Essays In Pastoral Medicine Part 9

Four known attempts have been made to separate double monsters surgically, but all failed owing to crude surgery; modern methods might be successful in some cases.

The second order of double monsters comprises the parasitic cla.s.s.

There are three genera of these terata, with five species and seventeen varieties. The chief of these only will be mentioned. The _Heterotypus_ is a parasitic child which hangs from the abdominal wall of the princ.i.p.al subject. Varieties of this species are the _Heteropagus_, which is a parasite with head and arms; the _Heterodelphus_, which has no head; the _Heterodymus_, which has a head, neck, and thorax. The _Heteralitis_ is a second species, in which the parasite is inserted at a distance from the navel of the autosite. The _Epicomus_ is the only example, and it consists of a parasitic supernumerary head. The _Polypnathus_ is a parasite attached to the jaw of the autosite. When fastened to the upper jaw, it is an _Epignathus_; at the lower jaw it is an _Hypognathns_. Another group is made up of terata having parasitic legs which are attached to different parts of the autosite,--to the pelvis, the head, the abdomen, and so on. Finally, there is the _Endocyma_, which is a parasite enclosed within the body of an autosite.

Parasites are nourished through the blood supply of the autosite, and the parasites usually are incapable of motion. The autosite can feel when the parasite is touched, and in some cases the autosite can localise the touch. In India, in 1783, a child was born which had a supernumerary head attached to the autositic head, crown to crown; it lived four years. The parasite's eyes were always partly open, but they appeared to be incapable of intelligent vision. They contracted under strong light, and when the autosite was suddenly awakened both sets of eyes moved.

Gould and Pyle (_Anomalies and Curiosities of Medicine_) give an account of an Italian boy, aged eight years, who had a small parasitic head protruding from near the left third rib. Sensibility was common.

Each of the heads received baptism (one was called John and the other Matthew), and there was question as to whether extreme unction should be administered to the parasitic head. A similar case occurred in {86} England in 1880 (_British Med. Journal_), and the parasitic head could be pinched without attracting the attention of the autosite.

Teratologists now exclude Dermoid Cysts from the lists of terata. The hair, teeth, and particles of bone found in these cysts are looked upon as the development of abnormal ectodermic and endodermic cells, rather than as evidence of a separate personality.

There is only one well-authenticated case of a triple monster, and this happened in Italy in 1831. The monster had a single broad body with three distinct heads and two necks. It was killed in delivery.

In Katadidyma (terata divided from above downward), when we have dicephali, ischiopagi, or pygopagi, there are evidently two individuals present. Is the Diprosopus, however, the two-faced monster, possessed of one or two souls? The cases vary, as we said, from examples with two distinct faces and four ears to cases that have merely two noses. What portion of a human body is required to contain a new soul? That is an interesting question for the psychologist and a very practical one for the moralist, and no moralist has yet attempted to solve it. The presence of a brain is not essential, because acephalous monsters develop without brain, and they are born alive; they have a vital principle which is identical with the soul.

Among the Terata Anadidyma (divided from below upward) the Syncephalus and the Craniopagus are unquestionably two persons. Is the Dipygus (single down to the navel, double below) one or two persons? Mrs. B., the example already given, was as double below the navel as any Dicephalus is above that point. She had features so well ordered in unity that she was a pretty woman, but that unity ceased at her waist.

Was her husband unknowingly a bigamist? I think he was. After a consideration of the fission of terata, and the non-essential quality of the brain, why should fission that started at the feet differ from fission that started at the head?

In the _Rituale Romanum Pauli V._ (t.i.t. ii. cap. i. nn. 18, 19, 20, 21), the following directions for the baptising of terata are given:

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18. In monstris vero baptizandis, si casus eveniat, magna cautio adhibenda est, de quo si opus fuerit, Ordinarius loci; vel alii periti consulantur, nisi mortis periculum immineat.

19. Monstrum, quod humanam speciem non praeseferat, baptizari non debet; de quo si dubium fuerit, baptizetur sub hac conditione: _Si tu es h.o.m.o, ego te baptizo,_ etc.

20. lllud vero, de quo dubium est, una ne, aut plures sint personae, non baptizetur, donec id discernatur: discerni autem potest, si habeat unum vel plura capita, unum vel plura pectora; tunc enim totidem erunt corda et animae, hominesque distincti, et eo casu singuli seorsum sunt baptizandi, unicuique dicendo: _Ego te baptizo_, etc Si vero periculum mortis immineat, tempusque non suppetat, ut singuli separatim baptizentur, potent minister singulorum capitibus aquam infundens omnes simul baptizari, dicendo: _Ego vos baptizo_, in nomine Patris, et Filii, et Spiritus sancti.

Quam tamen formam in iis solum, et in aliis similibus mortis periculis, ad plures simul baptizandos, et ubi tempus non pat.i.tur, ut singuli separatim baptizentur, alias numquam, licet adhibere.

21. Quando vero non est certum in monstro esse duas personas, ut quia duo capita et duo pectora non habet distincta; tunc debet primum unus absolute baptizari, et postea alter sub conditione, hoc modo: _Si non es baptizatus, ego te baptizo in nomine Patris, et Filii, et Spiritus sancti._

AUSTIN oMALLEY.

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VII

SOCIAL MEDICINE

The influence of the clergyman or the charitable visitor in matters of health and sanitation can scarcely be overestimated. The removal of prejudices with regard to sanitary regulations for the prevention of disease and modern advances in the treatment of disease is an important social duty. There is no doubt that if this influence be properly directed, sanitary measures of various kinds will be much more readily enforced and the precautions necessary to prevent the spread of serious infectious ailments more faithfully observed. As this amelioration of sanitary conditions will affect mainly the poor, lessening their suffering and adding to their possibilities of happiness, its accomplishment becomes a great Christian duty, obligatory on all those who are interested in the uplifting of the poorer cla.s.ses.

