For the very excellent reason that corners and angles are unsanitary, there are to be no more of them in the construction of houses and office buildings of the better class. They are being built with "round" corners; even the ceiling and walls, and floor and walls, meet in a curve,—no square crevice or corner where dust or germs can gather.

If we add moisture to a sunless spot, we have the ideal environment for germs to breed and flourish in. There is always moisture or humidity in the air if the altitude is low, and if it is near the ocean, or any large body of water, the moisture is relatively greater. For this reason we send patients with pulmonary disease to the mountains, where the altitude is much higher, where there is no moisture, and consequently where there are practically no germs. We cannot move our homes to the mountains, however, so what must we do to get rid of the moisture and the germs where we are compelled to live? What do we do with the family wash when it is wet? We hang it up in the yard, in the sun and in the breeze, because we know from experience that the wind and the sun soon dry anything wet. They do more; they freshen everything, so that anything exposed to the sun and air smells fresh and sweet and is fresh and sweet and pure. So to make our homes sweet and fresh and dry we must chase the stale air away, and the moisture with it, by opening our windows and letting in the sunlight and the breeze, every day, and for as long as possible every day. Open windows and sunlight and fresh air,—all you can get,—this is the song of health, the joy of life, the only agents that will keep the eager, busy, little white blood cell healthy and willing and alert. This is the reason you must keep the windows of your bedrooms open at night, as well as by day, so you and your children will get fresh, pure, sweet air, and not stale, moist, germ-laden air to breathe.

FACTS ABOUT TUBERCULOSIS

Tuberculosis, or consumption, is a disease of poor air, dusty quarters, insufficient nourishment, and, above all, of ignorance with regard to its dangers and what we now know of the possibilities of its cure. The more we know about it the better chance there is to cure it, and better still, prevent it.

Not very long ago the death rate from consumption was one in six, that is, every sixth person who died in this country died as a result of tuberculosis in some form. It is now about one in eight. This is a remarkable decrease—about one-third of its former ratio of victims are now spared. Not so very long ago the disease was regarded as practically fatal; now it is classified as one of the eminently curable diseases. The universal dissemination of this knowledge will do much to rob the "Great White Plague" of its terrors.

Investigation and observation have demonstrated that there is in the great majority of people a definite tendency successfully to throw off the disease. It is a curious and astonishing fact, which we have learned from the study of the results of autopsies; we find, in nearly every instance, that every person in whom death occurred after thirty had had consumption at one time and resisted it and died of some other disease. We mean by this that at some time, in all likelihood during one of the "colds" of childhood, every one of us contracted consumption, but because of our vitality we successfully resisted and conquered it. In other words, the white blood cells won their fight.

This knowledge is of great value; it taught the scientists who were studying the characteristics of the disease that there were conditions, possible of attainment, under which the human organism could definitely and victoriously defeat the invasion of the tubercle bacilli.

The public mind, until recently, was imbued with the fallacy that the disease was hereditary. It was thought that if it "ran in the family" the victims of it were almost certain to die. We know definitely now that consumption is not hereditary, and that, instead of death being certain in a patient in whose family it has been, this fact alone ensures the victim a much better prospect of cure than if it had never existed in the family. The explanation of this seeming paradox is quite logical from a medical standpoint. The theory of the vaccine treatment of disease is that if you infuse into the blood the products of the germs of certain diseases, the individual in whose blood the vaccine has been put, will wholly resist that particular disease, or if he acquires it, it will be in a mild and more modified form. If a family for a number of generations has had various members die of tuberculosis, the blood stream of the family will have become so impregnated with the toxins, or poisons, of the disease, that, in time, a certain immunity will have been established. Consequently, tuberculosis in an individual, the blood of whose ancestors has been accustomed or habituated to the poison of the disease, will run a milder course, be more modified in its type, and will respond to treatment easier than in an individual whose family history is free from the taint of tuberculosis.

In proof of this principle, it is a well-known fact that consumption runs a rapid, fatal course among those nations which have not hitherto been exposed to it. The death rate among our American Indians when it was first introduced among them was enormous.

The same truth applies to syphilis. The blood of the civilized race has become so thoroughly syphilized, that it is no longer so susceptible to the disease as it once was: and the disease as we know it to-day does not manifest the same virulency as it did years ago, or as it does in a race in whom it is grafted for the first time.

These ideas of the curability of the disease and of its non-heredity are extremely important and supremely suggestive. Tuberculosis takes only the quitters and the supine. Anyone who will fight bravely against the disease can always resist its ravages for many years, if not to the extent of living out a normal life.

THE TENDENCY TO DISEASE.—Mothers should understand just what is meant by "the tendency to disease." We assert that consumption is not hereditary, but we know that certain individuals are born with the tendency to tuberculosis. Just what does this mean?

Let us suppose a tubercular mother gives birth to a child. It would be foolish to assume that this child comes into the world with a normal standard of resistance; but it is certain he is not tubercular and doomed at the moment of his birth. He may be what is ordinarily termed a weak, puny, sickly infant, but the germ of disease is not implanted in his constitution. If he is taken from his mother, taken away from the tubercular environment, and brought up under the best hygienic and sanitary surroundings, it is possible for him to become a robust, healthy, normal man.

The tendency to disease in this case will not materialize. If, however, we permit him to remain with his tubercular mother, to nurse her milk, to live in what necessarily is an unhygienic and unsalutary environment—the presence of the consumptive mother renders it so—the probability is that the tendency to disease, which in his case is the tendency to weak lungs, will materialize, because of his weak resistance, poor nourishment, and unfavorable surroundings. If, therefore, his method of living does not contribute to building up and strengthening what is in the first place a weak structure, the structure itself will, during the first strain put upon it, give way, and naturally the weak spot will be the point of election for the invasion of disease. This strain may be one of the infantile diseases,—scarlet fever, or measles, or whooping cough, or it may be bronchitis. Instead of convalescing from these conditions, as a normally constituted child will, this child, whose potential resistance is below standard, will fail to reach the rallying point, will afford a fertile field for germ invasion, and will develop tuberculosis,—not directly, however, as a result of having had a tubercular mother, but because he was not removed from the tubercular environment and given a fair chance. The high infant mortality is, to a very large extent, caused directly by this "tendency to disease," plus unfavorable environment, and this is wherein the eugenic propaganda has found its field of promise and is unassailable reason for active existence.

Let us take another illustration, so that mother may have a full understanding of the far-reaching effect of the "tendency to disease."

We cannot justly assume a child to have outlived its hereditary tendencies until it has reached the period of its full growth, physically, mentally, and morally. We know that this period is about the twenty-third year. Now a young girl of eighteen, or even twenty, who is successfully resisting an inherited tendency, is likely to reach her full physical and mental growth, providing she does not subject her vitality to a serious physical strain, or providing she is not the victim of a serious illness. Suppose this young girl marries and becomes pregnant; this condition immediately changes the fighting or resisting equation; she is no longer conserving her strength and energy; she is spending it out, wasting it so far as it applies to her own upbuilding. The percentage in favor of a successful fight against the inherited tendencies is greatly reduced, and as a matter of fact, statistics show—as is fully explained in the article on "The Evils of Early Marriage"—that many of these young mothers succumb to disease as a result of pregnancies at this period of immaturity, when they could have otherwise lived. The "tendency to disease" has therefore an economic value and the state should build along the line of the conservation of health in its broadest sense.

THE BEST TREATMENT FOR TUBERCULOSIS.—The most important factor in the present-day treatment of consumption is the right kind of nourishment. This cannot be emphasized too strongly. In the first edition of this work, it was stated that the most important factor in the treatment of this disease was fresh air. The author has had very good reasons to change his opinion radically in this respect.

So emphatically may this truth be asserted that it is now not at all necessary to seek a change of climate in the hope that such a change may aid the patient. It must not, however, be understood that this reasoning applies to charitable cases. If the patient is so situated that it is not possible to provide a proper environment, a change may do good. It is not the change of air that is responsible for the improvement, however, though it no doubt contributes in these cases; it is the altered environment.

