Medical Society of the State of North Carolina. An.

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abuse. Recently there have been investigations into the administration
and control of many of the public institutions of the country. In several
instances these investigations disclosed the fact that ignorant and in-
competent men had been placed in charge of hospitals, insane asylums,
and other essentially medical public institutions, and that public money
which had been appropriated for the protection of society was being
applied to entirely different purposes. The medical profession and its
organizations cannot evade a certain amount of the responsibility for
such conditions. The public thinks that the physicians control these
hospitals, and holds them responsible for every imperfection. When
such conditions as these are disclosed the people are convinced that
the medical profession is most to blame ; that if these institutions are
abused and their funds are misapplied it is because the physicians offi-
cially connected with them either connive with the politicians or permit
the politicians to use these institutions as part of the political machinery.
In this relationship to State medicine Ave occupy a position of very great



56 NORTH CAROLINA MEDICAL SOCIETY.

importance. The sentiment and effort of medical organizations as a
whole are always in support of the best thing for the whole people ; but
as has been pointed out, the administration of medical organizations
is usually left to those who have the time and inclination to seek such
positions, and these abuses creep in through inattention on the part
of the individual members who are so busily engaged in serving hu-
manity that they have no time to devote to medical society politics. It
is the plain duty of every physician to give enough of his time to his
local. State, and National societies that he may keep in touch with
every part of their spheres of influence. He owes it to himself and to
humanity to lend his personal aid to the protection of the honor of his
profession. We often hear that the people are losing confidence in
physicians as a class. "We hear also that the practice of medicine has
become commercialized, that suffering humanity is being exploited for
the benefit of individuals and institutions. We see pseudo-medical cults
and brazen quackeries flourishing all about us, and many of us fail to
realize that even though these practices are as old as civilization, the
influence of an enlightened and honorable medical profession should
have crowded them out of existence long ago.

All that is destructive in the influence of the profession can be traced
to the influence of the individual physician who through ignorance, in-
attention, or selfishness fails to assume his full responsibilities. Neither
the profession nor the public appreciate the quality and extent of the
influence of the individual physician in molding public opinion. The
most intimate family friend is the physician. He is consulted in every
perj)lexity. He is usually looked upon as a man of broad view whose
intimate knowledge of humanity and the conditions under which we live
fit him beyond others to be a confidential adviser. A sufficient number
of people still regard the physician in this way to make him a potent
factor in the affairs of every community. The local administration of
laws enacted to promote physical welfare is usually a failure if but few
physicians give their patients and friends advice which conflicts with
the requirements.

'No law of any sort can be enforced unless the people are willing
that it should be enforced. There is but one way to produce this will-
ingness, and that is through educating the people to a realization of the
benefits to be secured. This is especially true of public health regula-
tions. The regulation of human conduct in matters of sanitation and
disease prevention is a comparatively new field. The laity understands
little of the nature of the benefits to be secured and less of the scientific
bases of these laws; as a result they are usually considered oppressive



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 57

and confiscatory. In all mattery pertaining to health regulations the
family physician is appealed to at once. His opinion is usually ac-
cepted without question, especially if this opinion is in accord with what
the inquirer thinks is his interest or convenience. It is impossible to
say how much the physician may be influenced by the desires of his
patient in giving this sort of advice. Whenever his advice is not in
accord with the regulation in question there is a clash of authority which
results badly for all concerned. Practically all opposition to health
regulations is based directly upon advice and opinions which have been
given by physicians. A physician giving such opinions should remem-
ber that if the health authorities promulgate a regTilation they very
rarely do so without sufficient cause and without authoritative support
in public health practice. Every health officer knows that he must be
able to convince his board of the value of a regulation before he can
secure its passage, and every member of a legislative body realizes that
he must be able to defend his actions before the public. The physician
should also remember that unless he has had especial training in pre-
ventive medicine, or has given the subject very recent and thorough
study, he is not competent to pass upon the merits of a health measure.
While it is true that his education and experience are closely identified
with the disease problem, his time and attention have been given to
curative procedures rather than preventive measures. It is also true
that the science of pathology is the basis for both branches of medical
learning, but curative and preventive medicine diverge from this basis
at right angles and meet no more. In pursuing the curative branch of
the disease problem, the physician usually confines his study to diag-
nosis and to medical and surgical therapy. The student of preventive
medicine must take an entirely different course. He must devote his
time to the study of chemistry, biology, bacteriology, and engineering.
He must study law, administrative procedure, and public health ac-
counting. If he has ever practiced curative medicine he must change
his attitude toward humanity completely; he must cease to deal with
the individual as such, and must train himself to contemplate the dis-
ease problem as it aifects humanity in the mass. There has been enough
experience to prove that no physician can be a successful health officer
while he continues to practice curative medicine. . This is the most
potent argument for the whole-time health officer. It is now being used
as a reason for making public health work a branch of engineering,
and there is little doubt that this view will be generally accepted in
the future. It is certainly true that the scholastic training which is
being given in our first grade universities to those who Avish to adopt



