Part 10

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

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

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

The poor children have to suffer many things from many people. People hesitate, as a rule, to accept recommendations with regard to the administration of drugs to their animals when the person who gives the recommendation is known not to be an expert in the matter. Almost any suggestion, however, with regard to the dosing of their children is likely to be followed by loving but indiscreet mothers. It is well known now, and in many cases is admitted, that the so-called soothing syrups so often given to children contain opium in quite appreciable quantities. Needless to say, nothing much worse than this could possibly be given to children. The child soon becomes accustomed to its daily dose of opium and craves the repetition of it. It will not sleep without it, and as this adds to the sales of the remedy, this special ingredient continues to put money in the pockets of the manufacturers, but at the expense of the nervous stability of the child, and lack of resisting power later in life. It would be hard to say how many of the nervous wrecks so commonly met with in young adults now are to be attributed to this unfortunate state of affairs early in life; but undoubtedly this evil has had much to do with the noticeable increase in the nervousness of our people. The more nervous the heredity of the child, the more it must be guarded against such mistaken methods of inducing sleep, or the result is sure to be serious.

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Scarcely too much can be said in condemnation of most of the proprietary remedies for constipation, though it is in this department of medication that the non-medical are freest with their advice. First, the cheapest possible drugs are selected by the manufacturers of such remedies. Secondly, those drugs especially are employed which, while producing the desired immediate effect, are always followed by a reaction which requires further use of the medicine. One finds testimonials, however, from all classes of the community, even from clergymen, with regard to such remedies, though at the last international medical congress it was confidently asserted, by three of the most prominent specialists in digestive diseases in the world, that the modern problems in digestive disturbances are so much more intricate than they used to be, and the affections which develop are so much more difficult of treatment, because of the use of these unsuitable remedies, and the consequent habituation to drugs, which has been acquired during the prolonged period of their employment.

In recent years catarrh has become the word that is supposed to attract popular attention most, and accordingly is the watchword of the proprietary medicine manufacturer. A long time ago, that is, about half a century ago, catarrh was supposed really to mean something in medicine. Those were the days of humoral pathology, when disturbances of secretion were supposed to be the basis of all disease. Accordingly, whenever there was an excessive discharge from the nose, a patient was said to be suffering from catarrh, and as the nasal secretion was supposed to be connected in some way with the brain, it is easy to understand how significant such a pathological condition might well be thought. In more recent years, the word "catarrh" has still been employed by physicians who thoughtlessly employ terms that they think will be better understood by the laity, owing to their familiarity with them, though they have been outlived in medicine. From representing an affection of the nose, catarrh, as a consequence, has come to be employed for an excess of secretion from any mucous membrane. Accordingly we hear of catarrh of the stomach, catarrh of the bladder, or catarrh of the {101} bile-ducts, and there has come to the general public a notion that catarrh is an all-pervading affection whose ravages must be prevented, at all hazards, and whose beginning must be the signal for prompt medical treatment.

As a matter of fact, catarrh, when it means anything, means only that stage of inflammation in which there is an increased secretion and which represents an inflammatory condition so mild as often to be described as only hyperaemic, that is, due to an increase of blood in the part. It is rather easy to understand that if more blood flows through a mucous membrane, there will be greater secretion from it than would normally be the case. This is what happens in the production of catarrh. As a rule, it is only a passing congestion without any lasting changes in the tissue. Catarrh may, however, continue to be present if the irritation, which originally caused the congestion, be allowed to continue. It is this irritation, however, which needs to be treated, and not the catarrhal inflammation, which is only a symptom of it. The three most used words in popular medicine,--catarrh, rheumatism, and gout,--when traced to their etymological signification, mean the same thing. Catarrh means a flowing down, rheumatism a state of flowing, both being formed from the Greek verb [Greek text], to flow, while gout is derived from the Latin word _gutta_, a drop, which hints at the excess of fluid that is supposed to be the basis of the disease.

