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them from engaging in its laudable prac- over the pathogenesis of disease as well as tice. It has also given rise to a pernicious its etiology, pathology, diagnosis and treatpolicy which is still quite prevalent in the ment are also closely allied. While all medical profession and in its more aggra- these in large part are purely medical techvated form adopts for its slogan the words, nical studies fit only for the scientific phy''the public be damned,” thus excluding the sician and surgeon, yet their fundamental public from all consideration. Fortunately, principles must be popularized and the conthese excuses are becoming less rampant in tagious death-dealing character of vice, the profession, and it is now regarded as a crime and other social evils must be laid sign of educational, moral weakness in a bare to the public before any general, much medical man when he offers such a plea. less special, methods of their prevention will
To such extremes, however, has this be instituted, and this educational task, I offensive formula been carried in the past repeat, belongs largely to the medical proby some medical men that the public has
fession. not only protected but censured the medical As leaders and teachers of public morals profession in bitterest terms, and have and conservators of public health not only finally resented the slur by not only turn- the doctor, but also the more intelligent ing the tables and damning us, but have al- layman must be taught the necessity of recmost entirely refused to take the medical ognizing the true significance of heredity profession into their fullest.confidence as and eugenics as well as the need of approwell as declined to recognize more just their priate legislation regarding marriage of the ethical standards. Moreover they have unfit, such as epileptics, consumptives, legally, morally and socially put those who syphilitics, confirmed criminals, the feebleclaim the name of doctor in the same class, minded and the more acute and chronic believing that all doctors are "tarred with insane, as well as many other defectives, inthe same brush."
cluding their appropriate classification surThat the medical profession today feels gical, sterilization and specialized forms of keenly the low public esteem in which it is treatment and prevention. held beside the disgrace which many of our In addition, modern social medical needs more unworthy so-called members have of mankind demand certain forms of segreheaped upon it, is very clear. Hence our gation and rigid classification of the varimore enlightened and sagacious leaders be- ous functional or borderland abnormal men. lieve the time is at hand when we as a pro- tal states known as the psychoneurosis, fession should become more directly related more especially those found to exist in our to the general public by studying the larger public schools and colleges, or roaming at social preventive medical necessities and large on the street of the city as well as the ministering to them, not only in their more more pronounced types of insanity, all of strictly medical, mechanical aspect, but in which require improved methods of care, their larger, practical educational, scien- treatment and prevention. tific and humanitarian, preventive, social The duty of disseminating this practical welfare relationship.
knowledge, more especially in its medical It is, therefore, one of the essential func- preventive aspects, of necessity belongs to tions of the newer mission of the doctor and the medical profession, and we are criminhospital to subserve this great educational ally culpable when we neglect to ignore cause by regaining, if possible, the lost such a public obligation. public esteem and confidence and restore to the medical profession its former valued
THE NEED OF SUPPRESSING QUACKERY. public prestige by getting into closer direct Moreover, all forms of medical quackery sympathetic educational touch with the under any cultism or pathy it may be people and entering more deeply into their known should be publicly condemned aud larger preventive social medical needs and the medical profession purged of its many moral welfare interests.
disreputable members and fraudulent fak
irs, while the general moral tone and ethiTHE NEED OF POPULARIZING SCIENTIFIC
cal standards of the profession must of neMEDICINE.
cessity be greatly elevated, enlarged and When preventive medicine is understood ennobled in order to meet the larger modern arightly, and practically applied, it will be medical, social and moral welfare needs of found that primarily it relates to the the people. studies of a medical college curriculum, In this connection we regret to note the such as anatomy, physiology, hygiene, sani- favorable encouragement given at the prestation, chemistry, bacteriology, psychology, ent time to all kinds of medical charlarheredity, eugenics and prophylaxis. More- try by the general public, and even the clergy, are not free from such vice, as evi- titioner depends upon his knowledge and denced by their ready willingness to fur- application of these principles in his own nish written public and private endorsements practice, while the salubrious character of known medical quacks and quack reme- and moral virtue of any city or community dies, patent drugs and similar proprietary is also gauged by the same standard which articles.
