Second. No matter what your confidence in the medicine, or how highly recommended it is, consult a physician before using very much of it.

Third. Take no medicine internally without a physician's advice.

Throughout this chapter the word "patent medicine" will be used in its widely accepted form, in the everyday sense, without regard to its legal definition, and will be held to include any of the above-mentioned classes, unless a direct statement is made to the contrary.

In Germany the contents of patent medicines are commonly published, and in this country, notably in Massachusetts, the State Boards of Health are analyzing these preparations, and making public their findings. In North Dakota a law has been passed which requires that a proprietary medicine containing over five per cent of alcohol, or any one of a number of specified drugs, be labeled accordingly.

On

PURE FOOD BILL.-A far-reaching and important step, in the movement for reform of patent medicines and for the protection of the public, has now been taken by the United States Government. June 30, 1906, an act was approved forbidding the manufacture, sale, or transportation of adulterated, misbranded, or poisonous or deleterious foods, drugs, medicines, or liquors. This act regulates interstate commerce in these articles, and went into effect January 1, 1907. Section 7 of this act states:

"That for the purposes of this Act an article shall be deemed to be adulterated: in case of drugs:

"First. If, when a drug is sold under or by a name recognized in the United States Pharmacopoeia or National Formulary, it differs from the standard of strength, quality, or purity, as determined by the test laid down in the United States Pharmacopoeia or National Formulary official at the time of investigation; Provided, that no drug defined in the United States Pharmacopoeia or National Formulary shall be deemed to be adulterated under this provision if the standard of strength, quality, or purity be plainly stated upon the bottle, box or other container thereof although the standard may differ from that determined by the test laid down in the United States Pharmacopoeia or National Formulary.

"Second. If its strength or purity fall below the professed standard or quality under which it is sold."

Section 8 states that a drug shall be deemed misbranded. "First. If it be an imitation of or offered for sale under the name of another article.

"Second. If it (the package, bottle or box) fails to bear a statement on the label of the quantity or proportion of any alcohol, morphine, opium, cocaine, heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate, or acetanilid, or any derivative or preparation of any such substances contained therein."

What are the motives which impel persons to buy and use patent medicines? The history of medicine offers a partial explanation. In somewhat remote times we find that the medicines in use by regular physicians were of the most vile, nauseating, and powerful nature. We read of “purging gently" with a teaspoonful of calomel. Then during the wonderful progress of scientific medicine, beginning a little more than a half century ago, the most illustrious and use

ful workers were so busily engaged in finding the causes of disease and the changes wrought in the various organs, in observing the noticeable symptoms and in classifying and diagnosticating them, that treatment was given but scant attention. This was nowhere more noticeable than in Germany, the birthplace, home, and world-center of scientific medicine, to which all the medical profession flocked. Patients became simply material which could be watched and studied. This was an exemplary spirit, but did not suit the patients who wanted to be treated and cured. This fact, together with the peculiar wording of the laws regulating the practice of medicine, which allow anyone with the exception of graduates to treat patients, but not to prescribe or operate upon them, accounts for the number of quacks in Germany.

Dr. Jacobi states that "there is one quack doctor to every two regular physicians in Saxony and Bavaria." 1

Another cause for the use of patent medicines is mysticism. Ignorance is the mother of credulity. It is reported that Cato, the elder, recommended cabbages as a panacea for all sorts of ills, that he treated dislocations of the limbs by incantations, and ordered the Greek physicians out of Rome. The ignorant are greatly influenced by things that they cannot understand. Therefore, as the mass of people are utterly ignorant of the changes in structure and function of

1 1 Jacobi, Jour. Am. Med. Assn., Sept. 29, 1906.

9 Ibid.

the body caused by disease, and also the limitations of medicines in their power of healing such alterations, their belief in the mysterious power said to attach to patent medicines is not surprising. When testimonials of the efficacy of patent medicines purporting to come from respectable divines, merchants, and statesmen are offered, the proof of their power seems incontestable.

Economy and convenience are added incentives to the employment of patent medicines. This method of saving the doctor's fee is engendered by those physicians who themselves write prescriptions for nostrums.

Why not, indeed, eliminate this middleman (the doctor) and buy the nostrums direct?" So say the unthinking. But what doctor worthy of the name would prescribe a medicine the composition of which he was ignorant? Yet it is frequently done. As Dr. Cabot has so aptly put it, what would be thought of a banker or financial adviser who recommended his client to buy a security simply on the recommendation of the exploiter of the security? Yet that is exactly the position of a doctor who recommends a nostrum.

In view of the fact, therefore, that persons of undoubted intelligence are in the habit of purchasing and using remedies of this character and since many of the most widely advertised preparations are extremely harmful, even poisonous, we have taken the liberty of pointing out a few "danger signals," in the guise of extravagant assertions and impossible claims, which

are characteristic signs of the patent medicines to be avoided.

DANGER SIGNALS.-There are many picturesque and easily grasped features in the literature, labels, and advertising of patent medicines that spell danger. When these features are seen, the medicine should be abandoned immediately, no matter what your friends tell you about it, or how highly recommended it may have been by others than your physician.

Claiming a Great Variety of Cures.-Perhaps of all features of patent medicine advertising, this is the most alluring. No one drug or combination of drugs, with possibly one or two exceptions, can or does "" cure any disease. Patients recover only when the resistance of the body is greater than the strength of the disease. This body resistance varies in different persons, and is never just alike in any two individuals or illnesses. The patient must be treated and not the disease, so it is the aim of every conscientious physician to conserve and strengthen the vital forces and, at the same time, guard against further encroachment of the disease. There is no cure-all, and even if a drug or combination of drugs were helpful in any single case, they might easily be totally unsuited, or even harmful, in another case, with apparently similar symptoms. When a maker claims that his particular concoction will cure a long list of diseases, the assertion bears on its face evidence of its falsity.