The eighteenth amendment and the part played by organized medicine

Preface

The first pages of this book were included in a paper written as a protest against the candidacy of a regular Army officer who was seeking the nomination of one of the great parties for the office of President of the United States. This general officer had entered the Army through the medical branch of the service and still maintained his membership in the medical organization, which expected to avail itself of his Administration (if that ever became a reality) to push its special legislative programme. Ten days after the protest referred to reached its destination, together with the protests of others, an inquiry as to the source of the candidate's campaign fund was begun in the Senate. That investigation ended his presidential aspirations.

With this inception, the book has been continued and completed in order to draw public attention to a question of national concern — the real meaning of the prohibition movement, and its relations to Organized Medicine and other interests. Under the guise of altruism, a grave injustice has been imposed upon a free people by a relatively small number of zealots and profiteers. It seems important, therefore, that the public should know the facts.

C. T. S.

Introduction

Like many others, I used to look upon prohibition as a dream of the idealist. It was a dream with which I was not particularly concerned. My ideas on the whole subject were rather vague, like the ideas of most people on most subjects of importance; but I believed in a general way that the removal of intoxicating liquors from ordinary use would be a good thing for the country. The harm which alcohol had done and was doing was quite obvious. Like others, I had seen lives ruined by over-indulgence and homes broken up. I had drawn what seemed natural conclusions from casual observation and reflection. But when I began to give the question serious consideration, I had to admit that I really knew nothing about prohibition, good or bad. I had certain impressions, which might be justifiable or otherwise. That was all; and it was not enough.

I began to read some of the literature on the subject. One of the first books which came to my attention was Dr. Eugene Lyman Fisk's "Alcohol — Its Relation to Human Efficiency and Longevity." Many of his statements conflicted with the opinions viii INTRODUCTION

I had formed in the loose way just described. The book, however, was persuasive, and I read it through a second time. After this second perusal I became skeptical; and I then read it once more, critically, checking up the various statements, with the result that I had to discard many of them as worthless. I do not mean to question Dr. Fisk's sincerity, of course; but apparently, as in the case of so many of our scientists, his field of observation has been distinctly limited. The impression which I received from the book was that if the prohibitionists were obliged to resort to propaganda such as this, there must be something wrong with their cause.

I went over the matter with others. They became interested, and we traced some of the propaganda down to its sources. What had been at first merely curious inquiry soon developed into an absorbing study, not only of the theories of the prohibitionists, but also of the forces behind the movement. The moral plea on which prohibition was originally put forward had now been subordinated to the question of health. The American Medical Association had joined the ranks of the anti-alcoholists and had passed a resolution condemning alcohol both as a food and a medicine. We followed the activities of the association through its various channels of influence. The trail led from one of the great medical institutions to another, until it finally brought up

INTRODUCTION ix

in the medical departments of the national government.

The aged fisherman of the Arabian Nights could not have been more astonished when he removed the seal of Solomon from the mouth of the jar which his net had brought to the surface, and saw the genie issue forth, than we were at the result of our investigations. We found a giant organization occupying the centre of the stage. Torn by factions within, pressed on all sides by virile foes without, it was turning and twisting, grasping at any weapon which would preserve its life for even a short time longer. It was medievalism struggling against the advance of civilization. We found, indeed, more than the power behind prohibition itself; we found the reason why disease has been able to flourish in spite of all that science has accomplished for its control. We found men of international reputation in the world of medicine prostituting their profession, and forgetting their personal honor, to maintain an organization which has long outlived its usefulness and which has no place in a civilized community in a modern age.

There is but one excuse for prohibition, and that is ignorance. Is the ignorance displayed by our medical authorities on the subject of alcohol real or assumed? Do they sincerely believe, or merely pretend to believe, that prohibition will mean an x INTRODUCTION

improvement in the health of the people? The question is on a par with another one which has been asked rather frequently: Did the Inquisitors of the Middle Ages believe that the rack and the fagot would advance the cause of truth, or did a certain proportion of them, at least, employ these unpleasant arguments mainly to further their own interests and protect their special organization?