For these three diseases, however, the most varied remedies have been proposed, and practically entirely without success, when tested, in a large number of cases. As a matter of fact, under the two words catarrh and rheumatism, there is grouped a series of affections very different from one another, and requiring very different treatment. The important thing is not so much the suggestion of a remedy as the recognition of the particular cause which in one case is producing an excess of secretion and in the other is giving rise to the so-called rheumatic pain. When the exact cause can be found, it is usually not so difficult to succeed in preventing the recurrence of the troublesome symptoms. It is with regard to these two diseases, however, that in non-medical circles even intelligent men are ready to give advice. They constitute {102} the most puzzling problem that the physician has to deal with, but the non-medical mind waives the difficulty and suggests the remedy. In this matter one is forcibly reminded of a famous expression of Josh Billings, who used to say, "It is not so much the ignorance of mankind that makes them ridiculous as the knowing so many things that are not so."

Clergymen, lawyers, members of Congress, and of various state legislatures, all permit their portraits to appear, advertising the merits of some trumped-up cure for catarrh or rheumatism. It is interesting to realise, then, that in most cases, according to expert testimony, the remedy they recommend so highly consists of nothing more than diluted alcohol flavoured so as to taste like medicine. The only real effect is the alcoholic exhilaration which follows its ingestion and gives the sense of well being, because of which the testimonials are provided. As one of the medical journals said recently, it would be very interesting to make a list of the men and women throughout the country who, by permitting their portraits and recommendations to be used in the advertisements of various patent medicines, have practically confessed that they like to take their whiskey rather dilute but mixed with a little bitters. The whole question illustrates the tendency of the proprietary medicine man to exploit some phase of medicine long after it has ceased to be of interest to the medical profession.

With regard to all of these things clergymen may do a great humanitarian work by protecting the poor from the efforts of advertising remedy-makers to get their hard-earned money. It is sometimes said that long years have been spent in the preparation of a remedy. This not only is never true, but never has been true in the history of proprietary medicines. Some one who has an eye to business gets hold of a prescription of which he knows nothing, but of which his advertising agents are able to say much, and the result is sometimes a fortune for the advertiser. There is always a pretence of philanthropy, but it is the mask of heartless hypocrisy. Unfortunately many of our religious journals are tempted by the promptly paid bills of such manufacturing concerns to print their advertisements. They are aiding in a {103} deliberate swindle, and if this were better understood there would be much less suffering and fewer vain hopes. The best-managed newspapers and magazines in the country are now absolutely refusing all medical advertisements. This is the only proper attitude in the matter, for there is a place to advertise medicines, if they are worthy, and that place is the medical journals. If the popular advertising could be reduced, we should soon have much less of the proprietary medicine evil.

There are many ways in which clergymen by their example, their advice, and their influence can be of great assistance to practitioners of medicine. It is very sad, then, to find that some of them, having elabourated theories of their own on certain subjects, or having taken up with peculiar notions, are in opposition to the accepted medical teaching of the world. Occasionally they are found among the ranks of the anti-vaccinationists, though if there is anything that has been demonstrated to a certainty, it is that vaccination has practically eradicated smallpox, considering the frequency of the disease a century ago, and that it would absolutely eradicate it, if the practice could be made universal. Statistics are at hand to demonstrate this beyond all possibility of doubt. There are a certain number of people, however, who apparently, out of a desire for singularity as much as anything else, refuse to accept the evidence. It is very unfortunate to find clergymen among them, for it tends to bring the clerical judgment into disrepute.

Nearly the same thing might be said of antitoxin for diphtheria. Clergymen seem to consider it necessary for them to have their minds made up as to whether the use of diphtheria antitoxin is advisable or not. If they have once committed themselves to the expression of the opinion that antitoxin is of no value, then no amount of evidence will succeed in changing their opinion. Under these circumstances it becomes extremely difficult at times for physicians to succeed in having families permit them to treat their patients after the manner in which they are convinced the treatment should be carried on. If such clergymen would only realise that the clergyman has, as a rule, much less right to express {104} opinions on medical subjects than has the physician to air views with regard to theological principles, there would be much less friction, and it would be better for patients in the end.