Patients who in their own homes enjoy sanitary and hygienic care; who may have a room of ample size for their exclusive use, which is thoroughly aired, day and night; who are provided with the "right kind of nourishment," and who will obey implicitly the rules which the physician, who is conversant with this particular method of treatment, will lay down, may be assured that a prompt response will ensue. The intelligent reader will understand that this statement does not apply to patients in the last stages of the disease. The assertion, however, must rightly be regarded as revolutionary. It is not what we were taught—it emphasizes, nevertheless, what every physician already knows, that, theoretically, consumption is a disease that should respond to treatment. That we have not had greater success with it in the past, must be attributed to our method of treatment. The fact that most of us have had the disease, and have recovered, conclusively demonstrates its curability. Those individuals who fail to recover promptly do not possess the vitality to throw it off spontaneously. If at this time—the real beginning of the disease—it is discovered, and the right treatment instituted, we immediately supply the organism with the ingredients it is deficient in and we are justified in looking for favorable results if the patient adheres to the instructions.

The second essential in the treatment of consumption is an abundance of fresh, pure air. We therefore direct the patient to remain in the open as much as is possible. If circumstances permit him to sleep out-of-doors, so much the better; if not, he must sleep in a room with the windows open to the fullest extent, winter and summer. There are no exceptions to this rule. If it storms, the outside blinds may be closed, but the windows must remain open. The city air is just as efficient for our purpose as is the air of any other vicinity—the point is, to get enough of it from a mechanical standpoint. The advantages from sending patients away, even under the old belief, were more than discounted by conditions incident to the new environment that were detrimental to their progress. Now that we know it is not necessary or essential to procure any other kind or quality of air than exists in any city, all our efforts may be concentrated in the interest of the patient in directing the "right kind of nourishment" and in supervising his conduct. In few instances is it necessary to prescribe any medicine.

In exceptional cases the cough may require some sedative remedy, especially if it disturbs the patient at night. Experience has taught us, however, that to live twelve hours in the open air and to sleep with the windows wide open, will do more for the cough than any medicine we possess.

Pleuritic complications may cause pain, but this feature is best aided and permanently relieved by fresh air also. Very recently there were made exhaustive experiments in this connection in St. Thomas' Hospital, London, England. It was decided to subject patients to open-air tests for pleuritic pains in the course of consumption. This particular hospital is situated on the River Thames, in a notoriously damp and foggy part of the city; despite this drawback it was conclusively shown that the patients who lived night and day on the balconies breathing this heavy, murky, damp atmosphere, were relieved of their pains quicker, and more permanently, than those who were shielded in the wards of the hospital.

Inasmuch as the patient must be adequately nourished, his cure depends upon the condition of the stomach. It is known that the germ works more actively in a patient who is losing weight. When the germ is very active, its poisons, circulating in the blood, cause fever and fever results in tissue waste. We must therefore bend every effort toward overcoming this tendency. If we can get the patient to take sufficient food and if he digests it thoroughly, the weight will increase, the fever will subside, and the tissue waste will stop. Patients must be extremely careful, therefore, what they put into their stomachs. Only simple, tasty, highly nutritious food should be taken, and digestive energy should not be wasted on less nutritious materials. For this reason incalculable harm has been done by indiscriminate medicine-taking. Medicines exert a bad influence on the stomach and those patients who take them lose their appetites. Drugs should never be taken except for a definite purpose and only on the advice of a physician. These patients should particularly be guarded against the use of advertised patent medicines. They are always bad, and never under any circumstances are they of any advantage, as is clearly shown in the chapter on "Patent Medicines." Thousands of persons die of consumption every year who would have lived had they not taken such remedies.

The following article is sent out by the New York Department of Health as a Circular of Instruction regarding Tuberculosis.

INFORMATION FOR CONSUMPTIVES AND THOSE LIVING WITH THEM

CONSUMPTION IS CHIEFLY CAUSED BY THE FILTHY HABIT OF SPITTING.—Consumption is a disease of the lungs, which is taken from others, and is not simply caused by colds, although a cold may make it easier to take the disease. It is caused by very minute germs, which usually enter the body with the air breathed. The matter which consumptives cough or spit up contains these germs in great numbers—frequently millions are discharged in a single day. This matter, spit upon the floor, wall or elsewhere, dries and is apt to become powdered and float in the air as dust. The dust contains the germs, and thus they enter the body with the air breathed. This dust is especially likely to be dangerous within doors. The breath of a consumptive, except when he is coughing or sneezing, does not contain the germs and will not produce the disease. A well person catches the disease from a consumptive only by in some way taking in the matter coughed up by the consumptive.

Consumption can often be cured if its nature be recognized early and if proper means be taken for its treatment. In a majority of cases it is not a fatal disease.

It is not dangerous to live with a consumptive, if the matter coughed up by him be promptly destroyed. This matter should not be spit upon the floor, carpet, stove, wall, or sidewalk, but always, if possible, in a cup kept for that purpose. The cup should contain water so that the matter will not dry, or better, carbolic acid in five per cent. watery solution (six teaspoonfuls in a pint of water). This solution kills the germs. The cup should be emptied into the water closet at least twice a day, and carefully washed with boiling water.

Great care should be taken by consumptives to prevent their hands, face, and clothing from becoming soiled with the matter coughed up. If they do become thus soiled, they should be at once washed with soap and hot water. Men with consumption should wear no beards at all, or only closely cut mustaches. When consumptives are away from home, the matter coughed up should be received in a pocket flask made for this purpose. If cloths must be used, they should be immediately burned on returning home. If handkerchiefs be used (worthless cloths, which can be at once burned, are far better), they should be boiled at least half an hour in water by themselves before being washed. When coughing or sneezing small particles of spittle containing germs are expelled, so that consumptives should always hold a handkerchief or cloth before the mouth during these acts; otherwise the use of cloths and handkerchiefs to receive the matter coughed up should be avoided as much as possible, because it readily dries on these and becomes separated and scattered into the air. Hence, when possible, the matter should be received into cups or flasks. Paper cups are better than ordinary cups, as the former with their contents may be burned after being used. A pocket flask of glass, metal, or pasteboard is also a most convenient receptacle to spit in when away from home. Cheap and convenient forms of flasks and cups may be purchased at many drug stores. Patients too weak to use a cup should use moist rags, which should at once be burned. If cloths are used they should not be carried loose in the pocket, but in a waterproof receptacle (tobacco pouch), which should be frequently boiled. A consumptive should never swallow his expectoration.

A consumptive should have his own bed, and, if possible, his own room. The room should always have an abundance of fresh air—the window should be open day and night. The patient's soiled wash-cloths and bed linen should be handled as little as possible when dry, but should be placed in water until ready for washing.

Rooms should be cleaned daily, but in order to prevent the raising of dust, all floors must be well sprinkled before sweeping, and all dusting, etc., done with damp cloths.

If the matter coughed up be rendered harmless, a consumptive may frequently not only do his usual work without giving the disease to others, but may also thus improve his own condition and increase his chances of getting well.

Rooms which have been occupied by consumptives should be thoroughly cleaned, scrubbed, and whitewashed, painted, or papered before they are again occupied. Carpets, rugs, bedding, etc., from rooms which have been occupied by consumptives, should be disinfected. Such articles, if the Department of Health be notified, will be sent for, disinfected, and returned to the owner free of charge, or, if he so desires, they will be destroyed.

When consumptives move they should notify the department of health. Consumptives are warned against the many widely advertised cures, specifics, and special methods of treating consumption. No cure can be expected from any kind of medicine or method except the regularly accepted treatment, which depends upon pure air, an out-of-door life, and nourishing food.

Consumptives having an opportunity of entering a sanatorium, should do so at once.

WHEN DELAY IS DANGEROUS.—Inasmuch as it is mother's duty to watch over the health and the efficiency of all members of the household, she would do well to establish a rule to err on the safe side in every case of sickness. That rule should be never to delay too long in obtaining medical aid.