Some light on the first question, at any rate, should be found in the ensuing pages.

Contents

CHAPTER PAGE

INTRODUCTION vii

I THE ISSUE 9

Chapter I , . The Issue

America has embarked upon a great experiment, the elimination of alcoholic beverages from her national diet. The fact that wine has had its recognized place in the human economy from time immemorial seemed a matter of small consequence to the theorists who championed the prohibition movement. There were certain manifest evils connected with alcohol, therefore alcohol must go. And alcohol has gone, to a large extent. True, it still lingers in the homes of the rich and the provident; poisonous substitutes are being purveyed at fantastic prices by bootleggers, saloon keepers and other profiteers ; and the home-brewer is warming to his work and gradually learning the secrets of success. But the old order has certainly changed, yielding place to new. Is the new, however, better than the old, or is it fundamentally vicious?

io THE EIGHTEENTH AMENDMENT

Whenever we interfere with natural laws or established custom, trouble is to be expected; and whether expected or not, it will come. It is safer to build our houses, and even our ultra-modern skyscrapers, from the foundation upward rather than from the skyline downward; or the downward will be very clearly accentuated. But in these days of unrest, "try anything once" seems to have become the maxim of the advanced thinkers who would guide mankind to the great visionary higher level.

There has never been a time in the history of the world when the theorist was more in evidence. The wonderful progress seen everywhere in the arts and sciences during the present generation has encouraged theoretical speculation. The hypotheses of yesterday are the inventions and discoveries of to-day, by which the earth, the sea, the air have been brought under man's dominion. Success has bred a carelessness, even a contempt, for nature's laws, until we now find those who are willing to believe that the very laws of life itself can be disregarded. At the risk of platitude, it is just as well to state a simple truism: It is not by ignoring natural laws that man has triumphed, but by understanding them ; not by denying, but by observing them.

The shallow theorist, the bigot or the misguided moralist may become a source of serious danger to a community. There is no more perilous element

THE ISSUE n

in society than the fanatics who really believe in their fallacies, unless it be those who are willing to exploit their false doctrines for profit. "Uplift" is being used more and more frequently to disguise personal interest. It is time that people should begin to think for themselves, for they are being exploited in a way which has become a menace to popular government. With the spread of education, or rather the ability to read and write, the dissemination of false doctrines has become increasingly easy. The prohibition movement offers one of the most conspicuous examples.

The fate of the Eighteenth Amendment in the Supreme Court cannot be allowed to end the controversy. There is more than a legal principle involved: there is the vital question whether a nation can defy the laws of nature and still maintain its economic position. And with this there are the connected issues, the health, happiness and freedom of action of the American people.

It must be remembered that the Supreme Court can only pass upon a case as presented. Unfortunately the real issue, the interest of the public in (and so intimately depending upon) the question, has never had a hearing. It has been a characteristic feature of the prohibition propaganda to present the controversy in a misleading aspect, and to make it appear a conflict between temperance on the one side and the liquor interests on the other. A careful consideration of the subject from the economic standpoint is not desired. Any attempt to turn on the light has been met by the Anti-Saloon League — the stalking horse of the real interests behind the movement — by raising the bugaboo of the liquor trade. The liquor traffic as it once was, and the true and continuing relation of alcohol to the human system, are two very different things.

The public's interest in the case can be simply stated, and it is doubtful whether any court — except the final court of appeal of the whole people — has the power, or is competent, to pass on the question : Is alcohol necessary either as a food or a medicine for our individual or national well-being?

Chapter II The Moral Plea Fails

There are two aspects from which prohibition may be considered : the physical side, its effect on the health of the nation, or as Dr. Fisk phrases it, "its relation to human efficiency and longevity"; and the ethical side, its influence on national morals. After all, our morals are in a way but a higher sanitary code, for we have been put on this earth presumably to do appropriate work — God's work, in no canting sense — and moral guidance is to the end that we shall be fit in mind and body to carry on this work and assist our neighbors in the performance of their share, to the mutual welfare of all.

