The Home Medical Library, Volume 2 (of 6)

Part IV

DISEASE AND DISORDER OF THE
MIND

ALBERT WARREN FERRIS

CHAPTER I

Insanity

Insanity is the name given to a collection of symptoms of disease of the brain or disorder of brain nutrition or circulation. The principal test of insanity lies in the adjustment of the patient to his surroundings, as evidenced in conduct and speech. Yet one must not include within the field of insanity the improper conduct and speech of the vicious, nor of the mentally defective. Crime is not insanity, though there are undoubtedly some insane people confined in prisons who have been arrested because of the commission of crime.

Then, too, while mental defect may exist in the insane, there is a certain class of mental defectives whose condition is due not to disease of the brain, but to arrest of development of the brain during childhood or youth, and these we call idiots or imbeciles; but they are not classed with the insane.

Mental Disorder Not Insanity

We frequently hear repeated the assertion, "Everybody is a little insane," and the quotation is reported as coming from an expert in insanity. This quotation is untrue. The fact is that anyone is liable to mental disorder; but mental disorder is not insanity. To illustrate: a green glove is shown to a certain man and he asserts that its color is brown, and you cannot prove to him that he is wrong, because he is color-blind. Green and brown appear alike to him. This is mental disorder, but not insanity. Again, a friend will explain to you how he can make a large profit by investing his money in a certain way. He does so invest it and loses it, because he has overlooked certain factors, has not given proper weight to certain influences, and has ignored probable occurrences, all of which were apparent to you. He was a victim of his mental disorder, his judgment, reason, and conception being faulty; yet he was not insane. Again, you answer a letter from a correspondent, copying on the envelope the address you read at the head of his letter. A few days later your answer is returned to you undelivered. In astonishment, you refer to his letter and find that you have misread the address he gave, mistaking the number of his house. This was an instance of mental disorder in your not reading the figure aright; but it was not insanity.

What Autopsies of the Brain Reveal

The changes in the brain accompanying or resulting from disease, as found in some chronic cases of insanity in which autopsies are made, consist largely in alteration of the nerve cells of the brain. The cells are smaller and fewer than they should be, they are altered in shape, and their threads of communication with other cells are broken. Nerve cells and often large areas of gray matter are replaced by connective tissue (resembling scar tissue), which grows and increases in what would otherwise be vacant spaces. All areas which contain this connective tissue, this filling which has no function, of course, cease to join with other parts of the brain in concerted action, and so the power of the brain is diminished, and certain of its activities are restricted or abolished.

Curious Illusions of the Insane

In the normal brain certain impressions are received from the special senses: impressions of sight or of hearing, for example. These impressions are called conscious perceptions, and the healthy brain groups them together and forms concepts. For instance, you see something which is flat and shiny with square-cut edges. You touch it, and learn that it is cold, smooth, and hard. Lift it and you find it heavy. Grouping together your sense perceptions you form the concept, and decide that the object is a piece of marble. Again, you enter a dimly lighted room and see a figure in a corner the height of a woman, with a gown like a woman's. You approach it, speak to it and get no reply, and you find you can walk directly through it, for it is a shadow. Perhaps you were frightened. Perhaps you imagined she was a thief. Your first judgment was wrong and you correct it. The insane person, however, has defective mental processes. He cannot group together his perceptions and form proper conceptions. His imagination runs riot. His emotions of fear or anger are not easily limited. He has to some extent lost the control over his mental actions that you and other people possess if your brains are normal. The insane man will insist that there is a woman there, and not a shadow, and to his mind it is not absurd to walk directly through this person. He cannot correct the wrong idea. Such a wrongly interpreted sense perception is called an illusion. Another example of illusion is the mistaking the whistle of a locomotive for the shriek of a pursuing assassin.

What Hallucinations Are

The insane man may also suffer from hallucinations. A hallucination is a false perception arising without external sensory experience. In a hallucination of sight, the disease in the brain causes irritation to be carried to the sight-centers of the brain, with a result that is similar to the impression carried to the same centers by the optic nerves when light is reflected into the eyes from some object. An insane man may be deluded with the belief that he sees a face against the wall where there is nothing at all. When the air is pure and sweet and no odor is discoverable, he may smell feathers burning, and thus reveal his hallucination of smell.

Delusions Common to Insanity

The insane man may have wrong ideas without logical reason for them. Thus, an insane man may declare that a beautiful actress is in love with him, when there is absolutely no foundation for such an idea. Or, he may believe that he can lift 500 pounds and run faster than a locomotive can go, while in reality he is so feeble as scarcely to be able to walk, and unable to dress himself. Such ideas are delusions. Sane people may be mistaken; they may have hallucinations, illusions and delusions; but they abandon their mistaken notions and correct their judgment at once, on being shown their errors. Sane people see the force of logical argument, and act upon it, abandoning all irrational ideas. The insane person, on the other hand, cannot see the force of logical argument; cannot realize the absurdity or impossibility of error. He clings to his own beliefs, for the evidence of his perverted senses or the deductions from his disease-irritation are very real to him. When we find this to be the fact we know he is insane.

Yet we must not confound delirium of fever with insanity. A patient suffering from typhoid fever may have a delusion that there is a pail by his bed into which he persists in throwing articles. Or he may have the hallucination that he is being called into the next room, and try to obey the supposed voice.

