Part 1

THE HEALTH MASTER

By Samuel Hopkins Adams

Associate Fellow of the American Medical Association

Boston And New York Houghton Mifflin Company

1913

_To George W. Goler, M.D., a type of the courageous, unselfish, and far-sighted health official, whom the enlightened and progressive city of Rochester, N. Y., hires to keep it well, on the “Chinese plan,” this book is inscribed, with the hope that it may, by exercising some influence in the hygienic education of the public, aid the work which he and his fellow guardians of the public health are so laboriously and devotedly performing throughout the nation._

Contents

INTRODUCTORY NOTE I. THE CHINESE PLAN PHYSICIAN II. IN TIME OF PEACE III. REPAIRING BETTINA IV. THE CORNER DRUG-STORE V. THE MAGIC LENS VI. THE RE-MADE LADY VII. THE RED PLACARD VIII. HOPE FOR THE HOPELESS IX. THE GOOD GRAY DOCTOR X. THE HOUSE THAT CAUGHT COLD XI. THE BESIEGED CITY XII. PLAIN TALK

INTRODUCTORY NOTE

To dogmatise on questions of medical practice is to invite controversy and tempt disaster. The highest wisdom of to-day may be completely refuted by to-morrow’s discovery. Therefore, for the simple principles of disease prevention and health protection which I have put into the mouth of my Health Master, I make no claim of finality. In support of them I maintain only that they represent the progressive specialized thought of modern medical science. So far as is practicable I have avoided questions upon which there is serious difference of belief among the authorities. Where it has been necessary to touch upon these, as, for example, in the chapter on methods of isolation in contagious diseases, a question which arises sooner or later in every household, I have advocated those measures which have the support of the best rational probability and statistical support.

Not only has the book been prepared in consultation with the recognized authorities on public health and preventive medicine, but every chapter has been submitted to the expert criticism of specialists upon the particular subject treated. My own ideas and theories I have advanced only in such passages as deal with the relation of the physician and of the citizen to the social and ethical phases of public health. To the large number of medical scientists, both public and private, whose generous aid and counsel have made my work possible, I gratefully acknowledge my debt. My thanks are due also for permission to reprint, to the _Delineator_, in which most of the chapters have appeared serially; to _Collier’s Weekly_, and to the _Ladies’ Home Journal_.

The Author.

I. THE CHINESE PLAN PHYSICIAN

THE eleven-o’clock car was just leaving Monument Square when Mr. Thomas Clyde swung aboard with an ease and agility worthy of a younger and less portly man. Fortune favored him with an unoccupied seat, into which he dropped gratefully. Just in front of him sprawled a heavy-shouldered young man, apparently asleep. Mr. Clyde was unfavorably impressed both by his appearance and by the manner of his breathing, which was as excessive as it was unusual. As the car swung sharply around a curve the young man’s body sagged at the waist, and lopped over toward the aisle. Before Mr. Clyde’s restraining hand could close upon his shoulder, he had tumbled outward to the floor, and lay quiet, with upturned face. There was a stir through the car.

“The horrid drunken creature!” exclaimed a black-clad woman opposite Mr. Clyde. “Why do they allow such people on the cars?”

The conductor hurried forward, only to find his way blocked by a very tall, slender man who had quietly stepped, from a seat next the window, over an intervening messenger boy and the box he was carrying. The new arrival on the scene of action stooped over the prostrate figure. One glance apparently satisfied him. With a swift, sharp motion he slapped the inert man forcefully across the cheek. The sound of the impact was startlingly loud. The senseless head rolled over upon the left shoulder, only to be straightened out by another quick blow. A murmur of indignation and disgust hummed and passed, and the woman in black called upon the conductor to stop the assault. But Mr. Thomas Clyde, being a person of decision and action, was before the official. He caught the assailant’s arm as it swung back again.

“Let him alone! What do you mean by beating a helpless man that way!”

