recall, too , how Mul “ v an e ff y , after he had circumvented a few sti drinks , felt ” s cho r n ful ele hun t s hi hi s hi of p , and ac eved storic mas “ ” t e r m a s t ado n i c r o u e y of a , g that was terrorizing the

neighborhood . And it is true that the unaccustomed things make one afraid : the soldier exulting in the smell of powder and the detonating ordnance might well tremble in the presence of a virulent plague ; the doctor 70 A DOCTOR’ S VIEWPOINT

e ei s t o i e and the nurs , b ng accu tomed pest l nce and held to cope with it, seldom succumb to infection, to which l a r e fear, I understand , is wonderfu ly conducive . We a all of us afraid until we get used to things . This h s — o f been so of many famous commanders Augustus , the ‘ v A o f ictor at ctium , of Turenne , Napoleon, of Nay . A ’ ‘ coward is he, declared the bravest of the brave , who ’ boasts that he was never afraid . Demosthenes talked

fight aplenty , but he ran away from his first engage ment, as did also Cicero . I recall the incident of the Russian commander about to mount his steed ; as he — ‘ ’ hi s . stood , legs trembled with fear Damn you , swore he, looking down and apostrophizing these unruly mem ‘ ’ ’ ’ bers ; for this I ll take you where it s hot $ Upon which l he vaulted into the sadd e, charged into the midst of ” the fight and was killed . “ o f l e One of powerful imagination, ofty temp rament, ” “ l of fine acute sensibilities , observed the novelist, wi l e vince fear such as would be beyond the comprehension A n di of a clodhopper . d an apprehension of saster , ill- c r es c endo however founded, may, like the in music , e lead to a veritable palsy of f ar , inhibiting reason which is the most supermannish of our acquisitions , the last developed and the first to be relinquished : and s o an abj ect and helpless terror seizes on one who could K not fairly be called a coward . ipling in one of his s storie , describes the quivering dread of something that t he you cannot see , a fear that dries the inside of

mouth and half the throat , that makes you sweat on

ul . the palms of the hands , and g p This is a fine fear , K wrote ipling, a great cowardice , and must be felt to

be appreciated . De Maupassant also wrote of fear o f ( which, he said, the boldest man may feel) as a sort ul t decomposition of the so , a errible spasm of brain and THE COWARDICE OF BRAVE ME N 71

r heart, a kind of reminiscence of fantastic ter or in t he ” past . ‘ “ Well, then, said the scientific guest , the essence of fear seems to lie in the instinct of self- preservation ; h it is the signal to the sentient creature , human or ot er wise , to protect himself as best he can, against hurt or mi h i e r o b a . death . But speaking of g p It is odd what a variety of phobias are experienced by people not e s i all p e c y timorous , and who are only so with regard to ff the one phobia that particularly a ects them . These fears are instinctive ; sweet reasonableness plays no part in them . There is claustrophobia , the fear of ff closed spaces , which was so dreadfully su ered by In t elle c tual Li e Hamerton , who wrote the f , and who was in all other respects a superbly normal Britisher , m a good rider , a swi mer that could smoke his pipe in the water and all that sort of thing . Then there is , o n the other hand, agoraphobia , the fear of open spaces which appears to be a legacy from our remote Simian ancestors , who were arboreal in their habits . Therein indeed lay their salvation from utter extinction , and the possibility of our own more or less fortunate exist

ni . ence , through the Darwi an processes Monkeys in the tree tops could with impunity satisfy their j ocund propensity to pelt with cocoanuts the foe on the plain below . Comparatively feeble in body , they were safe only by reason of the agility with which they could climb out of reach and swing from bough to bough and tree to tree . But that monkey who descended to the gro und was like to be done for ; on the flat or in the jungle he had little chance against the spring of the tiger or the speed and wind of the wolf . So our arbo real forbears had an instinctive aversion to ex tended excursio ns ; and their present day descendant 72 A DOCTOR ’ S VIEWPOINT

ff who su ers from agoraphobia craves to be near , not necessarily trees , but some vertical protective structure ; in going about an open square he actually hugs the sides of buildings ; with a stout cane in hand or with a compani on he is not s o fearful . Then there is ailuro hi phobia , the fear of cats , w ch a cousin of Dr . Weir ff i n Mitchell su ered ; the cat might be invisible to him , the next room perhaps ; but h e could not stand for it Al to be in the same house with him . so there is ochlo o f m phobia , the fear the stare , which see s to be a phenomenon not rare in Germany . It is i nflicted upon those w h o i n a dvertently cross gentlemen in the military w a a s r y . I have , fortunately for me , not yet expe ienced ln Si St i l lt s the , horrendou , glassy stare of the Berlin Herr Lieutenant ; but I am informed the Krupp works A n do not turn out a more paralyzing weapon . d how l many , not otherwise lacking in courage , have shrivel ed ‘ before the Gorgoni an British who the devil are you ’ ” you stare . These are but a few of many phobias .

The host had left the room for a moment , and was “ r now returned with a book from the library . We we e mentioning the timi d speaker ; as to that here is some; thi ng from Carlyle . And he read “ The speaker is as the ass whom you took and cast headlong into the water . The water at first threatens a a to swallow him , but he finds to his stonishment th t a n d he can swim therein , that it is buoyant bears him s e — y along . One sole condition is indi p nsable audacit , a n m vulgarly c lled impudence . Our do key must co mit r e e r himself to his water element , in f daring st ike forth h e a r his fou r limbs from him . T n sh ll he not d own and a n d a d sink , but shoot gloriously forth swim , to the o n mi r a t i o n of the bystanders . The ass , safe landed h n i k the other a k , shakes his rough h de , wonderstruc

74 A DOCTOR’ S VIEWPOINT

“ rej oined the Baron ; but my lackey should as sur edly have flayed him $” “ : Well , the Baron now spoke In the heat of battle

the soldier knows not fear . Indeed , he welcomes with passionate ardor the wild charge . Here is not so much r e calm courage which is in evidence , but rather the version to primitive and basic blood frenzy , in which fear has no place . It is when death cannot be antici pated , coming upon one vaguely , from a quarter one knows not where , that the fear of it affects the bravest . f c For instance , when I was a cavalry o fi er in the Seventy l war, my fellows and I would be encirc ing a camp fire ; ff we would be smoking, chatting and sipping our co ee , when s udde dnly the blood of one among us would be spattered upon hi s coffee cup and his quivering body ’ would fall prone , stricken by a cowardly sharpshooter s w bullet . There ere no braver men than we ; but at such times there were none among us whose faces were not blanched with fear . No , my comrades ( that was his term for all worthy men) , the thing one feels under n o such stress is t, what you call nervousness ; many mili

i t i s the s o l tary men say it is that . But i duty of the dier first of all to be truthful ; let us then use the right word . In such moments there comes upon the hardiest ” a great fear of death, of dissolution, of annihilation . “ “ I am thinking, said the doctor , of a case of seren n est heroism in which fear had no part , of cah antici patiou of certain death , the moment of which could not , however , be assured . There walked into the hos pital where I serve a negro , not much over thirty , hav ing the soft , musical voice of his people , a smile that would make you , knowing his sure fate , choke to see, - and an ashy gray hue upon his dark face . He bared hi hi s bre ast , from w ch a tumor protruded the size of THE COWARDICE OF BRAVE MEN 75

a cocoanut cut in half ; the sharp , stabbing pain of which he complained indicated how the aneuris m w a s eating thr ough his ribs and breastbone ; the veins about hi s chest were engorged ; one could see the heaving ex p ans i v e pulsation ; the humming b r ui t could be heard

as well as felt . He was at once put to bed, where good physicians and kindly nurses could be with him con t a s n tly . I was relieved he did not ask me what his

chances were ; indeed he knew as well as I as to that .

Next day I visited him . His wife had come with a

‘ r i hi m p attling picanniny who was try ng to play with , and could not understand why it was being thwarted i n and held back . But sitting up had been absolutely t e r di c t ed the father for fear of a strain ; and the mother had to suppress this absurd little c reature as best she ni could . I had never quite known the mea ng of the w ord resignation until, in these circumstances , I con t em lat ed i hi ff p the quiet , yearn ng face of t s su ering negro . A few nights after, while a nurse was watching l w as him, he sudden y gasped, his whole body gripped

for a moment in a mighty convulsion, and then he hi s turned flaccid upon back . The death was merciful ;

for the aneurism had ruptured while he slept . i And then they j oined the lad es , one of whom was extolling a society formed by elderly maiden ladies for the protection of cats ; so that wicked small boys might not hurt their feli nes ; and by way of conservation s against those cruel doctors , who were vivisecting cat under the base pret ence of benefiting humankind $ A ’ WOM N S SEVEN AGES .

3 “ Everyone knows all about Shakespeare s Seven Ages ” of Man speech in that most entrancing of all human hi comedies , wherein Orlando vanquished more than s

. far enemies , as Rosalind so exquisitely admitted But, a s s ev en a es o w o ma b I know, the g f n have not yet een written up . And I am going to make a try at the — a theme , after Shakespeare long way after The Thou ’ - sand Souled . And from the doctor s viewpoint . The first age of woman is of course that of the girl hi baby . Naturally the best t ng about any baby is to — e u eni z ed ul be well born g , we wo d say nowadays . Not hi necessarily of blue blood ( w ch , in the physical sense fin e - mi fin e- d at least, is impure blood) , but nded and bo i e d , no matter whether the spoon in the mouth be of m silver or of pewter . And as a atter of fact most of l us are well born . You may recall Dr . Oliver Wende l ’ “ Holmes bull that one should be careful i n the selection ’ ” of one s ancestors . Of course there can be no choice ’ here ; and equally of course most of us couldn t imagine a better parentage than t he one we are blessed with . After all only a small minority are not as well born b e ‘ as might desirable . There are children born with — a dreadful disease tendencies , even with diseases sad e n heritage indeed . And yet for even these the right v i r o nm e n t and the right care after birth are a wonderful i Ko -Ko rect fier . Some indeed would say, with , that 76 WOMAN ’ S SEVEN AGE S 77

“ heredity has nothing at all to do with the case , that environment is everything ; but they are extremists , for a good heredity is not to be decried .

And here comes the factor of imitation . I talked recently with an orthodontist— one of those tooth He s traighteners . was for having it that heredi ty has very little to do with queer features and homely j aws mi and crooked teeth . I re nded him that famili es through many ge n er at i o ri s are known to have family character i s t i c s— hi hi the famous Habsburg c n , for example , w ch is as typical in the present King of Spain as it was in

Philip the Second several centuries ago . There is a book on that subj ect which gives many portraits of m e n m and women in that Habsburg fa ily , every one of - - ni them big chinned . But my j aw ma pulator friend hi rej oined that my instance proved not ng , that imita di tion was here at work, and not here ty . What infant ,

- seeing big chinned people about it , would not exercise ul its basic faculty of imitation, wo d not be constantly working its plastic baby chin, so as to have it corre s p o n d with the biologic chi n- scheme constantly pre sented for its observation and becoming part and par l cel of its experience . Give a baby a bul dog for a companion, and it will sit for hours trying to imitate the ugly j aw of its pet . The same with the Teddy ’ bear , which is so perverse a substitute for the girl baby s

- doll . May not that child in time look bear like and act so , too , becoming afterward an unbearable woman, of the sort a trifle too frequent nowadays . o r t ho den t i s t Well, if my friend is right as to facial expression , may not his view be equally valid for the thousand and one things babies are supposed to be “ l d . : born with . Reca l the vau eville j oke Says Jones I have a lovely baby ; folks say it looks j ust like me . 78 A DOCTOR’ S VIEWPOINT

“ ’ ’ o i n s : e e l Rej Smith Oh, I shouldn t worry ; mayb sh l ” outgrow it .

e And as to the s cience of eugenics . It is a scienc

which promises to do a lot of good . But remember

that nature devised eugenics long before our time . Dar win expressed this un iversal phenomenon in his law of

the survival of the fittest . By far the most of our

parents have mated well, simply because they have fallen ’ helplessly in love with one another , under nature s won “ e r f l li d u and generally benignant influence . Fal ng in ” love is a beautiful and romantic phrase , the scientific

equivalent of which is natural selection . We are now “ ” having eugenics contests , for better babies , which, “ as a newspaper headline puts it , are picked for their ” “ e the brawn . There are perfect scores prepar d , and items being height , weight , circumference of chest

abdomen, shape of ears , bones of skull, cheek limbs , s feet , quality of muscles , and so on . The whole read like these pugilism schedules prepared for the bettor who may thus be put in a position to know whether t o put his money on the Harlem Spider or the Bowery ff - Co ee cooler . In the baby score before me only six l per cent . is for disposition and ten per cent . for facia

. hi expression That is to say , the psyc c factor in eugen ics is here greatly mi nimized . For my part I maintain the psychic— the spiritual factor is pretty much the

whole thing . The test of good birth in a child is the n i oble souls of its parents ; that obtaining , the r ght s physique will pretty generally follow . I believe uch sentiments as this of Elizabethan Spencer ought to be hammered into people these materialistic days

ul For of the so the body form doth take , e Since soul is form ; and doth the body mak . WOMAN ’S SEVEN AGES 79

Give a chi ld in my keeping up its sixth ye ar ; and though you may then take it from me forever, and I may never see its face again, it will yet throughout its ” life abide steadfast by the training I have given it . If the religious teacher who spoke thus had doubled this “ ul n o t de ar t formative period , it wo d surely p from the path laid out for it in that dozen years . I believe the m p rinciple is tremendous , and ost important of con sideration in this twentieth century chaos of a civiliza tion, when all evil is supposed to be avoided and rec t ified by means of laws rather than through reverence for the home and the family ideal . The first dozen years are the most impressionable in existence ; which means that the child’s destiny is developed nowhere else than in the home ; and that it were well- nigh hopeless t o assure its right development anywhere else . Of course the school and the reli gious teacher must play their adj uvant part . Childhood is the formative p eriod , both for mind and body . The ancients were insistent on the sane mind in the sound body ; and we - da of to y fully recognize how right they were . It is superb , the things that are done nowadays to assure the health of our school children . And many of the schools that are now building are marvels for healthful ness and sanitation . I have read of a little girl whose mother was combing her hair with a rubber comb in the gloaming of rather a cool evening ; there came sparks from those curls in the process . She asked her mother how those sparks came . And her mother answered that “ ’ ” they were electricity from her hair . That s funny, so A nocr on ’s VIE WPOINT

