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reliable physician." Will they? Probably not, for they
knew that before, and the actual inquiries raised have not
been answered.

Partly as a result of the lack of intimate medical guidance
previously given to a degree at least by the family doctor,
the priest, the pastor there is a growing distrust in ortho-
dox medicine. This is naturally fostered by the cults.
Strangely enough, this distrust and antipathy are furthered
by pessimists in the ranks of medicine itself.



"The rank and file of physicians are hopeless."

"The average doctor does about as much harm as he
does good."

Admiration has been expressed for the courage of. the
medical man who gets up before a professional group and
declares that doctors and nurses are much overvalued,
and ". . . don't save lives anyway." One sometimes wonders
whether this is courage or an effort to be conspicuous. Is
it a conscious effort to appraise the value of medical service
at its true worth, or an unconscious manifestation of ex-
hibitionism, oV perhaps both ?

At any rate, it would seem that medical practice is some-
what on trial and is going to be compelled to answer such
questions as, Why send them to a doctor anyway? Why
call the nurse? Do doctors really save lives?

Now these questions are perhaps rather hard to answer
statistically, yet the clinical evidence seems clear. Aside
from the physical comfort and mental reassurance which the
nurse and the doctor frequently give, is there ever any im-
mediate, vital, life-saving, or life-prolonging service which
the doctor performs? This may be somewhat aside from
the problem of general medical guidance, but it is an inter-
esting and significant aside.

Doctors do save lives! It seems obvious that the surgeon
who diagnoses an appendix about to rupture and removes it,
frequently saves the patient's life. The physician who ex-
amines his patient, finds an incipient case of pulmonary
tuberculosis, advises with reference to rest, food, and other
methods of treatment, makes provision for home or institu-
tional care, and arranges also for the necessary nursing
service, plays a big part in saving his patient's life. A
physician who by examination makes a diagnosis of a
moderately advanced, yet more or less controllable heart
lesion, and gives competent medical advice as to a conserva-
tive and compensating regime for living, not only saves
that person's life, but may very materially prolong it.

DID the striking decline in diphtheria mortality follow-
ing the discovery of diphtheria antitoxin not prove
clearly that the doctors in those days who were giving
antitoxin early in the disease and in sufficiently large doses,
were literally saving thousands of lives? Take the boy
with "growing pains." He is taken to the doctor with
vague symptoms, but enlarged and infected tonsils are dis-
covered. Almost certainly their removal in many instances
prevents further rheumatic sequelae, very possibly including
incapacitating if not fatal heart lesions and premature death.
Think of the numerous mastoids that are prevented each
year by the thousands of middle ear infections that are
relieved by skillful yet simple and obvious surgical treat-
ment. Or consider even measles, prior to the days of con-
valescent serum : did the old family doctor with his gracious,
comforting kindly reassurance, and with his suggestions about
symptomatic treatment and the environment of the sickroom,
together with his detection of danger signals of pneumonia



386



"SEE YOUR DOCTOR'



387



did he ever prevent the development of the more serious
complications of this disease? He undoubtedly did!

One should perhaps also remember what goes on in the
everyday life of the psychiatrist. The manic-depressives
diagnosed, institutionalized, and treated does this save
lives? Even with the best of medical care, it is stated that
about 80 per cent of manic-depressives ultimately commit
suicide. Were it not, however, for the type of treatment that
arrests many cases of this affliction, it is believed by psy-
chiatrists that this suicide rate would certainly approximate
IOO per cent. Furthermore, those effectively treated are
known in hundreds of instances to lead useful, creative lives.

OF course the test for the skeptic is to be found when
he is face to face with distressing illness in his own
family. Let us suppose a wife or child ill with pneumonia.
Will he or will he not call an experienced clinician? Is he
likely to see any advantage in having cultures taken, in
having the organism typed, possibly in using a pneumonia
serum ? Is he likely to find that after all there is considerable
advantage in having in the home a nurse with excellent
professional training, who knows how at least to carry out
the doctor's orders, and to give general care leading to the
comfort of the patient? Even comfort will seem of con-
siderable importance and not altogether inseparable from
the factors that bear upon the life and death chances of
the patient.