The morals, as commonly understood, of the Western nations are rooted in the law of Moses and the teachings of Christ. The miracles, sacraments and revelations of the Christian and Jewish religions alike are opposed to prohibition. It is difficult to see how any moral ground can be asserted for this fetich unless we are ready to discard the clear guidance of both the Old and New Testaments. Nothing could be plainer than Christ's acceptance of wine in the institution of the Blessed i 4 THE EIGHTEENTH AMENDMENT

Sacrament, the miracle at Cana of Galilee, and his teaching in the city called Nain. The Christian religion preaches temperance, not prohibition. There is no Christian virtue, nor any other kind of virtue, in a self-denial that is enforced by a prison cell or moral straitjacket. If the Church had had the disposal of the immense sum by which prohibition was purchased, were there not vital purposes in accordance (not at variance) with Christ's teaching, for which the money could have been well spent? Is total abstinence so paramount that the Church is willing to subordinate everything else for this one aim, — or are we now practising evangelism intensively, virtue by virtue ?

The law of Moses is accepted by both the Christian and the Jew as essentially the revelation of God. It has an important bearing on the subject not only morally, but physically also. There may be some who doubt the divine origin of the Hebrew laws, but they cannot question the historical fact that under these laws the people rose from a condition of slavery to the glory of a great nation under Solomon.

For four hundred and thirty years the Israelites had lived in Egypt. Generation after generation had been born in slavery, the burdens of their Egyptian taskmasters pressing harder and harder upon the subject race. Everything possible was done to break their spirit, even to the murder of their male

THE MORAL PLEA FAILS 15

children. Moses was called upon to lead his rescued people to the Land of Promise and take possession of a country already inhabited by warlike tribes. A long period of preparation was necessary to fit the wanderers for their task. During the pilgrimage a new generation was born free from the demoralizing influence of slavery, and trained under laws of morality and health which have become the foundation of our civilization.

The law of Moses deals distinctly with the use of alcohol, in the form of wine. In the directions for the harvest it divided the product of the vineyard in the same manner that the grain of the field was apportioned. The first share was for a drink offering to the Lord. After that came the share of the owner of the vineyard. The third share was reserved for the poor as a necessary food. There is no hesitation or hypocrisy here. Wine is dedicated both to the glory of God and to the natural use of all the people.

So much, briefly, for the religious aspect of the question. The prohibitionists cannot base any legitimate arguments on the Christian or Mosaic dispensations.

Alcohol is a food in the broad sense, because under certain conditions it may be essential for the proper nourishment of the body. The alcoholic craving has its foundation in normal requirements.

This, together with the fact that alcohol is a free gift of nature, will make it impossible to suppress its use by prohibitory laws. The passage of the Eighteenth Amendment has not changed the human system: it has merely put back the cause of temperance a hundred and fifty years. Anyone can make alcohol. Indeed, in many of the products of the kitchen, where sugars and acids are combined, the housewife must exercise the greatest care to avoid making it. The American people had become accustomed to buying their alcoholic beverages ready made. The manufacture was in the hands of a very small percentage of the population and so was easily regulated. The Eighteenth Amendment has changed all this. America is fast becoming an. immense brewery. The relation between supply and demand is not a matter of fiat, but of fact. The substitution, however, of tyros for experts in brewing and distilling, and of compulsory stealth for natural freedom, can scarcely be considered an improvement. Still, experience teaches; the novice becomes an adept, even under unpleasant conditions. There will be more and better illicit alcohol as time goes by.

The use of alcohol may be regulated, but not prohibited. So far from improving the morals of the people, prohibition will only increase hypocrisy and graft. There is not much doubt about this, for it has already happened.

Chapter III The Health Plea

Prohibition failed as a moral issue because the two great American religions were traditionally opposed to it. Something new had to be tried, and the success of the dry movement in certain Southern states offered a suggestion. Prohibition had made headway there because it was distinctly to the advantage of the South to remove temptation from the negro race. Self-interest is a powerful entering wedge for any argument, and the leaders of the dry campaign began a survey of the country in an effort to find interests which coincided with their own and which they could utilize.