In nearly twenty years of active general practice I have had hundreds of "hurry" calls to "come at once." In not over a dozen of these calls did any of the cases demand immediate attention from a medical standpoint. Most of them, however, should have had earlier aid. People wait too long in the hope of spontaneous recovery, and when, instead of recovery, they realize that the patient is quite sick, they become conscience-stricken and send a "rush" call for the doctor. After delaying from day to day they decide to get professional advice and send a messenger for a physician with instructions to "go for another if he can't come at once." It is imperative he should come instantly, though they have delayed for a week in requesting his services. Every physician has these calls every week of his life. If an individual has survived a week's neglect, it is quite within reason to assume that he will survive another hour,—and during that hour the physician may have time to complete whatever he may be doing when the call comes.

If you have been guilty of bad judgment in not sending earlier for aid, don't add discourtesy to your sins. The world demands of us, and every person has the right to expect, a certain degree of consideration and courtesy. If we do not give it, we only harm ourselves because the lack of cultivation is a detriment which limits growth and happiness. The degree of attainable happiness is limited by the degree of "goodness" that is in us. If you are not considerate, depend upon it, there is an element of happiness which escapes you, and you cannot attain it till you are considerate.

It is inconsiderate and it is discourteous to send an immediate demand for a physician "to come at once" if there is no urgent need for his services, and if you have just been inspired for aid after a week's blindness, there is no urgency in the matter. A call in an hour would do just as well.

Take the following case: A mother discovers a small quantity of blood in the diaper of her two months old baby. There is a larger quantity in the afternoon and she decides to give the baby a dose of castor oil. During the night it slept fitfully and in the morning it has a large stool as a result of the castor oil and there is a large quantity of blood in the stool. She sends a "rush" call for a physician. The physician discovers the following facts: The baby is being artificially fed; it has been vomiting its food for a week; its stools have been green, foul and contained mucus; it had a fever for a number of days; it has lost much weight and looked pale and sickly. The physician obtained this history from the mother—she therefore knew the baby's condition. Why did she delay sending for a physician? How sick did she want the child to be before the need for aid seemed justifiable to her? Why didn't the sight of blood in the stool suggest the need of assistance? What do the public expect of physicians in such cases? But why ask questions? Many mothers will doubt the existence of such a mother as is described above. They need not; she was one of my own patients. I do not understand such women; I only know that such mothers exist in quite large numbers. This particular mother has other children; she is a good housekeeper, is personally attractive, and is thought well of in the community. If such seemingly heartless conduct can spring from such a source is it not evidence of the fact that the average mother needs instruction, needs education, and does it not bespeak the need of eugenics being sown broadcast throughout the land?

Delays are dangerous in all sicknesses that last, despite a thorough cleaning out of the bowels. To wait, hoping that "things will change," is bad practice. It is unjust to the medical profession, and it is infinitely more unjust to the victim.

There are two kinds of surgical operations—those of choice and those of necessity.

Every one knows about the operations of necessity, most of which must be performed as a result of accident, but few people understand the dangers of delaying what are termed "operations of choice." These are for such conditions as appendicitis, cancer, and stomach and bowel troubles.

Delaying an operation of choice lessens the chances of living, and really makes an operation of necessity with fewer chances of recovery than from the operations that must promptly follow injuries.

When we feel that an operation is needed, or are in doubt about it, the wise thing to do is to consult medical authority. Then, if it is found there should be an operation, there is plenty of time to make every arrangement. We can begin to diet, which is generally necessary and there is every chance for speedy recovery.

If a man breaks a leg and it has been set badly, the surgeons do not rebreak it at once, but allow it to heal and the patient to regain his strength, when it is again broken and reset properly. This is an operation of choice.

But if a terrible fracture of the leg results from a fall, with the shattered bone protruding, an operation of necessity must follow to mend torn arteries.

It has been learned through recently gathered statistics that about thirty per cent. of the people operated on for appendicitis die simply because they delay the operation. This should have been an operation of choice, when every arrangement could have been made long beforehand; the delay makes it an operation of necessity, with the victim in such poor physical condition that he has not half the strength to recover that he would have had if he had been wise enough to consult a physician when he first suspected that something was wrong.

These same statistics go to show that fully 99 per cent. of the appendicitis cases, when taken in time, are cured by means of the operation, thus affording the strongest proof of the folly of delaying such things.

The total number of deaths from appendicitis each year, due to delay in operating, is greater than the number of deaths during the Spanish-American War. There are instances where the doctors do not advise operations soon enough.

Above all things, when a reputable physician advises operation, do not think you know more than the physician, but have the operation performed at once. Nine times out of ten this will be the means of saving your life.

WHAT TO EAT AND WEAR IN HOT WEATHER

No faith should be placed in the so-called "hot-weather" foods. The cereals and other manufactured foods advertised as possessing marvelous qualities, have in reality no advantage. Some of them have more or less value as ordinary food, but they certainly possess no unusual superiority. Home cooking is the best in summer or any other time.

Great care should be taken to keep the system in the best possible condition. This will prove the most effectual safeguard against the heat. Some foods do not agree with certain individuals, and these should be carefully avoided in summer. Every person will have to judge for himself in this matter. Otherwise the diet should be balanced carefully so that enough, and yet not too much, is eaten. As much fruit as possible should be eaten, and meat never more than once a day. It is not well, however, to omit it entirely.

Food sustains the body through the heat it generates chemically, and it is therefore impossible to eliminate a certain heating effect. If the system is kept normal, however, and the diet properly balanced, this should not be felt. Work is performed by the body and energy expended. This must be replaced with the heat value of food. A certain amount of fat, starch, and the other constituents of a well-balanced diet is essential.

Fat meats and other forms of fat are the most heating of all foods and may be minimized in summer. The amount of food necessary is, of course, largely governed by the nature of the work performed by the individual. Brain workers can eat very little in the morning and during the day, reserving until evening the single heavy meal. If they have been doing this the year around they probably will be cooler during the morning and afternoon if a light breakfast and luncheon are eaten. It is not well, however, to make any radical change from one's regular habits.

Manual workers require more food, and the heavy meal had best be eaten in the middle of the day. All three meals should be substantial. There is no danger of eating too much if the system is not overburdened.

Not only is pork rich and fat, and therefore very heating, but it is the quickest of all meats to spoil. Veal also spoils very quickly if not kept at the proper temperature. Of all meats mutton has the best keeping qualities. Beef also keeps well and is a safe meat to eat in summer.

Flies are dangerous under any conditions, but particularly should they be avoided where meat is kept. The bacteria they carry thrive particularly on meat, and therefore are apt more rapidly to multiply than if deposited on some other food. Care should be taken to buy meat only from places where adequate protection is provided against flies.

It is of the greatest importance to keep the meat at a uniform cold temperature. It should not be allowed to become heated, and then cooled again. Some meat shops still keep the meat on open counters or hooks and replace it in the refrigerators at the close of the day. These shops should be carefully avoided. Modern methods provide glass-covered refrigerating counters which keep the meat cool while it is on display.

Meat should be kept at as low a temperature as possible. The ordinary refrigerator is at a little above freezing and temperatures at or below zero are preferable.

SCIENTIFIC DRESSING.—By dressing scientifically it is possible to minimize the effect of the heat. The heat from the sun must be kept away from the body and the heat generated by the body permitted to escape. These results can best be accomplished by having the clothes very loose fitting, so as to leave ample air space, and by having the outer clothes of a good non-conductor of heat. The cloth, of course, should be as light in weight as possible, but it is more important to have it a good non-conductor of heat and of porous weave.

Not enough attention is paid to the selection of colors for resisting the heat. Two cloths identical except in color will show a great difference in the comparative amount of heat they let through. Light shades should be chosen, but care should be taken to see that they are not glaring, so as to irritate the eye and increase the mental effect of heat.

Linen and silk are better non-conductors than wool. And the weave of a cloth has a great deal to do with the amount of heat it lets through. Smooth, hard weaves absorb much less heat than fuzzy weaves. For this reason, serge is much cooler than worsted of the same shade and weight. A mistake is often made, however, in getting serge of a dark blue. It should be of as light a color as possible; gray is much cooler than blue. A white serge is much cooler than white flannel, because it is less fuzzy.

Linen is much cooler than woolens, because it is a better non-conductor and is of more porous weave. The linen thread is rough, which causes inequalities in the weave, permitting a more thorough circulation of air. Cotton is a still better non-conductor than linen, and would be preferable for summer clothes but for the fact that it neither wears nor holds its shape so well.