Certain delusions are commonly found in certain types of insanity. Depressed patients frequently manifest the delusion that they have committed a great sin, and are unfit to associate with anyone. Excited and maniacal patients often believe they are important personages—kings or queens, old historical celebrities, etc. Paranoiacs commonly have delusions of persecution and of a conspiracy among their relatives or their associates or rivals. Victims of alcoholic insanity have delusions regarding sexual matters, and generally charge with infidelity those to whom they are married. General paretics in most cases have delusions of grandeur; that is, false ideas of great strength, wealth, political power, beauty, etc.

The emotion which accompanies mental activity is generally exaggerated in all insane people except the demented. One sees extreme depression, or undue elation and exaltation, or silly glee and absurd joy. Intensity of emotion is frequent.

Crimes Impulsively Committed by the Insane

An interesting mental feature of many insane patients is the imperative conception, or imperative impulse. This is a strong urging felt by the patient to commit a certain act. He may know the act is wrong and dread the punishment which he expects will follow its commission. But so constantly and strongly is he impelled that he finally yields and commits the act. Crimes are thus perpetrated by the insane, with a full knowledge of their enormity. The fact that such impulses undoubtedly exist should modify the common test, as to an insane person's responsibility before the law. The statute in many countries regards an insane criminal as responsible for his act, if he knows the difference between right and wrong. This decision is unjust and the basis is wrong; for an impulse may be overwhelming, and the patient utterly helpless during its continuance. However, a patient who has committed a crime under stress of such an irresistible impulse should be put under permanent custodial care.

Physical Signs of Insanity

The physician who is skilled in psychiatry finds in very many insane patients marked physical signs. There are pains, insensitive areas, hypersensitive areas, changes in the pupils of the eyes, unrestrained reflex action, and partial loss of muscular control, as shown in talking, walking, and writing. Constipation and insomnia are very early symptoms of disease in a very large proportion of the insane.

It is productive of no good result for a layman to try to classify the insane. The matter of classification will be for several years in a condition of developmental change. It is enough to speak of the patient as depressed or excited, agitated or stupid, talkative or mute, homicidal, suicidal, neglectful, uncleanly in personal habits, etc.

Illustrations of Various Types

There are very interesting features connected with typical instances of several varieties of insanity, as they were noted in certain cases under the writer's care. A depressed patient with suicidal tendencies cherished the delusion that war with Great Britain was imminent, and that in such an event British troops would be landed on Long Island between New York City and the spot where he conceived the cattle to be kept. This, he argued, would cut off the beef and milk supply from the city. He therefore decided to do his part toward husbanding the present supply of food by refusing to eat; an act which necessitated feeding him through a rubber tube for many weeks. He also attempted suicide by drowning, throwing himself face downward in a shallow swamp, whence he was rescued. This young man was an expert chess player even during his attack.

A maniacal patient wore on her head a tent of newspaper to keep the devil from coming through the ceiling and attacking her. She frequently heard her husband running about the upper floor with the devil on his back. As a further precaution she stained her gray hair red with pickled beet juice, and would occasionally hurl loose furniture at the walls and ceilings of her rooms and assault all who approached her.

A man who presented a case of dementia pulled the hairs from his beard and planted them in rows in the garden, watering them daily, and showing much astonishment that they did not grow. He spent hours each day in spelling words backward and forward, and also by repeating their letters in the order in which they appear in the alphabet. When he wanted funds he signed yellow fallen leaves with a needle, and they turned into money.

A case of general paresis (commonly though improperly called "softening of the brain") passed into the second stage as a delusion was uppermost to the effect that there was opium everywhere; opium in his hat, opium in his newspaper, opium in his bath sponge, opium in his food. He thereupon refused to eat, and was fed with a tube for two years, at the end of which time he resumed natural methods of nutrition and ate voraciously. Another general paretic promised to his physician such gifts as an ivory vest with diamond buttons, boasted of his great strength while scarcely able to walk alone, and declared he was a celebrated vocalist, while his lips and tongue were so tremulous he could scarcely articulate.

Fixed Delusions of Paranoia

Paranoia is an infrequent variety of insanity in which the patient is dominated by certain fixed delusions, while for a long time his intellect is but slightly impaired. The delusions are usually persecutory, and the patient alleges a conspiracy. He is generally deluded with the belief that he is a prominent person in history, or an Old Testament worthy, and there is usually a religious tinge to his delusions. A patient of the writer believed himself to be the reincarnation of Christ, appearing as "the Christ of the Jews and the Christ of the Christians" in one. Over the head of his landlord, who requested overdue rent, the patient fired a revolver, "to show that the reign of peace had begun in the world." He wrote a new bible for his followers, and arranged for a triumphal procession headed by his brother and himself on horseback, wearing white stars.

How the Physician Should Be Aided

When there is a suspicion of irrationality in a person's conduct, and certain acts or speeches suggest insanity, the whole surroundings and the past life must be considered. Frequently when the eyes are once opened to the fact of insanity, a whole chapter of corroborating peculiarities can be recalled. It is wise to recall as many of these circumstances as possible and note them in order as they occurred, for the use of the physician. Strikingly eccentric letters should be saved. Odd arrangement of clothes, or the collecting of useless articles, should be noted in writing. Changes in character, alteration in ideas of propriety, changes in disposition, business or social habits, and great variation in the bodily health should be noted in writing. Delusions, hallucinations, and illusions should be reported in full. It conveys nothing to anyone's mind to say that the patient is queer; tell what he does or says that leads you to think he is queer, and let the physician draw his own inferences from the deeds or speeches. Write down, for example, that the patient talks as if answering voices that are imaginary; or that the patient brought an ax into the dining room and stood it against the table during the meal; or that he paraded up and down the lawn with a wreath of willow branches about his neck; in each case stating the actual fact. It is important to ascertain exactly what the patient's habits are, as to the use of alcoholic beverages, tobacco, and drugs (such as opium), and also as to sexual matters. To secure such information is extremely difficult, and the help of a close friend or companion will be necessary. After the mind begins to waver many a patient plunges into dissipation, though formerly a model of propriety.