“Do you know more about this affair than I do?” The crisp query was accompanied by a backward thrust of the tall man’s elbow which broke Mr. Clyde’s hold, and—smack! smack!—the swift double blow rocked the victim’s head again. This time the man groaned. The car was in an uproar. Mr. Clyde instantly and effectively pinned the tall man’s elbows from behind. Some one pulled the bell, and the brakes ground, throwing those forward who had pressed into the aisle. Against this pressure, Mr. Clyde, aided by the conductor, began dragging his man backward. The stranger was helpless to resist this grip; but as he was forced away he perpetrated a final atrocity. Shooting out one long leg, he caught the toe of his boot under the outstretched man’s jawbone and jerked the chin back. This time, the object of the violence not only groaned, but opened his eyes.

“I’ll have you in jail for that!” panted Mr. Clyde, his usually placid temper surging up.

Other passengers began to lift the victim.

“Drop him!” snapped the tall man, with such imperative decisiveness, that the helping hands involuntarily retracted. “Let him lie, you fools! Do you want to kill him?”

Misgivings beset and cooled Mr. Thomas Clyde. He had now reached the rear platform, still holding in his powerful and disabling grasp the unknown man, when he heard a voice from an automobile which had been halted by the abrupt stop of the car.

“Can I be of any help?”

“Dr. Magruder!” exclaimed Mr. Clyde, “come in here, will you, and look at a sick man?”

As the doctor stepped aboard, the captive with a violent wrench freed himself from Mr. Clyde’s relaxing hold and dropped from the platform into the darkness. Dr. Magruder forced his way through the crowd, took one look at the patient, and, right and left, struck him powerfully across the cheeks time and again, until the leaden-lidded eyes opened again. There was a quick recourse to the physician’s little satchel; then—

“All right,” said the doctor cheerfully. “He’ll do now. But, my friend, with that heart of yours, you want to sign the pledge or make your will. It was touch and go with you that time.”

Waiting to hear no more, Mr. Thomas Clyde jumped from the rear step and set off at a rapid pace, looking about him as he ran. He had not gone a block when he saw, by the radiance of an electric light, a tall figure leaning against a tree in an attitude of nerveless dejection. The figure straightened up.

“Don’t try to man-handle me again,” advised the man, “or you may meet with a disappointment.”

“I’ve come to apologize.”

“Very well,” returned the other coolly; “I appreciate it. Many a fool wouldn’t go even so far.” Mr. Clyde smiled. “I own to the soft impeachment. From what Dr. Magruder said I judge you saved that fellow from the hospital.”

“I judge I did—no thanks to you! You’ve a grip like a vise.”

“Yes; I keep in good training,” said the other pleasantly. “A man of my age has to, if he is to hold up his work.” He looked concernedly at the stranger who had involuntarily lapsed against the tree again. “See here,” he added, “I don’t believe you’re well.”

“No; I don’t believe I am,” answered the tall man in uncompromising tones; “but I do believe that it is peculiarly my own affair whether I am or not.”

“Nonsense! Man, your nerves are on the jump. You used yourself up on that chap in the street car. Come across to my club and take something to brace you up.”

People usually found it hard to resist Mr. Clyde’s quiet persuasiveness. The stranger, after a moment of consideration, smiled.

“Begin with a fight and end with a drink?” he asked. “That’s a reversal of the usual process. If your cuisine runs to a cup of hot milk as late as this, I’d be glad to have it.”

As they entered the club, Mr. Clyde turned to his guest.

“What name shall I register?”

The stranger hesitated. “Strong,” he said finally.

“Dr. Strong?”

“Well—yes—Dr. Strong if you will.”

“Of what place?”

“Any place—Calcutta, Paris, Mexico City, Philadelphia, Rio. I’ve tried ‘em all. I’m a man without a country, as I am without a profession.” He spoke with the unguarded bitterness of shaken nerves.

“Without a profession! But you said ‘Doctor.’”

“A title isn’t a profession,” returned the guest shortly.

Turning that over in his mind, Mr. Clyde led the way to a quiet table in the corner of the diningroom, where he gave his order. Observing that his new acquaintance was _distrait_, he swung into the easy conversational flow of a cultured man of the world, at the same time setting his keen judgment of men to work upon the other. There was much there to interest a close observer. The face indicated not much over thirty years; but there were harsh lines in the broad and thoughtful forehead, and the hair that waved away from it was irregularly blotched with gray. The eyes, very clear and liquid, were marred by an expression of restlessness and stress. The mouth was clear-cut, with an expression of rather sardonic humor. Altogether it was a face to remark and remember; keen, intellectual, humorous, and worn. Mr. Thomas Clyde decided that he liked the man.