Mohair is very light in weight and cool looking. As a matter of fact, however, it is a fairly good conductor of heat, is closely woven, and usually comes in dark shades. It is a woolen cloth, and any woolen has its threads woven more closely on account of the process of manufacture than linens, cotton, and silk cloths. Linen is perhaps the best material for summer wear. It is porous in weave, light in color, and of fairly light weight.

It is well to remember that the safety valve of the body in hot weather is the evaporation of perspiration, not the act of perspiring. If the hand is put in a glove, for instance, it will perspire much more than if in the open air, but it will not be as cool. It is the evaporation that is a cooling process. If the perspiration is absorbed it cannot evaporate. That is why loose fitting undergarments are cooler than tight ones. It is also the reason why cotton is cooler next to the skin than linen or silk; it absorbs moisture less freely.

DRINK PLENTY OF WATER.—Water, and a great deal of it, is desirable at any time during the summer. It should be drunk freely during the day. Lemonade also is good, the slight acid being an aid to digestion. It is best to have beverages cooled only to a moderate temperature. Ice water is not bad, but it would be preferable if it were not at so extreme a temperature. Ice is resorted to only as a convenient means of securing a palatable temperature; the system does not crave extreme cold. Water at the temperature of the air is nauseating, so ice is put into it and the other extreme secured. Sixty degrees is the ideal temperature for drinking water. If this could be conveniently obtained it would be preferred to a greater degree of cold. Not only is it less harmful to the system, but it is more satisfying and thirst-quenching. Water put in bottles and left in a refrigerator until properly chilled is the best way of preparing a summer beverage. When any beverage is sufficiently cold to cause a pain in the head or throat when drinking it the result may be harmful. Cold water poured on the wrist or head has a cooling effect and tends to reduce the ice water habit.

If one could afford it, it would be well to drink nothing but mineral water in the summer. Not only does it assure purity, but the gas is an aid to digestion and serves to render the water more palatable. This results in more of it being drunk than if it were flat water, and it is desirable to drink as much water as possible in hot weather. By mineral water I mean carbonated bottled waters intended for table use. Care should be taken that the water is only lightly impregnated with salt.

It is much safer to drink a well-known water. The water may not be bottled at the spring or it may be bottled under unsanitary conditions. In many cases mineral water is not all that it should be in cleanliness. Unless one is sure of the purity of a bottled water good hydrant water supplied through the city pipes is safer.

In traveling, however, and at summer resorts it would be well to drink nothing but mineral water of a well-known brand. Only by doing this and by being certain that the bottle has not been refilled can one be safe. The supplied on trains and in resorts frequently is not as pure as that supplied in large cities.

On the whole, however, mineral water has no particular advantage over ordinary water except that the well-known brands are sure to be pure, and the carbonization makes it more tasty and so increases the amount consumed. It is much safer and more healthful to drink a well-known mineral water than the so-called soft drinks, many of which are unclean and harmful.



DISEASES OF WOMEN



CHAPTER XXIX

DISEASES OF WOMEN

Importance of Diseases of Women—The Beginning of Female Disease—Ailing Women Are Inefficient—As Home-makers, as Wife, as Mother—Few Ailing Women Become Pregnant—The Chief Cause of Female Disease—The Existence of the Average Mother—Female Diseases Are Avoidable—The Story of the Wife—Women Who Don't Want Children—Abuse of the Procreative Function—What the Woman with Female Disease Should Do—Cancer in Women—Cancer of the Breast—Cancer of the Womb—What Every Woman Should Know About Cancer—Change of Life—The Menopause—The Climacteric—The Average Age at Which the Change of Life Occurs—Symptoms of the Change of Life—Importance of a Correct Diagnosis—Danger Signals of the Change of Life—Conduct During the Change of Life.

No conscientious physician can give thought to this subject without being profoundly stirred. It may justly be said that all types of disease affecting the general health, the happiness, and the efficiency of the people are equally important, and should elicit the same degree and quality of kindly consideration. For many reasons this is not so, as I will endeavor to show. The dominating reason which renders diseases of women an exception to this rule may be mentioned here, however, so that the reader will keep its supreme significance prominently in mind while considering the subject in its various other aspects. "Diseases of women" rank first as a eugenic problem. They have a direct and far-reaching influence on posterity. They affect the environment of the home and thereby the health and the efficiency of all concerned.

The diseases which form the basis of the statements in this article are as follows: leucorrhea, displacements, or malpositions of the internal organs; lacerations, ulcers, tumors, sexual incompetency, and the venereal complications.

It is not possible or desirable to tabulate the symptoms which result from these conditions. They would not convey to the average individual a just picture or an intelligent summary of the life of a victim of these ailments. An actual description of the life of a patient will be more effective because it will depict the incidental domestic atmosphere in which most of these patients live.

THE BEGINNING OF FEMALE DISEASE.—When a woman first begins to feel the effects of so-called "female weakness" she is conscious of not feeling "fit." She wonders what the matter is. She may not have actual pain at this time, simply the consciousness that "she is not what she used to be." Her work seems harder and more tedious, she worries without cause, she begins the day with less energy and ambition than she used to, her disposition is more uneven, more irritable and she tires easier and is more willing to retire earlier than formerly. After a time she has more or less undefined pains. It may be an occasional headache, or backache, or she may have various severe neuralgic twinges. She gets nervous and moody; her appetite is not good and she is troubled with constipation. A little later, the general condition growing worse, her nervous system suffers most. So she drifts into neurasthenia and has fits of crying and periods of melancholia. She is more irritable, more impatient, more dissatisfied with herself, her family, and her friends. She loses faith in herself, in the future, and even in her religion, and she may contemplate self-destruction.

There are thousands and thousands of just such women in the world, and the pity is that many of them are mothers. It is surely self-evident that these women must be failures as efficient factors in many ways.

NEUROPATHIC ANCESTRY[C]



From a first glance at the chart it would appear that Daniel was an accidental case of feeble-mindedness. His progenitors were, however, decidedly neuropathic. The presence of apoplexy, paralysis, alcoholism in a family should be watched for with vigilance because of their possible effect upon the nervous system of the offspring.



Parents would do well to scrutinize the man who "led a fast life" before allowing him marry their daughter. The world would be shocked if it knew how many men with disease enter into conjugal relations. David's father had syphilis. David's feeble-mindedness was probably only one of the awful results.

[Footnote C: "Feeble-mindedness; Its Causes and Consequences," Goddard, The Macmillan Company.]

AILING WOMEN ARE INEFFICIENT

FIRST OF ALL AS HOME-MAKERS.—No woman can possibly be expected to successfully conduct a home if she is not enjoying a reasonable degree of good health. A home inefficiently supervised is an instrument for evil. It engenders discord and discontent, and it is lacking in the spirit which is essential to the cultivation of good-fellowship and which encourages harmony.

AS WIFE.—Most men resent the burden and the discomfort and the expense of an ailing wife, no matter how well-intentioned they may be. It is a failing of the male species to be cursed with the inability to understand any type of nervousness in a wife. Being inexplicable to him he attributes the symptoms to an evil imagination or to a bad disposition. He believes he is being imposed upon and proceeds to resent it. Many homes are rendered permanently miserable and unhappy by a failure to comprehend the real source of the trouble and to apply the remedy. Being inefficient as a home-maker the wife is not able to carry out her part as housekeeper. The home atmosphere is wrecked, the husband seeks comfort and congenial fellowship elsewhere. His efficiency is compromised and his earning capacity interfered with.

AS MOTHER.—Anyone familiar with the exacting obligations and responsibilities of motherhood can well appreciate that normal health is an essential requisite to its successful consummation. The success of motherhood depends upon the proper exercise of many diversified qualities, and those in turn primarily depend upon an adequate degree of physical fitness, otherwise failure is certain to ensue. A woman, therefore, cannot exercise her function of motherhood if she is a neurasthenic.