Finally, consider a case of typhoid in any poor industrial
home. For some reason, hospitalization is impracticable.
Does even hourly bedside visiting on the part of a nurse
have any bearing upon the patient's prospects of recovery?
The nurse goes into the home, working under the doctor's
directions, and able intelligently to follow out his direc-
tions. She is trained to make the best of the hygienic
possibilities of the home environment. She is trained to
instruct other members of the family to care for the patient
during her absence. Given equally severe types of the
disease in different homes, with the doctor and the nurse
in attendance, even though intermittently, in one home, and
no medical or nursing provision in the other on which
patient's life would you like to wager?

It apparently is not necessary to go very far in the clinical
field in order to reach the point of feeling quite justified
in referring people to doctors and nurses. This is especially
true when you consider the alternatives, which are either
no care at all, or miscare under quackery. If doctors "do
not save lives," where lies the patient's next best chance
with no doctor at all or with the quack or anti-medical
artist of one type or another?

However, in spite of all of this clinical evidence, there
are no very clear-cut figures as to just how much doctors,
as such, do save lives. We do have some very significant
data on the advantageous effect of the combination of
doctors, nurses, and personal health education. I refer here
to the mortality experience of the Metropolitan Life In-
surance Company among its industrial policyholders. Dur-
ing the period 1911 to 1926, this combination of services
was offered to millions of policyholders. It included,
primarily, nursing care of the acutely ill, a privilege which
was extended to policyholders, however, only when they
were under the care of a regular, licensed physician. Now,
it is interesting to note that the decline in mortality among
these industrial policyholders, in excess of the decline in the



Registration Area of the United States, for the same period,
represents a cumulative net saving of 275,000 lives. This
means, incidentally, a saving of about sixty-five million
dollars in death claims, which in a mutual, cooperative
enterprise such as the Metropolitan Life Insurance Com-
pany, goes back to the members of the association, or the
policyholders in dividends, or cheaper insurance. For the
period 1911 to 1925, the average duration of life among
the industrial policyholders of the Metropolitan has in-
creased by 8.88 years, whereas for the Registration Area,
this increase has been only 5.16 years. Admittedly, it is
impossible to ascertain what proportion of this excess im-
provement in mortality results from medical service, what
from nursing service, and what from health education. But
as the health education was carried out in large part in
homes subject to medical care, and as the nursing service
was extended only to homes with the advantage of medical
care, it seems to be an experience that materially supports
our clinical belief that we are still justified in urging people
to "see the doctor."

After all, we recommend that people "see the doctor" not
only to save their lives. It is important also for them to see
the doctor for the scientific treatment of minor ills. Prompt
medical diagnosis and treatment will lessen even partial
incapacity, and will decrease the cost of limitable illness.
The physician, particularly in the immediate future, will
be expected not only to treat minor disease and to save life
in threatened major catastrophes, but will also detect in-
cipient lesions when curable, and give hygienic advice as to
health conserving methods of living. In many instances,
if he does nothing more after a thorough examination than
to confer upon the patient "the grand and glorious feeling"
that his symptoms are of slight importance, that he is func-
tioning normally, and still going strong, he will be per-
forming a very valuable mental hygienic service in this
neurotic age.

How, what, in more detail, do people who seek medical
advice by mail want to know? What do they ask about?
We have already indicated in a rough way, the range of
these inquiries, and what percentage of them results in a
worth while correspondence. Of course, not all of the in-
quiries are serious:

"Is certified milk fattening? I would like to fatten my
husband, and at present he weighs only ninety-eight pounds
soaking wet."

ONE lady writes that she is suffering from "an enlarge-
ment of the oriole in her throat." A man, after stat-
ing that he is "64 years old" and "used to ride 40 miles
on wheel before breakfast" complains of photophobia, and
adds "extreme sensitiveness to light: it makes me tired."
Another correspondent complains that he is unable to detect
odors as readily as other people, and asks "which of the
exercises is best for this failing of mine."

Some questions, such as the following are obviously easy
to answer in a way that promises to be somewhat helpful.