“You’ve been a traveler, Doctor?” he asked.

“Yes. I’ve seen life in many countries—and death.”

“And traced the relations between them, I suppose?”

“Oh, I’ve flashed my little pin-point lantern at the Great Darkness in the fond hope of discovering something,” returned the other cynically.

“In a way, I’m interested in those matters,” continued Mr. Clyde. “They’ve organized a Public Health League here, and made me president of it. More from finance than fitness,” he added, humorously.

“Finance has its part, too,” said the other. “Give me millions enough and I’ll rid any city of its worst scourge, tuberculosis.”

“Then I wish to Heaven you had the millions to spend here in Worthington! We’re in a bad way. Two years ago we elected a reform administration. The Mayor put in a new Health Officer and we looked for results. We’ve had them—the wrong kind. The death rate from tuberculosis has gone up twenty-five per cent, and the number of cases nearly fifty per cent since he took office.”

“You don’t say so!” said the stranger, showing his first evidence of animation. “That’s good.” Mr. Clyde stared. “You think so? Then you’ll undoubtedly be pleased to learn that other diseases are increasing almost at the same rate: measles, scarlet fever, and so on.”

“Fine!” said Dr. Strong.

“And finally, our general mortality rate has gone up a full point. We propose to take some action regarding it.”

“Quite right. You certainly ought to.” Something in his guest’s tone made Mr. Clyde suspicious. “What action would you suggest, then? he asked.

“A vote of confidence in your Health Officer.”

“You propose that we indorse the man who is responsible for a marked rise in our mortality figures?”

“Certainly.”

“In the name of all that’s absurd, why?”

“Let me answer that by another question. If disease appears in your household, do you want your doctor to conceal it or check it?”

Mr. Clyde took that under advisement. “You mean that this city has been concealing its diseases, and that Dr. Merritt, our new Health Officer, is only making known a condition which has always existed?” he asked presently.

“Haven’t you just told me so?”

“When did I tell you anything of the sort?” The younger man smiled. “That’s five questions in a row,” said he. “Time for an answer. You said that deaths from tuberculosis had increased twenty-five per cent since the new man came in.”

“Well?”

“You’re wrong. Tuberculosis doesn’t increase in sudden leaps. It isn’t an epidemic disease, rising and receding in waves. It’s endemic, a steady current.”

“But look at the figures. Figures don’t lie, do they?”

“Usually, in vital statistics,” was the imperturbable reply. “In this case, probably not. That is, they don’t lie to me. I’m afraid they do to you.” Mr. Clyde looked dubiously at the propounder of this curious suggestion and shook his head.

“Don’t get it?” queried Dr. Strong. “Perhaps you recall the saying of Thoreau—I think it the profoundest philosophical thought of the New World—that it takes two to tell the truth, one to speak and one to hear it.”

“You mean that we’ve misinterpreted the figures? Why, they’re as plain as two and two.”

“Truth lies behind figures, not in them,” said Dr. Strong. “Now, you’re worried because of a startling apparent swelling of the tuberculosis rate. When you find that sort of a sudden increase, it doesn’t signify that there’s more tuberculosis. It signifies only that there’s more knowledge of tuberculosis. You’re getting the disease more honestly reported; that’s all. Dr. Merritt—did you say his name is?—has stirred up your physicians to obey the law which requires that all deaths be promptly and properly reported, and all new cases of certain communicable diseases, as well. Speaking as a doctor, I should say that, with the exception of lawyers, there is no profession which considers itself above the law so widely as the medical profession. Therefore, your Health Officer has done something rather unusual in bringing the doctors to a sense of their duty. As for reporting, you can’t combat a disease until you know where it is established and whither it is spreading. So, I say, any health officer who succeeds in spurring up the medical profession, and in dragging the Great White Plague out of its lurking-places into the light of day ought to have a medal.”

“What about the other diseases? Is the same true of them?”

“Not to the same extent. No man can tell when or why the epidemic diseases—scarlet fever, measles, whooping-cough, and diphtheria—come and go. By the way, what about your diphtheria death rate here?”