Inasmuch as it has been proved that the regeneration of the race is dependent upon the maintenance of mentally and physically fit mothers, any condition that interferes with this standard is contrary to the eugenic requirement. Children sent out into the word unfit physically or morally are factors detrimental to the best interests of society and to their own progress and prosperity. A mother rendered incapable through sickness is, therefore, a menace to the home and to the eugenic promise.

FEW AILING WOMEN BECOME PREGNANT.—Nature fortunately seems to apprehend the true condition because few of these women become pregnant. This suggests an inquiry into the cause, or causes, underlying this unfortunate situation.

Are women responsible for these ailments?

Most married women whose health is broken down by some disease peculiar to their sex refer the commencement of their suffering to a confinement or premature birth. The large majority of those women whose health is affected, because of some "female weakness," suffer from a displacement, or malposition of the internal organs, and as this condition is most frequently a product of maternity, there would seem to be some reasonable degree of justification for the assumption that the wrecked health is the result of a legitimate physiological act, and consequently a natural phenomenon. This is not, however, altogether true. A displacement is not, under any circumstances, a natural process. It is the result of causes which are avoidable. Most of them are the penalties imposed by nature because of the infraction of her laws. We will not consider those causes which have their beginning in wrong methods of dress or conduct during the years prior to maternity. Many such cases exist, but they are too few in number to justify consideration at this time. They are frequent enough, however, to suggest to mothers that it is always wise to keep a close watch over the tendencies and conduct of their daughters.

THE CHIEF CAUSE OF FEMALE DISEASES.—When a woman has given birth to a child her womb begins to contract and in a very brief space of time will resume its normal position, provided nothing interferes with the process. Nature will do exactly what is right if she is permitted to work in her own way. In another part of this book I have explained why it takes time for the recently pregnant womb to contract to its normal size. There is a 600 per cent. increase in volume to be got rid of by absorption. This takes time and nature can not be hurried without "taking chances." This is just where the "cause" exists which we have been looking for. Women do take chances.

Every woman should stay in bed for at least three weeks after confinement and should spend another three weeks convalescing before she assumes any domestic duty. This is a reasonable proposition when one considers the actual situation. There is an enormous amount of readjustment to be undertaken, and there is no way of hastening this process. There is, however, a way to assist nature and to prevent mistakes. That way is to remain in bed a sufficient length of time to allow proper contraction of the womb. While the ligaments and muscles are still lax, to not undertake any muscular effort that will overtax or overstrain them,—a condition that favors displacement by weakening the support of the womb. A woman cannot understand why she should stay in bed when she feels well enough to get up. It is, however, unjust to censure the sex on this account. I am convinced the fault lies with the medical profession who do not take time to explain, in language which a woman may understand, the important reasons why they should stay longer in bed despite the fact that they do feel well.

THE EXISTENCE OF THE AVERAGE MOTHER.—In considering this subject it is necessary to give some serious thought to the domestic and financial circumstances of the thousands and thousands of average mothers. Every observing, thinking person knows that the average mother's existence is more or less of a never-ending tragedy. Physically, mentally, and spiritually, they are victims of unalterable economic and social exigencies. They are compelled, because of ignorance, to live an unsanitary and unhygienic existence. The care of home and children, and maybe the unappreciative and inconsiderate attention of a careless and vindictive husband, add to the incidental worries,—fraying her nerves and disposition,—of the ordinary routine of a cheerless, hopeless life. Add to this experience the enormous drain of frequent child bearing upon her vitality, and we have a picture with which every physician is familiar.

Can such a woman possibly observe the essential rules of the hygiene of pregnancy? Has she the time and the means to build up her reserve energy and strength to competently undertake the duties of maternity or motherhood? Is she physically fit to give birth to a child? After it is all over can she devote the time to permit nature to do her share of the physical readjustment? Can she afford, or will she be permitted to remain in bed long enough to allow conditions to be favorable to getting up without "taking a chance"? Inasmuch as her muscular tone is poor, her strength depleted, her vitality wasted, her ambition and hope at a low ebb, nature should be given a longer time, under the most favorable hygienic and domestic conditions, to help in the problem of readjustment, because her whole future, as an efficient machine, as wife, as mother, as home-maker, and as an economic individuality, is dependent upon how this crisis is met. This is the most important problem which an enlightened civilization has before it. It is the supreme eugenic task, and it is the most pressing and the most vital question for statesmen to solve. No man can deny that the permanency of the state is dependent upon the function of motherhood, yet motherhood is conducted by unskilled labor—labor, the quality of which no business would tolerate. We also know that the health of the workman has become an economic problem. Capital finds that labor is of better quality, and consequently more remunerative in every sense, if the environment is conducive to happiness and health. Yet motherhood, the most important labor in the world, upon which the very existence of the state depends, in addition to being performed by unskilled labor, is undertaken by physically unfit and frequently unwilling laborers, in an environment which is a disgrace to civilization and which cannot be duplicated in the whole realm of the brute world. This is the quality of labor, the products of which constitute the state.

If anyone is disposed to believe that this is an over-drawn picture, let him study the facts brought out in the recent patent medicine investigation. It was found that one small, unimportant, quack medical company had under treatment at one time (the day the government closed it up) 200,000 women, suffering exclusively from female diseases. How many similar cases must there be to support the large advertising concerns, whose tentacles reach to the remotest corners of the country and who limit their activity and cater to "diseases of women" only. Let him also give some thought to the fact that no specialty in the whole field of legitimate medical practice has grown with such enormous strides, or is as remunerative to the ordinary physician as the department of "diseases of women."

FEMALE DISEASES ARE AVOIDABLE.—If, as has been asserted, the great majority of these ailments are traceable to causes which are avoidable, what is the remedy? In one word it is "Enlightenment." We must educate the ordinary mother who is so busy over her wash tubs and babies that she has no time to seek information upon subject which she doesn't even know exist, who does not even know how to feed her baby as well as the scrubbiest cat does her kitten, who does not know what eugenics means and is interested in it even less. We must stop limiting our talks to theorizing in clubs and societies. We must carry the tidings to the firesides of those hundreds of thousands of women who would listen and act, but who do not know what to do or how to correct their faults.

There is another feature of this subject which should be recalled in this connection. It has already been gone into in detail in the article on eugenics. There are many thousands of women who are compelled to fight the battle of life, upon whom an unjust disease has been grafted, which is sapping their strength and vitality, and which they do not appreciate or understand. Husbands infect wives unwittingly, wreck their constitutions, blast their hope of ever having a child, and then heap upon them abuse for an inability for which they are themselves directly responsible. Many homes are desecrated in this way and the real culprit is never suspected. Many women, who begin their married life under the most auspicious conditions so far as physical fitness or temperamental quality is concerned, have their health, and happiness, and success utterly ruined, and after spending a miserable, wretched existence, have their hope of maternity forever blasted on the operating table. The story of "the wife" has never been told. It is God's riddle.

WOMEN WHO DON'T WANT CHILDREN.—Sometimes the woman is at fault. Many young wives begin married life with the intention of not having a child for a year or two. They don't want to be tied down too soon. They want some fun themselves. They are willing to become the legal mistress of a man, but they are not willing to assume the responsibilities of married life. It is difficult to understand the ethics of this type of morality. I have always given these young wives credit with simply not knowing what they were doing. Either their education or their common sense is lamentably deficient, or what is still worse, their mother was the wrong kind of a woman. If these unfortunate young wives have no regard for the cultivation of a good conscience, they should at least have some regard for their own health. From a purely selfish standpoint,—the standpoint of efficiency and success,—one would imagine these women would be unwilling to risk their whole future physical welfare on the chance of immunity—and it is a small chance.

ABUSE OF THE PROCREATIVE FUNCTION.—In order to carry out this programme, various means are brought into requisition. In many cases I have known the wife has compelled the husband to wear devices which rendered conception impossible. This is a highly reprehensible procedure. If continued for any length of time it will seriously affect the husband's nervous system and general health, as this act is simply a form of self-abuse. Any husband who will tolerate such imposition is beginning married life wrong. He will pay a high price for his complacency. Any woman who suggests or acquiesces in such an arrangement is a moral degenerate and is absolutely unworthy of ever becoming a mother.