“ ’ she observed, here I ve got electricity in my hair, and ’ ” grandma s got gas in her stomach . We have cer t ai nly got past the gas age mature people remember and into a very truly electric age in education . ( By the way , they have even been talking of electrifying school children at their studies , by having currents in the walls of the school room ; they might better electro cute them than do that . ) It is essential to develop the child’ s imagination or at least to educate and direct this faculty to the end that the ideal shall ever be for it the real in life . Con ’ sider how rich it makes the child ; it doesn t have to l al l have mil ions , for it will then enj oy l that mi lions — can bring and much more . The wonderful books that are written for children, the fairy tales , the flowers in our parks , the folk dancing (in Hellas dancing, besides w as being a pleasure , so important a factor in life that c ales t he n i c s l it was a part of religious service) , the chi r d en go through , the exquisite poise and sense of form and rhythm which are got from the music of the old - a masters ( Papa Haydn and the child natured Moz rt ) , seeing the comedies of Shakespeare and others (by which many a tenement little girl acquires the charm and graces of a gentlewoman) . What matter limed walls , kitchen chairs and pressed crockery to the child that can by i magination acquire taste and a gentle womanly disposition . Lafcadio Hearn gave us his ex qui s it e presentments of Japanese life before he visited an that land ; it was mostly in his imagination y way , d for he coul see with his physical eye almost not at all , “ ” poor f ellow $ And the Laird in Trilby painted s u perh pictures of Arabian life out of his imagination ; but after he visited Algiers and really saw these places his pictures of them were atrocious . How pauce are

82 A DOCTOR’ S VIEWPOINT

Yet even with her still tremulous hand ( tremulous

as the body of a little bird) on the gate , she can com prehend that in all things good and pleasurable there must come responsibili ties and cares as yet un c omp r e

hended . And although she has no fear , courageous

nl . emotions are certai y aroused in her And now too , she finds the life into which she has come to be stim ula t i v e of faith and truth in the Power that has pre pared and ordered this field for her indwelling through o f out the remainder her existence . ’ In Za n t s epic portrayal the courage and the trust e i li mostly in the eyes , wh ch are large and clear and liquid and deep and very frank ; in them all the fear l e lessness that wi l be needed are to be found . Then b sides the eyes , that superb painter has presented a most W hi ingratiating and insome face , and t s with infinitely gentle touch . And the as yet immature figure is ex qui s it ely portrayed ; a n d last of all the luxuriant hair ul caressing tenderly the head and the sho ders . What ’ poet s heart this Zant must have ; and what a veritable seer he must be , to be able to grasp as he does the innermost , the fundamental in life . The other paintings in my mind is Abbey ’s Sir Gala had, whose ideal was

nl To love one maid o y , cleave to her ,

‘ And worship her by years of noble deeds .

s is But thi , as Kipling would say , another story, not he re to be dilated on .

For this stage Shakespeare represented man as “ seek ’ m o t h ing the bubble reputation , even at the cannon s n ; ’ he comes now upon the time to fight the world s ba ttles WOMAN ’ S SEVEN AGES 83

’ w le ( ho futi so many of them are ) , to do the world s

work . For the woman it is the time of wifehood and d motherhoo ; and hers is indeed the harder part . The i l fe of man is glory, the life of woman is love .

“ For men must work, and women must weep , ” Thus runs the world away .

And here , quite absurdly , a practical idea enters my al matter of fact, profession head ; it is a descent i n ul : deed , from the sublime to the ridic ous The most important thi ng for bringing babies triumphantly to weaning is the right kind of milk ; if they get that their tummies won’t be behaving so badly (mewling and ’ s o on, in the nurse s arms , as Shakespeare graphically but rather inelegantly put it . ) The best kind of i n ’ fa n t s food is that which is drawn form its dear moth ’ er s breast ; practically all the digestive di sturbances of infancy ( oftentimes fatal as they are) do not trou ble breast fed infants . Of course some mothers are i n capacitated by illness or weakness from giving their a s ll b bies thi natural nutriment ; and, sad to te , there a r e some mothers so rebelli ous of this blessed function that they consider the demands of fashi on and of s o hi c i et . y superior to it , wort er and paramount Thus , for one reason or another , many babies have to be bo ttle fed ; so that the science of infant feeding by ’ modified cow s milk has been developed .

a And here is a grotesque notion . Next after the m bit i o n to portray adequately the countenance of The Christ the painter has striven to present The Madonna l an d Her Child . In the former essay a most all have

i . fa led , in the latter not a few have succeeded And we have many beautiful , sympathetic and precious can v as s es and ma rbles of the mother and her infant . But 84 A DOCTOR’ S VIEWPOINT

hi what would you t nk of a madonna , instead of giving her sacred breast , pictured as feeding her babe out of “ l - a bottle labeled percentaged, ime water, Pasteurized cow’ s milk $” A mother who fed her baby thus (perhaps through no fault of her own) or had the nurse to do it in her l ’ stead, bewai ed her baby s death to a great physician ; “ ” “ it had pleased Providence , she said, to take her baby ” s he from her . The doctor told her had no right lay ing the fault on Providence . Providence had had nothing at all to do with the matter . It was bad milk — that killed her infant bad milk , for which humankind and not the Deity , is blameworthy . r And now about anothe picture . Everybody has seen it in print shops . It represents a young mother of the poor, clad in a cheap shawl , weeping over the corpse of her first born . I have seen that picture in the very — life and death ; and the memory sometimes haunts me .

It was in a squalid tenement . There was nothing in the room save a kitchen table on which the dead baby

i

. Ab lay , and the rickety chair in which the mother sat s olu te ly no thing else ; it looked. like an eviction for rent — ’ unpaid though I don t know as to that .

I had knocked several times at the door , and had r eceived no answer . Then I went in . Just as in the c pi ture sat the mother , hugging that rigid little body, w ith its baby head so endearingly shaped ; constantly r kissing its thin waxen hands ; c ying convulsively , so that the tears kept running down her checks ; whilst she t a lked to , even crooned to , the little creature she had borne and had s o willingly suffered for ; cuddling it to he r breast and begging it to smile the way she had coaxed it to in life ; doing the things mothers lo v e ° t o do with their infants . All the tragedies of the ancient WOMAN ’ S SE VEN AGES 85

al Greeks , and all others imagined since, p ed after that hl one before me , whilst I stood speec ess and reverential — — and to speak truthfully frightened . For here w as ul the most awf , the most epic, the profoundest of all r hur i an tragedies .

We come now t o what is in man really the noblest — and superbest age that of his maturity . For women it is no less noble than any other ; but as certainly it f is the most di ficult of them all . i I once knew, professionally in the beginn ng, a lady who beli eved in mind cure ; and the reason she wanted my ministrations and my prescriptions was that she was s he not then so strong in faith as was going to be later . It was only a matter of time when her faith would b e come so strong that she would not need doctors and di me cines . She had had, before calling on me , a nervous

- affection . Several years ago she lived in a low lying city by a vast body of water ; her doctor there advised her to go for relief into a dry equable cli mate of some hi s e altitude . T s h did and soon became well . Shortly after her arrival there she came upon some Christian — Scientists who interested her in their cult and pres ently be gan to attribute her return to health to their influence ; finally she became one of them . Soon after wards she came to New York to li ve ; in this trying climate her symptoms returned and were not alleviated “ ” by the healers . She then dropped that cult for hi reasons w ch need not here be detailed . Then she took hi up theosophy, in w ch she presently found some o b c t i a le j e o n b features . Following upon thi s she took di up and in turn scarded mental science, spiritualism, 86 A DOCTOR’ S VIEWPOINT

new thought, and what not else . On the occasion o f her last call on me she began very buoyantly to ent er “ tain me with an account of a splendi lecture she had “ ” atten ded by one Professor Blank . This lectur e had so appealed to her that she had decided to attend a course which had been arranged ; and had already paid — ui in advance as req red . e Now, according to the professor, everything go s by e vibrations . The explanation of the nature of thes vi b r a ti o n s seems to have been omi tted from that precious course of lectures . Health and happiness lay entirely in keeping harmoni ous with these vibrations ; and by the end of the course the way how to achieve this har o mony would dawn in fullest illuminati n upon you . It was explained in the first lecture t hat the lecturer had t h u ht himself been a Christian Scientist , a new o g e r , an d an adherent of several other like systems ; but one after another they had seemed so strange and ecc entric and un m s on able ( amazing how your Paracelsian loves that word) , that one after the other he had lost faith in i them . But now he had h mself, through prolonged Nir - H . e vana like abstraction, come - upon the right idea ’ was the man for your money ( though he didn t of course p ut it that way) and if you valued health or happiness you wer e by all means to keep clear of that shop across

e . the way , or any oth r ’ e n Now all this seem d, in that poor lady s arration , so absurd to me that my face presently broadened into — a smile which was at once checked by he r saying very “ ” : i ? piteously Why , oh why are you laugh ng at me And s he then fell to weeping . w as n o l i e r Indeed , and in very truth, it augh ng matt . She surely felt conscious of a lack of dignity and of n ormal womanli ness ; her nature must have bee n p er WOMAN ’ S SEVEN AGES 87

meated ( subconsciously no doubt, except at such mo h ments as this ) , with the knowledge that her p ilosophy b k of life was absurd . But she had now come to e li e a man that had been fighting continuously agai n st the d m unfairest kind of odds ; knocke down, he j u ps up to continue the struggle , and is again worsted ; after many such encounters a sort of inertia i s inevitable by which no kind of fight can be put up as obtained in the be i t i ginn ng . And so h s gentlewoman had now come to be f i a flicted with a psychic inertia , wh ch rendered her incapable of rising above and freeing herself of abuor m ali t i e s i . The whole trouble probably orig nated like

: . this She was past forty and she had not married Now, there are many superb women who have not married, ffi and for reasons all su cient for them . But thi s does not obviate the fact that such singleness is not the be st state at all, but is the greatest pity in the universe .

As for my poor friend , she was extremely charming ; and if any woman had ever been born for wifehood it s he was . Had she so elected she would have made some s he i r r e one among the many had known a hopeless , t ri ev able o ptimist for the rest of his days . She had chosen a “ ” inste d to be a bachelor girl, like so many foolish women nowadays ; she had deliberately set aside her man i fe s t destiny . And what kind of a miserable alterna tiv e was hers $ I have written at greater length than I had intended ; and can only in a few words state that in thi s example is to be found the germ of so much of the chaos in which we are existing (not living at all) these days . f Herein is to be found the genesis of the suf ragette, femi n i s t e the , the man hater, the divorcee , the woman i who would rather pet an mals than love children, she

s o l s . who ineptly rai s at fate , the female Prometheu 88 A DOCTOR’ S VIEWPOINT

It is a dreadful thing indeed how frequently the ideal of the family and of the home which are the fo u n da l tion and the keystone of all civi ization , of all r e fin e ments , f all human relations , , a o “of all hopes of hum n ul advancement from savagery , sho d be most subverted by those who ought , for their own security , to be the most j ealous supporters of this ideal . ’ And as for mere man ; why , bless you , that sex isn t ’ nearly so bad as it seems . It certainly doesn t deserve — to have its face scratched leastwise, not as a sex .

In my youth I had t he bles sing good fortune to know an elderly gentlewoman , now since gone to her sure ffi reward . It would be di cult to imagine anybody more necessary to her kin, her friends , or to the community

he . e n in which s lived No family matter, whether the a m e n t g ge of a granddaughter, or the starting in busi ’ ness of the boy of hi m who had married her niece s hu s ’ band s second cousin, was ever concluded without her interest being solicited . Any friend who had ever sat u at her table or had dr nk a cup of tea under her roof, might claim consideration alm ost a s warm as for those actually of the blood , or who had married into it . And a made man was that tradesman who could deliver his

goods at her basement door . Her home , I mu st be

careful to add , was in that elysium about Washington

Square Park , in the Metropolis .

Now , ordinarily , people are apt to drop in to tea — — hi of Sunday evenings high tea and welcome . But t s

dear lady had high tea every evening . Youngsters

would come in the late afternoon, and have their heart

90 A DOCTOR’ S VIEWPOINT

t h out with the fortunate company gathered there , in e ’ n e fl be ign ulgen c e radiating from the head of the table . s ? Lagging uperfluous on the stage Well, hardly . Ah h r $ , how we have s ince been missing e

” o f all e m e men Last scen e , the justifi d oth r of , who

rests in her armchair on the porch, surrounded by her ’ hi e comforting c ldr n and her children s children, whilst th e rays of the setting sun touch warmly her whi tened

hair . Serene she sits , her eyes steadfast upon the west li erly glow, as the twi ght gathers , and the evening star

appears , musing of many things in the past , but mostly of memorials dearly treasures and fondly laid aside in s e om old cabinet .

“ r e Her hallowed b idal dr ss ,

Her little dainty gloves , a Her withered flowers , her f ded tress .

Br illa t - Savarin had an aunt with whom he felt a mu

tual and very warm affection . When past her ninetieth year he was summoned to her bedside . He brought with him some of his best and most restorative wine . He most gently raised her head and induced her to take some of this good wine . She thanked him , and sinking “ dl ll e back contente y on her pi ow , said to him , My d ar , n should you come to my years , you will understa d that a e ee e the g d n d d ath j ust as the young need sleep . LET US GO OUT INTO THE SUNSHINE

It seems like harking back to another generation to have read that President Finley , of the College of the t l i s Ci y of New York, did his thirty miles n n ne hour t o o in the night time, , when pretty much everybody was asleep . He began his j aunt with Elizabeth, New

Jersey, and ended up in Princeton for breakfast . A fine example for his students ; and one that could have been set only by a man sound in body and mind ; one h muc too rare in these days of trolleys and motors .