There are certain sanitary regulations that clergymen should not only not oppose, but endeavour, by every means in their power, to have those who respect their opinions follow out as carefully as possible. Such sanitary regulations have in the past twenty-five years practically cut down the death rate of our large cities a half. There is no greater source of alleviation for the physical evils, at least those which afflict the lower classes, than the due enforcement of modern sanitation. There are prejudices, however, that must be overcome, and the clergyman should be found beside the doctor, helping him rather than opposing him, as is sometimes the case.

JAMES J. WALSH.

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VIII

SOME ASPECTS OF INTOXICATION

There are various drugs that, through acute or chronic poisoning from their use, cause mental disturbance,--alcohol, chloral, cannabis indica, somnal, sulphonal, paraldehyde, ether, chloroform, antipyrin, phenacetin, trional, chloralamid, iodoform, atropine, hyoscyamus, salicylic acid, quinine, lead, arsenic, mercury, opium and morphine, the bromides, cocaine, and others. Of these intoxicants alcohol always has been most commonly used by western nations, but the moral aspects of alcoholism have not been shown with sufficient insistence. There are many sots in human society much less reprehensible than to the unskilled observer they appear to be; others are more blameworthy.

Morality, as far as the agent is concerned, apart from the nature and circumstances of the deed, supposes, first, voluntary acts, or acts that proceed from the will with a knowledge of the end toward which the acts tend; and, secondly, free acts, or acts that under given conditions may or may not be willed. If by unavoidable chance one stumbles against a man standing at the edge of a wharf, knocks him into the water, and drowns him, the act has no element of morality in it, because it is not voluntary and free. If a mind is diseased, and, impelled by a mad notion of persecution, it brings about a like killing, there is no question of morality, because the agent is not free, and when fully analysed his action is not voluntary.

An act is more or less voluntary and free, and therefore more or less moral, as the agent is affected by ignorance, passionate desire, fear, or disease. Ignorance, fear, and disease may be such as to remove all quality of morality from an act. {106} Certain diseases or pathological conditions, especially of the nervous system, can take out of an act the elements of voluntariness and freedom that are necessary to make the act moral or immoral, provided, however, these pathological conditions are not brought on through the fault of the subject in which they exist. If a man voluntarily becomes drunk with alcohol, or some other drug, he is, of course, accountable for the evil he may unconsciously do while under the influence of that drug, and if he begets an idiot or a criminal imbecile in his drunkenness, he must atone somewhere for the blinded soul of his child. Here, again, there are certain extenuating circumstances, because very few drunkards are fully conscious of the extent of the evil in alcoholism.

Apart from the other requirements that go to make an act moral, the agent must be sane; that the act be immoral, he must be sane or insane, either temporarily or permanently, through his own fault; that it be devoid of morality an act must be a mere _actus hominis_, or it must be the act of a person blamelessly insane. If a man knows that an alcoholic is liable to beget a criminal imbecile solely because of the alcoholism,--and most men are aware of that fact,--this father or grandfather is more or less accountable for every larceny, rape, and murder done by the imbecile. The law, therefore, should put the imbecile into safe keeping, then seek out the father and hang him.

Insanity is a common condition, but it has not been satisfactorily defined. It supposes an appreciable unsoundness of the will, memory, and understanding, or of one or two of these faculties, but no alienist has given a short differentiation of that unsoundness. Where shall we draw the line between the weak but responsible will and the insane will? What degree of opacity between intellect and the world separates the ignorant man from the lunatic? The extremes of sanity and insanity are readily recognisable, but the intermediate degrees are not clear. There is no test to apply to all cases; each must be diagnosed from its peculiar symptoms, but the will of an insane man is always weak. It can not deny or defer the gratification of a desire, nor can it keep up an effort. Even in its lightest forms insanity is selfish and {107} impolite, because it lacks the force of will necessary to take trouble. It foregoes great future benefit for slight present gratification. The insane man is idle, or busy only in work that he likes, in pleasurable activity. A marked quality of sanity is the capacity for sustained work, and the man that shirks work merely because he does not like it is gratifying himself dangerously.