Some women buy expensive and fantastic syringes and proceed to abuse themselves with strong antiseptic solutions. This will result in killing the sensitiveness of the terminal nerves and end in depriving themselves of the pleasure with which a wise Providence endowed the procreative act. If the element of sexual incompetency enters the home of a young couple, it is the beginning of the end and each chapter of the story will be a worse hell than the one just ended. The wise husband will see that its cause will not be tolerated or begun in his family.

If pregnancy should unwittingly occur they do not hesitate to adopt drastic means to "bring themselves around." They will procure some prescription which may have gone the rounds as a "marvel" but which always fortunately fails when they need it most. Thus they subject their system to the shock of violent medication and lay up for themselves in the future untold miseries. If these means fail, they go to "a woman whom they know" who "brings them around." If these young wives only knew what they were doing they could not be bought at any price to submit to such surgical tragedies. The least probable result will be that when the time arrives and circumstances are opportune to have a baby, and when it is their dearest wish to be a mother, they will discover that they no longer possess the ability to conceive. Many homes have been rendered childless in just this way. You cannot violate the laws of nature without paying the penalty in some way, and it is usually a sad reckoning.

WHAT THE WOMAN WITH FEMALE DISEASE SHOULD DO.—To those wives who are suffering with "female weakness," or who are in poor health without apparent or known cause, I would strongly advise a visit to their family physician or to an expert in diseases of women. Tell him exactly how you feel and submit to a thorough examination. Most of the diseases of women are readily curable, and if treated right all the symptoms which have rendered life miserable will disappear. It may be stated with the strongest emphasis, however, that no treatment from an advertising concern, or any patent medicine ever made, will in any sense cure any of these ailments. Every cent invested in any of these nostrums is money wasted. Medicine by the mouth is never necessary to affect a cure of the actual ailment. A physician will doubtless prescribe a tonic for your general rundown condition. But even this would totally fail if the cause of the ill health was not removed, and this necessitates an examination and special local treatment. For any advertising concern to assert that it can tell what ails a patient by simply filling out a symptom blank is utter nonsense. It is worse. It is obtaining money under false pretenses, and should be punishable by imprisonment at hard labor for a long term.

CANCER IN WOMEN

My only object in referring to this disease is to direct the attention of women to its symptoms.

The only cure for cancer at the present time is the knife. If the disease can be reached it can be cured, if taken in hand early.

In women, cancer occurs most frequently in the breast and in the womb.

CANCER OF THE BREAST.—Of all the tumors which affect the breast, cancer is the most frequent. Any tumor in the breast of a woman forty years of age or more is quite likely to be a cancer. A tumor (or lump) which has remained small for years and then begins to grow rapidly has changed its type and become cancerous. Many such tumors change in this way during the "change of life." Any tumor of the breast, at any age, which remains despite effort to dissipate it should be removed by operation. A physician is not justified in assuring a woman that a lump in the breast is harmless. It should be cut into and examined to positively decide its character. Early operation of tumors of the breast has greatly reduced the percentage of deaths from cancer.

CANCER OF THE WOMB.—Occasional slight hemorrhages becoming more frequent, and later more abundant and offensive, constitute one of the first symptoms of cancer of the womb. Between the actual bleedings there is a discharge resembling dish-water. This discharge has a foul odor. Pain is as a rule a late symptom. Sometimes a severe pain extending into the hip or abdomen is an early symptom but it is very infrequent. Every woman over thirty who has a persistent leucorrhea, or any irregularity of the menstrual function, should be examined for cancer.

WHAT EVERY WOMAN SHOULD KNOW ABOUT CANCER.—Inasmuch as cancer is curable if taken early, every woman should take steps to be on the safe side.

If cancer is not taken early, it is certain death. A very large number die who could have been saved.

Every lump in the breast should be positively diagnosed by cutting into it and examining it. It would be safer to remove every tumor of the breast at an early date.

Any discharge from the privates of a woman which has a bad or foul odor is suspicious; any irregular bleeding is more than suspicious. Any woman having these symptoms should be examined by a competent physician. Every woman over thirty-five years of age should be examined by a physician every six months. No woman should enter the change of life without a very thorough examination. Cancer is a disease which does not permit "taking a chance" with. It is far better to be certain, since it is curable if caught early, than to find out about it when too late, because, "too late" means death.

"CHANGE OF LIFE." THE MENOPAUSE

The average period of life during which a woman menstruates is from thirty to thirty-two years. When this period is about to expire she enters what is termed the "change of life," or the menopause, or the climacteric.

The average age at which "change of life" occurs in this country is about the forty-sixth year. It may normally occur, however, at any time between the fortieth and fiftieth year. There are cases on record when it has occurred earlier than the fortieth and later than the fiftieth year. When menstruation in a girl begins early, the menopause occurs late. On the other hand, if a girl does not have her regular monthly periods until she is older than usual,—about the eighteenth or twentieth year,—the "change of life" will set in at a very early age. Women who are victims of certain exhausting diseases, as, consumption, Bright's disease of the kidney, diabetes, or whose health is poor because of general physical debility from any cause, or who have had a large number of children in rapid succession, enter the "change of life" earlier than they otherwise would if their health was good. In women who are excessively fat the menopause is apt to occur at an early age. On the other hand disease of the generative organs, or the presence of tumors of the womb may retard the process. Women in the higher walk of life, those living in cities those who do not labor or exercise sufficiently will enter this period at an earlier date than those who live in the country, who work and are physically more healthy.

SYMPTOMS OF "CHANGE OF LIFE."—When the menopause begins, the monthly periods are less profuse, the flow is scanty. As the months pass, menstruation becomes less and less until it ceases entirely. In a certain number of cases it stops abruptly and never appears again. Sometimes a period misses altogether, or a number of periods are passed over without any sign of menstruation, after which it may reappear either as a scanty flow, or as a profuse discharge. This may be followed for a number of months by irregular appearances of the menstrual phenomenon and then by its total cessation.

These may be the only symptoms or signs of the "change of life," and this is the normal state if the health is good. It cannot, however, be said that this is the average experience. Unfortunately the women of the present time do not live lives which conduce to robust health at this period of life. We find as a rule that the general health is below par. So they suffer from headache, "flushes," digestive disturbances, and many nervous symptoms which appear to be directly caused by the process through which they are passing. The "flushes" are disagreeable experiences. They consist of a feeling of heat which spreads over the entire body as if the blood was rushing to the surface and to the head. These flushes are followed by sweating and chilly sensations. The nervous symptoms may be quite marked. The woman loses her interest in the daily happenings. She may have mental vagaries, she is irritable and often melancholy and periods of seeming insanity may occur.

IMPORTANCE OF A CORRECT DIAGNOSIS.—It is a mistake to attribute every symptom a woman may have at this time of life to the menopause. She is just as liable to develop conditions at this time, which she would at any age, and which have no relation to the "change of life." Every symptom should, therefore, be carefully investigated, because serious conditions may complicate the menopause, and if attributed to it and neglected, may end disastrously.

During the "change of life," the generative organs become smaller or, as it has been termed, "dry up." The breasts also are involved in the shrinking process. It is quite a common experience for women to "lay on" fat, to become "flabby," at this age.

It is important that women should become familiar with the ordinary symptoms of the "change of life," in order that they may be constantly on guard against conditions that may indicate danger. Medical investigation has conclusively proved that many women lose their lives because they regarded the presence of certain symptoms as common to the "change of life." There is a tendency to disease at this time which must be intelligently considered, and if women are not posted to note unusual signs or symptoms they may neglect or ignore them, only to find when too late that these signs and symptoms were no part of the "change of life."

THE DANGER SIGNALS OF THE CHANGE OF LIFE.—There are certain "danger signals" which should warn every woman that something is amiss, these are:—

(1) Profuse bleeding during the process of the "change."

(2) Bleeding occurring between the regular menstrual periods.

(3) The reappearance of slight bleedings or hemorrhages after menstruation has ceased for a number of months.