Samuel Johnson tramped through the Hebrides , for all his scrofula . Ollie Goldsmith was for years a way farer throughout Europe . Mark Twain tramped — ’ “ ” abroad whenever he couldn t get a hitch or take a “ Blaiki e i n boat . , his immortal book on How to Get ” Strong and How to Stay So , in the last of many e l ditions , as wel as in the first , maintained the best of all exercises to be walking . “ ” “ e Giv me, enthused Hazlitt , the clear , blue sky over, my head , and the green turf beneath my feet , a ’ winding road before me and a three hours march ; and ” “ : then to thinking . Whereat Stevenson And he must ” have a winding road, the epicure . Poor, sick Robert w ho c ould h Louis , \ appreciate, but could not enj oy , suc gratification . In ot her generations men thought nothing of thirt y

mi es . l l For Dickens it wou d—have been j ust a freshener, a regula r morning exerci se j ust o n e hearty me al o f 92 A DOCTOR’S VIEWPOINT

fresh air . Lily Langtry, in her prime , frequently di d

her twenty miles a day ; no wonder she was handsome . Nor is that wonderful old bishop to be forgotten

who died now some two years ago , at three score and ’ ten ; and who regularly spent a fortnight s vacation for many years in tramping—through the Shenandoah ni valley one summer , somewhere in Virgi a the next . He

loved for a season at least to become a simple wayfarer . ’ Being anxious to know intimately his Master s o w n ni people , he slept at ght in the homes of poor work i n me n g , got their points of View, sympathized with them , mended their clocks (he was amazingly dexterous at — such handiwork for a clergyman) , admired their pigs ,

and told their children stories . And they , for their part , not at all realizing the huge enj oyment and ben efit he was getting out of it all , pitied that poor , old

- white haired man , with the long, flowing beard , who a- j ourneyed foot, since seemingly he had not the where withal to travel any other way . Especially should walking entice those who work mostly with their brains . The season is now on . The t he clear sky , the bracing breeze , rustling boughs , the s murmuring water , the birds , their throats simply burst — be ing with melody these our brethren, which should

our familiars , are calling ; let us go forth and walk .

- Select little frequented roads , as free as possible from “ devil wagons .

But take some precautions : Be very careful not t o overtax the strength in the beginni ng ; in walking as i n l everything else , one must avoid extremes . Radica

changes are not without danger when abruptly made . The desk or the office in the city is an altogether othe r envi nm ro ent than the woods . LET US GO OUT INTO T HE SUN SHINE 93

GET WHOLESO MELY TIRED

’ li In going for a day s walk, on a Sunday or a ho day, there is no harm in getting stiff and wholesomely tired ;

a warm bath at bedtime will set that right . But when — — the trip is to be extensive as for a fortni ght the - man machine must not be overtaxed at the start . No more than five miles the first day ; ten the next ; fifteen

or so the third . And then you may begin at daybreak an d walk until you are canopied by the stars ; and even - fi r s t were that day the twenty of June , no harm will

ha ln e s s . come of it , but much good and pp ul The way to walk is to throw back your sho ders , mil i t ar i — y fash on the chest out , the pectorals expanding, the nostrils dilated with the fragrance of all outdoors , c the lips losed, the head erect . The arms to swing half w a y, not like a windmill . Have your mind diverted by the everch a nging scenery ; there is nothing else that l wi l so surely get the cobwebs out o f the brain . m l This simple, pri eval exercise is preferab e to any other, in that it is not necessarily in the contestant l class of ath etics . No preparations ( except as I have stated) are needed to be in prime for it . And in other — — sports boxing , tennis and the like what men do not e ? b come slower in their movements after thirty Who ,

even the most expert , could , after fifty , think of com peting with young men in them ? Nor is there any better way than walking tours for middle- aged gentle di an men to ssipate undistributed middle , and to restore

the belt line to its normal . Very little paraphernalia is required ; certainly little

if you are going for the day only . A stout easy pair — of shoes are essential such as have been tried out a 94 A D OCTOR’ S VIEWPOINT week or so beforehand ; and the feet must be well bathed i t e and nursed ( vasel ned, if necessary) at the end of h l day , so that they wi l not be tender . Many a walking trip has gone to pieces the first day or two by reason e of blistered feet . Talcum powder is t o b dusted in the shoe if there has been perspiration .

r es. A good wayfarer, who is not too fussy, and o f s o n abl y democratic tendencies , can find a good lunch in s g place anywhere along the road . Some very plea ant recollections o f my own are of my seat on any c on v e ni en t barrel in the country store , crackers and cheese in one hand , a glass of ginger ale or cider in the other ; and a di scussion of the perversities of our political l an system with the vi lage coterie . Hotels great d t he small, magnificent and modest ( the latter generally more comfortable) are never lacking.

m ss A cake of chocolate in the pocket will never be a i . hi s T s is a most ustaining food . I understand that German soldiers on forced marches are rationed w ith

- u it . Weston ate often in his walks ; an egg beaten p A s in a cup of hot coffee was a favorite refreshment . —“ often as he hungered he ate I presume a little at a time ; for such energy as he displayed disposed rapidly of tissue waste , which had as rapidly to be replaced. — That is what we are after in a walking vacation to r e di new our bo es , to get rid of the sluggishness stored up through months of sedentary occupation ; and to get ll rejuvenated, or better sti , born again . Throughout ’ Weston s last walk from the A tlantic to the Pacific he lost but eighteen pounds . And when he felt drowsy he hi m s ate ; and this , he declared , restored and bani hed t i . m ld n o im at e sleep Here , however , the a ateur shou t LET US GO OUT INTO THE SUNSHINE 95

A s to companions o n the walk : A party i s usually congenial ; because i f you are bored by one member, you can easily find another more in keeping with your l temperament . In a party you wil always find your man - f o either sex. But if you are to have one companion ’ be sure he s agr eeable ; o therwise there is no torture ’ hi s s o exquisite as a day s walk in company . Not only ff o n hi s does he make you su er own account, but you s lose all the other pleasure into the bargain . If you a r e not absolutely sure of your man , go alone ; you will be surprised what a good fellow you will then b e come acquainted wi th $ Don’t wait to get your own experience about this ; take mine . ( This , reader, is ’ s trictly en t r e no u s ; and I had rather it wouldn t go f urther . ) Remember that walk which Anstey and a n o ther took on the Cader Idris in Wales ? After the first hour they began to be bored with each other ; then ff r they got o ensive , then sa donic , then insulting, and “ : finally fit for any crime, as for instance Do you know wh y you remind me of this mountain said A n “ ” “ s 0 ? . s tey . N , why returned his companion Becau e ’ ” you re a cad awry dressed .

DISCOVERIES F OR ALL ll Every one wi surely find, in a little search , delightful ni walks in his own vici ty . I give you here my own ur T he M e t r o discoveries around o greatest of cities . p olis is supposed by many to be a sort of colossal prison, where one is doomed to spend the most of his years in

- canyon like streets , with never a hope of rural delights . ul Not at all so . Suburban New York has tr y Olympian happiness for the man who is good for from ten t o t ’ wenty miles before nightfall . Within half an hour s r ide one might imagine himself in the heart of the Berk 96 A DOCTOR’ S VIEWPOINT

r e e s shires . In Westchester County there a Gr y Oak , ’ r Hastings , Scarborough , Dobb s Ferry, I vington,

Sleepy Hollow, Tarrytown, to be visited afoot . Walk K from White Plains to Mt . isco ; and Central Valley,

for a longer trip , from Newburg ( to which place the “Al ” ff bany Day Boat takes you) to Su ern . Or from ' Sufl er n to Greenwood Lake , thence to Lake Hopatcong, ff and back to Su ern, if you like ; or from Newburg to Je r V 1s Port , thence along down the Delaware to the Water Gap and so home ; or from Nyack to Rockland

Lake . For the tramp along the Palisades from Fort Lee to Nyack no other word than magnificent is fit and what a climax is that sail across the Tappan Zee i n e in the twilight, w th the train to take o home in the evening $ ’ ll Or for an afternoon s outing, take the tr o ey t o Prospect Park in Brooklyn ; walk thence along the park until you reach the Ocean Driveway ; and so , continuing

afoot , with the briny air in your face to Coney Island ; o u o then , if y are not yet satiated, return by way f o r Cr psey Avenue to Fort Hamilton, and to the B ook “ ” 3 9t h Ee r A n d e s lyn end of the Street r y . so hom , a s a J Pepys would y . Or take the trolley to amaica and hi start in any direction , for Long Beach ( t s is indeed

superb) , or for Garden City . Or go from Flushing e ll to Lawrence and thenc t o Rockaway, and by tro ey home . But I would give you n ow the bonn e b ou che of the — feast a week in latter September or early October : I boarded the M m y Po w ell which took me through the Hudson in the late afternoon and the twilight to Round out ; then I trollied to Kingston where I slept for the

. N Rou n do u t night ext morning I returned to , ferri—ed to Rhinecliff and then on my shoes to Pine Plains i

SENSE TRAINING

T o one ambitious of leading the scientific life , sense “ training is from the beginning most essential . Seeing ” is believing , but the belief thus founded may not be

. v rational Seeing, re iewed and, if necessary , revised by dl ul b e s o u n . the reasoning fac ty , will then y based Only be — from such process can facts born facts , the sole

building material with which science can work . The senses are by no means a sure guide ; the very best they e : can do is to appreciat phenomena that is , appearances . The stick appears broken in the pail of water ; reason

assures that it is not . Using a bright spoon for a

mirror, one appears variously , as he holds the spoon

inside or outside , or up and down, or sideways ; but it is to be hoped one does not look any of those ways in

reality . Cross the middle over the index finger ; roll their tops over a bread pellet in the palm of the other

hand , and the sense of touch will convey the impression l r of two pel ets ; but reason cor ects the impression , and r n convinces us there is but one . Reason must ever b i g

judgment , memory and experience to bear upon the perceptions which the se nses convey to the cer ebrum ; by these means reason must constantly be rectifying

false sense . It is amazing how frequently the imagination plays o — il fast and lo se with the sense functions delusions , l s i o n s u . and hallucinations being the result Le Bon , in “ s d his fa cinating book The Crowd , a Stu y of the Pop ” u lar Mind , tells of a crew shipwrecked upon a raft , 98 SENSE TRAINING 99

w ho kept eagerly scanning the horizon for a sail . After i some days of watch ng one of these poor men, his r f psychism pertu bed by his suf erings , being obsessed hi through desiring to see a rescuing s p , unquestionably saw something ; and so desperate was the hope of his hi m companions , that one and all agreed with that the thing he pointed out was a vessel whi ch could rescue h t em . When they came upon it , however, they found it but a tree which had evidently been uprooted and had 1n hi s a dmi r gone adrift in an equatorial storm . Tuke , “ fl ” able book The In uence of the Mind on the Body , relates how a boy who had on an afternoon seen a ff hanging , which had naturally much a ected him , took a stroll along a country road in the evening of that dreadful day . He presently saw proj ected against the

- moon lit sky the gibbet of the afternoon , and the crim ul inal suspended from it . He ran home dreadf ly fright ened , to find that a cord dangling over the brim of his hat had by his overwrought imagination been meta h s e morp o d into the aerial gallows . Every reader will recall how he has in like manner been tricked by his senses . Hundreds of instances might be cited of delusions entertained by the unscientific , the unsophisticated, the highly emotional ; people in whom such aberrations are not without excuse . We who pride ourselve s upon our attainments in science are so prone to consider such delusions the exclusive property of r i geniuses , spi itual sts , theosophists and other people whose imaginations tend to work overtime , that we feel dis tinctly humiliated to learn how men even eminent in sci ence have been the victims of psychic perturba tions . As , for instance , when the telephone was i n a vented, lecturer who was giving a public exhibition of the apparat us clearly and repeatedly heard the notes 100 A DOCTOR ’ S VIEWPOINT

’ of a trumpet whi ch he had arranged to be pla fied at the other end . He declared that he heard ; nor need the hi s record be doubted . Yet none of audience could hear the trumpet ; and for the all- s u ffic i e n t reason that the trumpeter had made a mistake in the day , and was not in his place at all . A very modern instance of “illusion caused by a spe cies of auto- suggestion based on preconcerted ideas t h N - h is furnished by e episode of the rays , w ich all com e petent men now agree nev r had any existence at all . Blo n dlo t Professor believed (in good faith , of course) , s 1903 H that he di covered these rays at Nancy in . e e described them b fore the French Academy of Sciences , a hi s which body g ve him a gold medal for discovery . 1906 Up to , there were published one hundred and —S i seventy xoriginal papers concerning these rays . ’ Blo n dlo t s observations were in turn confirmed by such

- well known physicists as Charpentier and Becquerel . The N - rays were considered to be given o ff by almost all substances when in a state of strain ; a tempered steel bar , Nernst lamp , and even a human nerve and e s muscle would emi t them . The rather fanciful s u gg tion was advanced that if a cert ai n radiation were given o ff by our bodies , according to their degree of activity, our thoughts might possibly be photographed “

nl . thoughts being o y brain rays Of course , the K F i elki work within the last year of Drs . ilner and n “ ” in London , as to the photographing of the atmosphere or the “ aura” which the human body is considered to exhale , springs at once to mind . ) N - ul The rays , stated French investigators , co d be reduced or removed by anaesthetics ; a tempered steel u i e s bar , for that matter , could be chloroformed into q j cence . Following upon this the invitation came natural

102 A DOCTOR’ S VIEWPOINT

that if no r esults could really be obtained in E ngland t e or Germany, h explanation of the French experiments must be subj ective and psychological rather than o h e c tive l j and p hysica .