These defects are found commonly in sane persons, but the lunatic can not rise from them, and he adds to the defects of will a warped intellect. He can not adjust himself to his surroundings, and the fault is in himself, not in the circumstances. His intellect may be brilliant, but it sooner or later shows a taint. The insane man is not a free, rational agent.

Alcoholism readily passes over into unmistakable insanity, and it almost always is the cause of nervous degeneration in the children born within its influence. This, is a phase of the evil not sufficiently insisted upon by those that plead for total abstinence.

Chronic poisoning by alcohol induces hardening and calcification in the walls of the arteries, degeneration of the nerve cells and dendrites, wasting or overgrowth of the heart muscle, and fatty degeneration of the liver and kidneys. The nerve centres that control the circulation of the blood are paralysed by it, and, as a sequence, the arteries and capillaries are diminished in calibre. This state in turn obstructs the flow of the blood, and the body is not nourished, nor are the waste and poisonous results of metabolism carried off as they should be. Alcohol prevents the haemoglobin of the blood from doing its office, which is to supply oxygen and remove carbon dioxid. It absorbs the necessary water from the tissues, and thus it acts as a corroding poison. It is also a functional toxin, because it depresses the activity of organs by injuring the innervation. The poison affects the brain, and as the cerebral gray matter, especially its pyramidal cells, are the physical instruments of thought, will, and memory, or the means of communication between the soul and the outer world, the exercise of these spiritual functions is checked or inhibited by it.

A tendency to excess in the use of alcohol commonly {108} manifests itself before the thirtieth year, and in some cases it may be removed at the alcoholic climacteric, which is from the fortieth to the sixty-fifth year. Those that become drunkards are usually of a neuropathic constitution, through inheritance or abuse. Severe diseases, like influenza, syphilis, typhoid; injuries to the head, sunstroke, shock, worry; the disturbance that may accompany puberty, pregnancy, lactation, and so on,--cause a nervous depression which is soothed by alcohol, and thus a habit is fixed. The reckless prescription of alcohol by some physicians is another cause of the habit, and the use of proprietary medicines is a still more prolific source of drunkenness and the consequent misfortune.

Cider, beer, ale, and porter contain from 4 to 6 per centum of real alcohol; light wines, red and white, and natural sherry, 10 to 12 per centum; strong sherry and port, 16 to 18 per centum; brandy, 39 to 47 per centum by weight, or 46 to 55 per centum by volume; and whiskey, 44 to 50 per centum by weight, or 50 to 58 per centum by volume. The effect of these liquors on the body is due primarily to alcohol, and secondarily to ethereal derivatives of alcohol. Some owe a part of their effect to non-volatile substances,--beer from which all alcohol has been boiled can still affect the body in a marked degree.

The chemist of the Massachusetts State Board of Health (Document No. 34) gives the percentage of alcohol in the common proprietary medicines, and these percentages will be found in the article on _Social Medicine_.

The weakest of these compounds are twice as strong in alcohol as beer, and they treacherously bring about the habit of drunkenness in disposed persons who may be very desirous to avoid such a calamity.

Some men and women are quickly destroyed by alcohol; others resist it more or less successfully for a lifetime, as far as mere existence is concerned. Alcoholism is one of the commonest causes of insanity, but it is often an effect of insanity. It may be an early symptom of paresis, or a part of the maniacal stage of circular insanity. In poisoning by alcohol the higher nerve centres are first affected and the {109} lowest last. The sense of human dignity and of morality, the exercise of the intellect, are more or less inhibited before the motive muscles are affected.

The usual effect of alcoholic poisoning is boisterous exaltation of mind, but there is a depressed type of drunkenness which weeps. Some patients at once are subjected by hallucinations and delusions, others are so depressed that they have a suicidal tendency, others may have a maniacal frenzy that is destructive or homicidal. In these neuropathic conditions muscular co-ordination is commonly well preserved--the patient is "drunk in the head and sober in the legs."