becomes eviderit in their lower mortality Also their constant encouragement of the rates, favorable vital statistics, and greater divorce evil with all its consequent suffering reduction of vice, crime and pauperism. by marrying the known unfit for the price As a result of these evolutionary medical of a fee, which is not only a shame and dis- social movements we therefore discover that grace to themselves and their sacred call the modern well-trained, competent physiing, but a menace to society, which needs cian and surgeon desires to become not greater emphasis from the legal as well as only efficiently prepared in the more strictmedical profession, for it not only ignores ly technical details of his profession, but moral and civil law, but also ecclesiastical also well acquainted with the more practias well as medical ethics.
cal features of the intricate social, moral, Newly awakened to these various profes- psychologic and even religious pathogenic sional human aspects of disease and suffer- causes of diseases and their pernicious ing the modern doctor fully realizes his in- effects upon the entire human economy, toadequacy and failure of present methods to gether with the special details of their abmeet all such social, moral, legal and medi- solute prevention. cal exigencies. While the existing medical His scientific medical practical knowledge system with its known faulty machinery of is therefore applied to not only the objecdispensary and hospital does not provide tive physical clinical foregrounds of disremedies for the relief of poverty, ignorance, ease, but also the equally essential subjecunemployment, ill-assorted marriages, tive, mental and social details associated moral and legal defects and similar under with the backgrounds of his patient, thus lying pathogenic factors of disease and suf. regarding him as a whole, body, mind and fering, yet the modern, progressive doctor soul. does not fail to see new spheres of medical In its largest therapeutic sense the Newer usefulness to mankind in their correction Mission of the Doctor and Hospital is and prevention. Hence, not only the entire therefore recognized today to be not so practice of medicine, but the whole point of much one of saving persons from the bad view of the medical profession is at the pres- effects of disease (this of course is necesent time undergoing a remarkable evolution sary), but the greater medical service to as well as revolution, which has for its key- mankind lies in protecting and preserving note the greater medical and surgical effi- the health and life of the citizens by the ciency through the instrumentality of a removal and prevention of the ravages of larger social, moral, public, preventive wel- all its known social, psychologic and pathofare service of both hospital and medical genic causes, and to this larger and more practice, which must of necessity be made humane service the medical profession are sufficiently comprehensive and sagaciously already committed. benevolent in its several departments to In order that this larger modern social subserve and relieve the varied ills of hu- medical welfare propaganda can be made to manity.
reach its highest state of efficiency the
medical profession as a whole must of nePREVENTIVE MEDICINE THE GREATEST ASSET cessity become more practically and personTO HEALTH AND HAPPINESS.
ally interested in its divine mission and purAll medical authority agree that when pose by taking upon themselves the fullest the principles underlying the more advanced function of their sacred duty to mankind in methods of scientific preventive medicine is the manner already outlined. In return for duly and efficiently enforced it furnishes their larger gratuitous public sacrificial servthe most important asset toward fostering ice, and work of love for humanity (which we the maintenance of health, longevity and admit is already burdensome to some of social and moral happiness.
our members), the National, State and city Dull indeed, therefore, as well as sordid governments and public officials, as well as must be the medical practitioner as well as citizens must be taught by us to respect our citizen who fails to discern, much less sanc- larger accredited professional rights in a tion, the sacred trend of these more exact, manner heretofore unrecognized, and be just and discriminating social, moral and more graciously willing in the future to medical reforms. Indeed the actual en- guard and protect our medical, ethical and lightened test of the moderu medical prac- legal interests in such a way as will appeal to our better judgment and satisfied ap- with the surprising results obtained in some proval. That the National, State and city of the cases, we could not state that melu. public officials have often in the past large- brin was superior alike to all other antily ignored the public gratuitous work of the rheumatics and antipyretics. We too have medical profession as well as treated with had failures in which the salicylic prepararidicule their voice in matters pertaining tions and aspirin either alone or in combinto hygiene, sanitation, education and gen- ation with melubrin have obtained results eral forms of legislation is very clear. better than those from the latter alone.