These symptoms are always suggestive of the presence of conditions that should not exist. They may indicate cancer, or some less serious condition that is amenable to cure by prompt and efficient treatment. Inasmuch as they may mean the beginning of cancer,—as explained in the preceding chapter on cancer, and which should be read in this connection,—immediate steps should be taken to find out the actual facts. Delay means death if it is cancer, while the most recent statistics show that in many cases a complete cure is possible if the surgeon gets the case early.

CONDUCT DURING "CHANGE OF LIFE."—When a woman enters the "change of life" she is approaching a crisis that demands the most conscientious attention on her own part, and the sincerest consideration by all around her. She has reached the time of life when she owes herself something, and if she is wise she will willingly pay the debt. If she is not in good health she must make every effort to regain it promptly, even if radical measures must be employed in doing so. Nothing will contribute to her mental and physical comfort more than robust health during this period.

She must employ every hygienic measure that experience has taught us contributes to our well being. She must live an outdoor life as much as possible, taking sufficient exercise to keep the muscles and bodily functions in good condition. If she cannot exercise enough she should sit out of doors, dressed in seasonable clothing, and she should make up the deficiency in exercise by employing a competent masseuse. A thorough massage twice a week is sufficient. If her physician recommends an occasional Turkish bath it is a desirable aid as it helps the skin to throw off any excess of waste matter that may be circulating in the blood.

The home environment of these women should be congenial, and they should be relieved of the work and worry incident to domestic life. The nervous condition demands this degree of consideration, and the husband should make it his business to see that the wife, who has toiled to aid him during all the long years of married companionship, is accorded every possible help through the most trying and important period of her life. It is not to be understood, however, that she should be left without occupation. It is possible to indulge in congenial work which will occupy her time and attention without overtaxing her strength or fraying her nerves. A certain amount of amusement is desirable, and helps to tide over periods that might lag and encourage introspection and worry. An entire change of scenery and surroundings. A visit to the seashore or to the mountains is to be commended.

During this period the diet should be simple and the bowels should be kept open regularly. Inasmuch as these patients frequently suffer from digestive disturbances, it is wise to refrain from those articles of diet that ordinarily cause indigestion. Such articles are, sweet dishes, pies, pastries, candies, fresh bread, fried food, sugars, and the relishes and seasoning extras which constitute the et ceteras of the table. Meat should never be taken to excess, alcohol and all stimulants are to be avoided. Water may be taken freely to advantage.



THE PATENT MEDICINE EVIL



CHAPTER XXX

THE PATENT MEDICINE EVIL

What Mothers Should Know About the Patent Medicine Evil—Tonics—Used by Temperance People Because it Could "Stimulate"—Stomach Bitters—Blood Bitters—Sarsaparilla—Celery Compounds—Malt Whisky—Headache Remedies—Pain Powders—Anti-headache Powders—Headache Powders—Soothing Syrups—Baby's Friends—Catarrh Powders—Kidney Pills—Expectorant—Cough Syrup—Lithia Waters—Health, Wealth and Happiness for a Dollar a Bottle—New Discovery for Consumption—Consumption Cure—Cancer Cures—Pills for Pale People—Elixir of Life.

WHAT MOTHERS SHOULD KNOW ABOUT THE PATENT MEDICINE EVIL

Much has been written about the patent medicine evil during the past few years. One very thorough crusade has been instituted and efficiently carried through, exposing the evils of the patent medicine business. Whatever legislation is in force to-day which has for its object the regulation of the evil, is largely a product of that crusade. Notwithstanding these efforts, it is a fact that scarcely any of the great majority who should be interested in the subject, because they are its victims, have any knowledge of the nature or extent of the evil, or appreciate its far-reaching and pernicious influence. For two reasons I regard it as peculiarly fitting, that the subject should be given adequate consideration in this book:—

First, because mothers should be told the whole truth about all conditions that have any influence on the health of the members of the home.

Second, because though we are the victims of many evils and many forms of "graft," which directly or indirectly affect our pockets and our morals, we submit to them because they have no bearing on the physical well-being of the race. As mothers, however, and as the conservers of the fitness of the family and the home, we are directly and rightly interested in an evil which deeply affects the health and the efficiency of members of the family as the patent medicine evil does. It is through the mothers of the race that this enemy of the home must be finally and completely overthrown. If every mother in the land could be taught to understand even a fraction of the truth of the insidious wrong hidden under the mask of the nostrum advertisement, we would witness a righteous resentment that could only be satisfied by legislative enactment that would wipe out forever the whole infamous business. No spasmodic or localized effort will ever succeed against this public enemy. Its very strength is the people whom it dupes and despises, because they supply the money with which the patent medicine combine fights its battles.

It has been estimated that three hundred millions of dollars are spent annually on patent medicines and fake medical cures in the United States. Three hundred million dollars fraudulently obtained every year, mostly from the poor, is surely a subject deserving of honest and careful consideration.

The pure food and drug act compelled the manufacturers of patent medicines to publish the formulae of their remedies on their labels. This is a big step in the right direction. Many States have helped the propaganda in one way or another, but much remains to be done. When the formulae were demanded it was discovered that all nostrums belonged to a certain class. For example it was found that the soothing syrups—which are fed to babies—all contained opium in some form, or an equally dangerous drug. The headache remedies were all dangerous, every one of them containing ingredients which affect the heart seriously. The so-called tonics owed their chief virtue to their stimulating effect, which was due to the alcohol they contained and which in many instances practically equaled ordinary whisky in quality, quantity, and effect.

It has been authoritatively stated that more alcohol is consumed in this country in patent medicines than is dispensed in a legal way by licensed liquor venders, barring the sale of ales and beer.

Many so-called remedies were found to contain absolutely no medication at all. They were simply sugar, or starch, or some harmless substance. But they were being sold to cure anything from kidney disease to cancer. It was an astonishing revelation and in a way it showed how far men will go to attain financial success.

A well-known tonic was at the time of the investigation one of the most prominent proprietary nostrums in the country. The actual cost including bottle, label, contents, and packing is between fifteen and eighteen cents. It costs in the drug store $1.00 per bottle. It was found to contain alcohol and water and a pinch of burnt sugar for coloring purposes, and one-half of one per cent. of mild drugs. It was claimed that it would cure all or any of the diseases listed in the book, and that list practically includes all the ills of man. It is within the limits of truth to assert that this tonic, though advertised as a medicine, was largely in demand as a stimulant and intoxicant,—just as a certain famous malt whisky is to-day. Voluminous evidence is on record wherein it is shown that it was used in enormous quantities as a stimulant, in exactly the same way as ordinary whisky is used. The dose of any medicine is, as a rule, seldom over a tablespoonful three or four times a day. The average individual would imagine that there would be some risk attached to increasing the dose from a tablespoonful to the contents of a large size bottle. The only risk was that the patient got a more profound and maybe a more satisfying "jag." In "no license" towns this tonic was bought by the druggists in gross lots and used exclusively for its intoxicating properties. In southern Ohio, and in the mountain districts of West Virginia the "—— jag" was a standard form of intoxication. In many Southern newspapers there appeared regularly advertised cures for the "—— habit," brought on by the use of this preparation,—and no doubt the cure was a stronger percentage of liquor as this scheme was frequently worked to steal the patients from one remedy to another.

The following communication was sent out by the Department of the Interior, as a result of the alarming reports which were regularly reaching Washington regarding the prevalence of drunkenness among the Indians, despite the fact that "no liquor" was sold in these government reservations. The fact was that the Indians had discovered this pleasant tonic.

DEPARTMENT OF THE INTERIOR

Office of Indian Affairs.

Washington, D. C.

To Indian Agents and School Superintendents in charge of Agencies:

In connection with this investigation, please give particular attention to the proprietary medicines and other compounds which the traders keep in stock, with special reference to the liability of their misuse by Indians on account of the alcohol which they contain. The sale of ——, which is on the lists of several traders, is hereby absolutely prohibited. As a medicine, something else can be substituted; as an intoxicant, it has been found too tempting and effective....