The Causes of Insanity

The two great causes of insanity are heredity and stress or strain. Lunacy is not infrequent in children of epileptic, alcoholic, or insane parents, and those born of parents suffering from nervous disease frequently are in such condition that shock, intense emotion, dissipation, or exhausting diseases render them insane. Drinking alcoholic beverages is the most potent factor in the production of insanity. Mental strain, overwork, and worry come next. Adverse conditions, bereavement, business troubles, etc., rank third, equally with heredity. The arterial diseases of old age, epilepsy, childbirth (generally in the neurotic), change of life, fright and nervous shock, venereal diseases, sexual excesses or irregularities follow in the order named.

A Temperate, Virtuous Life the Best Preventive

To avoid insanity, therefore, one should lead a righteous, industrious, sensible life, preserve as much equanimity as possible, and be content with moderate pleasure and moderate success. In many cases, people who are neurotic from early youth are so placed that unusual demands are made upon them. Adversity brings necessity for overwork, duties are manifold, and responsibilities are heavy. In ignorance of the fact that they are on dangerous ground and driven by circumstances, they overwork, cut short their sleep, and, conscientiously pressing on, finally lose their mental balance and insanity is the result, a great calamity which is really no fault of theirs. Undoubtedly such is frequently the sad history; and for this reason, as well as for the general reason that the insane are simply ill, all insane should be cared for sympathetically. To consider the insane as constantly malevolent is a relic of the old-time, absurd belief that insane people were "possessed of the devil." It is no disgrace to be insane, and the feeling of chagrin at discovering disease of the brain in a relative is another absurdity. Avoidance of insanity should be studied with as much devotion as avoidance of tuberculosis. Yet there should be no detraction from the fact that the heredity is strong. No one should be allowed to marry who has been insane, for the offspring of the insane are defective.

The tendency of the times is toward nervous and mental disorder. In the large cities the strain is too constant, the struggle is too keen, the pace is too swift. Haste to be rich, desire to appear rich, or ambition for social distinction has wrecked many a bright, strong intellect. This is the age of the greatest luxury the world has ever seen, and a large proportion of people in cities are living beyond their means, in the gratification of luxurious desires or the effort to appear as well as others. Stress and strain are voluntarily invited. Children are pushed in their studies and overloaded with too many subjects. Genius and insanity, worry and dementia, proceed among us hand in hand; the overwrought brain finally totters.

False Ideas Regarding Insanity

Curious ideas regarding insanity are common, and are apparently fostered by the reportorial writers of the daily papers. We read of people who are "insane on a subject." This is an impossibility. Many people can be drawn out and led into a betrayal of their mental condition only when a certain topic or idea is discussed. But although exhibiting their insane condition only when this topic is broached, they are in no respect sane. Not every act of an insane man is an insane act, we must remember. Forgetfulness of this fact leads to errors in the superficial. You will hear people say that a certain person must be sane, because during a half day's companionship nothing astray was noticed. True, there may be a long period of self-control, or of absence of test; but occasional conduct will establish the fact of constant insanity. Again, we hear the expression: "He cannot be insane; there is too much method in such madness." The answer to this silly remark is that there is method in all madness except some epileptic insanity and terminal dementia. Insane people prepare careful plans, with all the details thoroughly considered, and perfect methods to escape from hospitals with the greatest cunning. One must never take it for granted that the insane person is so demented mentally as to be unable to appreciate what is said and done. One should never talk about the insane man in his presence, but should include him in the conversation as if sane, as a general rule, allaying his suspicions and avoiding antagonism. Do not agree with the delusions of an insane person, except so far as may be necessary to draw them out. Yet avoid argument over them. Simply do not agree, and do not strengthen them by appearing to share them. His food should be prepared for him, and his medicines administered to him as to any other sick person. His baths should be regularly taken.A depressed patient should be very carefully watched. If the slightest suspicion of a suicidal impulse be present, the patient should never be left alone. Many a valuable life has been saved through the moral support of constant companionship; while we read very frequently of the death of an insane patient who sprang from a window during a brief period of relaxation of watchful care. Some people think it a protection to one insane to elicit from him a promise not to be depressed, and not to do anything wrong. One might as well secure a promise not to have a rise of temperature. The gloom of despondency and the suicidal impulse are as powerful as they are unwelcome and unsought; and the wretchedly unhappy patient cannot alone meet the issue and resist.

It is unreasonable to be offended by acts or speeches of an insane patient, to bear a grudge or expect an apology. Very frequently such a patient will turn savagely upon the nearest and dearest, and make cutting remarks and accusations or exhibit baseless contempt. All this conduct must be ignored and forgotten; for the unkind words of an unaccountable and really ill person should not be taken at all seriously.

Should a patient escape from home, it is the duty of the one in charge without hesitation to overtake him, and then accompany him or at least follow at a short distance. The nurse should go with and stay with the patient, telephoning or telegraphing home when opportunity offers, and finally securing aid; he should know where the patient is at all times, foregoing sleep if necessary to protect his charge, and should avoid as long as prudence permits the publicity of an arrest; though the latter may finally be essential to safety, and to the prevention of embarking on a voyage, or taking a train to a distance, or purchasing weapons.