v ci en ti ue l i i n Finally, the R e ue S fiq sett ed the quest on a very simple way . It was proposed that several boxes of exactly similar appearance , some containing pieces of lead, others of tempered steel, should be sealed ; and Blon dlo t or his assistants were to decide which of the Blo n dlo t boxes contained the active material . refused “ t o o this test, saying that the phenomena were far ” “ delicate for such a trial ; and he left everyone to hi s — exe r i own opinion on the N rays , either from hi s own p ” ments , or from his confidence in others . Thus was the dispute transferred from the realm of fact to that a s ci of opinion, experimentation ceased , and so far s ence is concerned the incident was closed . Such inci dents as these are rather humiliating t o the e fle scientific temperam nt , which , nowadays , is j ust a tri i - t o . incl ned self satisfaction Fortunately, they are ex t r emel y rare . Science is knowing ; good science is ever certainty grounded upon demonstration . To this end ’ - v o the pre requisite is the trained senses . Science s l taries , moreover , if they are to serve her wel , must ever be free of auto -suggestions and haphazard c on e s j c t ur e incapable o f ve r ification . EUGENICS

hi he Francis Galton, the founder of eugenics , w ch defined as “ the study of the agencies under social con trol that may improve or impair the racial quali ties ” of future generations , either physically or mentally , hi s was himself singularly fortunate , both in own hered a t s ity and in his way of life . The G l o n have been a superb Quaker stock through many generations ; the grandmother of Francis was a descendent of Barclay , the apologist ; Charles Darwin was his cousin ; his moth er, two brothers and two sisters at least, were nono “ s - : gen at i o n . At eighty six he wrote I find old age thus far to be a very happy time on the condition of sub ” mitting frankly to its many limitations . The quota M e mo i r s o M Li tion is from f y fe (Dutton) , one of the - ff di r e s most content di using books in existence . (A g e o t e sive a n c d is irresistable . During an e xploring expedition in Southwest Africa Galton visited

Ov am a s . the p I did much to make myself agreeable , investing King Nangoro with a big theatrical crown that I h a d bought in Drury Lane for some such pur pose ; but I have reason to believe that I deeply wounded his pride by rej ecting the present he offered in r e h turn . His niece appeared in my tent , raddled wit red ochre and butter , and as capable of leaving a mark

- ’ on anything she touched as a well inked printer s roller . I was dressed in my own well- pressed suit of white linen ; ” so I had her ej ected with scant ceremony ) These memoirs tell of an astonishing number of talented rela~ e s o t iv continuing to the present generation, that f 103 104 A DOCTOR’S VIEWPOINT

’ Galt on s h Hi s s e e grandc ildren . own psychic gift w r of the superlative order ; hi s mental acumen was amaz

. A nd ing, his vision extraordinarily broad his marriage dl was most haply , into a family har y less remarkably hi s w n— than o the Butlers . And he naively wrote (pre “ s um a bly sometime after the honeymoon) : I protest a gainst the opinion o f those sentimental people who hi ” t nk that marriage c oncerns only the principles . Thus were his li nes cast ever among all that has been and i s e best in English life . His fortune was altogeth r ample o f s o - i m a for the needs well poised and philosoph cal a n . Especially di d he enj oy association with the finest t em e r am en t s hi s — Ka p of day Maine , y, Hallam , Tom Tay

lor, Tom Hughes , Spencer , Huxley , Faraday , Tyndall,

Gladstone , Burton , Pollack and scores o f others . It were di fli cult withal to conceive a man more s at ur at e d li r with loving kindness , more so citous fo human e i s i welfare ; and this , inde d, the spirit in wh ch the l l eugenist must work . The man who dec ared he wou d do nothing for posterity— “ for what has posterity done ” for me - would never have been able for to shine in

the high eugeni c line . And there is a kind of eugenics characterized by the lopping o ff of all save o n e of the rosebuds o n a branch so that the one may become mag n ific en t by absorbing the sap t he others should have ’ had ; but that kind of eugenics had no place in Galt o n s b t o scheme . He ecame enthusiastic perpetuate his own s Olympian status , nobly desirou that all humankind e e ze — hi might become ug ni d well born , in the ghest sense of the word—that there might come into being races

-o of highly gifted artists , saints , mathematicians , admin ” t s . is t r a o r , mechanicians and the like ’ Galt o n s mantle fell on Karl Pierson wli o botli i n lofty spirit and in good works has borne it e xceedi ng

106 A DOCTOR’S VIEWPOINT

i of eugen cs ; but this cannot yet be done scientifically,

that is , reasonably . Pearson and his London colleagues reprehend such “ a dogma proclaimed in the name of eugenics as : At last it is possible t o give definite advice to those about to marry or those who do not wish to transmit their undesirable traits ; weakness in any trait should marry

strength in that trait , and strength may marry weak “ ” ness ; and they stand aghas t at the evil worked by ni l the rapid popularization of euge cs , fee ing certain “ that a movement thus careless of its facts and vaunt ” ing in its conclusions must collapse . Among the many zealous Ama i c an workers in the ” ’ eugenic field are those in the Carnegie Institution s Station for Experimental Evolution at Cold Spring

Harbor , New York , of which Dr . Charles B . Daven port is the Director . Cons iderable important literature has thus far been given out from this Institution ; i ( some of wh ch , it must be noted, is adversely criticized by the London School we have just considered) . Its ’ Eugenics Record Office aims t o be the country s clear i n v es t i ati o f ing house for an g n p race , o f heredity , of blood lines ; and it issues to all desiring it personal i a advice as to the suitab lity of prospective m rriages ,

and the probabilities of inheritance . Thus far the data collected by this Office have been mainly of abnormal types ; but this has been because such information has been easier to get . And here it should be noted that scientific eugenists do not have to make experiments ; our race is making them all the time and great many

more than science needs for her observations . Some one wrote asking “ if they were to have a farm up there ” in the woods and experiment o n all sorts of freaks ;

no , it was answered, such experiments are, melancholy EUGENICS O7 t o relate , all too many of them constantly being made . Every child- bearing marriage is an experiment in eu e ni c s g , and there are as many experimental results as r there a e children born . The collection of normal data has been difli cult be cause many people have imagined eugem s t s to be i n t e r e s t ed nl o y in imbeciles , degenerates , epileptics and t he like ; but Dr . Davenport aims to collect from whom e so ver will send their names , information about normal individuals , the talented, the genius , the comparatively - - m o r aled i n right minded and the right ; and he hopes , ’ z o f deed , that the American citi en s idea social duty will include the recording and depositing with the Rec ll ord Office of fu information about his genealogical tree .

In brief, the work of this office is to learn how every characteristic behaves in heredity . ffi This O ce is but three years old , yet thus far such facts as the following (which with all - due deference hi to Pearson and s confreres we beg to set down , have been deduced) If two epileptics marry, their children will all be epileptics ; the same is true of all imbeciles .

If an epileptic or insane marries a normal individual, one- half or one- fourth of the progeny will usually i n herit the parental abnormality ; the others will probably un dev el be normal . A recessive trait ( one present in oped germ form and never becoming active in a given i n r s dividual) may remain ece sive for generations , but will very likely become active when it meets a like trait — recessive or not . The marriage of cousins is not bad in itself, if both families are of sound stock ; but such marriage will naturally bring out any common traits and intensify weaknesses , recessive or otherwise . Those of auburn tresses (if naturally so ) are mark adly antip athetic and seldom marry those having r ed 108 A DOCTOR ’ S VIEWPOINT

hair . A good environment strengthens good traits , but ll a c it wi not guarantee the conquest of bad inheritan e .

Love , in a mature and sensible human being (but who , however mature , has ever been sensible in such prem i s es ? ) may be in itself a eugenic choice ; the fact of two wholesome beings w ishing to spend their lives to gether is like t o be founded on insti nctive traits that l wi l make for a good inheritance , to be enj oyed by a normal posterity ; but love offers practically no more - o than an even chance . ( Nevertheless your thorough g

- ing eugenist , wise and mellow natured man that he is , would not do away with love ; he would preach no doctrine of scientific mating as opposed to the marriage of personal choice ; but he would combine with love , if such a thing is possible , common sense and fore thought . ) Marriage with a n individual of bad blood will tend to drag down the inheritance of good blood ; imbecility is often introduced into “ bloodlines” that ’ have hitherto been good . One s inheritance cannot be j udged by a consideration of the parents , for normal parents may have abnormal , even criminal children ; the k r inheritance must be traced bac f o generations , and the records of cousins , uncles , aunts , brothers and sisters m : must be exa ined one does not inherit from his parents , but from the family germ plasm . b ona d Thus , the fi e eugenist would have love and the ” eugenic principles go auspiciously hand in hand in the marriage of the future , for happier homes and healthi er children ; and for the minimum of insanity ,

s . of hereditary degenerations , pauperi m and crime And f succinctly , the obj ect of the Eugenics Record O fice at “ Cold Spring Harbor is to serve eugenic interests in the capacity of a repository and clearing house ; to build up an analytical index of the traits of American

MEDICAL RESEAR CH AND EDUCATION

It were good, as has been said, for every man to know somethi ng about law ; it were even better for every man di to know something about me cal science . Indeed, next

to philosophy, which is the gist of all the sciences , o n e s where is there comprehending o many others , r e s o t o lated intimately human life, entering into s o many of the infinitely complex phases of civilization ; what is there in human experience, from conception t o e n di ? the grav , alie to me cal science — The physician must know much o f physics the na f e s ture of heat , o lectricity, o f light, the mathematic en e fic ent of refraction, in order to get many of his b ’ results . Chemistry is ever medicine s handmaid . From l the mechanics does medicine derive, among much e se, is principle o f factors of safety , by which the body t o r e enabled to bear the unusual strains of life , and endu ’ di s n notwithstan ng, to the end of man s allotted pa . Architecture has found in anatomy the principle of t he e hollow pillar . What builder would proce d without consulting the hygienist and the sanitarian, for the help they can give in the manifold aspects of home life . What public work would be designed in defiance of the of the dictum that the health of the people is the s u preme law . The biological sciences (how objurgated s by some is that word science, which means ab olutely nothing else in all the world than j ust “knowing ”) the se sciences are furnishi ng medicine most valuable i and salutary data as to the vital phenomena of hered ty, environment , function and will . 1 10 RESEARCH AND EDUCATION 11115

Do you i magine the physician and the painter have ? no bond Examine , then, more carefully the next time you see them the Venus of Botticelli and the Blessed Damozel of Rosetti ; and recall that the models from whom these men painted were consumptives . How shall you understand Ni et s c hke or Verlaine aright without hi knowing something of psyc atry . If you have not discerned pathology in literature , how toxemia coursing ff s through the blood a ect genius , read then again any page of poor tuberculous Robert Louis , or Lawrence Stearne or Marie Ba shki r t s e ff or hear again such eerie ’ music as much of pathetic Chopin s , notably the First

Polonaise . If you think melody has nothing to do with fl ni medicine , re ect upon the Dancing Ma as of the Mid

- dle Ages and the Tango of to day . Learn, too , of the — — hundreds literally o f transcendent geni uses in liter ature and the arts , who have succumbed most untimely and most drearily , for them and for us , to The Cap tain of the Men of Death . Whereby the world has lost inestimable treasures o f the soul and of the i n

t elle c t . Have the poet and the physician nothing in common ?

Read, then , from the book here under review “ It IS in the putting forth of the hyp othesis that the true man of science shows the creative power which makes him and the poets brothers . His must be a ’ sensitive soul, ready to vibrate to nature s touches . Before the dull eye of the ordinary mind facts pass one after the other in long procession, but pass with

f . o f out ef ect , awakening nothing In the eye the man of genius , be he poet or man of science , the same facts light up an illumination , in the one of beauty , in the other of truth ; each possesses a responsive imagination .

Such had Bernard , and the responses which in his youth 112 A DOCTOR’S YIEWPOINT

e a d found expression in verses , in his matur r n trained ” mi o f s . nd took the form scientific hypothesi . (Foster) A nd hi f t s by Dr . Eliot, o Harvard : “ ur The imagination of Darwin, of Paste , for example, is a s high and productive a form of imagination as that o r of Dante , or Goethe even Shakespeare, if we regard the human uses which res ult from the exercise o f imagin ative powers ; and mean by human uses not merely meat and drink, clothes and shelter, but als o the s atisfaction ” o f mental and spiritual needs . The physician must be a metaphysi cian also who i would consider aright emotional epidem cs , such as the

Crusades , Witchcraft and the modern congeners of ll these phenomena . He wi never have studied history aright w ho does not grasp ( most historians have not) the part whi ch pandemics o f s uch di seases as Bubonic t Plague , cholera , smallpox, malaria and the Great Whi e ff Plague have played in human a airs . How oftentimes h as medi cal j urisprudence served the ends of j ustice . Though the practice of theology and o f medi cine a r e - ni to day , fortunately , not often u ted in the individ ual a s x e s s e n t i all , they are nevertheless y complemental ffi as they were in the stone age , when the o ces of priest - and physician were one . And the President Emeritus of Harvard has told us that no reli gion is worthy the name which will not take sympathetic account of pre v en t i v e medicine . s hil Consider , too , how horrendous a part yp is plays in social life ; that tuberculosis has ever been and is now one of the most dreadful economi c degradations in i e l s civilization . And the h gh st statesmanship seeing in preventive medi cine a pillar of fire light ing the way to national happiness and the worthiest prosperity of peoples .

114 A DOCTOR’ S VIEWPOINT

upon observations as pregnant as any to be found in T o philosophy . quote “ The human being i s a p art o f the whole of nature and cannot be understood without it . What is wanted is a satisfactory general view of the pr ocess of the ni u verse . Possessing this , we shall find the key in our hands which will open the most secret recesses o f the ” - Go m er s art o f medicine . p . It i s well that the sciences of nature hold out a t s o ff the tractions to many di erent types of mind , for edi fice of science is built of material which must be drawn from many sources . A quarry opened in the o f interest one enriches all of these sciences . The deeper we can lay the foundations and penetrate into o f hi the nature t ngs , the closer are the workers drawn together, the clearer becomes their community of pur ni pose , and the more sig ficant to the welfare of mankind ” i —Welc h the upbu lding of natural knowledge . . “ l Some day , perhaps , the mystery of ife and being, a s which presses on the physiologist on other men , and indeed , with a double weight , may be solved . Some day , wha t w h perhaps , man may know not only he is , but y

- he is . To day, after but three thousand years of his tory and three hundred of science , it were indeed diffi cult to imagine how this can be so . We can only trust

- - . o ff m that it may be Some far to orrow may arrive , when the clearer vision of a milli on of years of science and of history may fathom the secret and read the reconcilement of the hopes and the destinies of man . “ A hair , they say , divides the false and true ; Yes ; and a single Alif were the clue ; — Could you but find it , to the Treasure house A n d peradventure to the Master , too . RESEARCH AND EDUCATION 1 15

“ In the field of observation chance favors the pre ” m —Pear c e uo t in Pas t ur pared ind . , q g e . “ Remarkable achievements are never uni que occur r en s c e in nature . Even the greatest men rest on the shoulders 6f a large multitude o f smaller ones who have preceded them ; and epochal di s coveries emerge out of a p eriod of intellectual r estlessness that affects many ” — le ' . F ane r minds . “ Every citizen should b e inspired with love o f per sonal and public hygiene, as were the Greeks . Every physician should be deeply grounded in physiologic medicine and provided with proper facilities for using f it practically . Every public health of icer should know hl thoroug y the contributions of etiologic medicine . All e fi o r t s should be made to promote these fundamental ” —B a r en needs of society . de . “ The discoveries whi ch have transformed the face of modern medicine have been in the field of infectious diseases , and in no other department of medicine could k new knowledge have meant so much to man ind , for the infectious diseases have a signi ficanc e to the race possessed by no other class of disease, and problems relating to their restraint are scarcely less social and — l h . We c economic than medical . “We cannot agree exactly on what a ‘good doctor’ ‘ ’ ‘ ’ l l s a is . Some wil say Practical ; some wil y Scientific ; ‘ ’ ‘ ’ some will say Knowledge ; some will say Heart .