58 NORTH CAROLINA MEDICAL SOCIETY.

public health work as a career will not enable any one so trained to
qualify anywhere for the practice of curative medicine. There is prob-
ably not a physician in the country who could pass an ordinary civil
service examination for a position in any up-to-date public health organi-
zation without especial preparation ; few members of the medical pi'o-
fession have been brought to a realization of these truths, and those
who have not do not hesitate to advise their patients and friends on
matters in connection with which they have had neither training nor
experience. Physicians are often sincere in thinking themselves quali-
fied to give this advice. These simply do not realize that much is
known on the subject that has not come to their knowledge. The laymen
who receive the advice feel perfectly secure in following it because
from the standpoint of the layman the physician is the only person
to appeal to in any matter in which disease is involved. Every health
officer has had the following exj)erience : A health problem presents
itself for solution. It may be an insanitary excreta disposal, a munici-
pal waste problem, an epidemic, a water supply for the public, or one
of many other such important matters. He studies his local situation
closely, obtains and reads the literature on the subject, studies the
methods that have been used in other locations, and perhaps consults
recognized authorities in person, laying his problem before them and
asking help. He laboriously develops his plans, places them before his
board, and with their consent, which he obtains by convincing them that
he has given the matter sufficient study and that his proposed methods
are practical, he presents his plans to the public and asks for the co-
operation which he must have in order to succeed. These plans may
involve inconvenience to the public, or may necessitate expenditures on
the part of property owners in making improvements. There may be
some question of expenditure from the public funds for public facilities
or service. There are few health measures Avliich do not carry one
or all of these features. In a few days Mr. Leading Merchant visits the
health office. Perhaps he will begin by stating his appreciation of the
eiforts of the health officer. He winds up, however, by telling him that
this new measure is not advisable, is too expensive, is a hardship, and
without fail he will state that he has consulted Dr. A., who is his family
physician, and that he has had the matter explained to him fully and has
been told just how the situation should be met in a way that will disturb
no one. Mr. Leading Banker follows up with advice and counsel from
Dr. B., who has proposed a perfectly harmless and comfortable solution
of the difficulty. Mr. Extensive Landlord and sometimes Mr. Popular
Minister come in with felicitations and the plans of Drs. C. and D. All



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 59

these plans, as stated, are carefully adjusted to tlie comfort of the in-
dividual advised, and all are backed by the professional and social stand-
ing of the accommodating doctor, jSTot infrequently Mr. Rough Neck
makes a stormy entrance without ceremony and tells the hapless health
officer that he is a menace to the public welfare and that he should be
suppressed. Sometimes he is rude enough to suggest painful and dis-
agreeable methods of suppression which he thinks suitable. He is sure
to tell his victim before he leaves that he knows just Avliat he is talking
about, because Dr. E., who w^as practicing medicine before the health
officer was born, told him all about it. Allowance must always be made
for imaginative activity on the part of these citizens, and the liberal con-
struction they are led to place on the utterances of their physicians
through self-interest. The health officer himself is so often misquoted
that he should know how easily wrong impressions are spread. Citizens
do not hesitate to quote members of health boards, even State health
boards, in supi^ort of their contentions. The result is that after all his
labor and pains in devising a way out of his difficulty, the health officer
must devote mouths and. sometimes years to the task of proving his
contention in the face of what is generally accepted by the public as
professional opposition. If physicians and health boards remain silent
and permit this acceptance, then there is real professional opposition.
The most important health matters are held up in this way, needless
sickness and death occur, and many good health officers are compelled
to abandon their efforts because the medical profession and the official
health boards of the locality or State do not come to the front with
denials and with active sup^Dort of sound public health practice. Of
all the relationships of the medical profession to State medicine, this
is the most important.

It is the duty of every physician to recognize preventive medicine as
a specialty more widely separated from his daily routine than any medi-
cal specialty. He should frankly tell his clients that he will not be
prepared to advise them on a preventive measure until he can take con-
siderable time to study the situation in all its aspects. He should knoAv
that preventive medicine is founded upon exact scientific data to a
much greater extent than any of the branches of curative medicine ; that
theory and practice march more nearly band in hand here than else-
where ; that every generally accepted public health procedure has been
proven beyond all reasonable doubt. There are of course many pre-
ventive measures still in controversy and in the process of development,
but these are not to be classed among the generally accepted methods.