"There is an old nut in my place of business that doesn't
believe in vaccination, etc.,' and goes around preaching her
doctrine, and I would like to prove to her that she is wrong.
Not being an authority myself, I have quite a time of it."

"Will you kindly send me any booklets or other literature
you may have on the subject of the care, cure, and preven-
tion of tuberculosis."



388



"SEE YOUR DOCTOR"



"Do you know if there is a book on cancer which would
tell something about the development of it, and how the
patient is affected?"

"Have you any information as to the prevention of
measles and scarlet fever?"

"What is the theory on which the practice of vaccina-
tion or the use of serums is based?"

As we implied earlier, however, the great majority raise
questions that are either not easy to answer directly, or that
cannot be answered at all without direct medical informa-
tion concerning the patient's condition or that can only be
answered effectively with some opportunity for further more
or less intimate medical guidance and follow-up. Frauds
and advertised "cures" stimulate many inquiries. A routine
reply is not always an adequate answer to such inquiries as
the following:

"My wife and I have almost made up our minds to try
an advertised cure for diabetes. Yet we are hesitating and
decided that you might possibly give us what knowledge
you have of the Sanborn treatment for diabetes."

"We would like to know whether you think Ovaltine is
harmful or not. I have trouble in sleeping."

'I am forty pounds overweight and would like to reduce.
Is there anything injurious in the Marmola tablets?"

"I would greatly appreciate your opinion by return mail
on the advisability of the use of reducing soap when applied
to a full bust or a fat face."

A SUFFERER from cancer writes: "Am I wasting
_/y_ valuable time in trying to purge myself through the
blood?"

A supposed sufferer from anaemia asks whether there is
any way to put hemoglobin in the blood "without resorting
to so-called patient medicines."

Then, it is not surprising how many inquiries reflect the
previously mentioned extensive and possibly growing discon-
tent with and distrust for the orthodox medical profession.
This is reflected in questions from individuals who have not
yet broken away from the medical fold, but who for one
reason or another question the validity of medical advice
and the ability of the medical profession. This is found
especially in communications with reference to periodic
health examinations.

For many years, health departments and voluntary health
agencies have been urging people to go to their doctors for
an annual health examination. Unfortunately, the medical
profession both individually and in an organized way, was
slow to take up this movement. Consequently, they were
not, and indeed are not yet to any great extent, equipped or
mentally adjusted to give the type of service required in
this field of personal hygiene and the private practice of
preventive medicine. Yet people are to a greater and greater
degree going to their doctors for this service. With what
result? "Some doctors don't seem to know what you are
driving at when you come in and say that nothing is the
matter with you but you want to be examined." Another
writes: "It has been my experience when I have asked for
such an examination, I only receive the examination in one
local spot, and must have a number of visits, and this is
not satisfactory." Another: "Where would you advise a
person to go in order to get a good, efficient, general ex-
amination? Personally, I don't know of a physicion in
whom I have enough confidence to make a good examina-



tion." Another requests a definite outline of what an
examination should cover, and adds: "I feel that the average
physician's examination is entirely too superficial unless he
follows an outline prescribed. . . ." Hundreds of letters ask
that a local physician be recommended, which it is ordinarily
impracticable to do. "I wish to be thoroughly examined
so will you please send me the name of a doctor." "What
physician or at what hospital could I get a complete
physical examination, including X-ray inspection of teeth
and other parts?" "Could you kindly advise me where three
members of one family may have thorough examinations
and obtain correct analysis of their conditions, and recom-
mendation on how to live to gain good health, also at what
cost this may be obtained?"

These health examination inquiries represent the type of
mind that is looking to some extent for preventive medical
advice. But after all, the great bulk of the inquiries come
down to one thing, namely, a need for sound medical
guidance with reference to diagnosis and treatment, and
particularly to treatment. Now, of course, diagnoses can-
not be made by mail, treatment cannot be advised by mail.
The only answer to a considerable bulk of these inquiries
is "consult your physician." "Are my decayed teeth affect-
ing my general health?" "What diet would you suggest
for me: I work indoors?" "How long should treatment
for a four-plus Wassermann be continued?" "Would you
advise the use of insulin in my case?" These illustrations
might be listed by the thousand, where the only answer is
"consult your doctor or dentist." That is the only answer,
and a corollary to it is the increased opportunity and respon-
sibility of the medical profession for meeting these seekers
after health with sympathy and intelligence. It involves
not only increased medical service, but a growing opportunity
for the practice, on an individual basis, of preventive
medicine.