L n ul all . yo . ( The good doctor sho d be of these) “Wonderful as were the isolated achievements of the great discoverers in medicine in the early centuries , the great continuous advan ce in medicine during the past eighty years resulted from organized laboratory ' e fi o r t based on the principle of exact experimental meth ods ; and it is the duty of the university so to organize 116 A DOCTOR’ S VIEWPOINT

its laboratories and hospitals that this advance o f med i c i n e by research may continue, side by side with teach s e ing, as a univer ity function of ben fit to students and faculty as well as t o the state and the general public t o welfare , and thus be an aid the advancement of ” - P ar ce civilization . e . “ It is the privilege and duty of hospitals t o extend their field of usefulness by opening their wards more a di freely to undergr duates in me cine , t o elevate the

standards of work done by nurses , internes , residents di ff s o and atten ng sta , to foster research . By doing i n they are not harming the patients , but are rather ll ul suring them better and more ski f treatment . They are serving to enli ghten and educate not only the indi vidual , but the observing public as well , eager to learn ” and to be instructed in knowledge of medical matters . —He r r i ck . “ He who purposes t o study medi cine should have i n i hi h gh degree three gifts , not one of w ch is common i among mankind , yet all of wh ch he must have : the power of reliable observation, intellectual endurance ; ” —M iu o t loy alty . . “ a r The die is cast , the book is written , to be re d eithe

now or by posterity , I care not which . It may well s ix wait a century for a reader, as God has waited s ” — . Ke l r thou and years for an observer p e . “ We may regret the loss of many charming features whi ch have been erased from the landscape of science hi i by all of t s m nute specialization, of which no one s can fore ee the end, and such a sentiment is much the same and as unavaili ng as that for the return of the the days of stagecoach . The great instruments o f — progress in modern li fe steam and electricity in t he Q i e - ndustries , subdivision of labor and increasing sp cial

118 A DOCTOR’S VIEWPOINT it s eddi s and e currents , expressive o f cer tain doubts and errors that fringe all progress ; but it make s continuous advances on its w ay to the ocean of its destiny . Very gradual has been the progress of it s widening and deepening, for it is a product of human ui ingen ty and artifice , and only skilled engineers could direct the isolated currents of science into the s ome ” w t sl s a of i - ha uggish tre m med cal utility . Her ter .

Pr o fess or Pearce tells o f six impor tant activities i n s cientific medicine in the present day : l . Immunity is the very basis of preventive medi cine ; it is one of the most fundamental properties o f living thi ngs ; by it untoward environmental agencies Immun o lo are repelled . gy ( or serology) would explain ’ and apply the mechanisms by which one s body is e n abled to resist disease ; and this science seeks to e s t abli sh laws fo r the conditions determini ng natural resistence to infectious disease, and for the factors i hi whi ch increase or d minish t s resistance . Up t o 1890 b ac t er i olo i St s r w er e studying almost e n g — t i r ely the causation of the germ that is , the bacterial, the in fectious diseases , and were attempting, with con e s s ider abl success , to combat these diseases by mean of vaccinations ( still a most valuable pro c eeding) . r - l Since then , however, a new and eve widening fie d i hi e of investigation has been opened , n w ch have b en, and are being studi ed : the mode of action of invading germs and the mode of action of their pr oducts ( tox ins) the processes of infection and of intoxication ; t he me chanism by which the host combats the invasion and i l o it was oun abor ts or throws o ff s uch infect on . A s f d RESEAR CH AND EDUCATION 119

that the toxins (poisons ) generated by the bacteria produce not only an often fatal intoxication ( toxemia) but that each toxin thus developed has its di stinctive

effect . The poison of each bacterium has its own

peculiar and specific action . ( For example , one does not contract any other disease than typhoid from

the typhoid germ) . Thus was begun the serum ther a p y through which were evolved the wonderfully ben efic e n t i diphtheria and tetanus antitoxins , and the m p e t us thus given has lead to investigations of great

and permanent value . M ong the bodily forces above indi cated we can : here mention only phagocytosis , by which our white

blood cells engage in a Homeric , though microcosmic

battle with the invading bacteria , either engulfing, lit “ ’ e r ally eating em alive (when the host recovers) ; or being themselves destroyed by the i nvaders ( the host dying in consequence) ; the bacteriolytic (germ destroying) properties in certain body fluids ; the prop e r t y in blood serum of agglutinating or clumping to

gether pathogenic germs the opsonins , those substances o s on o in blood serum ( p , I cater to) which have the power to prepare bacteria for ingestion and digestion

by the whi te blood cells . We must mention also the ’ extension of Pasteur s principle of vaccination to pro $ t e c t i e v ( prophylactic ) vaccinations against cholera , plague and typhoid fever ; and the contribution in recent years to the list of curative sera of the ant im e n i n o c o c c u s g serum , used against cerebrospinal meningi ha s tis , a disease which heretofore had a mortality of

practically one hundred per cent . And as to the

dreadful disease cancer , against which thus far the only “ hope is the knife , no one of those most conversant with 120 A DOCTOR’ S VIEWPOINT — the problem would be surprised to find to morrow that ” has i s it been solved and that cancer curable . 2 . The bacteria are vegetable parasites the pro t o zo a are ani mal germs or parasites . Among the lat ter the essential causes of amoebic dysentery and ma laria were discovered before 1 890; since then fifteen diseases are known or suspected to be of protozoal r o t o z oolo l i origin . And p gy has resu ted in the d scovery o f the r ole mosquitoes play in the transmission of di s ease- germs ; in the formerly pestilent Tropics being made habitable for the whi te man ; in the achi evement of Gorgas , without which the Panama Canal would i never have been bu lt . “ ” 3 dukko . Our little Ehrlich ( that p f who could or would not pass his exams and who w a s nearly flun ke d hi in consequence , but who instead busied mself with i a most extraordinary variety of chem cal compounds ) , c hemo t her a h a s created a new science , p y, based on the principle that a specific chemical affinity exists between m living cells and given che ical substances . Ehrlich believed that for each specific parasite a specific cura tive drug could and must be found . The destruction s l of germ , animal or vegetab e , outside the body is a comm onplace of surgical and public health measures ; but the destruction of such germs within the living body has never , until Ehrlich accomplished it , been — possible not without at the same time destroying also , in part or in toto , the cells of the host . To avoid the latter it was necessary , therefore , that the protozoa destroying substance should have a specific chemical affinity for the protozoa in question , but little or none ’ for the cells of the host . Ehrlich s most brilliant suc 606th cesses thus far have been with Salvarsan , the chemical combination with which he experimented in

122 A DOCTOR’ S VIEWPOINT

a other substances which may lter normal function . This science includes not o nly the study of the mode of action of remedial agents in healthy individuals and the influence of such action on various abnormal con di t i o n s l f , but a so , the ef ect of a great variety of sub a i n st nces , short , of all animal, vegetable or mineral substances in any way capable of altering normal f physiology . Nor is the study of the ef ect of these s ubstances limited to man and the higher ani mals ; but it includes the use of the lower invertebrate forms , - i n clu bacteria and protozoa . It is , therefore , an all sive branch of biology , dealing with the comparative study of the action of chemical bodies on animal life .

Its achievements are of interest to physiology , to which science it has contributed much, both in method and : in fact to chemistry, in that pharmacology has added largely to the data concern ing the interaction of cell and chemical substance ; and to practical therapeutics , di in that it presents new reme es , explains the action of old ones , and defines the limitations of drug therapy . And it has a definite relation to the general public o welfare in that , by its meth ds , it establishes procedures for determining the potency of therapeutic remedies ; ill f thus preventing, on the one hand , ef ects from a drug of unusual power ; and , on the other , guaranteeing a remedial agent of standard strength .

Exer imen t al Pa tho lo an d Pa t holo i c al Ph 6 . p gy g y s i olo gy are branches of pathology and physiology which , combining the methods of both those sciences ab with those of chemi stry attempt , by the study of normal conditions experimentally produced , to explain the disturbance in function consequent upon cell or tissue injury or disturbances in physiological or chem o - s ical equilibrium . C ordinating as they do the method RESEARCH AND EDUCATION 128 of of the medical sciences and having for their obj ect the elucidation of definite problems in clinical medicine , they are essentially the methods of a science of cli nical medicine , and have added materially to the ’ e lat ter s advanc . EDITORIAL EFFUSIONS

HOW GEN IU S MAN IF ESTS ITSELF

A great sculptor once had his soul so satur ated with W — l a onderful sunset its softness , its ca m , its quiescent and gradual change of coloring and its peace- suffusing — quality that he wanted to portray it ; but he was no painter . So in stead he wrought in marble a little child asleep ; and thi s he di d so successfully that people

‘ contemplating the equanimi ty and trustfulness in its i n r e fant countenance , the stone that seemed almost to be mi spiring, declared that it put them in nd of a sunset and were bettered accordi ngly . So also fifty years ago a boat builder ( this is imagined for the facts are not “ v known nor do they in the least matter, since they ha e nothing at all to do with the case” ) was profoundly nl li moved by a quee y , a soul compel ng, and a good diffusing woman ; but he was no poet and could not e mani fest his devotion in rhym and rhythm . Yet his imperative ambition was to interpret hi s inspiration into something that might in turn benefit the world . So he bui lt a poem : he designed a most beautiful white vessel wi th exqui sitely graceful lines ; and he named her the Mary Powell . And so transcendently delight f li ul was that vessel , when outlined against the love est s o scenery in the world, swift and sure her course along the noblest river , dashing the rainbowed spray from her bow, so benignant her existence , that these her fifty years past people have never tired admiring , 1241

126 A DOCTOR’S VIEWPOINT H Tyndall, Frankland, Huxley, ooker, Busk, Avebur y,

and Spencer . Later members were Darwin and many

another of those amazing nineteenth century giants . “ ” “ u It has happened , observed H xley , that these cronies e have developed into bigwigs of various kinds , and th re fore the club has incidentally— I may say accidentally ” fl Hu ~ a good deal of in uence in the scientific world . x le y once overheard two members o f the A thenaeum “ X l ? ” I say , do you know anything about the C ub I ” “ ? ” “ Oh, have heard of it . What do they do Well, ff i n e they govern scientific a a rs ; and really, o the Whol , ’ ” they don t do it badly .

ee n Nevertheless , a guest of this club must have b shocked and saddened by the frivolity obtaining among its members . There were no rules , save the unwritten aw mi l not to have any . But skeletal nutes were kept , “ as Talked politics , scandal, and the three classes of ” s — r witnesse ; liars damned liars , and experts . Excu sions were organized for the members and their wives , “ ’ ’ ” as recorded by the algebraic notation xs plus y vs ; “ ’ ” the xs of the outings to be paid by the It w as suggested in the beginning t o name this club “ t he “ ” i n Blastodermic , that being the part of the ovum which the rudiments of future organism first appear ; “ ” apparently x was decided on because it stood for the unknown quantity , and so committed the club and its members to nothing . In this coterie the observation of “ Herbert Spencer seems to have been lived up to : It is a great mistake for adults , and especially those who work their brains much , to give up sports and games .

The maxim on which I have acted is , be a boy as long ” as you can . d A r e m s c e l n 3 . r v r mong the mi en c s of Unc e D a , Ha a EDITORIAL EFFUSIONS 27

man of the era when Hallis and Halew or thy were up to-date dormitories are these

One morning James Russell stood, hat in hand, to

- assist absent minded Dr . Peabody ( whose sight was n ot so good as it used to be) to alight from the old

- - horse car in Harvard Square ; the ever humane doctor,

seeing the inverted hat , dropped therein a coin , with “ ” - $ ll a There , my good man, there Lowe ever after

cherished the coin as a memento . The Autocrat of the Breakfast Table was once a — — guest and a very approachable one at the Profile i House , in the Wh te Mountains . One evening char ades were in order ; and Holmes asked permission to

put one on . This was j oyfully agreed to ; whereupon ul he had a brief cons tation with a friend . The latter then appeared, as if for a morning stroll, and rambled

aimlessly upon the stage ; then Holmes followed , walk ing briskly ; the two gentlemen met , saluted cordially , “ and then left the stage . A word of five syllables in ” “ that one act , announced Holmes . Nobody could guess “ ” - a - the word, which was met physician . The appreciation of this charade was s o cordial that

Holmes was asked to give another . He and his fellow ’ conspirator complied ; to everybody s m ys t ific ati o n they “ went through precisely the same scene . A word of ” three syllables in that one act , announced Holmes this “ time ; the word was metaphor . Uncle Dan tells how, when Holmes was just a struggli ng young doctor some

where along Charles Street , he once threatened to put “ ” out a sign, Small fevers gratefully received .