Diversions.—Music favorably affects many patients, so the pleasure of listening to it should be afforded at frequent intervals. Patients should be encouraged to absorb themselves in it. It is often possible to take insane people to opera, musical comedy, or concert. Vocal and instrumental practice at suitable intervals is of great value in fixing the attention, filling the mind with desirable thoughts and memories, and allaying irritability. Drawing and painting are of service when within the number of the patient's accomplishments. Intellectual pastimes, as authors, anagrams, billiards, chess, and many games with playing cards, are generally helpful. Gardening, croquet, and tennis are very desirable. Golf, rowing, swimming, and skating are excellent, but are within the reach of very few insane patients. All regular occupation that necessitates attention and concentration is of supreme value; in fact, insane patients not infrequently ask for occupation and find relief in the accomplishment of something useful, as well as in the healthful sleep and increased appetite that attend judicious physical fatigue.

The Beneficial Atmosphere of Sanitariums

After caring for an insane patient for a time at home, the question arises as to the desirability of sending him away to a sanitarium. Generally this is a wise course to pursue. The constant association with an insane person is undermining; the responsibility is often too heavy; children, often inheriting the same neurotic tendency and always impressionable, should not be exposed to the perverting influence; it may not be safe to keep a patient with suicidal or homicidal impulses in his home; the surroundings amid which the insane ideas first started may tend to continue a suggestion of these ideas. Removal to strange locality and new scenes, the influence of strangers, the abandonment of all responsibilities and duties, and the atmosphere of obedience, routine, and discipline are all beneficial. An insane person will generally make a greater effort for a stranger than for a familiar relative. Discipline, in the form of orders of the physicians, and exact obedience is very often very salutary. There is a feeling with some that all discipline is cruel. This is not so, for the conduct of an insane person is not all insane, but frequently needs correction. Many cases of mental alienation improve promptly under custodial care, many need it all their lives. A great many cases of insanity are never obliged to go away from home, and there is a considerable number who carry on a business while still insane, rear a family, and take care of themselves. In general, a depressed patient should be kept at home as long as there is absolute safety in so doing. Most other forms of mental disease progress more rapidly toward recovery in sanitariums or hospitals equipped for such patients. Prospects of recovery are never jeopardized by confinement in a proper institution. Mental and physical rest, quiet, regularity of eating, exercising, and sleeping are the essentials which underlie all successful treatment of these cases. Dietetics, diversion by means of games, music, etc., regular occupation of any practicable sort, together with the association with the hopeful, tactful, and reasoning minds of physicians and nurses trained for this purpose are of great value. It must be remembered that in wholly civilized localities madhouses have been replaced by hospitals, keepers have been replaced by nurses and attendants, and the old methods of punishment and coercion have been long since abandoned, in the light of modern compassionate custody.

Certain forms of insanity are hopeless from the start. Few recover after two years of mental aberration. Omitting the hopeless cases, over forty per cent of the cases of insanity recover. About sixty per cent recover of the cases classed as melancholia and mania. Most recoveries occur during the first year of the disease; but depressed patients may emerge and recover after several years' treatment.

FOOTNOTES:

[10] Caution. Dangerous. Use only on physician's order.

APPENDIX

Patent Medicines[11]

The term "patent medicine" is loosely used to designate all remedies of a secret, non-secret, or proprietary character, which are widely advertised to the public. This use of the name is erroneous, and it is better first to understand the exact difference between the different classes of medicines generally comprised under this heading. Only in this way can one comprehend their right and wrong use.

A Patent Medicine is a remedy which is patented. In order to secure this patent, an exact statement of the ingredients and the mode of manufacture must be filed with the government. These true "patent medicines" are generally artificial products of chemical manufacture, such as phenacetin. The very fact of their being patented makes them non-secret, and if an intelligent idea is held of their nature and mode of action, they may be properly used. Physicians with a full knowledge of their uses, limitations, and dangers often, and legitimately, prescribe them, and thus used they are the safest and most useful of all drugs and compounds of this class.

A Nostrum.—The Century Dictionary defines a nostrum as "a medicine the ingredients of which, and the methods of compounding them, are kept secret for the purpose of restricting the profits of sale to the inventor or proprietor." Some nostrums have stated, on their label, the names of their ingredients, but not the amount. There has been no restriction upon their manufacture or sale in this country, therefore the user has only the manufacturer's statement as to the nature of the medicine and its uses, and these statements, in many instances, have been proved utterly false and unreliable.

A Proprietary Medicine is a non-secret compound which is marketed under the maker's name. This is usually done because the manufacturer claims some particular merit in his product and its mode of preparation, and as these drugs are perfectly ethical and largely used by physicians, it is to the maker's interest to maintain his reputation for the purity and accuracy of the drug. Familiar instances of this class are: Squibb's Ether and Chloroform, and Powers & Weightman's Quinine.

From the above definition it may be seen that the only unreliable medicines are those which are, in reality, nostrums. In regard to all of these medicines the following rules should be observed:

First.—Don't use any remedy that does not show its formula on the label.Second.—No matter what your confidence in the medicine, or how highly recommended it is, consult a physician before using very much of it.

Third.—Take no medicine internally without a physician's advice.