It is perfectly obvious that these people can be helped
only by direct contact with competent medical service. Most
of them need a thorough examination, specific advice as to
treatment, and continued medical follow-up. Other types
of inquiries which can be wisely and helpfully handled only
by local, direct, and intimate contact are to be found in the
fields of mental hygiene, heart disease: "Can you suggest
some special doctor who might be able to put me on my feet
again;" gastro-intestinal conditions, "I would appreciate it
very much if you would tell me of a good diagnostician as
I suffer greatly from indigestion;" orthopedics, "I have
suffered with foot troubles for eleven years. Can you re-
commend an orthopedist to me ?" dermatology, ". . . sores on
my arms and body. Can you do anything for me either by
sending or recommending a doctor?" ophthalmology, "I
wonder if you would please give me the name of an eye
doctor;" roentgenology, "Would be very grateful if you
could supply me with the address of a reliable X-ray house.
We are working people and cannot afford to take chances
with the quacks;" glandular therapy, "Can you recommend
a good doctor for simple goiter one whose charges are
reasonable ?"

Then, again, in this field of treatment as well as in the
field of prevention, the correspondence reiterated a grow-
ing and certainly decidedly critical attitude toward medical
service.

"I have been having throat trouble for a good many
years. An examination institute (Continued on page 393)




Courtesy National Association of Book Publishers



Letters & Life

In which books, plays and people are discussed

Edited by LEON WHIFFLE

Scripts for the Summer Solstice




great annual pother over summer reading
ls upon us. Shall we read light literature
during dog days or seize the long hours to
win through the serious books we have
missed in the hurly-burly of the year? There
is only one precise rule: Do what you like.
Slogging through great tomes for conscience sake will profit
you little, nor will stuffing your crop with fiction. Part of
every well-planned vacation should, of course, be devoted
to the blessed anodyne of detective stories; but for the rest,
most light books do not draw you deep enough into fantasy
or puzzle you with character or even tease you enough with
plot to make you forget yourself. Therefore, I have made
earnest search to discover a summer list that will entertain
because the books mean something, and yet will never bore
you with sodden fact or profitless theory.

For pure delight compact of dare-deviltry and exotic
thrills I would put first in my traveler's bag Revolt in the
Desert, by T. E. Lawrence. Here are a dozen Beau Gestes
made into one gorgeous sun-drenched tale of war, Arab
sheiks, intrigue, and blazing desert landscapes. This is a
whole new cut of life revealed in brilliant words by the
gentleman Crusader who helped England break the Turk's
control in Palestine and Mesopotamia. The gist of this
Arabian night is a long train of camel-riders padding
through the shadows to blow up a railroad with very
modern dynamite. Here are alarums and excursions, blood



and valor, enough to make you forget anything . . . and it's
all true. On the sense side, you will learn geography and
folk-lore and Oriental politics and the ethics of the desert,
and perceive again what makes the sun refuse to set on the
British Empire. The bright words of those charges over
the sands to Allah or to loot will wake your dull blood;
and the tale of how the Sherif feeds his guest on whole
lambs will keep you chuckling into the night and give you
sympathetic indigestion. Yes, this book will lend color to
a week of summer (or winter) for it is an outdoor book, a
man's book, a book of fantasy and style and humor and it
proves that skyscrapers are dull things.

