Vol. 18

W

HAT is one to do when he finds himself hopelessly out of rapport with the spirit of his times? The tide of professional thought and endeavor sets strongly in a direction of which he does not approve. Shall he allow himself to be swept into the current and be carried in the same general direction, seeking only to provide for his own interests and endeavoring to ride the waves instead of being submerged? Or shall he stand like a rock in the stream and deflect at least a portion into the better channel?

The trend of the medical movement is toward the specificity of disease, and to its treatment by means directed against each malady as a pathologic entity. The type of a remedy is antitoxin directed against diphtheria per se; applicable to every case, regardless of individual features, age, sex, race, symptoms, strength of patient, vehemence of attack, points of least resistance and greatest peril, environment, and accessory causes impelling toward malignancy and death.

The treatment? Over against the word "diphtheria" is set the other word, "antitoxin," and woe be to him who dares attempt to add aught thereto. Let his name be anathema. I have heard men in medical meetings demand that he who dares

No. 7

utter another word on treatment of diphtheria be refused a hearing! The truly scientific chap falls in line, and looks for therapeutic advance in serums, opsonins, salvarsans, and similar specifics.

I simply can not and will not fall in line. It is of very little moment to the world or the profession that any one individual should stand aside from the crowd and be neglected. It means a very great deal to the world, and more to the medical profession than to any other, that the man in whose mind is implanted the conviction of a truth should adhere to it. The freedom of humanity today is built on sturdy old Luther's declaration: "Here I stand, God help me, I can not do otherwise!"

The way of progress for us does not lie in the development of specifics for disease, but in the study of physiology, the detection of aberrations from physiologic function and their correction. Earlier, still earlier, we must learn to detect the beginnings of disease and the causes at work; to remove these and restore harmonious, equable activity to the organic functions. It is not the illustrious orator in the school, the skilled specialist, the daring wielder of bistoury and of scalpel, the accomplished manipulator of test-tube and reagent, of microscope and stain. It is you, YOU,

YOU, who must do this work; the Doctor, unlimited, the greatest of specialists, he whose specialty is the man himself, not any single organ or region or tissue or function.

The way to study and treat cases is to individualize them, not take them en bloc. The time to take cases is in the beginning, before irreparable damage has been done. The way to treat patients is to strike at the causes of disease, to remove these, the foundations, when the malady will fall of itself. This means individual study, early study, steady surveillance; and this again brings us to the noblest of our duties, the prevention of disease, and its arrest in its very incipiency.

Irresolution is a worse vice than rashness. He that shoots best may sometimes miss the mark; but he that shoots not at all can never hit it. Irresolution loosens all the joints of a state; like an ague, it shakes not this nor that limb, but all the body is at once in a fit. The irresolute man is lifted from one place to another; so hatcheth nothing, but addles all his actions.-Feltham.

ILLINOIS AND MEDICAL EDUCATION

A great deal has been said by a very few men about the deplorable condition of Chicago in the matter of medical education, and in the heat of this discussion The Illinois State Board of Health, which is our examining body, has been severely criticized.

We do not care to open the old discussion or to go over the ground again, but we would suggest that some of the captious critics, who have found in Illinois everything that is bad and in Baltimore and Boston practically everything that is good, should investigate some of the work which has been done right here in the State of Illinois for the advancement of medical education and the protection of the medical practician.

It is true that we have many colleges too many. But this excessive educational activity, after all, is nothing but the outgrowth of the surpassing energy of the West, so strongly exemplified in the Chicago spirit. Incidentally, the weaker colleges are being weeded out or, what is even better, made stronger.

Not everyone knows that a Chicago institution-the old Chicago Medical College, now the medical department of Northwestern University, was really the pioneer in the new medical education. This was the first school in the country, we believe, to introduce the three-year course; it was one of the first to insist upon four years of study for the practice of medicine.

So, also, Illinois was one of the first states of the Union to insist that adequate qualification should be required from the men desiring to enter the profession of medicine. This state was one of the earliest to require an examination of candidates desiring to enter the profession. It was the pioneer in advocating reciprocity between the different state boards, this much-to-be-desired movement having been instituted largely by and owing much to the energy of the Secretary of the Board, Dr. James A. Egan.

