JOHN PUNTON, M. D.

racy of late, chiefly along the lines of anatomy and physiology, together with the instrumentality of the perfected microscope.

Moreover improved bacteriological, phaṛmacological and chemical laboratory methods have also greatly aided a more complete and rational system of investigating pathological processes, which in their present matured state furnish us more correct definite knowledge concerning the intricate nature and character of disease and its allied methods of transmission and propagation.

The principal practical results, however, of such advance afford us the means of rendering finer discrimination in classification and diagnosis of diseased conditions and consequent enlargement of technical medical nomenclature, all of which tend to increase the great mass of specific knowledge relevant to each department of medicine.

DISEASE SOCIAL NOT INDIVIDUAL IN ORIGIN.

Notwithstanding the marvellous scientific

AND HOSPITAL.*

JOHN PUNTON, A. M., M. D., Kansas City, Mo. Member American Neurological Association; Member American Medical Association; Ex-President Kansas City Academy of Medicine, etc.

In taking a retrospective view of the principal features which characterize the age in which we live none are more conspicuous and striking than the rapid ad

vance of medical science.

In the many hundred years of its existence no such medical triumphs are recorded or more brilliant surgical results achieved than those which belong to the present period.

In the scientific development of the larger and more complete knowledge of man and his diseases, the great difficulty of the

medical scientist has been to discover the cause of disease or its pathogenesis, so that the resulting symptoms could be definitely associated with the underlying tissue lesions. A constant fact in the progress of practical clinical medicine enforced the truth that just in proportion as our knowledge of the anatomy and physiology of a part increased did our knowledge of the symptomatology

of its disease advance.

At every step in its progressive forward march the chief aim of medical scientific investigation has been to bring symptoms into connection with lesions, and this has been done to a remarkable degree of accu

Presented to the members of the "Travel Study Tour" of American Physicians on board Steamship "Bremen" en route to the International Medical Congress held in London August 6 to 13, 1913. Published by request of the organization.

cine, prior to the development of modern bacteriology and pathology disease was largely considered an individual matter between the patient and his physician.

Moreover the special cause of the communciable diseases as well as the method of their transmission from one person to another was until quite a recent period practically unknown, hence there were few means provided for their prevention or of even recognizing their presence before an epidemic broke out.

Through the work of such able leaders as Pasteur, Lister, Koch and many others, the germ theory of disease which heretofore had been treated largely as a joke (by not only the laity, but also the medical profession) became an established scientific fact, and following the results of their teaching led to the important discovery that the cause of most if not all communicable diseases were not only due to specific germs, but their particular nature and character as well as method of transmission and propagation was also disclosed.

The further elaboration of this special knowledge revealed the remarkable scientific fact that nearly all diseases are not individual but social in origin, that is to say they can be directly traced to faulty social and moral conditions which at the present time are largely beyond the control of any one class or profession.

For instance, tuberculosis which was formerly regarded as hereditary in origin, or due largely to inherited factors is now known to be chiefly caused by insanitary

Yellow fever and malaria are now known to be carried by the mosquito which finds its breeding place in stagnant pools.

Typhoid fever is due to polluted water or bad milk supply, or to transmission by the common house fly.

Our awful infant mortality is due to a variety of causes, most of which are now known to be social and economic rather than individual.

Meningitis,

poliomyelitis, pneumonia, scarlet fever, measles, diphtheria, smallpox and many other infectious and contagious diseases are all known today to be largely due to faulty social conditions which are for the most part preventable.

Then, again, syphilis that terrible scourge of the human race as well as gonorrhea are both due to specific germs which are largely transmitted through the social vice of prostitution. Hence the significant fact remains, that most if not all the communicable diseases from which mankind suffer today, are due to social rather than individual offenses, and the remedy for them and their prevention must of necessity be found in the primal factors which constitute and underlie our social organism. In the scientific elucidation of the remarkable fact that nearly all diseases were social rather than individual in origin, it was also discovered that the pathogenesis of disease was not always confined to germs or purely physical material lesions capable of actual demonstration as was formerly believed and taught.

SOCIAL AND PSYCHOLOGICAL CAUSES OF
DISEASE.

Hence much of the disease and suffering is recognized today to be found associated with not only physical but also sociological and psychological conditions, the morbid mental manifestations of which must be seriously considered and understood before much can be done for either its amelioration or prevention.

It is, however, not lack of medical scientific knowledge concerning the nature and character as well as the special physical causes of the dreadfully common fatal diseases which confront us today, but it is the great social, psychologic, and moral factors which underlie their special cause, transmission and prevention that concern more especially at this time, as these are the known responsible agents for much of the physical, mental and moral suffering

us

and distress which is found to exist in the world today.