Professor Virchow, the distinguished German pathologist, used to say that popular medicine was in all ages at least fifty years behind scientific medicine. He had himself discovered the principles of cellular pathology nearly half a century before his death, yet he declared that the popular mind still believed in the old doctrines of humoral pathology,--that is, that the conditions of health and disease depended on the const.i.tution of the fluids of the body (the blood, the bile, the mucus, and so forth), and had not generally accepted modern advances in medical knowledge of the underlying basis of disease in the solid tissues. There is no doubt that many old-fas.h.i.+oned notions long since discredited by physicians are still very generally accepted by the popular mind, and even the intelligent cla.s.ses sometimes harbour convictions with regard to the good or evil effects of habits {89} of life, diet, and the operation of drugs of various kinds that are entirely contrary to present-day medical knowledge.

It is extremely important, then, that the clergyman or charitable visitor, in giving views on medical matters, which are sure to have much more weight than he perhaps attributes to them himself, should be careful not to make statements for which he has not good authority in modern medical science. It is very easy, in a matter of this kind, to state principles that are not the result of education, properly so called, but are gleaned from early false impressions obtained one knows not how or where, entirely without definite consciousness as to their real origin. The physician himself finds that he is compelled to be careful of this same tendency to put too much stress on traditions with regard to health which he imbibed before he began to study medicine. It is perhaps not so surprising, then, to hear physicians complain often that clergymen instead of being a help are sometimes a hindrance to the enforcement of modern hygienic rules, because they still cling to old-fogy notions of hygiene and sanitation retained from a defective early training. Owing to the influence that the clergyman is sure to exert, this becomes an extremely important matter. Great harm may be done and the physician discredited, almost without a realisation, on the part of the clergyman, that he is interfering in another's department. Sympathetic coordination of clerical and medical efforts would accomplish much good that is now unfortunately left undone.

There is no doubt that for the important crusade against tuberculosis, for instance, the aid of the clergyman will accomplish much for the reduction of the death rate from this disease. What is needed at the present moment is a universal conviction that tuberculosis is not an hereditary but a communicable disease. This does not mean that it is virulently contagious and that as a result sufferers from tuberculosis must at once be segregated from other members of the family and from the community generally; but it does mean that careful precautions must be taken with regard to the disposal of sputum, with the enforcement of the most exacting cleanliness on the part of consumptives themselves. {90} It also means that the person suffering from the disease should not sleep with those as yet unaffected, nor be allowed to live in very close contact, especially with children or susceptible individuals.

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

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

This shows, too, the reasonableness of the modern treatment of consumption, which consists not in the giving of {91} drugs, but in securing for the patient a plenty of fresh air for many hours a day and the encouragement to consume a liberal amount of nutritious food.

Most of the much advertised remedies for consumption are really harmful rather than beneficent. Many of them are ordinary cough mixtures containing considerable opium, which lessens the cough, it is true, but also lessens the appet.i.te and locks up the bowels. Besides, the cough is nature's method of removing material from the lungs which has become disintegrated, and if allowed to remain will certainly bring about the spread of the infection in the pulmonary tissues.

Cough is a natural protective reaction to be encouraged, and is not in itself a source of evil needing to be suppressed. If cough is bothering the patient so much at night as to cause loss of sleep, then it is necessary to make a choice between two evils and somewhat to suppress the cough, even though it involves certain other inconvenience to the patient. All these so-called consumption cures contain materials that are almost sure to disturb the appet.i.te and upset the stomach. The fate of a consumptive patient absolutely depends on his stomach; just as little, then, of medicine must be employed as possible. This will indicate the necessity for clergymen rather advising against than in favour of these proprietary medicines which have been definitely known to do so much harm in recent years.

Many a patient delays an appeal to medical aid so long, as the result of trusting to such medicines, that a curable case of consumption becomes incurable, or else develops to such a condition as to require years of treatment on the fresh-air, abundant-food plan, where months would have sufficed before.

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

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

[Footnote 1: 28th Annual Report Ma.s.s. Board of Health; food and drug inspection, 1897.]

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

TABLE

From the Report of the Ma.s.sachusetts Board of Health

_Tonics and Bitters_

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

Per cent, of Alcohol (by volume).

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

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

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

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

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

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

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

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

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

An almost precisely similar state of affairs obtains with regard to another cla.s.s of favourite popular remedies. A number of so-called blood-purifying remedies have been recommended at various times, and here, as in other things, it is surprising to find how many intelligent people lend themselves to the exploitation of the public in the interests of the proprietary vender, who cares only to sell, and cares very little what effect his remedies may produce. Most of the sarsaparillas are said to be blood purifiers. It is surprising what vogue this word "sarsaparilla" has obtained. A little more than half a century ago a German chemist and pharmacist announced that the sarsaparilla plant contained certain principles that could be extracted by boiling, and that form excellent remedies for atonic and anaemic conditions. This announcement was received by the medical profession very kindly, and immediate tests as to the efficacy of the new remedy were made. As a result of these tests, within a few years the inefficacy of sarsaparilla became very clear. It is almost entirely without effect upon the human system. In the meantime, however, the word "sarsaparilla" was one to conjure with for the popular mind, and the sarsaparilla remedies began to be manufactured.

Millions have been made on them and out of the public. The only active agent as regards tonic qualities which they contain is, as we have said, alcohol. Most of them however, contain at least one other well-known drug likely to be at least as harmful as alcohol. This is iodide of potash. Very few of the so-called sarsaparillas are without a notable proportion of this strong mineral salt, as the Ma.s.sachusetts Board of Health said.