We may add here the experience of James Payn, Co r n hill M a azi n e at one time editor of the g , the door of whose sanctum was one day opened by an unan 128 A D OCTOR’ S VIEWPOINT

n d o un c e caller . The latter had a goodly roll of pape rs hi s under arm, whereby Payn scented a poet with a “ ” “ ’ - . ? never ending epic Well , sir I ve brought you ” something about sarcoma and carcinoma, announced “ the caller . We are overcrowded with poetr y ’ ul li co dn t accept another ne , not even if it were by ” “ $” “ Milton . Poetry flashed the caller indignantly ; do you know anything about sarcoma and carcinoma ? ” “ ’ ? ” Italian lovers , weren t they ventured Payn . The call er retreated i n the greatest wrath ; under the same roof as the Co r n hill was the office of a medical and surgical j ournal, and that it was had been sought by the medical writer of t he treatise on those lesions with the eu pho n i o us names . PULICIDE

Some may 1mag1ne it to be an easy thing to kill a flea ; such delusion will be dispelled by the following

statements , which are authoritative , being based on a report on F lea D e s t r u c ti on of the United States Public

Health and Marine Hospital Service . It should b e premised , however , that the investigation noted , though d nl thoroughly scientific , was limite in scope ; for o y the Pn lew i r r i t an s Ho lo s lln s an o maln s , the p p y and the Cer a t o h llu s ac n t u s p y , with two other varieties were ex a mi n e d ; and, as every one knows , this is but touching

the fringe of the flea question . Pretty much every insect can be destroyed by c o r r o d f r ing it with chemicals , or by suf ocating it out ight , or by euthen i z i n g it with ether or chloroform or laughing

gas . Not so , however , the festive flea, which will

survive all these modes of execution combined , with i s others added . It will survive the agency which k ll “ ” i t s host , such as the rat or the squirrel ; and (with

13 0 A DOCTOR ’ S VIEWPOINT

human survivor who has been submerged in whisky ; yet

fl a ll eas come out seemingly the better for it , after e 98 t being soaked in absolut alcohol ( per cen ) . Again, a flea left to swim in formalin ( a very powerful i ns e c “ ” e ti ide) was apparently dead in twelve hours , but “ ” . 1 00 revived It took per cent . phenol more than one ll minute to ki a flea , etc . The conclusion is that water is of little value in flea destruction ; glycerine is p r ac tically inert ; alcohol is practically inefficient ; kerosene

and miscible oil are efficient ; formalin, phenol, mercuric chloride and t r ek e s ol in the strength used as disinfect

ants are of little value , and powdered sulphur of none ;

the fumigants , bisulphide of carbon , hydrocyanic acid “ f gas , and sulphur dioxide are highly e ficient in the strength employed for fle a destruction

It would seem , on the whole , that the surest way to kill a fle a ( and be able to testify under oath that he is really defunct) would be to place him on one of those impenetrable plates used in naval warfare , and con fine him thereon by means o f cables fastened securely

\ to each of hi s several legs ; t he n to train upon him ( from as near a distance as would be feasible ) an irresistible pro $e c t ile from one of those t w elv e i n ch

no t s $ guns . If the flea should ( by rea on of the phe n omen al spring mentioned) break away and get out o of range , it might fairly be assumed that its destru tion beyond resurrection had been consummated; that

‘ whi c h t he is , considering the unerring aim for Ameri can navy is so j ustly famous : i f the experiment were tried in the Cuban or the Patagonian navy, one would be rash to guarantee the result . EDITORIAL EFFUSIONS 3 1

U N SOIE N T IF I C FUTILITIES

True s cience is perforce both sane and utilitar ian ;

and her votaries have ever definite obj ects in view,

which they seek by reasonable and practical mea ns . There have been instances of doings assumed to be ul dl scientific that wo d har y fill these specifications , but which have a j ocund interest and may besides possibly

have ins tructive point . An illustrious nature lover ( and not a natur e fakir by any means) b ec om mg interested in the question “ ” Why does a mosqui to refuse to touch a frog ? and perhaps with an ultimate view to the elimi nation of

both these pests , rightly concluded no fair answer could be given the question until it was determined hi if the mosquito does really make t s blessed exception .

So the experimenter repaired after nightfall to a marsh, where he held up a frog in the presence of the mosquito

host . His hand was most grievously bitten, while the frog had never the slightest occasion to scratch him o f ni self . One is here reminded the Hiber an gentleman

who held his dog all night in the snow to freeze it . It appears never to have occurred to our nature lover to have saved himself those dreadful stings by wearing a glove stout enough to be impermeable even to m o s qui all toes . Nor for his pains did he prove anything worth

while . For whether mosquitoes sting frogs or no , the tw o genera have from time immemorial been known to

flourish in the same sort of place . There seems to be hi an amicable relations p , a sort of business understand

ing between them, the mutual obj ect being the vexation m o s ui of humankind . True , frogs are supposed to eat q toes ; but thi s seems to be done genially and without e h at, after the fashion of the companionable walrus 13 2 A DOCTOR’ S VIEWPOINT

“ ” i n Ali ce in Wonderland, who after dancing with the oysters , tearfully devoured them . And yet the alleged o n s ee proclivity the part of frogs , to eat mosquitoes , ms not to have dimi nished the visible and working supply a of the l tter . Their j oint presence in marshes has been s o detrimental to nocturnal comfort and to the value of nearby real estate that something ought certainly — be done something rational , however . These creatures are both musically inclined and presumably they enj oy ’ — each other s songs a penchant not generally shared by their human neighbors ; and yet after some persons ul we have heard sing, we sho d rather , if we had to make a choice , decide not unfavorably to the marsh ni nl de zens . Be all this as it may , the o y rational pur pose o f any experimentation in the premi ses would be the elimination of the mosquito and the frog ; and there is no other way to achi eve thi s than to drain the marshes . “ e Another scientific gent , a r sident of the cactus belt , was some time ago ( possibly still is ) zealous for the formation of a cult of cactus eaters . The spineless cactus of lower California has been hi s favorite food ; ha he s been eating it , drinking concoctions of it , taking it in soup and omelette and salad ; and he gained weight in the fortnight when he lived exclusively on cactus . Nevertheless he has , no doubt , long before this , found the habit an absurdly expensive one ; and any - lli cactus eating cult , unless it be made up of mi onaires , must inevitably die out for the monetary reason alone . It was some time ago reported that a fellow- citizen l ni hi s hi s has made a wi l consig ng body , after death , de to various mechanical uses . Buttons are to be ma of his bones ; leather bags of his skin ; fiddle s t r i n gs of i r s some o f hi s more int mate internal elations . Thi

A DOCTOR’S VIEWPOINT

d an d i . egeneracy , psych c emotive obsession We shall

. leave it to the reader to make out what Dr . Hall has m nl been driving at , selecting for co ment o y the phrase ” e n rudimentary paranoia . Here seems to us an hi mi trancing phrase , w ch ght be very agreeable to ’ femini nity when rendered neath the summer moon , ’ m elli flu o u sl a o softly and y, as in a song to one s own c o m a ni m e n t — p that is , if one is quite positive he knows “ di how to sing . And yet some might hold that ru hi mentary paranoia sounds blood t rsty . Well , we confess this the more inclines us toward it ; we are mi taken with its pri tive , elemental verve . And we might j ust as well express here our impatience wi th present

- day methods of love making . It irks us to think of young men constantly on their knees (he who begins there will always stay there) , fooling away the time ’ that should be used in doing the World s Work , whilst “ ’ a : ll the maiden b cks and fills , as I wi and I won t ; maybe and yet I am not sure ; this is so sudden ; I will be a sister to you until we know each other s o c a n better ; and , father will miss me ; and , how I ” live without mother ; and so on . Much preferable the o n e good old primeval plan when , having developed a healthy , robust rudimentary paranoia , selected a fairly sizeable club , sought out the obj ect of his adoration , fetched her a whack on the head ( nothing brutal , of s ufli c i e n t course , but j ust to the end in view) , and o ff carried to his abode her unresisting form . Depend upon it , homes were happy in those days ; with no talk o f divorces or suffragism or feminism or such like folderols .

SOCIAL EXCITEMEN TS Somethi ng like a decade ago a Washington news EDITORIAL EFFUSIONS 13 5

' paper correspondent wrote of a Congress of the D augh ters of the American Revolution and its disorderly meet “ ings : It is the unani mous opinion of those who have attended the Congress that , while the Daughters of di l the American Revolution, in vidua ly , are nearly all l i inte l gent , refined and attractive women, collectively ” they are an uncontrollable mob . These identical words — would have been r e appli cable to the Twentieth Con t i n en t al Congress , held in April last , of these same

Daughters of the American Revolution . Again all sorts fr e of heinous accusations were made ; not once, but “ ” quently, was a rumpus started ; the Madame Pres wi a r o b r i o u s ident was , th p p intent , stigmatized by a “ ” a member of the opposing faction as a czar , an h solute and relentless despot being no doubt implied in this term . This same Madame President was alleged to have committed the heinous crime of changing her — mi nd a phenomenon whi ch has from the very begin ning of the race been agreed to ' be not at all a crim inal proceeding, but rather a most indubitable right and ni All privilege of the femi ne nature . sorts of di sagree able asseverations and unpleasant insinuations were

. w a s made The Revolution thus , for at least the twen t i e th time , fought all over again ; only the British had no hand in the business . The fighting was all done in the American camp , where all the casualties o c curred .

Now, every reader will surely agree, and that with hi out qualification , with the Was ngton correspondent we have quoted , as to the charm, the amiability, the sense of justice and the gentlewomanliness of each and every one among those Revolutionary Daughters . By ul what occ t processes , then, is the normal individual, o n m beco ing a member of an assemblage , likely to 13 6 A DOCTOR’ S VIEWPOINT take leave of hi s or her natural temperamen t and im characteristics ; by what means is the human unit , mediately it becomes merged in a crowd (meani ng by

‘ the term a collection of people) moved to do an d s ay thi ngs that would not be thought of in the i n di v ida ul s u es c apacity . These psychic factors are mainly gg tion and the force of inordinate social excitement ; under their influence the individual loses the power of calm observation , of logical thought ; for the time being “ he is no longer king of all that is under hi s own hat ; his highest and last developed cerebral functions ( rea son and j udgment) are for the time being inhibited, “ and out of the circuit . ( These phenomena apply equally to males ; so let us now write our observations “ as of the masculine term , since man embraces

The individual in the crowd , then , has for the time being, undergone reversion ; he assimilates with unusual readiness the ideas of others , however unreasonable they may be ; and he proceeds in accord with those u n r e a with whom he has associated himself, however sonable or unfair their proceedings may be . “ Suggestion is the insinua tion of a belief or 1mp uls e s into the mind of the subj ect by any mean , as by words ” or gestures , usually by emphatic declaration . The art in suggestion lies in the ability to present an idea in such a persuasive , convincing and apparently prob able light as to command the assent of the subj ect . The process is precisely represented in the everyday ex “ ” : pression What made you put that idea in his head . The essential difference between suggestion and hyp n o t i s m is that in the latter the subject arranges b e forehand to submit to hypnotism . He is generally t he fully aware that he is about to undergo process . Suggestions are oftener than not implant ed in the sub

13 8 A DOCTOR’ S VIEWPOINT

PSYCHIC R ESEAR CH hi Such subj ects as apparitions , psyc sm , spiritualism and the li ke have been so much exploited by charlatans

- and pseudo scientists , with interests so obviously per sonal and selfish , that reasonable men , honestly desirous of ascertaining the truth , have generally abandoned this

field . Professor Hyslop , however , is an honest , earnest “ searcher for the truth , and his latest book , Enigmas of Psychi cal is entitled to scientific considera hi hi s tion, even though t s must be quite adverse to posi l “ ” tion . He accuses scientific men , especial y physical “ ” or materialistic scientists , of purposely and even ma li c i o u sly ignoring the work of tho s e engaged in psychic ff n research , of a very culpable indi erence to super ormal “ ” e or metaphysical ph nomena . Science , he declares , “ having become accustomed to residual facts within its m own domain , is loath to ad it the existence of facts whi ch limit that domain or demand the acceptance of a ” i i n larger than the ord nary material world . Let us quire how j us t are these accusations

Charles Darwin some thirt y years ago , when spirits was were rather rife in England , invited to inquire into

their nature and habits . Though skeptical , he respect fully and attentively considered the subj ect and got h Huxley to help im . The latter visited a seance held “ in a private house and reported to Darw in that the performance w as so gross an imposture as ever came ” . w a s under my notice Professor Darwin , who also “ : present , declared Unless I had seen it I could not have beli eved in the evidence of any one with such per

e . . b e l n hl fe t good faith as Mr Y ( the host ) g so wort ess . It has given me a lesson with respect to the worthles s

‘ o s o e b e t . u r e B t n ; H r r B T n r C0. EDITORIAL EFFUSIONS 13 9

ness of evidence which I shall always remember , and, ” l di ffide n t . besides , wi l make me very in trusting myself Charles Darwin concluded concer ning the medium on this occasion who “ had the highest credentials To ul my mind , an enormous weight of evidence wo d be requisite to make one beli eve in anythi ng beyond mere ” “ tr ickery ; and again : The Lord have mercy on us all ” if we have to believe in such rubbish . Tyndall , who “ ” e investigated spirits exhaustively , has describ d his many diffi culties in conducting a thoroughly scie n tific r a investigation in the p esence of believers or , sh ll we ul e say , gullible people . He co d not persuade th m to employ such ordinary precautions as are e ssen tia l to investigate these phenomena ; and he clearly dem on t r a t u n a m n s d . e their fraud le t char cter . Prof Si o New w a s r comb , who perfectly willing to oblige the spi itists m a m h a s and to study the pheno en which interested the , “ ” left in his Remin iscences diverting accounts of how he found it impossible to continue on the farcic al line s

. a m laid down by them F raday , at the cost of much ti e and trouble , convinced all who were open to conviction that fraud and self- deception wer e at the bottom of most of the spiritis t doings with whi ch he came in con “ tact . He was shocked at the superstitions which in thi s day of boasted progress are a disgrace to the age and whi ch afford astoni shing proofs of the vast flood of ignorance overflowing and desolating the highest ” places . If these great names do not s ufi c e Professor Hyslop

we would add that Podmore , who was president of the

Psychic Research Society, demonstrated in his book , “ ” r Studies in Psychic Resea ch , the preposterous and “ ” flimsy basis for most of the established facts o n

. w a which spiritism was founded This book , by the y, ’ iZl‘lsO A DOCTOR S VIEWPOINT is a s p lended exposition of the laws of evidence which s hould obtain in any investigation , and is well worth a s t r o w the perusal of both physicians and lawyers . J , “ ” mi in hi s Fact and Fable in Psychology , sub ts some very illumi nating data . Balfour , the recent British premier , as the result of an exhaustive study of psychic phenomena , has become the most conspicuous modern “ ” example of the philosophic doubter . Among the great men in science who have taken up thi s subj ect was Wal “ ” w ho lace , has been characterized as a willing believer ; thi s should not surprise any one who has noted how “ easy Wallace was in the hands of the anti- vaccina

t i o n i s t s .