For drama I offer you two volumes. First, Paul Green's
The Field God and In Abraham's Bosom, the Pulitzer
Prize play. They should be read out of doors where you
are close to the manoeuvres of haymaking and the revolving
cycles of the soil. Both are born of the earth, the earth
as it yields human aspiration and tragedy in the fields of
North Carolina. They deal with elementals the struggle
of a Negro visionary to make his dreams come true, and the
way primitive passions bend and create a tiny group on a
farm. The summer is a good time to return to elementals
and to remember that man is only articulate dust and must
find in Mother Earth his strength whether from hard-won
crops or primitive emotions. These are sad plays, but not
discouraging. They read well, being independent of the
artifices of the stage. No vacation is perfect without tears



389



390



LETTERS & LIFE



for tears make the sunshine more blessed and here are tears
for the hard fate of good men and dreamers in an irre-
concilable world.

In Marco Millions you will find a new Eugene O'Neill,
an O'Neill who takes the material of Sinclair Lewis and
works it into the impudence and gayety of Bernard Shaw.
It's a bravura piece with as many chuckles in it as you
found in Shaw's Caesar and Cleopatra. This fantastic satire
on big business and human vanity pictures the greatest
traveling salesman of all time, Marco Polo, who made his
million and won the love of Kublai Khan's daughter, but
left her to return to Venice and Donata who "is a mighty
fine little woman," and whose picture he carried in a locket
all the time and showed on small provocation. Marco, who
told the truth and so won the reputation of Prince of
Liars, is shown as a kind of poetical 'Babbitt who wanders
among strange people and many religions, and untouched
by anything, lets the light of his horse-sense in on the
heathen.

HE goes through the Arabian Nights talking the lingo
of the Pullman smoker, even telling the jokes! Here
is satire and symbolism directed at our modern commercial
crassness, but ever and anon lit up by that flash of mystic
poetry O'Neill shares with all Celts. There is a pure and
moving beauty about the love and marriage and death of
the little Princess that could only come from Ireland. The
play marks a mile-stone for O'Neill, I think, for it cuts
deeper and sweeter into the final emotions of life in a way
never done before, and displays an intellectual mastery over
his material that promises a sureness in his future plays
we have sometimes missed amid the gropings of The
Fountain and The Great God Brown. Life is beautiful
and tragic and funny to this man, and that always means
great art.

While I speak of poetry let me urge you to read Edward
Robinson's last poem, Tristram. The old legend has never
been told with more dignity and emotion, nor in lines that
possess such human simplicity and life-likeness. These kings
and princesses with fair white hands are not vague symbols,
but suffering people who move to their doom with the same
wonderment and pain that leaps onto the front pages of
the newspapers sometimes in this very year. This is a
better love story to read on a summer's afternoon than are
those cheap and cynic things parading in too many modern
novels. You might also stick in your pocket the new set of
Pamphlet Poets issued for twenty-five cents. These include
some of the best from Emerson, Witter Bynner, Edna
Millay, Emily Dickinson, and two groups selected from
the New York Wits, running all the way from Clement
Moore to H. C. Bunner and Guy Carryl, and from four
Negro poets.

WE are opulent in biography these days so I dare only
recommend two volumes that have amused and in-
structed me. Lloyd Morris presents a picture of Hawthorne
that shows the man and his setting better than anything I
know. His odd and austere mother and strange sisters and the
life they led in the dim Salem house account for much in the
introspective Nathaniel. The story of his love and marriage
and the idyll of their life at the Manse in Concord is fragile
and full of poetical passion. The queer group that tried to
mingle transcendentalism and market-gardening on Brook
Farm are etched with quiet humor and yet with such



human friendliness that you love them while you laugh at
them. And Concord becomes a real village where gods like
Emerson and Thoreau took walks together and had their
little visitations of jealousy and boredom. No study of the
Concord group has ever made these gentlemen so real and
human. Through it all runs the tragedy of Hawthorne,
bred in the bone with the strange denying psychology of
the Puritan, yet full always of suppressed emotions and
wistful yearnings for the color and pageantry of life that
never came until he finally won his place as consul at
Liverpool, and there and later in Rome suddenly blossomed.
He came then to some measure of financial security, his
taste for wine and good cigars (of which none generally
suspect the gentle Puritan of tradition) found decent re-
lease, and he seemed ripe for greater work. But when he



Online LibrarySurvey AssociatesThe Survey (Volume 58) → online text (page 87 of 130)