“That is the exception to the rule. The rate is decreasing.”

Dr. Strong brought his hand down flat on the table with a force which made his cup jump in its saucer. “And your misnamed Public Health League proposes to take some action against the man who is shown, by every evidence you’ve suggested thus far, to be the right man in the right place!”

“How does the diphtheria rate show in his favor any more than the other death rates against him?”

“Because diphtheria is the one important disease which your medical officer can definitely control, and he seems to be doing it.”

“The only important one? Surely smallpox is controllable?”

“Smallpox is the poisoned arrow of the fool-killer. It is controllable; but it isn’t important, except to fools and anti-vaccination bigots.”

Mr. Thomas Clyde softly rubbed his cleanshaven chin, a sign and token with him that his mind was hard at work.

“You’re giving me a new view of a city in which I’ve lived for the first and last forty-five years of my life,” he said presently. “Are you familiar with conditions here?”

“Never have been here before, and have no reason to suppose that I shall ever return. Traveling at night is too much for me, so I stopped over to have a look at a town which has been rather notorious among public health officials for years.”

“Notorious!” repeated Mr. Clyde, his local pride up in arms.

“For falsifying its vital statistics. Your low mortality figures are a joke. Worthington has been more jeered at, criticized, and roasted by various medical conventions than any other city in the United States.”

“Why, I’ve never seen anything of that sort in the papers.”

Dr. Strong laughed. “Your newspapers print what you want to read; not what you don’t want to read. They follow the old adage, ‘What you don’t know won’t hurt you.’ It’s a poor principle in matters of hygiene.”

“So one might suppose,” returned the host dryly. “Still you can scarcely expect a newspaper to run down its own city. I’ve known business to suffer for a year from sensational reports of an epidemic.”

The other grunted. “If a pest of poisonous spiders suddenly bred and spread in Worthington, the newspapers would be full of it, and everybody would commend the printing of the facts as a necessary warning and safeguard. But when a pest of poisonous germs breeds and spreads, Business sets its finger to its lips and says, ‘Hush!’ and the newspapers obey. You’re a business man, I assume, Mr. Clyde? Frankly, I haven’t very much sympathy with the business point of view.”

He rose and pushed his chair back.

“Wait a moment,” said the other. “Sit down. I have something that may be of importance to suggest to you. It occurs to me that Worthington would be the better for having a man with your ideas as a citizen. Now, supposing the Public Health League should offer you—”

“I am not at present in medical practice,” broke in the other.

“Even at that, I was thinking that you would be of use as an advisory physician and scientific lookout.”

For a moment, the other’s face brightened, an indication which Mr. Clyde was quick to note. But instantly the expression of eagerness died out.

“Ten hours a day?” said Dr. Strong. “It couldn’t be done properly in less time. And I’m a mere nervous wreck, bound for the scrap-heap.”

“Would you mind,” said Mr. Clyde very gently, “telling me what’s wrong? I’m not asking without a purpose.”

Dr. Strong held out his long arms before him. “I’m a surgeon without a right hand, and a bacteriologist without a left.” The sinewy and pale hands shook a little. “Neuritis,” he continued. “One of the diseases of which we doctors have the most fear and the least knowledge.”

“And with the loss of your occupation, general nervous collapse?” asked Mr. Clyde. Being himself a worker who put his heart into his work, he could guess the sterile hopelessness of spirit of the man banned from a chosen activity.

Dr. Strong nodded. “I may still be fit for the lecture platform as a dispenser of other men’s knowledge. Or perhaps I’ll end up as medical watchdog to some rich man who can afford that kind of pet. Pleasing prospect, isn’t it, for a man who once thought himself of use in the world?”

“Good idea,” said Mr. Clyde quietly. “Will you try the position with my family?”

The other stared in silence at his questioner.

“Just consider my situation for a moment. As you know, I’m a layman, interested in, but rather ignorant of, medical subjects. As wealth goes in a city of one hundred and fifty thousand population, I’m a rich man. At any rate, I can afford a considerable outlay to guard against sickness. In the last five years I suppose disease has cost my household ten thousand dollars in money, and has cost me, in worry and consequent incapacity for work, ten times that amount. Even at a large salary you would doubtless prove an economy. Come, what do you say?”