The Illinois Board was also the pioneer in the matter of allowing credit points to a physician for a certain number of years in actual practice. Ten years ago candidates from any other state were required to pass exactly the same examination before the Illinois Board and to make exactly the same grades irrespective of whether they were just out of college or had been in the harness fifty years. This manifestly was unfair to the old practicians, hence the Illinois Board decided to allow a credit of one percent on the average rating for each year of bona fide practice since graduation. More than twenty states have, since then, followed the example of Illinois in thus giving the older practician the square deal.

The Illinois Board was also the pioneer in requiring a photograph as a means of identification of candidates. Probably a dozen states have followed this excellent example. Illinois is the only state that requires the physician by whom the candidate is introduced to certify to this photograph, which the applicant must have on his table before him throughout the examination. Numerous frauds have been perpetrated upon other boards by men who have hired substitutes to go through the examination for them.

Besides being the examining body for physicians, The Illinois State Board of Health is also the examining body for the embalmers. Furthermore, it is charged with the supervision of and enforcement of the health-laws of the State. The duties devolving upon it are enormous, and they have been met with marked ability, in spite of the lack of cooperation on the part of those who should support it at every point.

It is to be regretted that a small number of irresponsible self-advertising muckrakers should be able to secure a hearing in the public press, for their sensational and defamatory attack of this great official body that has done so much for the physicians of this State, and incidentally of all other states of the Union.

A curious controversy is being waged in the columns of The Critic and Guide. Upton Sinclair, of "Jungle" fame, declared that syphilis, gonorrhea, and malaria could be cured by fasting! Editor Robinson, in denying this assertion, promptly offered to put up $1000 against a similar sum, to put the matter to a critical test. Sinclair quite as promptly backed out, thereby demonstrating the depth (?) of his belief in the things he advocates.

All this is trite, the commonplace experience of every American who knows the game of bluff.

However, there is a deeper significance to the seemingly trivial incident mentioned. It indubitably furnishes evidence on the mental status of the laity as regards matters medical, and that deserves some closer consideration.

Let us assume that Mr. Upton Sinclair is, not so much his individual self, as the representative, the average man, of his class the ordinarily educated and intelligent newspaper-man or litterateur. He

would certainly claim to be that much, and undoubtedly rates himself much higher. He has succeeded in getting into the limelight and has a following. Many may have been impressed by his work and are ready to accept his dicta as possessing a certain measure of authority, or at least as deserving consideration. As such, he ventures into the department of a special calling, a profession held by men of particular education and training, and to these specially instructed men he delivers opinions concerning their affairs, with a force and self-confidence that carry weight with men of his own type as well as the vast masses of less qualified judgment.

Instances are not wanting where men of superlative genius have instructed specialists in the latters' special sphere; as, when Napoleon pointed out to Talma an error in that great actor's conception of a character he had represented. But Napoleons are rare, and Sinclair is not a Bonaparte. Besides, the views of an emperor at whose feet all Europe lies are apt to be accepted as law, if not as gospel.

To the physician, the absurdity of Mr. Sinclair's assertion verges on the grotesque. All three diseases are of parasitic nature, syphilis and malaria being due to animal organisms, and gonorrhea, to a coccus. That either could be in any manner affected by fasting is as likely as that pediculi capitis could be banished by that means. In fact, Dr. Robinson would do well to propose phthiriasis as a better malady in which to make the test, since the laity could judge of the results more readily than in dealing with microorganisms demonstrable only by the delicate methods of the biologic laboratory. Such a test surely would prove instructive to the rash Mr. Sinclair, and the easy gradation from a parasite visible to the naked eye to those that require the compound lens for their disclosure might result in an increase of his wisdom-also caution.

In every vocation of man there are to be found amateurs and professionals. Sometimes the former score off the latter; and then there is a howl of delight, for the crowd always sympathizes with its own and delights in going against the exclusive.