Throughout this chapter the word "patent medicine" will be used in its widely accepted form, in the everyday sense, without regard to its legal definition, and will be held to include any of the above-mentioned classes, unless a direct statement is made to the contrary.

In Germany the contents of patent medicines are commonly published, and in this country, notably in Massachusetts, the State Boards of Health are analyzing these preparations, and making public their findings. In North Dakota a law has been passed which requires that a proprietary medicine containing over five per cent of alcohol, or any one of a number of specified drugs, be labeled accordingly.

PURE FOOD BILL.—A far-reaching and important step, in the movement for reform of patent medicines and for the protection of the public, has now been taken by the United States Government. On June 30, 1906, an act was approved forbidding the manufacture, sale, or transportation of adulterated, misbranded, or poisonous or deleterious foods, drugs, medicines, or liquors. This act regulates interstate commerce in these articles, and went into effect January 1, 1907. Section 7 of this act states:

"That for the purposes of this Act an article shall be deemed to be adulterated: in case of drugs:

"First. If, when a drug is sold under or by a name recognized in the United States Pharmacopoeia or National Formulary, it differs from the standard of strength, quality, or purity, as determined by the test laid down in the United States Pharmacopoeia or National Formulary official at the time of investigation; Provided, that no drug defined in the United States Pharmacopoeia or National Formulary shall be deemed to be adulterated under this provision if the standard of strength, quality, or purity be plainly stated upon the bottle, box or other container thereof although the standard may differ from that determined by the test laid down in the United States Pharmacopoeia or National Formulary.

"Second. If its strength or purity fall below the professed standard or quality under which it is sold."

Section 8 states that a drug shall be deemed misbranded:

"First. If it be an imitation of or offered for sale under the name of another article.

"Second. If it (the package, bottle or box) fails to bear a statement on the label of the quantity or proportion of any alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substances contained therein."

What are the motives which impel persons to buy and use patent medicines? The history of medicine offers a partial explanation. In somewhat remote times we find that the medicines in use by regular physicians were of the most vile, nauseating, and powerful nature. We read of "purging gently" with a teaspoonful of calomel. Then during the wonderful progress of scientific medicine, beginning a little more than a half century ago, the most illustrious and useful workers were so busily engaged in finding the causes of disease and the changes wrought in the various organs, in observing the noticeable symptoms and in classifying and diagnosticating them, that treatment was given but scant attention. This was nowhere more noticeable than in Germany, the birthplace, home, and world-center of scientific medicine, to which all the medical profession flocked. Patients became simply material which could be watched and studied. This was an exemplary spirit, but did not suit the patients who wanted to be treated and cured. This fact, together with the peculiar wording of the laws regulating the practice of medicine, which allow anyone with the exception of graduates to treat patients, but not to prescribe or operate upon them, accounts for the number of quacks in Germany.

Dr. Jacobi states that "there is one quack doctor to every two regular physicians in Saxony and Bavaria."[12]

Another cause for the use of patent medicines is mysticism. Ignorance is the mother of credulity. It is reported[13] that Cato, the elder, recommended cabbages as a panacea for all sorts of ills, that he treated dislocations of the limbs by incantations, and ordered the Greek physicians out of Rome. The ignorant are greatly influenced by things that they cannot understand. Therefore, as the mass of people are utterly ignorant of the changes in structure and function of the body caused by disease, and also the limitations of medicines in their power of healing such alterations, their belief in the mysterious power said to attach to patent medicines is not surprising. When testimonials of the efficacy of patent medicines purporting to come from respectable divines, merchants, and statesmen are offered, the proof of their power seems incontestable.

Economy and convenience are added incentives to the employment of patent medicines. This method of saving the doctor's fee is engendered by those physicians who themselves write prescriptions for nostrums. "Why not, indeed, eliminate this middleman (the doctor) and buy the nostrums direct?" So say the unthinking. But what doctor worthy of the name would prescribe a medicine the composition of which he was ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it, what would be thought of a banker or financial adviser who recommended his client to buy a security simply on the recommendation of the exploiter of the security? Yet that is exactly the position of a doctor who recommends a nostrum.

In view of the fact, therefore, that persons of undoubted intelligence are in the habit of purchasing and using remedies of this character and since many of the most widely advertised preparations are extremely harmful, even poisonous, we have taken the liberty of pointing out a few "danger signals," in the guise of extravagant assertions and impossible claims, which are characteristic signs of the patent medicines to be avoided.

DANGER SIGNALS.—There are many picturesque and easily grasped features in the literature, labels, and advertising of patent medicines that spell danger. When these features are seen, the medicine should be abandoned immediately, no matter what your friends tell you about it, or how highly recommended it may have been by others than your physician.

Claiming a Great Variety of Cures.—Perhaps of all features of patent medicine advertising, this is the most alluring. No one drug or combination of drugs, with possibly one or two exceptions, can or does "cure" any disease. Patients recover only when the resistance of the body is greater than the strength of the disease. This body resistance varies in different persons, and is never just alike in any two individuals or illnesses. The patient must be treated and not the disease, so it is the aim of every conscientious physician to conserve and strengthen the vital forces and, at the same time, guard against further encroachment of the disease. There is no cure-all, and even if a drug or combination of drugs were helpful in any single case, they might easily be totally unsuited, or even harmful, in another case, with apparently similar symptoms. When a maker claims that his particular concoction will cure a long list of diseases, the assertion bears on its face evidence of its falsity.One of the most widely advertised and largely sold catarrh remedies claims to cure pneumonia, consumption, dyspepsia, enteritis, appendicitis, Bright's disease, heart disease, canker sores, and measles. This is absolute fraud. No matter what virtues this medicine might have in the treatment of one or two ailments, no one remedy could possibly be of service in such a varied list of diseases, and it could not "cure" one of them.