60 NORTH CAROLINA MEDICAL SOCIETY.

There are enougli proven procedures, if properly and tliorouglily ap-
plied, to secure tlie practical control of smallpox, malaria, typhoid,
typhus, diphtheria, tuberculosis, cholera, tetanus, and many other con-
tagious maladies. If the members of the medical profession will so in-
form themselves and will advise their patients in support of these pro-
cedures, and will conscientiously refrain from criticising jmblic health
measures and public health officials without exact knowledge and suffi-
cient cause, they will contribute tremendously to the educational effort
which alone can make possible the freedom of humanity from the de-
structive preventable diseases.



THE HAERISON ANTII^AECOTIC LAW, AND THE DUTY OF
THE MEDICAL PROFESSION.



By Dr. J. Howell Way, Waynesville, N. C.

(President N. C. State Board of Health, ex-President Medical Society of the State of
N. C, ex-President .Tri-State Medical Association of the Carolinas and Virginia, etc.)



March 1, 1915, will stand forth in the annals of human effort to re-
strain the use of narcotics as a date marking, in a practical way, the
beginning of a new era in our Nation as regards the traffic in ''opium or
coca leaves, their salts, derivatives, or preparations." On that date the
Harrison antinarcotic law went into effect, and for the first time, so far
as I am advised, the physicians of this Nation became subject to a Fed-
eral license law and its accompanying special tax.

The suddenness with which the announcement came that practitioners
of medicine, dentists, veterinarians, and others must procure Federal per-
mits to continue to ply vocations hitherto solely licensed and directed,
from the earliest days of the Republic, by the various States, was more
or less of a surprise to j^robably the majority of the professional men
affected by the statute. In many instances there were manifestations of
a degree of irritation or resentment on the part of physicians, as well as
dentists, veterinarians, and pharmacists, at this extension of the power
of the Federal Government, with its resultant limitations of accustomed
professional rights and privileges of practice. Some protested they
would not register under the act, but, possessing State license to practice
their profession, would continue in their accustomed work without regard
to the Nation's restriction. With the passing of a few weeks, and the
campaign of education carried on in limited degree by the medical, den-
tal, and pharmaceutic periodicals, more especially the latter, and the



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 61

really helpful trade circular literature distributed by manufacturing and
wholesale drug firms, as well as the circular-letters to the interested pro-
fessions distributed from the various internal revenue offices to those con-
cerned, wiser counsels prevailed, and all law-abiding citizens, whether
professional or laymen, realized that none of the narcotics enumerated
in the Federal law could lawfully be '^produced, imported, manufactured,
compounded, sold, dispensed, or given away," to quote the language of
the enactment, until all the forms and formalities of the statute had been
complied with. Registration proceeded rapidly, and I was recently ad-
vised by an official of the service in ISTorth Carolina that iew if any indi-
viduals, entitled under State law to handle narcotics, had failed to com-
ply with the Federal regulations.

Following the passage of any legislation along new lines there is always
to be anticipated a period of uncertainty and indefiniteness as to the full
requirements of the law, its exact purposes, and the detailed methods of
operation whereby the officials intrusted with the enforcement of such
statute propose to attain the wished-for results. The confusion in the
various professions and trades affected by the Harrison law" was only
what was to have been expected ; but this has entirely subsided ; in the
main, rational constructions have been placed on the wording of the law,
and those wishing to comply with its provisions are finding, in my
opinion, little difficulty in so doing. The statute is not yet perfect, and
there may be objection to such statute, both in principle and in practice,
many excellent people believing the entire control of all such matter?
should abide solely with the lawmaking powers of the people of the sev-
eral States themselves. Be that as it may, the step has been taken, and
the regulation of the sale of not only the narcotics noted in the Harrison
antinarcotic law, but of various other things as well, will in time un-
doubtedly become a matter of National supervision and control.

Though bearing the name of its supposed author, the laAV does not rep-
resent the conception nor is its phraseology the fruition of the efforts of
a single mind. The aj^parent necessity for and advisability of such
enactment has been an evolutionary process in the social life of our
Nation, and the process has been going on in other countries as well.
The apparent necessity for Government control of narcotics, while com-
ing as a surprise to many, has been a very gradual growth. Its develop-
ment has been pari passu with the evolution of the intricacies of modern
civilization and the more complicated environs within which we live
today. It is one of the perfectly normal steps, one of the logical, one of
the to-have-been-expected movements that an enlightened nation would
have initiated sooner or later in the attempted throwing off a people a



62 NORTH CAROLINA MEDICAL SOCIETY.

burden of slavery; a thing, a condition, against which the race has ever
contended in its varied forms. From the earliest dawn of civilization
until now, and not only now, but on and on through future untold genera-
tions until man shall attain the summit of all his possible excellencies, and
shall achieve his perfect physical, mental, and moral standard of attain-
ment, there has been, and will continue to be, a ceaseless, incessant strug-
gle against the things that bind the progress toward its rightful ideal of
a human soul, and restrict the fullest fruition of humanity's powers.
This struggle to free ourselves from the slavery of the environs of custom
and of influence is as old as man himself, and in the dim and misty past,
centuries of struggle, millions of lives lost, treasure of inestimable value
lavishly spent, mark the conflicts incidental to the evolution of mankind,
of perfected man, as he contended against tribal slavery, feudal slavery,
the dominion of oligarchy and monarchy, chattel slavery, until at last
man, in free America at least, has reached a partial attainment of free-
dom, a semblance of true liberty which the world had never known before.
In Europe, war-cursed and king-ridden, we today witness humanity-
struggling in the working-out of a portion of these problems.