Professor Hyslop does not help hi s position by such “ ” “ ” characterizations as physical or materialistic s c i en

t i s t s . ul Herbert Spencer , the great form ator of the doctrine of evolution, was j ustly impatient of those who held that doctrine to be purely materialistic . His First Principles ” begin with an earnest and reverent “ ” consideration of the immaterial unknowable , whence is derived so much of the kn owable as finite human wis dom can by patience and reason come to understand . Science is knowing ; and the real scientist is eager only for the truth , no matter where he may find it or whither it may lead him . Each worker gathers what he can i hi s with n own ken, insisting only that his facts shall be true and absolutely incontrovertible ; and all which he gathers together he gladly adds to the sum of all science

or knowing, which is philosophy , in the hope that his gleani ng may redound t o the welfare and happiness of

his kind .

F ACTORS o r SAFETY ” The half of his strength he put not forth . In

1 42 A DOCTOR’ S VIEWPOINT demonstrated in the L aen n ac Hospital i n Paris that one may live with lungs reduced by operation to one sixth their usual capacity ; many a consumptive goes - e about with no more than that . From one half to thr e fourths the liver may be removed without j eopardy to life , hardly indeed to health . Many organs are

- bilateral ; one really needs but half of them . One half — — the brain would do and has had to after accidents or certain diseases . People have got along as if noth ing had happened after the removal of a whole kidney . “ Dr . Samuel J . Meltzer, in a superb lecture on The Factors of Safety in Ani mal Structure and Animal ” Economy , probably first showed in a scientific way how our bodies are provided with large margins of safety , over and above the maximum required by nor mal activity ; how thus are promoted the integrity of life , the perpetuation of species , and the processes of natural selection . He borrowed the term from the ni w mecha cal engineer who , in un itting imitation of nature , calculates that the engines , bridges , and other structures he builds should be capable of wi thstandi ng not only the stresses of reasona bly expected maximum loads , but also those of six or seven times such loads .

KILLING AND CONSERVATION In m odern warfare the cost of killing one soldier aver ages In the Boer “ row” this item came as high as The Balkan conflict with Turkey was conducted more economically ; and yet w as burned up in making one man food for powder—really r o fit le s s a scandalously p business , considering that the outlay was a dead loss ( nothing funny intended)

except in fertilizer product . The most expensive thing in nature is the destruction of human life ; t he EDITORIAL EFFUSIONS 14 3 proceeding would be outrageously costly for the world if not a dollar was sunk in it . At the head no one has any right to claim humankind to have more sense than the most dunderheaded creature in the cos mos . The Balkans have thrown a scare into Europe that is evaporating two billion dollars ; for such is what the six great European powers composing the Triple Alliance and the Triple Entente are paying for military — preparations not for war , but to prepare for war . Add to this money waste the loss of production by two and a half million young men being withh eld from ’ i the world s real work , for m litary and naval service ; and the total cost ( at the individual rate of $4 00 a n n u ally ) of the fighting forces of Europe would reach r a the three billion mark . All this is on the highly t i o n al theory that the more crushing and blood- sweat li s ing the war taxes levied on the toi ng ma ses , the less likelihood of international slaughter there will be $ It makes one recall Heine’ s terribly grim and unholy apos “ t r o he Al p to the mighty ; Oh , Thou magnificent Aris t o h an e s s p of the universe, how your sides mu t shake with laughter whilst you look down upon us mortals and contemplate the epic idi ocies of which we are capa ”

ff . ble . ( Or words to that e ect ) The paradox has been well put that the most precious thing in life is the cheapest (in dollars and cents) , whilst the most use less thing is the dearest , in money . And what is there i — cheaper than l fe conservation which is , by the way , the biggest idea the twentieth century has thus far evolved . Panama , for example, was a generation ago about the most pestiferous and gangrenous spot on the hi s globe . Colonel Gorgas and associates have turned that region into a veritable health resort ; only two or thr ee communi ties in these United States can to-day ’ 14 4: A DOCTOR S VIEWPOINT get under the Canal Zone death rate ; and the actual cost of this j ob has been the individual . The Rockefeller Commission for the Eradi cation of Hook worm Disease and its humane allies are curing many thousands of the people in our southland at some hi - i t ng under seventy eight cents the head . Wh ch is the nobler achi evement ; such a life- saving one ; or that other the man life- destroying proposition ? hi Nowadays , on t s side of the Pond at any rate , a great many people are seeing the point ; for example , these citizens who are in the Life Insurance business . Actuaries are estimating that is a safe estimate of the economi c value of lives that are lost dl ni nee essly each year in the U ted States alone , not nl through wars , but o y through preventable sickness w a and accidents . The idea of health conservation s ’ Professor Irving Fisher s of Yale . He several years ago outli ned a plan for the education of the p ublic t ni au t h r i o the end that Federal, State and mu cipal o ties might provide improved health protection ; and he m s u r a n c e i m suggested that life compan es , purely the “ ” e iilf ht e n ed way of business , and of g selfishness , could well afford to contribute l n money and brains to such a campaign . Well, the Association of Life Insurance

Presidents , representing policy holders all over the world ( some twenty millions 1n the United States alone) are working the suggestion for all it is worth . They t are educating heir clients , and urging them by every h means in their power , for personal and communal y gi e n e and for di sease prevention . And the movement is permeating every phase of our civilization . THE ETHICS OF INFECTION A hitherto unknown race of men— “white Eskimos

[14 6 A DOCTOR ’ S VIEWPOINT

“ says of the Newfoundland Micmacs , that consumption and the traders ’ rum are playing havoc with this fine race . Dr . Grenfell has observed that epidemic diseases have up to recent years been practically unk nown along the Labrador coast . The infections which the natives have contracted have been introduced mostly from O e regions to the south . n little Labrador settlement was for the first time visited by typhoid fever ; Grenfell , when he arrived on his healing mission, found eighty frozen bodies of those who had speedily and most miser

t o . ably succumbed it Tuberculosis , diphtheria and the exanthems are much more fatal among the Labradoreans than among us . “ Dana wrote in 183 51: It has been said that the greatest curse to each of the South Sea Islands was the first man who discovered it ; and every one who knows anything about the history of our commerce in those parts knows how much truth there is in thi s ; and that the white men , with their vices , have brought in diseases n ow before unknown to the islanders , which are sweep ing o ff the native population of the Sandwich Islands at the rate of one- fortieth of t he entire population annual ly . The curse of a people calling themselves Christians seems to follow them everywhere . Measles is an exanthem comparatively innocuous in il dl u n a c c u s civ ization , but dea y to primitive peoples 50 t o m ed to it . Dr . Stefansson says that it has killed o f per cent . the Eskimos in Canada and Alaska in the last fifty years . It was entirely unknown in the Fij i

Islands until introduced by whi tes in 1875 . Thereupon in a single epidemic of Fijians , men , di women and children , the aged and the young alike, ed

T e B ef o e t h e a s . D H r . : w o a s t an a R . i , . , J Y r r M EDITORIAL EFEUSIONS 147

s . most pitiably of measle How often, since the Span i ar ds following Columbus came in touch with the Carib beans (whose name alone is left) has benevolent assimi lation spelled pitiless extermination $ The negro in hi s e hi nativ Et opia knew nothing of consumption, syph li i s , alcoholism or cocainism until his white brother e hi m li came to b stow on the blessings of civi zation . Now tuberculosis is proving fatal to large numbers of the negro race in these United States . The same dreary story obtains regardi ng the American Indian whenever and wherever our people have come among them , with our tubercle bacillus and our fi r e - water ; for the Indian is dying of tuberculosis in greater numbers than the hi negro and in far greater numbers than the w tes . Thus racial susceptibility to bacterial di sease should give pause to those who contemplate the “ regeneration” of peoples too gratuitously assumed to be barbarian and inferior, and whose departures from civilized standards “ are conditioned largely by environment . The perpet ” ual quarantine urged by Dr . Stefansson for the white “ Eskimos seems reasonable and humane . He says : The only really intelligent management of the Eskimo in nl nm the wo rld is in Gree and . Here De ark has a per e t al ul ul p u quarantine , and as a res t the pop ation is on the increase . Nobody is allowed to land in Greenland

unless he is thoroughly inspected . Such an arrange ment is perfectly feasible for the protection of the ” Coronation Gulf Eskimos .

CONSUMPTION AND CIVIL IZATION The tu bercle bacillus is an index by inversion of the

real progress of the race . By it the claim of civiliza i tion to dominate human l fe may fairly be j udged . Tuberculosis will decrease with the substantial advance 48 A DOCTOR’S VIEWPOINT

of civilization, and this disease will as surely incr ease as civili zation retrogrades . Is this statement much too ? broad ? Is it untenable Consider, then There is no phase of life whi ch tuberculosis does not — touch nay , upon which it does not press with a most grievous , heavy hand . It claims , between infancy and old age , every seventh , and between adolescence and —i h maturity every third or fourth , life some of our communities every other life . Every other adult negro succumbs to it ’ Society s submerged strata , which cannot free themselves from the grip of pestilent environment the darkness , wretchedness , and starvation upon which the saprophytic bacillus propagates its teeming bil — lions yield victims far in excess of those claimed by all other infections put together .

ar e r a m Nor the rich , in fancied secu ity, ny freer fro the danger than were the gallants and the gentle ladies ’ in Poe s dreadful tale , who thought by isolating them u selves to escape the Black Death . For the bea tiful laces and garments worn by the well-to -do and the h pretty things worn by their c ildren , and often got at remarkably low prices ( for is he not a fool who does not buy a thing as cheaply as he can ? ) are like as not worked at and bent over and coughed upon from

- dawn until midnight by sweat shop consumptives . Thus much oftener than we imagine does the poverty of

Lazarus make itself felt in the house of Dives .

15 There scarcely a trade , or occupation , or business , u or calling which does not , in varying degree , give p e its quota of valuabl lives . And the factory is even more productive of tuberculosis than the home for the W hi con sumptive orkman , under conditions w ch have up

150 A DOCTOR’ S VIEWPOINT

self away, was absent ; he ( or what remained of him) all - a was found near by, engaged, with his old time ze l, in hi s favorite occupation of chasing the New Bruns

w hi l n hi s v . ick cat ; w ch he, turn, was trying to ivisect The third act takes place on a bleak bank of the East

River, with the reprehended Rockefeller Institute pro vi di n g the back scene . Several hours before dawn a venerable gentleman rang the bell at the entrance door i t o of the build ng . But there was no one to respond s a t his ringing . He therefore down before the doorstep , or waited about it in most inclement weather, until , hi s daylight . Being then admitted, he made known errand . He is connected with Berea College , where either a r eal or suspected case of epidemic cerebro spinal meningitis has developed ; and he was most aux ious to secure some of the serum which Dr . Flexner hi s e xe r i and associates have , largely through animal p mentation, evolved both for curative and prophylactic i d . purposes , against that dreadful sease At first it was hi s thought to refuse request , for the reason that the ll work on this serum is sti in the experimental stage . hi s aS su r an c e Finally , however , on that it would be ll ul r e s given only by ski ed physicians , who wo d be p o n sible for its proper use, several vials of this serum were entrusted to hi m ; and they were at once rushed o ff to K 1n entucky, the hope that they would reach their des i - l t i n at o n wi thin twenty four hours . Al men and women of really hum anitarian instincts may reasonably enter tain the belief that in thi s circumstance valuable human lives have thus been saved , and that much of the ghast liest sufferings in all medi cal experience has thus been averted . The reader must decide for himslf if this play h as e been a farce, a comedy, a drama or a trag dy . EDITORIAL EFFUSIONS 51

MONGRELIZ ED RACES

s Dr . Eliot , of Harvard, spoke recently of the change t i n 1mm1gr a o has wrought in the industrials , family life, an d civilization generally of Massachusetts ; he fears a great political evil in the lack of homogeneity now

obtaining in that population . Not in a century may

it become homogeneous if ever at all .

In his youth his community was homogeneous . His ’ father s servants , the men who worked the farm, the mechanics and all the servants at Harvard , were Amer i c a n s — , descended from pilgrim stock all except a de

cent Irishman who worked about Cambridge . Marvel

ous ; only one Celt to a whole American community . a u t n t u r - T emp o r m a . The puzzle to day would be to find a single puritan in a Hibernized ( though far from i hibernating) community . Dr . El ot emphasized that there was in his boyhood but one racial element and

- seems to deplore our present day mixture . Yet we may, like honest Touchstone , thank the gods for our ra ce

mixtures , trusting that homogeneity may come here

after . The point to emphasize is that those superb ’ puritans of Dr . Eliot s youth were themselves not at — all pure that is , ethnically . There has never been

since Homer, nor probably many thousands of years

before the blind bard, a pure race ; and providential it

is that this has been so . The English who supplanted the aboriginal Indians were by no means a pure type ; nor were the Dutch

themselves in all probability not a pure race , nor the

French nor the Spaniards . Take the Frenchman of

- to day . In the North are the descendants of the Belgae , the Walloons and other Kymri ; in the East those of Germans and Burgundians ; in the West Normans ; i n 152 A DOCTOR ’S VIEWPOINT

l - to recently prevailed , has infected his fe low workman i more than he has the members of his own fam ly . In literature and the arts how many precious lives have succumbed to this veritable captain of the men “ ’ of death . Consumption has ever been death s direct door to most hard students , divines , physicians , phil ” o s o he r s . p , deep lovers , zealots in religion Who can estimate the loss in beauty , poesy , in intellectual treas ures , and in all the sweetnesses, and refinements of life , which this disease h as inflicted upon us ? How many an inspired genius , even before his powers have matured, has suffered its most untimely visitation $ “ T r o kn e r Hus t en - The proverb goes , T o der T r o m ” p e t er ; nor has the sword ever been nearly as voracious of human life as has been the tubercle bacillus . And - a such scourges as cholera , the plague , small pox , l ' though t hey hav e been more gruesomely picturesque in their ravages , have never been in the running with consumption . An intensely practical spirit has come to be r ep r e s en t at iv e - h of our present day civilization , and of t is

i th x la d . e o u r we are excee ngly vain In p p phrase , every “ ” t hi ng is centered in the question : Does it pay ? and whatever fails to come up to the price o f money stand ard is eschewed contemptuously . To understand ade at el hi qu y t s tendency one has but to contemplate , for so long as he can endure to look upon it , the charac

t e r i z a t i o n . ha of Mammon which Mr Watts s painted . i — It is , then , nothing Short of astound ng the economic losses which we permit tuberculosis to inflict upon us ; astounding how our shrewdness , our business prescience , has in truth a mission machine no farther than the essentially obtuse angle the apex of which is the end o f it s nose .