Moreover they have treated with scorn But we have shown that when melubrin is and utmost contempt the purely medical given in proper dosage it is equivalent to ethical rights of the profession and severe- all previously tested remedies, especially in ly criticized our most sincere efforts to ele- acute articular rheumatism. vate the practical standards of public health We perceived one disadvantage, the neand social betterment, branding them as cessity of giving melubrin in large doses. sordid motives and selfish interests.
An advantage, however, appears in our exBy the mutual correction of all such mis- perience of the innocuousness of the latter takes and .a more intelligent, sympathetic even in large doses, as neither the gastropublic co-operation and study of our social, enteric tract nor kidneys showed any effects moral and medical needs may we arrive at of irritation. When we give salicylic prepa better understanding of ourselves and our arations in large quantities it is the gastri. neighbors, and may we not only as physi- tis which may develop that antagonizes the cians but as the more favored citizens of a treatment. Melubrin was once given with great and growing city as well as republic, success despite the presence of hemorrhagic work more harmoniously for the greater nephritis. If albumin did appear in the good of humanity and thus make ourselves urine under melubrin it lasted but a few more worthy disciples of the sacred voca
Hence nephritis in rheumatism does tion to which we are called. Such a divine not form a contraindication to this drug, purpose as this constitutes the very essence which may be given intensively in the of the Newer Mission of the Doctor and severest cases of acute polyarthritis. Hospital, and as medical men it is our priv- During a half year we have given 150,000 ilege as well as duty to help in its speedy grains of melubrin to 164 patients of every consummnation.
age and both sexes. It seemed to us im900 Rialto Building.
portant to investigate daily the urine and its centrifugate. We did not see a collapse after a large dose; neither was there any
complaint of tinnitus, vertigo, profuse MELUBRIN AS AN ANTIRHEUMATIC AND sweats, etc. In two cases only diarrhea set ANTIPYRETIC.
in and was successfully treated for two days
with opium without stopping the melubrin. DR. ERICH KEUPER, Berlin
We used the daily dose of 120 to 150 grains, Assistant in the First Division for Internal Medicine of the because this had been found safe in every City Hospital at Urban, Berlin.
way by Loening and Schrenk. On this In the past few years, a number of new
basis we almost always secured defervessubstances differing very decidedly from cence in from three to six days, while the one another, have been introduced as anti- pain subsided and the swelling yielded quite rheumatics; some of these, which are given notably. In all such cases we gave about in relatively small doses-pyramidon for 90 grains daily for the next four to six days. example-possess a purely antipyretic ac- After that we gave 45 grains daily and usu• tion. To this group belongs melubrin, re- ally completed the cure in a couple of days cently placed on the market by the Far- more. bwerke-Hoechst Co., and which has been The cessation of fever and pain was shown by Leoning and Schrenk to possess
strikingly prompt, and 36 cases of acute equal powers with pyramidon. We have articular rheumatism thus yielded to melu. tested from this viewpoint 164 cases com
brin. prising not only rheumatic affections of all
With chronic articular rheumatism and kinds but also other highly febrile affec- muscular rheumatism we must expect retions in order to determine whether the verses under any treatment. In 60 cases of benefit is to be attributed to the antipyresis.
chronic articular rheumatism we were unWe had in mind especially acute rheumatic able to convince ourselves that melubrin polyarthritis. If we were to rest content was a specific, but it was at least as useful The present work done under Prof. Starck at the Medical
as any other measure now before the pubDivision of the City Hospital, Karlsruhe.