Evolution, we have learned, is continuous, progressive change, accord-
ing to fixed laws, by virtue of resident forces; hence there may be no
stoppage in such processes of developmental purpose unless retrograde
processes dominate and determine our course. The contest of mortal man
for his rights as regards his relations with his fellows has been magnifi-
cent in both intent and achievement, and we feel, at least in free America,
that all men may secure a living chance. But with the acquiring of this
priceless blessing there comes the danger to the race of domination by the
direful influences of the slavery of unrestricted appetites, and it is this
factor in our promising civilization that must be fought, lest the splendid
structure, painfully wrought with ages of endeavor, crumble and fall
from internal decay.

Mankind from earliest recorded history has at every period of his exist-
ence, and in every nation or organization of individuals, manifested a
morbid desire for stimulation, and every country and all people, bond or
free, civilized or barbarian, alike, have evolved some form of product,
or secured by traflic from others, something that would stimulate or nar-
cotize — some material in some form that would bring tone to tired nerves
or rest to wearied brains, and relieve the body when pain-racked. Alco-
hol, in its many forms, has been most widely and generally used in all
ages of the past, as it is today, and while alcoholics are not included in
the list of drugs specifically restricted by National legislation, as are
opium and coca in the Harrison law, there are many thinking minds



MEDICAL JURISPRUDENCE AND STATE MEDICINE. 63

who well deem it merely a question of time when their usage will be
limited as compared with present-day consumption, if not wholly erased
from the list of narcotic substances ordinarily accessible to weak men
and women.

The Harrison antinarcotic law, as I have already noted, is not the
work of one mind, nor the framing of its phraseology that of a single
pen. During three sessions of Congress the measure Avas considered, and
even now as passed, and undergoing the testing out of actual service, it
is evident that it will undergo modification, or amplification, as time
passes. Its scope will manifestly be extended later on to include other
drugs and medicines affecting in similar manner the human species to
those now mentioned, and I am constrained to believe the recently sug-
gested move in ]^ew York State to secure the passage of a ''model anti-
narcotic law" in the various States of the Union will have an experience
like the "model vital statistics law" which went the rounds of the various
State legislatures, gradually winning favor in increasing number each
year until finally all the separate States will have similar statutes re-
strictive of the careless use of all narcotics. In fact, several of the
States now have antinarcotic laws, and the large majority have provided
for the teaching in their schools of the effects of narcotics and alcoholics
on the human body. But in practically all of the States there exists
scant or minor provision for enforcing such laws, and a considerable
number of such laws are so burdened Avith provisions and exceptions as
to practically nullify the obvious intent of such statutes to restrain drug
users and decrease their growing numbers. In addition to the drugs
enumerated in the Harrison law, several of the States restrict the sale
and use of a number of other drugs. In twenty States it is unlaAvful for
physicians to prescribe narcotics for habitual users — one extreme — while
our good daughter State of Tennessee provides for the registering and
licensing of narcotic habitues. 'New York permits the sale of hypo-
dermic syringes only on physicians' prescriptions, and requires the regis-
tering of all such sales ; and when it is remembered that such instru-
ments are used solely for the introduction of narcotics or stimulants into
the human body, barring the other minor uses by medical men and
laboratory investigators, I believe measures restricting sales of hypo-
dermic syringes should receive the careful consideration of our next
North Carolina Legislature.

The extent to which narcotic drugs are habitually used by citizens
of our ISTation, or even of our State, is only a matter of conjecture.
The number of drug habitues has been variously estimated by different
authorities as ranging from 100,000 to 4,000,000 for the entire jSTation.



64 NORTH CAROLINA MEDICAL SOCIETY.

Manifestly a i^elatively accurate estimate is practically impossible of
securing, but it is well to remember in this connection that the number of
habitues is limited to an extent at least by the amount of the available
opiates, and the visible supply of narcotics would not, in the judgment of
the Federal authorities, suffice to supply in excess of one-tenth of the
maxinumi number mentioned above. As far back as the year 1866 Dr.
Edward R. Squibb, testifying before a congressional investigating com-



Online LibraryMedical Society of the State of North Carolina. AnTransactions of the Medical Society of the State of North Carolina [serial] (Volume 62 (1915)) → online text (page 8 of 58)