Another remedy bases its assertion of "cures" on the fact that it claims to be a germ killer, and assumes that all disease is caused by germs. To quote from its advertising literature, it claims to cure thirty-seven diseases which are mentioned by name, and then follows the assertion that it cures "all diseases that begin with fever, all inflammations, all catarrhal contagious diseases, all the results of impure or poisoned blood. In nervous diseases—acts as a vitalizer, accomplishing what no drugs can do." It would seem that an intellect of any pretensions would recognize the fraudulent nature of this claim, yet thousands of bottles of this stuff are annually sold to a gullible public. These wide and unjustifiable claims are real danger signals, and any medicine making them should be avoided. There are many other remedies for which just as great claims are made; the two instances cited are merely representative of a large class. It is a waste of time, money, and health to buy them with any idea that they can fulfill their pretensions.Claiming to Cure Headaches.—The use of any "headache powders" or "tablets" should be avoided, except on the advice of a physician. The presence of pain in the head, or in any other part of the body, may be a symptom of a serious and deep-seated disorder, and it may often be a serious matter to temporize with it. At the best, these "pain relievers" can give only temporary relief, and their use may prove to be dangerous in the extreme. Their action is dependent upon one of the modern coal-tar products, usually acetanilid, because it is the cheapest. But, unfortunately, acetanilid is also the one with the most depressant action on the heart. The danger of headache powders lies in the habit which they induce, because of their quick pain-relieving qualities and their easy procurability, and from overdosage. If a person is otherwise in good health, the use of one headache powder will in all probability do no harm, but the dose should not be repeated without a doctor's authority. Many deaths have occurred from their continued use, or because of an idiosyncrasy on the part of the taker, but it is their abuse more than their use which has brought upon them such almost universal condemnation. Therefore, while the physician may advocate their use, do not take them without his advice and specific directions as to kind and dosage.

Claiming Exhilaration.—These medicines, by their insidious character, constitute a particularly dangerous variety. They depend, for their effect, upon the amount of alcohol that they contain. Many conscientious temperance workers have not only unsuspectingly taken them, but have actually indorsed them. Recently the published analyses of several State Boards of Health and the investigations made by Samuel Hopkins Adams, and published in his series on "The Great American Fraud" have shown that a majority of the "tonics," "vitalizers," and "reconstructors" depend for their exhilarating effect upon the fact that they contain from seventeen to fifty per cent of alcohol; while beer contains only five per cent, claret eight per cent, and champagne nine per cent. Pure whisky contains only fifty per cent of alcohol, yet few people would drink "three wineglassfuls in forty-five minutes"[14] as a medicine pure and simple. The United States Government has prohibited the sale of one of these medicines to the Indians, simply on account of the fact that as an intoxicant it was found too tempting and effective.[15]

If one must have a stimulant it is better to be assured of its purity. These medicines are not only costly, but contain cheap, and often adulterated, spirits.

Their worst feature is that they often induce the alcoholic habit in otherwise upright people. Commencing with a small dose, the amount is gradually increased until the user becomes a slave to drink. Could the true history of these widely used medicines be written, it would undoubtedly show that many drunkards were started on their downward career by medicinal doses of these "tonics" and "bracers."

Claiming Pain-relieving or Soothing Qualities.—The properties of this class of remedies depend generally upon the presence of cocaine, opium, or some equally subtle and allied substance. It should be needless to state that such powerful drugs should be taken only upon a physician's prescription. Habit-forming and insidious in character, they are an actual menace. When present in cough syrups, they give by their soothing qualities a false sense of security, and when present in "soothing syrups" or "colic cures" for babies, they may be given with fatal result. Never take a medicine containing these drugs without a full understanding of their dangerous character, and a realization of the possible consequences.

Testimonials.—These may mean anything or nothing; generally the latter. They are usually genuine, but, as Mr. Adams observes, "they represent, not the average evidence, but the most glowing opinions which the nostrum-vender can obtain, and generally they are the expression of a low order of intelligence."[16] It is a sad commentary on many men and women, prominent in public life, that they lend their names and the weight of their "testimony" to further the ends of such questionable ventures. Political and newspaper interests are responsible for the collection of this class of testimonials. An investigation of some men, who permitted the use of their names for this purpose, revealed that many of them had never tasted the compound, but that they were willing to sign the testimonials for the joy of appearing in print as "prominent citizens."[17] "Prominent ministers" and "distinguished temperance workers" are often cited as bearing testimony to the virtues of some patent medicine. It has been shown that, while the testimonials were real, the people who signed them had little right of credence, and were possessed of characters and attributes which would show their opinions to be of little value. Money and energy can be productive of any number of testimonials for any remedy. While some of them may be authentic, yet the fact that a medicine "cured" any one of the signers is no evidence that it will cure or even help anyone else. Many people recover from diseases with no medicine at all, and isolated "cures" can never be taken as a criterion of the value of any remedy or method.

Offering "Money Back Unless Cured."—Careful reading of this clause in most advertising literature will show that there is "a string attached." The manufacturers are usually safe in making this proposition. In the first place, the average person will not put the matter to a test. The second reason why this is a safe proposition for the maker is, that if the medicine does not cure, the patient may die, and dead men are hardly possible claimants.Claiming to Cure Diseases Incurable by Medicine Alone.—Probably no class of people are greater users of patent medicines than those unfortunates afflicted with the so-called incurable diseases. The very fact of the serious nature of their complaint, and the dread of surgical intervention, makes them easy victims to the allurement of "sure cures."