PREVENTION OF DISEASE A SOCIOLOGIC
PROBLEM.

In its larger and more comprehensive sphere therefore the preventive social aspect of human suffering becomes at once a practical, mutual, medical, religious, sociologic problem of the highest order, for when duly considered it not only revolutionizes our ideas of the cause and spread of disease, but transfers much of the responsibility of its appropriate treatment and prevention from the strict domain of medicine to the great moral and political forces which underlie our social organism and which constitutes the very basis upon which our national life and consicence as well as refined form of civilization exists. Hence the modern medical scientific aspect of social regeneration and preventive medicine, while recognizing practical methods of christianity as forming the very foundation upon which all such human reform is based and perfected, yet in its largest beneficent aspect appeals to the best efforts and interests of all classes of society.

RELIGIOUS VERSUS MEDICINE.

As fundamental to all such salutary changes modern scientific preventive medicine demands the universal application and moral practice of the common principles which enforces the doctrine that "cleanliness is next to Goaliness," and an "ounce of prevention is greater than a pound of

cure.

For the various church societies to provide Evangels of Mercy, and religious missions, as well as organized Sunday schools, homes for the friendless, and even churches in which to preach the Gospel to the more unfortunate, sick, defective, delinquent and dependent classes, is no doubt highly relig ious, deserving support, but to neglect their insanitary environments and evil habits as well as fail to provide for the treatment and prevention of disease incident to such misfortune, proves not only a useless task but a travesty on human need and human suffering which reacts at the present time most unfavorably to the great cause of justice and religion as well as medical science.

The recognition, however, and practical application of these two great humane medical principles, in all their various bearings to all classes of society, together with their moral and religious aspects, constitutes the solution of the modern problem of ensuring happiness and longevity to the race, by enforcing not only improved methods

of hygiene and sanitation but efficient medical, moral and religious adequate means and measures for the treatment and prevention of all forms of social, physical, mental and moral distress and suffering.

If the function of modern scientific medicine aims through its various agencies to contribute toward the great righteous cause of uplifting humanity and the social betterment of mankind by introducing a more perfect system of hygiene and sanitation as well as improved medical and surgical methods for the treatment and prevention of disease, then certainly we as medical men are called upon to study the relation which the modern practice of medicine sustains to such a desirable and worthy public enterprise. Indeed, it is this larger public preventive social aspect of medical practice which constitutes my theme and what may justly be termed "The Newer Mission of the Doctor and Hospital."

It is to certain religious, educational, humanitarian and scientific features of this newer misison of the doctor which I desire to emphasize in the hope that it may not only correct former erroneous inference but stimulate us all to do our part in the larger medical redemption of mankind.

RELIGIOUS ORIGIN OF MEDICINE.

Now in tracing the early history of medicine one is at once impressed with its actual religious origin and purpose. Indeed, its early practice was largely confined to the priests in their use and observance of certain sacred rites and religious ceremonies. Moreover, the early church functionaries took sole charge of the social, educational, medical and religious needs of the people so that ancient medicine became correlated as it were with religion itself. More especially in connection with the sick and afflicted did the early church extend its special humane benefits and even as late as the middle ages hospitals were built in connection with monasteries for the sole purposes of not only receiving and treating the sick and suffering, but where the orphan, the indigent and dependents of all kinds received not only medical care but food, shelter and religious protection.

Hence, as Dr. Cabot, of Boston, says: "It is not many years ago when the soul of the church, its intelligence, its energy and its creative genius were incarnate in the managing of schools and colleges, in the heal ing of the sick, in the care of the poor and in municipal government."

Gradually, however, one after another of these religious activities which once kept the church in close touch with the every

day needs and interests of the people were allowed to go more or less by default and were taken over wholly or in part by public, private and secular agencies, though there are of course numerous hospitals and schools managed and controlled today by various religious orders, yet they are few when compared with their great and growing need.

Deprived, however, to a large extent of its control of education of charity of medicine and of government, the church today represents according to high ecclesiastical authority, a nearly disembodied soul.

Everyone recognizes the present plight of the modern church in its helplessness to control the results of sin, in the form of disease and suffering, and it has even been accused of having lost its actual heart and soul. The same truth, however, would seem to apply at least to some extent to prevailing methods in the practice of medicine, as we shall see later, for it is an open question today by leading medical men whether the modern practice of medicine is not deprived of its heart and soul. Every physician familiar with the facts understand that no sooner was medicine divorced from its original religious control and intent and deprived of its christian auspices, than it began to swing rapidly to the opposite extreme from the spiritual to the material.