lic. It is certainly an asset that melubrin
can be given over long periods without any remedy given for chronic articular rheucausing disagreeable collateral effects. matism. Certain cases refactory to the acThis cannot be said truthfully of all anti- tion of a remedy improve under a change rheumatics. In any case, however, the of medicines, especially if hydro- and elecmedical treatment must be backed up thor- tro-therapeutics are added. In the case of oughly with hydro-and electro-therapy; SO melubrin, however, we are dealing with a that high doses of drugs need not be in specific antirheumatic, which should also creased. The author, in fact, was able by be of use in chronic rheumatism when emusing physical methods to keep the dose of ployed with system and patience. Some melubrin down to 90 grains daily, and in such course is necessary to prevent permanmore obstinate cases to 75 grains. With ent incapacity and invalidism. We have the condition still obstinate the dose could treated ten such patients within the last gradually be brought down to 45 grains, and six months with melubrin. All were beeven to 15 grains with successful outcome. tween 30 and 60 years of age, save a 15-year
Affections other than arthropathies also old boy. Most of them had had at least ten yielded to melubrin. Not only rheumatic attacks of acute articular rheumatism, and pleurisies but those actually tuberculous all had organic heart disease. There was were healed in the same manner. Four no temperature when first examined, save cases of sciatica and one of chorea minor on in one case, and the joints of all were swola rheumatic background were fully healed len but not very painful. In addition to as was also a case of morbus maculosus drugs all had the advantage of treatment Werlhofii in quick time.
with salt baths, hot air douches, electric Aside from the 112 cases in which melu- light baths, local use of salicylic acid, brin was employed for rheumatic affections, eosin, sunlight, etc., while both old and it was also used in 2 cases for its antipyretic new tuberculin cures had been tested as and analgesic effects. These were a great well as purely mechanical treatment. Five variety of conditions (typhoid, septicemia, of the ten were discharged as able to work, inuflenza, erysipelas, etc.). It may be there remained invalids because of stiff stated that the drug exerted no influence joints and senescence, and in the other two whatever on measles, although it was able the severity of the cardiac lesion gave hopeto lower the temperature decisively in the less prognosis. other affections. The antipyretic power In one case in a man aged 34 the benefit was shown in the positive cases by suspend- from melubrin was very distinct.
This ing it from time to time where upon fever as the one in which fever existed; 120 retained.
grains daily of melubrin causes complete We present a few case histories in which defervescence. After eight days without patients with acute rheumatic polyarthritis, fever 90 grains salicylic acid per day were chorea minor, sciatica, purpura hemorrhag- given whereupon fever returned and perica and exudative pleurisy were treated sisted seven days.
Then melubrin, 90 with melubrin. These are given in ab- grains, daily, was substituted and once stract only.
more everescence occurred and remained In acute rheumatic polyarthritis the pa- under the continuance of the remedy. On tient was a farmer, aged 38. On June 17, the other hand salicylic acid showed better 1912, he was attacked with chill. Violent control over the pain. The cure was compains in knee and ankle joints. High fever pleted with hydro-therapeutic measures and and mental confusion. He was given sali- a tuberculin cure. cylate of soda at home and at first improved. We gave melubrin in 15 cases of acute Pyrexia, however, did not abate, and this and 31 cases of chronic muscular rheumawith dyspena brought him to the clinic tism. Of the first series 12 were cases of (July 1). In addition to the original in- lumbago. flamed joints he was found to have bron- In order to obtain a pure picture of the chitis and left-sided exudative pleurisy. He action of melubrin we did not
as usual was placed upon melubrin for three days resort likewise to electric baths, hot air by which time the condition was under con- baths or vapor douches. In 10 of the 15 trol. There was no steady fall in tempera- cute cases we obtained by the end of the ture, for the latter showed the daily rise as third day, with an initial dose of 120 usual; but by July 6, five days after admis- grains of melubrin, a disappearance of the sion, patient was comparatively free from pain, while all the cases showed improveall serious symptoms. He was left under ment. We then reduced the doses gradual. treatment until July 20 and was then dis- ly. The average duration of treatment, charged "essentially improved."
until patients were able to resume work, It is difficult to judge of the efficacy of was nine days. Two cases terminated in two days while in the two most unfavor
Heraldings able 20 days were required.