The committee on the prevention of tuberculosis of the Charity Organization Society of New York City has announced in decided terms that there is no specific medication for consumption. Cancer, likewise, cannot be cured by the use of internal medicine alone. Surgery holds out the greatest hope in this dread disease. The medicines claiming to cure these diseases are, therefore, of the most fraudulent nature. Their use is positively harmful, for in taking them priceless time is lost.

Never temporize if there is any suspicion of the existence of such diseases as consumption or cancer. Self-treatment with patent medicines in such cases is worse than useless—it is actually dangerous to life itself. Consult a physician at the earliest possible moment, and put no faith in patent medicines.

There are, however, as has been pointed out, certain patent and proprietary medicines which may properly be employed by the physician. These include the newly discovered, manufactured chemicals of known composition and action; and single substances or combinations of known drugs in known proportions, which can only be made to best advantage by those having the adequate facilities. The habit of prescribing proprietary mixtures of several substances for special diseases is, however, generally a matter of laziness, carelessness, or ignorance on the doctor's part. This follows because no disease is alike in any two patients; because any one disease has many phases and stages; and because a doctor should always treat the patient and not the disease. Thus a doctor, after carefully questioning and examining the patient, should adjust the remedy to the peculiarities of the patient and disease. It is impossible to make a given combination of drugs fit all patients with the same disease.

The quantity of patent medicine sold in the United States is enormous. A series of articles by Samuel Hopkins Adams appeared in Collier's Weekly during 1905 and 1906, in which he not only showed the fraudulent character of many of the best-known patent medicines, giving their names and most minute details concerning them, but furnished much reliable information in an interesting and convincing manner. In the course of these articles he pointed out that about one hundred millions of dollars are paid annually for patent medicines in the United States. As explaining this, in part, he affirmed that as many as five companies each expended over one million dollars annually in advertising patent medicines.

What Are the Good Ones Good For?—In any great movement, when a dormant public suddenly awakens to the fact that a fraud has been perpetrated or a wrong committed, the instinctive and overwhelming desire is for far-reaching reform. In efforts to obtain needed and radical improvement, and with the impetus of a sense of wrong dealing, the pendulum of public opinion is apt to swing too far in an opposite direction. There are bad patent medicines—the proof of their fraudulent character is clear and overwhelming; but there are good ones whose merits have been obscured by the cloud of wholesale and popular condemnation. It is true that the manufacturers of even some of the valuable ones have an absurd habit of claiming the impossible. This attitude is to be regretted, for the makers have thus often caused us to lose faith in the really helpful uses to which their products might be put.

However, it is well in condemning the bad not to overlook the good. The mere fact that a medicine is patented, or that it is a so-called proprietary remedy, does not mean that it is valueless or actually harmful. The safety line is knowledge of the medicine's real nature, its uses and its dangers; the rules given above should be rigorously followed.

It is far easier to give general indications for the guidance of those wishing to shun unworthy patent medicines than to enable the reader to recognize the worthy article. It is safe to assume, however, that there are certain simple remedies, particularly those for external application, which have a definite use and are dependable. In justice it must be said that great improvement has taken place, and is now taking place in the ethical character of patent medicines, owing to recent agitation, and what is true concerning them to-day may not be true to-morrow.

The only proper, ethical patent medicine is the one showing its exact composition, and refraining from promise of a cure in any disease. Such a one might, nevertheless, advertise its purity, reliability, advantageous mode of manufacture, and the excellence of its ingredients with more modest and truthful claims as to its use.

The purchaser of a patent medicine pays not only for the ingredients, the cost of combining them, and the maker's just profit, but he also pays the exploiter's bills for advertising and distributing the finished product. With such standard remedies as those mentioned above, this added cost is usually a good investment for the purchaser, because trade-marked remedies which have "made good" possess two advantages over those less advertised, and over their prototypes in crude form: procurability and integrity.

Even at remote cross-roads stores, it is possible to obtain a popular remedy, one which has been well pushed commercially. And an article sold in packages sealed by the makers gets to the consumer just as pure as when it left the laboratory. This is not always true of ingredients held in bulk by the retailer; witness the evidence brought forward in recent prosecutions for drug adulteration.

It is not the purpose of this chapter, in any sense, to advertise or place the seal of its unrestricted approval upon any one article of a class. Its position in the matter is absolutely impartial. But in order that it may be as helpful as possible, it definitely mentions the most widely known, and therefore the most easily obtainable, remedies. There are other equally good remedies in each case, but as it would be almost impossible to mention each individual remedy with similar virtues now on the market, the ones discussed must be taken as representative of their class in each instance.

Do not forget that the use of these simple remedies does not justify their abuse. They may make great claims while their use is really limited. Do not rely upon them to do the impossible.

Vaseline.—This is pure and refined petroleum, and will be found of much service in many forms of skin irritation. It is useful in the prevention of "chapping," for softening rough skin, for preventing and healing bleeding and cracked lips, as a protective dressing in burns, cuts, or any acute inflammation of the skin where the cuticle has been injured or destroyed, or where it is desirable that a wound should be protected and kept closed from the air. Rubbed over the surface of the body when a patient is desquamating or "peeling" after scarlet fever or measles, it keeps the skin smooth, soothes the itching, and prevents the scales from being carried about in the air and so infecting others. Vaseline is a soothing, nonirritating, and bland protective ointment for external use. It is perfectly harmless, but should not be used for severe skin disease or for internal use, unless recommended by a physician in conjunction with other means of healing.