“You know absolutely nothing of me,” suggested the other.

“I know that you are a man of quick and correct judgment, for I saw you in action.” The other smiled. “You are, for reasons which are your own, not very expansive, as to your past professional career. I’m content with that attitude of yours, and I’m quite satisfied to base my offer on what I have been able to judge from your manner and talk. Without boasting, I may say that I have built up a great manufacturing plant largely on my judgment of men. I think I need you in my business of raising a family.”

“How much of a family?”

“Five children, their mother and their grandmother. I may warn you at once that you’ll have a jealous rival in Grandma. She’s the household guardian, and pretty ‘sot’ in her ideas. But the principal thing is for you to judge me as I’ve judged you, and determine whether we could work out the plan together.”

Dr. Strong set his chin in one thin, cupped hand and gazed consideringly upon the profferer of this strange suggestion. He saw a strong-built, clear-skinned man, whose physical aspect did not suggest the forty-five years to which he had owned. Mr. Clyde recommended himself at first sight by a smooth-voiced ease of manner, and that unostentatious but careful fitness of apparel which is, despite wise apothegms to the contrary, so often an index of character. Under the easy charm of address, there was unobtrusively evident a quick intelligence, a stalwart self-respect, and a powerful will.

Yet, the doctor noted, this man had been both ready and fair in yielding his judgment, under the suggestion of a new point of view. Evidently he could take orders as well as give them.

“Well,” said Mr. Clyde, “have you appraised me?”

The weary eyes of the other twinkled a little. “Physically you disclose some matters plainly enough, if one wishes to show off in the Sherlock Holmes manner. For instance, you’ve recently been in the tropics; your eyesight is better than your hearing, you drink lightly if at all, and don’t use tobacco in any form; you’ve taken up athletics—handball principally—in recent years, as the result of a bad scare you got from a threatened paralytic attack; and your only serious illness since then has been typhoid fever.”

Mr. Clyde laughed outright. “If you had started our acquaintance that way,” he said, “I’d have thought you a fortune-teller. Part of it I can follow. You noticed that I kept my left ear turned, of course; and the fact that my nose shows no eyeglass marks would vouch for my eyesight. Did you judge me a non-smoker because I forgot to offer you a cigar—which deficiency I’ll gladly make up now, if it isn’t too late.”

“Partly that—no, thank you. I’m not allowed to smoke—but principally because I noticed you disliked the odor of my hot milk. It is offensive, but so faint that no man without a very keen sense of smell would perceive it across a table; no tobacco-user preserves his sense of smell to any such degree of delicacy. As for the drink, I judged that from your eyes and general fitness.”

“And the handball, of course, from my ‘cushioned’ palms.”

“Obviously. A man at the heart of a great business doesn’t take up violent indoor exercise without some special reason. Such a reason I saw on the middle finger of your left hand.”

Holding up the telltale member, Mr. Clyde disclosed a small dark area at the side of the first joint.

“Leaky fountain-pen,” he remarked.

“As you are right-handed naturally, but write with your left hand, it’s clear that you’ve had an attack of writer’s paralysis—”

“Five years ago,” put in Mr. Clyde.

“And that your doctor made good use of the salutary scare it gave you, to get you to take up regular exercise.”

“And, incidentally, to cut out my moderate, occasional cocktail. Now, as to the tropics and the typhoid?”

“The latter is a guess; the former a certainty. Under your somewhat sparse long hair in front there is an outcropping of very fine hairs. Some special cause exists for that new growth. The most likely cause, at your age, is typhoid. As you’ve kept in good training, it isn’t likely that you’d have had any other serious ailment recently. On that I took a chance. The small scars at the back of your ears could be nothing but the marks of that little pest of the tropics, the _bête rouge_. I’ve had him dug out of my skin and I know something of him.”

“Right on every count,” declared Mr. Clyde. “You’ve given me cumulative proof of your value to me. I’ll tell you. Forget formalities. Let me ‘phone for a cab; we’ll go to your hotel, get your things, and you come back with me for the night. In the morning you can look the ground over, and decide, with the human documents before you, whether you’ll undertake the campaign.”