154 A DOCTOR’S VIEWPOINT

an amiable interest in the proceedings . The great ma o r i t i j y in th s audience were women, who wore the plumes of slaughtered birds in their hats ; and ( it being even ing) pet dogs , whose tails had been docked , and whose i ears had been cl pped, were reposing undisturbed at So home . The lady president of the Antivivisection c i e t y (in alliance with the International A n t iv a c c in a tion Union) spoke with the precision of statement so diffi characteristic of the feminine mind . The great culty in getting started in this country , she declared , “ is 50 . because , while no doubt per cent of the medical

- profession are to day at heart opposed to vivisection, its leaders in New York, confident in their eminence and power to punish , have sent out a practical prohibition to all physicians that they should not approve or sus ta in in any manner any movement toward a restriction ” i - of viv section . Several public spirited gentlemen were c o n s i c on the platform . One among these , in terms p uou s - for man like temperance of expression , stated that those medical experimenters who vivisected animals were virtuosos of agony, in whom curiosity , vanity or s u lan t e d humani t scientific zeal has p p x x y, and to whom harmoni es or discords of agon y or long- drawn cadences ” of torture , struck from quivering nerves are music . One clergyman contended that the practices condemned “ are continued for the purposes of commercialism , w e to obtain antitoxins , hich have not yet prov d their effiac y, and in some instances have been known to have e ” increased dis ase instead of decreasing it . Another “ maintained that vivisection is contrary p r 1mar 1ly t o the law of God this clergyman would no doubt a gen e r ati o n ago have denounced the adm inistration o f m chlorofor to women in labor, on the basis of some ll e scr iptural expression . The Rockefe er Institut was EDITORIAL EFFUSIONS 155

the centre Celts , who at the same epoch when their name took its origin consisted of foreigners of various ances try and of the aborigines ; in the South were ancient Aquitanians and Basques : without mention T e c t a s a e s i ng a host of settlers like the Saracens ; the g , who have kept at Toulouse the custom of cranial de fo r mit i e s ; and the traders who passed through the

Phocaean town of Marseilles .

Professor Boas , of Columbia , has found that when ni the ratio of race intermingling is as one to ne , there will be among the more numerous population only 18 t o in the fourth generation that will be of pure blood ; and where two types intermarry with equal

freedom, less than one person in in the fourth l generation wi l be of pure descent ; that is , within a century the process of intermixture in this nation should be complete— homogeneity achieved $ A mixed race become homogeneous i s as nearly per fe c t as a human race can be ; and the more elements that enter the mixture the nearer will the ideal be ? approached . Is the reader not convinced Look , Sunda then, on one of the recent pictorial pages of the y i T mes . One sees here the photographs of the adorable “ ” snow baby, taken during her first summer in Green land ; and so through the various eras of her existence to the culmi nating portrait of Miss Marie Ahn ighi t o

Peary . Here is a triumph of natural eugenics that has deli ghted the eye of every young fellow— and of cer — t ai nly one old fellow that has had the good fortune to

contemplate it . At least four races have been the blessed heredi ty of this most Winsome gentlewoman ; li for her father , Admiral Peary, is of Eng sh and French descent ; and her mother is of German and Russian for e b ar s . 156 A DOCTOR’S VIEWPOINT

SP U GS A N D SPEES — It i s a fine thing to be a spug a member o f the Society for the Prevention of Useless Giving ; this is an excellently purposed and was recently a very active s e f institution . Why not organize now a p and begin s e f ll without delay a membership canvass . The p wi not have so many calls for action made upon him ; but for all that he need not necessarily be a dead one . He certainly Will have for his consideration either a grave subj ect or a burning question , according to the W position he takes . The ily writer , having now worked the principle of suspense for all it is worth , explains s p e f to mean a Society for the Prevention of Exor ’ s u f bitant Funerals . At first it occurred to propose p , f s a Society for the Prevention o Useles Funerals . But — then not all funerals are useless some are , on the con t r ar h y, very well worth w ile . Instances in point will spring at once to mind ; for every reader has his own little list . One of the first things to come up for the ’ society s consideration would be , which is preferable , ? burial or cremation Both are not necessary , although a Chicago lady , whose husband died in New York , is reported to have deemed them so ; for when the under taker ( this j oke is at least as old as Chicago) tele graphed her whether he should cremate or bury , she W “ instantly ired back , cremate and bury , take no chances .

But very seriously , the enormous amounts which many

among the poor pay for the funerals of their dead , have e becom a grievous matter . In a most pathetically squalid tenement apartment one will see an expensive

ffi hi -ah co n, many flowers , elaborate funeral furnis ngs , ll t a o o ostentatious array of carriages , the neighbor

A DOCTOR’S VIEWPOINT

e s es t he animal that knows nothing . As scienc p rogres it but makes fo r a prolongation of the agony of death — the most dreadful an d the sharpest peak o f human “ All t he pain and horror , at least for the witnesses . doctors consider it their first duty t o protract as long

as possible even the most excruci ating convulsions . t o Who has not , at a bedside , twenty times Wished throw himself at their feet and implore them to Show ” mercy . The prej udice against the arbitrary induction ll e of a painless and premature death wi one day, b lieves - as the Belgian Shakespeare , be regarded as barbarian, “ a relic of the times when humanity was convinced that any known torture was preferable to those awaiting ” us in the unknown ; and he predicts that a day will come when science will no longer hesitate to shorten “ ll our misfortunes . When life , grown wiser, wi depart silently t o its hour, knowing that it has reached its e term, even as it withdraws every evening while we sle p , ’ ” knowing that its day s task is done . One hesitates to reopen this question whether phy s i c i an s should purposely hasten t he de at hs of sufferers /

o f\ t o s e fr om painful diseases , or h patients who would seem beyond recovery , and had therefore best be dead — a question which physicians must ever answer by a decided negative . But the views of a man of Maeter ’ t he linck s caliber cannot be slighted . And wonderful l skil and literary charm he evinces fascinate the reader , and give weight to opinions which might be ignored e were they less beautifully and touchingly expr ssed . “ ” e t Celi s an de Yet , the author of Pelleas is a mystic , a poet and a dreamer of exquisite dreams— such a o n e the like of whom the world is ever in need of, and

- perhaps never more so than—to day . On the other han d it i s essential for science certainly for medical s ci EDITORIAL EFFUSIONS 159 — ence to deal ever with the hard facts of life ; should science seek to evade its responsibilities in these prem — e ul i h i s s , she wo d swiftly be brought to book the

criminal courts , for example . For it is not given to science to appoint herself, upon her own initiative , an executioner of human beings . Among the hard facts which s c ience has to face are the following (which have to be reiter ated in every openi ng of the euthanasia dis c u s s i on ) : Physicians can never be sure that their i lli prognoses of a fatal issue are absolutely nfa ble . People that have suffered from seemingly irremediable e t u b e r c u ols i s cancer , or from chrom , have attended the funerals of the doctors who have ministered to them “ ” in their fatal illnesses . To err in medical prognosis is human ; only divinity can appoint unerringly the hour of death . Nor has the physician ( nor any other mor tal) any right to hasten a death upon his human as sumption of its inevitableness . Again, what a weed mi choked field of possibilities , cri nal or otherwise , would be sown were such advocacy as this of Maeterlinck to prevail ; were , for example , the physician overpersuaded by the specious pleas of heirs , or by the simulated pity of other individuals anxious to sever ties such as most ff of mankind find precious , to provide for the su erer , “ ” before his appointed time a gentle and easy death . These quotations from the writing of a most de serving Nobel prize winner “ for literature” make “ ” copy interesting indeed ; yet it is to be feared they do not accurately express the situation . Physicians are not hardened men ; there are none , as a class , more sym ’ o f pathetic . The span doctors lives averages shorter than in most other callings— and this probably because the sufferings of their fellow mortals take so much out of them . It is not essential to medical practice to A DOCTOR’ S VIEWPOINT prolong any convulsions ; and there would never be the im slightest occasion for anyone , on bended knee, to p lo r e the physician to alleviate sufferings . To relieve pa1n 1s a first principle in practice , and the physician ' t hi s c o r s e is always justified in u , in so far at least as the life of the patient will not be j eopardi zed by his ministrations . And the physician is ever eager to do this , if for no other reason than that there is hardly i ‘ anything so k lling as pain . As to the horror of death, this the spectators may have ; but it is the rarest phenomenon for him who is about to die to “ suffer” death . Immediately death impends , the end is almost i invariably benignant and beautiful . What , indeed, s there in all the cosmos so composed and con tent as the face of the dead ?

THE PHILOSOPHY OF PRAYER

Part of a recent sermon by a veritable man o f God is thus reproduced : In studying the biography o f any great man we are very likely to be impressed with the paucity of his deeds and sayings by comparison

“ with the influence he has exe rted upon his day and generation ; we cannot , by a consideration of the former, reach any j ust estimate of that influence . In such study we eventually become impressed, not so much by what the great man in the given instance did , or what — i he said, but by what he was his character . Th s is s o li ae of Washington, of Ju us C sar , of Abraham Lincoln, All of Richard Wagner, and many another . men , great ll and sma , do and say for the most part what their en v i r o nm e n t , what the conditions of their time , require o f them ; but if we are to discern the intrinsic secrets o f

“ the power they have wielded , we must study not s o

much their word and deeds , as their personal habits .

162 A DOCTOR’ S VIEWPOINT

and helpers stood about holding lanterns . In such Remb r an t e s que surroundings and with perhaps a dozen nurses as added spectators , all moved by the gravity of the case , Grandma, scalpel in hand , stood by the side of his patient , at the operating table . It was a most impressive moment when he closed his eyes , his head i s l bowed and h ips moving . Thus encouraged and forti fie d hi s , he got at once to work ; with hand from first hi s hi s s o to last so sure , eye so keen, and brain clear , t r n s fi r e di that he seemed quite a gu d . Thus d grandma do a piece of work that many a rising surgeon might A n as . d w have envied when the last stitch done , and the

- patient carried to her ward, those fellow internes saw a light— which possibly remained with them till they reached their own bedsides . e 1s The indubitable tr nd of modern thought monistic , the basic conception being of a cosmic oneness in which all phenomena , however diverse they may seem , - i n c - di are inter related and o or nated . It is from thi s

lat e ev viewpoint that we recall three papers , by the R .

. . . M o eu r e . D u D . Dr W R Huntington , the late Conway, and Dr . Lyman Abbott Nature of Prayer . The layman as to theology could not fail to have been impressed with an idea that suffused all these three papers by clergyman each of a di fferent Christian de nomination : that prayer is helpful to the individual not as to the granting of specific personal requests ; not that the inherently beni gnant laws of nature would be di st urbed in any personal behalf ; but that prayer ul is helpf in bringing him who prays into comfortable , restful and solitary relations with that First Cause i “ known to human kin as The Alm ghty , Jehovah , the ” an d power not ourselves that makes for righteousness , t he so on . ( May we not presume here to interpret EDITORIAL EFFUSIONS 163

e t rm righteousness as meaning rightness , orderliness ,

- consistent inter relation, universal oneness . ) It c an not but gratify the humani tarian who is not a clergy man to observe this departure from the theology of other eras ; it is gratifying especially to the medical r e scientist, by reason that this modern aspect of li i ous g faith, as here expressed by eminent clergymen, is much in unison wits scientific faith—faith in the li constancy of the universe, in the invariabi ty of its i laws , and in that infin te and eternal energy which

p e rmeates the cosmos . One may indeed venture the - nfl hope that, of the age long co ict between theology s o and science , which has oftentimes been so cruel, s dl - insi tent and so dea y, there remains to day but a ff all nl di erence, not at of ideas , but o y of nomenclature . May it not be hoped that somewhere between those a li two c mps , of metaphysics and of materia sm, a single standard can be raised to whi ch all devout may alike — ni repair the standard of the universality , the mo sm

o f . all human experience Could not , then, a philosophy — o f prayer comprehensible to all be evolved from which

could ensue a consistent therapeutics of prayer . As r e s u dly the human being needs help from without ; for, though a coeffi cient in the working out of hi s own

destiny he is , when unassisted, a pathetically helpless “ atom in the universal scheme . When such world com ” eller s p as Bismarck , Gladstone and Cromwell and the i d s l ke have humbly acknowle ged thi need , surely lesser

men may seek it as well as they, and without humilia

tion . Is it not that the various aspects of human — i l nature the physic—al, the intellectual, the vol tiona and the emotional when they have been perturbed t o by the stresses of life , are brought by prayer back their normal c o-ordination and functioning ; that the 164 DOCTOR’S VIEWPOINT

1n dividu al in prayer gets his relations to his h ment readj usted , and finds imself restored to har mony with the eternal verities . Such , we submit , would be a reasonable conception of prayer which might well d h i h be advi sed an taught both i n t e pulp t and t e clinic .