Pond's Extract.—Although the makers have claimed special virtues for this remedy, it is in reality an extract of hamamelis or witch-hazel, and probably differs little in its application or results from the ordinary marketed extract made by the average druggist. It is mild and bland, harmless when used externally, but should not be used internally unless ordered by a physician. It is soothing and healing when applied to wounds, sprains, and bruises; diluted with water it is a pleasant gargle for a sore throat, and may be applied externally on the throat by means of a flannel wrung out in a solution of it in hot water. For nosebleed it is often efficient when snuffed up the nose, or when pledgets of cotton are soaked in it and placed in the nostrils. It may be used as an application in ulcers or varicose veins, and from two to four teaspoonfuls with an equal amount of water injected into the rectum two or three times daily will often prove of great help in piles, particularly if bleeding. It gives relief when used for sore or inflamed eyes or eyelids, but in this, as in all other serious inflammations, it is not a "cure all," and the physician should be consulted if the relief is not prompt.Listerine.—Of the many mild liquid antiseptics "Listerine" is probably the best known. The remarks and recommendations concerning it, however, are equally applicable to many other remedies of a somewhat similar nature, such as glycothymoline, borolyptol, lythol, alkalol, formalid, etc.

Listerine is a solution of antiseptic substances with the addition of thymol and menthol in quantities sufficient to give it a pleasant odor and taste. It has a very strong hold on the public, and is a deservedly useful remedy.

Listerine has many helpful uses. It is potent enough to kill many germs, and is excellent for this purpose when used as a mouth wash, particularly during illness. In acute cold in the head it is soothing to the mucous membrane of the nose, if used diluted with warm water as a nasal douche. It serves a similar purpose when used as a gargle in mild sore throat.

If there is any reason to suspect that dirt or other foreign matter has come in contact with a sore or cut, the wound may be freely washed with a solution of listerine in order to clean it and render it as nearly aseptic as possible. When there are distinct signs of inflammation it should not be relied upon. Do not use it internally without a physician's advice.

Scott's Emulsion.—This is a good emulsion of cod-liver oil, widely prescribed by physicians for the many patients who are too delicate-stomached to retain the pure oil. For those who can take the refined oil straight, Peter MÖller's brand is in a class by itself.

In certain conditions cod-liver oil is one of the most valuable remedies known. As a concentrated and reconstructive food in many wasting diseases it is of great service. Weak and puny children, and all suffering from malnutrition may take it with benefit. It does help produce flesh, increase strength, and add to the body's resisting powers. It does not contain any medicinal properties, and its virtue is largely in its fat or oil, but as an aid to other remedies, or alone, when increased nutrition is desired, it is a reliable and helpful remedy.

Antiphlogistine.—There are many clay poultices on the market: antiphlogistine, antithermoline, cretamethyl, sedol, unguentum, yorkelin, and the Emplastrum Kaolini of the U. S. Pharmacopoeia. Antiphlogistine, being probably the most widely known, is here discussed. It is of value when a poultice is indicated. It is preferable to the homemade varieties in that it retains heat for a longer period of time and is antiseptic.

It should never be used in deep-seated inflammations, such as peritonitis, appendicitis, deep abscesses of any part of the body, or other serious conditions, unless recommended by a physician; for such ailments need more thorough treatment than can be afforded by any poultice. It is perfectly harmless, and may be used with decided benefit in aborting or preventing many inflammatory diseases. Applied in the early stages of a boil, felon, or carbuncle it may either abort the trouble or, if the disease has already progressed too far, it will hasten suppuration and shorten the course of the disease. When a poultice is indicated in bronchitis or pleurisy it is an excellent one to use; it will afford much comfort, and often hasten recovery. In nursing mothers, when the breasts become full and tender and signs of beginning inflammation are present, antiphlogistine spread in a warm and thick coat over the breasts will often afford relief.

Platt's Chlorides.—When it is desirable to use a liquid disinfectant Platt's Chlorides will be found a useful article, as will lysol and other marketed products. The source of a foul smell or dangerous infection should never be overlooked. No disinfectant can offer a safeguard if plumbing is defective, or other unsanitary conditions exist; in fact, disinfectants are often deprecated, since they afford a false sense of security. If a contagious disease exists in a household, other means than the use of a disinfectant must be taken in order to prevent the spread of the contagion. Disinfectants do have their uses, however, and are often essential. In case of an illness of a contagious or infectious nature, a solution of Platt's Chlorides or a similar disinfectant should be kept in all vessels containing or receiving discharges from the body. Pails containing such a solution should be in readiness to receive all cloths, bedding, or washable clothes which have come, in any way, in contact with the patient.

[11] The publishers announce this chapter as prepared independent of Dr. Winslow or any of the Advising Editors. Considered as an effort to give helpful information, free of advertising on the one hand and sensational exposures on the other, the article meets with the approval of conservative physicians. But the problems dealt with are too involved at present for discussion direct from the profession to the public.

[12] Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.

[13] Ibid.

[14] S. H. Adams, "The Great American Fraud."

[15] Ibid.

[16] S. H. Adams, "The Great American Fraud."

[17] S. H. Adams, "The Great American Fraud."

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