In chronic muscular rheumatism it is Are you an active member of the medical naturally difficult to estimate the action of knockers? Ye must be born again! the remedy. There were no total failures, 1 Is cleanliness next to godliness” a quoand we were able to note a prompt, favor- tation from the Bible? able influence over the pains. No unpleas. ant collateral effects were noted.
T The indications then for the removal of In 18
adenoids and hypertrophied tonsils would cases melubrin was alternated with other salicylic acid preparations, but no essential
be the presence of demonstrable enlargedifferences were noted. In all 31 cases
ment plus symptoms, and these symptoms patients were able to return to work.
would be the result of mechanical obstrucThere was one case of purpura hemor
tion or of infection or of both. rhagica, male 37, with exacerabations of Shop early! The holiday season rapidly articular rheumatism. The first severe
approaches, outbreak was accompanied by much swell
1 Some one says that good taste is a large ing of numerous joints and gingivitis. The
part of religion, while some one else says latter was so severe as to interfere with nu
that the kind of help given the farmer for trition. Prupuric spots developed over his stock should be given for his family. knees and ankles. Melubrin brought down the fever and pain and some of the swell
The family dinner when all can meet, ing. The stomatitis improved slowly, with
should be a daily happy event, with jollity one sight relapse. Discharged cured after and every one in the best of spirits. Then about five weeks' treatment with melubrin.
we could get along perhaps without so There was one case of chorea minor, in a
many "Gastric Aphorisms.
The poor 12-year old boy. History clean until a
bachelors take notice! cent attack of influenza. Chorea followed The point has been raised that there are close upon, of severe type, boy unable to too many medical societies. Otherwise, feed himself. Treated with hydrotherapy, how could the married man have a frequent aspirin, arsenic and chloral. Then placed excuse for his absence from home? on melu brin, which for the first few days
1 Our tubercular friend Knopf suggests produced no change. Improvemement now became rapid. Motor, disorder limited to
that discarded battleships be used for the intention movements, and patient could
tuberculous. walk a little. Mental state, which has The future of preventive medicine may been one of a pathy, then improved. After be right and all embracing, but it will nine weeks of melubrin he was pronounced prove debilitating to the medical profescured. Initial doses 90 to 120 grains, grad- sion. Salus populi suprema lex will prove ually reduced after improvement set in. to be our undoing. Thirteen cases of pleurisy with exudation
In London a man, responding to a toast, were seen. Two also had polyarthritis lifting his glass said, "A doctor is the man rheumatica, and, with the addition of three
who prolongs life and makes death easy." others, form a series which are classed as rheumatic. The other eight were evident
[ "He that conquers himself is greater ly tuberculous pleurisy. All cases pursued than he that taketh a city." Let hunters a favorable course under melubrin, the exu- after happiness consider. date having been quickly absorbed.
[ We are against "raw food faddism" and author, however, is far from imputing the consider it the diet of cranks. Dietetics a results solely to melubrin as other measures neglected study. usually employed were not omitted. The eight tuberculous cases with one exception
Dejerine says that psychotherapy depends
wholly and exclusively upon the beneficial received no tuberculin. Melubrin was nat
influence of one person on another. Elecurally given to antagonize fever and pain
tricity and vibration experts please notice. as well as a possible rheumatic tendency.
The ancient adage, “It is faith that saves
or cures. Do Your Christmas Shopping Early.-On
Also, neurasthenia is due wholly to pss. another page, in this issue, you will find a
chological factors, and that these psychoplan for making it easy for the doctor."
logical factors are essentially, if not excluIt is a suggestion made by Emery, Bird, sively, determined by emotion. Thayer Co., whose name is a household When you educate the public in cancer do slogan in Kansas City.
you tell them the cause?