Mr. S. H. Adams in "The Great American Fraud" writes as follows: "The other reason why this or some other of its class is often the agency of drunkenness instead of whisky is that the drinker of it doesn't want to get drunk, at least she doesn't know that she wants to get drunk. I use the feminine pronoun advisedly, because the remedies of this class are largely supported by women. Several of the others of these well-known proprietary medicines depend for their popularity chiefly on their alcohol. One celery compound relieves depression and lack of vitality on the same principle that a cocktail does, and with the same necessity for repetition. I know an estimable lady from the Middle West who visited her dissipated brother in New York—dissipated from her point of view, because she was a pillar of the W. C. T. U., and he frequently took a cocktail before dinner and came back with it on his breath, whereon she would weep over him as one lost to hope. One day, in a mood of brutal exasperation, when he had not had his drink and was able to discern the flavor of her grief, he turned on her: 'I'll tell you what's the matter with you,' he said, 'You're drunk—maudlin drunk!'

"She promptly and properly went into hysterics. The physician who attended diagnosed the case more politely, but to the same effect, and ascertained that she had consumed something like half a bottle of a certain swamp root that afternoon. Now, swamp root is a very creditable 'booze,' but much weaker in alcohol than most of its class. The brother was greatly amused until he discovered, to his alarm, that his drink abhorring sister couldn't get along without her patent medicine bottle! She was in a fair way, quite innocently, of becoming a drunkard."

Another famous stomach bitters was found to contain, according to an official State analysis, 44 per cent. of alcohol; another mixture contained 20 per cent. of alcohol; a certain blood bitters contained 25 per cent. of alcohol; a sarsaparilla 26 per cent.; a celery compound 21 per cent.; the malt whiskey is in this class and is a particularly obnoxious fraud, for it pretends to be a medicine and to relieve all kinds of lung and throat disease. It is especially favored by temperance people because in this way they get their "grog" in the guise of a medicine. It is sold in many places across the bar of saloons at 15 cents per drink, as many other brands of rye and Bourbon whisky are sold.

Think of treating any disease of the stomach with the famous stomach bitters containing 44 per cent. of alcohol,—just 6 per cent. less than the amount of alcohol in an ordinary bottle of whisky. Yet all of these patent medicines have made fortunes for their owners, some of them have made millions in a few years.

A number of years ago a company with a keen vision for profits conceived the idea of bottling the water of the Great Lakes and selling it at almost champagne prices. When delivered to the druggist ready for sale the "remedy" contained 99 per cent. water, the other 1 per cent. consisting of a few drops of an inert acid, used simply to give it a slight tart taste. The preparation had absolutely no medical utility of any description.

One of the greatest advertising crusades ever carried out in the interest of a patent medicine was inaugurated and in these advertisements it was claimed that it would cure:—

Asthma, Bronchitis, Coughs, Colds, Cancer, Dyspepsia, Fevers, Hay Fever, Leucorrhea, Piles, Quinsy, Skin Diseases, Throat Troubles, Abscess, Blood Poison, Consumption, Catarrh, Dandruff, Gallstones, Influenza, Malaria, Rheumatism, Tuberculosis, Anemia, Bowel Troubles, Contagious Diseases, Dysentery, Diarrhea, Eczema, Erysipelas, Goiter, Gout, La Grippe, Neuralgia, Scrofula, Tumors, Ulcers,

all diseases that begin with fever, inflammations, all catarrh, all contagious diseases, all the results of impure or poisoned blood. "In nervous diseases this remedy acts as a vitalizer, accomplishing what no drugs can do." These are the exact words of the advertisement. It ought to take a stronger vitalizer than water from the Great Lakes to induce anyone to believe such a story; and yet this company attained a remarkable success and had no difficulty in obtaining thousands of testimonials.

We are certainly a nation of dupes, and Barnum's dictum, that "the public loves to be fooled," is literally true. In a number of instances the proprietor of a successful remedy has been asked under oath if his preparation had any curative value and he has refused to answer the question, while thousands of foolish people have sent him unsolicited testimonials asserting its remarkable merits as a cure in all kinds of conditions. Some of these ignorant people actually believe what they write, but most of them write "to see their name in the paper," while many of them are paid for it.

It was stated in the literature sent all over the country by this company that their remedy was really liquid oxygen. It would be nearer the truth to state that the moon was made of green cheese. The one assertion can be disproved, the other cannot with scientific exactness. Liquid oxygen practically does not exist. Assuming that it could be obtained in teaspoonful doses, and assuming that some dauntless individual made the attempt to take a dose, he would never swallow it for the reason that it would freeze his teeth, tongue, mouth, and throat, so that they would be useless to him for the remainder of his life. If by any miracle it could be swallowed, the undertaker would have to thaw him out over a stove in order to assure him a respectable burial. We may safely feel certain that the nostrum was not liquid oxygen. It is, however, a very fair sample of the foolish kind of lies which all of these nostrum venders employ,—they are after, and appeal only to the ignorant. I am informed that the directors of this company decided to retire as ordinary millionaires rather than risk the chance of developing nervous prostration, in which event they might have felt it somewhat disloyal not to have taken their own medicine.

HEADACHE REMEDIES.—Most headache remedies are dangerous. The following are in this class; orange powders, bromo powders, pain powders, headache powders, anti-headache, and practically all headache powders or remedies sold in drug stores.

Many deaths are on record from the use of orange powders and from others. There are many examples of what an unthinking individual may do to helpless little children.

Orange powders were recommended for the cure of asthma, biliousness, headache, colds, catarrh, grip, diarrhea, hay fever, insomnia, neuralgia, seasickness, and sciatica. There is no known cure for a number of these diseases, and apart from the malicious assumption of the claim, orange powders will not cure any of them.

Another dangerous headache nostrum, widely advertised all over the country, is responsible for many deaths as a result of its use. It is absolutely unsafe, as previously stated, to use any of these remedies. Death by heart failure is on the increase in this country and it may safely be attributed to the indiscriminate use of these powerful and toxic nostrums.

The "soothing syrups" depend upon opium to effect their result. The drugging of helpless infants has been a source of profit to the vender of patent medicines for many years. A certain Baby Friend,—a touching name, and in which one would not expect to find an enemy in the guise of a deadly poison,—is a combination of sweetened water and morphine. This disgraceful mixture, considering the use for which it was designed, would be bad enough if it was the evil concoction of a man rendered irresponsible by a strenuous craving for blood-money, but to know that its proprietor is a woman seems beyond belief. I wonder if she would feel sufficiently respectable and decently clean enough to stand on the platform and face an audience of American mothers? I think not.

Catarrh powders contain, as a rule, cocaine, one of the most insidious and dangerous of drugs. None of them cure catarrh, they simply relieve for the time being at the expense of injuring more vital parts. Their use also very frequently disposes the victim to postpone treatment that would be beneficial until too late. M——'s Kidney Pills were said to cure Bright's disease, gravel, all urinary troubles and pain in the back or groins from kidney disease. Analysis showed them to consist of ordinary white sugar. They contained absolutely no medication, and yet they were freely sold to cure the above serious conditions. A famous expectorant and an equally famous cough syrup contain opium and when taken for the cure of cough are distinctly dangerous.

It is foolish and unnecessary to name any other patent medicine in the list of those that are distinctly harmful and dangerous to use. There are hundreds of them. It would take a book of a thousand pages to give their names and write the data that have been obtained against them. Every advertised medicine should be absolutely avoided. I could fill this book with the death certificates of those who have died as a result of the indiscriminate use of advertised nostrums. It is an appalling record; the unfortunate part being that it is impossible to acquaint every citizen with the facts.

Duplicity and misrepresentation are not confined to patent medicines. Even the mineral waters are misrepresented and lied about. A much-advertised lithia water, before the passage of the pure food and drugs act, was highly vaunted as a uric acid eliminant because of the lithia it was said to contain. Thousands, probably millions of gallons of it have been sold during the past twenty years, to people who could not very well afford to pay for it, because of this claim, despite the fact that it is well known that lithia is not a uric acid eliminant, and despite the additional important fact that the government analysis of this lithia water proved that it practically contained no lithia whatsoever. It is now being sold as an "alkaline diuretic." This claim is no better supported by facts than the former claim that it was a lithia water. Of course it is a diuretic, because water is the best diuretic we possess, but any ordinary pure water, which costs nothing, will just as effectually accomplish all that this lithia water could as a diuretic.