MEDICAL MATERIALISM.

Hence the teaching in the medical schools became radically materialistic and secular as well as markedly theoretical and speculative..

So universally popular, however, and persistent was this so-called scientific method of study pursued, that until quite a recent period the teaching in our medical schools and colleges has tended toward an ultra materialistic conception of man and his diseases. This was also emphasized by the misleading use of the term scientific which led the former medical student to believe that the minute histology of the cell, the microscopic structure of the microbe, and the material physical pathological process were more essential in diagnosis than the practical knowledge gained by a thorough clinical study of the personal constitution, habits and reaction of the individual to certain environmental conditions and circumstances as expressed in thought, speech and conduct, all of which cannot be fully solved in the pathological or bacteriological laboratory or even explained in materalistic

terms.

More especially is this true in that department of medicine which explains the phe

nomena of mind and mental action or medical psychology and its abnormalities, and which today occupies a most important growing place in practical clinical medicine. Consequently, when the former medical practitioner came in contact with the more common nervous affections, and especially the so-called functional abnormal psychological processes known today as the psychoneuroses, or those in which the material physical cause could not be actually demonstrated, medical men formerly refused to accept the reality of their existence, believing them to be purely imaginary ailments, and therefore gave little attention to their actual clinical study, much less their appropriate treatment. The continued and persistent careless indifference, however, on the part of the medical profession to recognize the purely psychic origin of many such morbid conditions, or take cognizance of the potency of mind, both in favoring the production as well as the relief of such abnormal mental states, undoubtedly gave birth to the origin, rise and popularity of so-called Christian Science, the Emmanuel movement and other modern bastard forms of medical practice.

Every physician, however, of experience today, recognizes that owing to the increased complexity, strenuosity and excesses incident to modern life the higher centers of the nervous system reacts in such a manner as to render many persons abnormally susceptible and vulnerable to various functional and even organic ailments, both imaginary and real, which may be of primal psychogenetic origin, and which often. often affect the visceral and other organs of the body in a very serious manner.

It is conservatively estimated that no less than 65 per cent of the ailments which affect the American people today are functional morbid nervous conditions, in which the primary factors are mental and moral, and in which psychotherapy has its special application and wins its greatest victories.

MEDICAL SKEPTICISM AND MORAL UNCONCERN.

Another unfortunate result of the former so-called scientific medical materialistic doctrine which interpreted all forms and modes of life as having a purely physical origin and purpose, gave birth to almost universal skepticism among the members of the medical profession so that atheism and agnosticism as well as other forms of infidelity were formerly the commonly accepted beliefs of medical men, and even today its pernicious effects are not entirely eradicated. When present it predisposes to careless methods of speech, conduct,

and even morals, and is often responsible for lack of appropriate sympathy and harsh methods of treatment to the more unfortunate sick poor in hospitals and dispensaries. Its pernicious hereditary influence is also expressed in the attitude assumed by the medical profession as a whole toward their clientele, for the sick are no longer regarded from their humanitarian standpoint as patients or human beings,

good cases, interesting cases, hard cases and bad cases. Hence their examination is often conducted with as much personal unconcern and apathy as a chemist searches for the unknown in his test tubes.

This is however not always the sign of disrespect or an intentional slight on the part of the doctor, but is largely the result of an enforced educational weakness transmitted or acquired by common consent or custom.

Granting that the doctor may have emancipated himself from such bondage, and that in his dealing with the sick and suffering he is kind, just, conscientious and considerate, as many of them are, with his heart wide open to human distress in every form, yet he finds today that his practice is usually so varied, uncertain and incongruous, besides subject to so much public criticism and severe commercial and often unscrupulous, irregular competition that he, like his friend, the modern business man, soon forgets his larger public duties to mankind, or avowed love for his profession, and therefore becomes absorbed (possibly of necessity) in his own individual financial private affairs, and recognizes that he too must also make a living. So great, however, are the multitudes of sufferers who crowd the dispensaries, hospitals and missions of our larger cities today as well as our offices, that little heed can be given to anything but the outward symptoms or their more urgent objective medical needs. Moreover, in order to economize time and expense routine methods of treatment are now carried on in our dispensaries and hospitals by printed prescriptions and stereotyped directions which are hurriedly handed out usually by an undergraduate or interne, and little opportunity is given to get even a glimpse into the actual life, surroundings and circumstances of many of the unfortunates who apply for treatment.

FOREGROUNDS AND BACKGROUNDS OF DISEASE.

A poor woman, for instance, with a malignant tumor may therefore apply to the dispensary or hospital for treatment and be told she ought to have it surgically removed