Of course, the soft drink manufacturers were not overlooked. But while they might prove helpful from the financial standpoint later on, they were unorganized and of little influence in the country, and the selfish viewpoint would be altogether too obvious. However, three great and thoroughly systematized interests were found in receptive mood : the American Medical Association, the Life Insurance Companies, and the Standard Oil Company.

There were also certain other large corporations whose efficiency experts had been able to show that alcohol was increasing the cost of labor.

The American Medical Association maintained the most powerful trained lobby in the country. As far back as 1907 the association had an agent in each of the 2,830 counties of the United States, and its list of approachable political leaders numbered 16,000. Its interest was so distinctly on the side of prohibition that it has become the great power behind the movement. The financial backing of the other organizations was naturally of great importance. In addition, the life insurance companies were able to furnish valuable statistics, and the private charities of the Rockefellers offered a convenient cloak. How much the latter were influenced by their relations with Organized Medicine it is impossible to say. But the plea of health and human efficiency was given the premier position in the propaganda for prohibition.

In enlisting medicine in their cause the dry party acquired one of the most powerful agencies in our modern life, the influence of the family physician. In many a home in America this is a greater continuous force than any other. There are many stories to illustrate the doctor's prestige, but one will suffice.

Tucked away in the hills of New England is a

THE HEALTH PLEA 19

little village, the summer home of two intimate friends. As boys they had left this same village to make their way in the world beyond. They had been schoolmates together, and later on attended the same college. They were both interested in the same sports and pursuits, and the boyish friendship grew and ripened with the years. One of them took up the study of medicine; the other went into business and afterwards married. In the course of events a child was born, and who more fitting to attend at that critical period than the friend whom the father had learned to trust since boyhood? Other children came, and the physician, then a rising practitioner, cared for them through the illnesses of childhood, and the children learned to trust their father's friend. And finally there came a time when the doctor was called upon to share in the family's affliction. The wife and mother, through an unfortunate accident, was injured beyond the curative power of any physician. But day and night he watched at her bedside, alleviating pain wherever possible and giving the immeasurable comfort of his presence and skill. If anything could add to that household's love and respect, it was his sympathy with their loss, his comprehension of their grief.

You may wonder, perhaps, as to the precise application of this episode. It is given here because it is typical, not merely individual; because there are thousands of similar cases throughout America. Think of what that must mean; the enormous influence exerted by such physicians amongst the members of innumerable families. And this influence, in itself so natural and splendid, is being exploited in a partisan cause and for special and specious interests. The general practitioner himself has not much choice in the matter. It is difficult for him to oppose for any length of time the settled policy of his professional organization. It is almost impossible for him to remain in the association and defy its crushing disciplinary powers, open and covert. He can try to do so, of course, if he chooses. Others have sometimes made the attempt, — and sometimes regretted it. As an alternative, the practitioner may resign his membership in the association and become an "outlaw." But that involves a new professional outlook, the severance of old ties, the uprooting of fixed habits, and an absolutely fresh start. Besides, he has still to face the resentment of the organization, which does not readily forget; and there is no efficient outlaw organization to which he can turn for protection. It is not surprising, then, that the harassed practitioner, when he differs from the views of the authorities, should decide to feign an acquiescence that he does not feel. Only the prom-

THE HEALTH PLEA 21

inent and pushing — the leaders of cliques and factions — have the privilege of self-assertion in medical circles. The rank and file have to be content with obedience, or the black list.

Chapter IV

To understand the recent opposition of Organized Medicine to alcohol, it will be necessary to trace the development of this great power through its earlier stages, describing in some detail the various incidents and influences which have led up to the present situation. Many of them are extremely instructive.

Beginning in a small way, in the meetings of the town and county medical societies for the discussion of scientific matters or social betterment, a huge organization has been built up. Gradually, the agents of this organization have obtained positions of importance in the various institutions and establishments concerned with the national health, until finally they have taken over the complete control of our medical departments, both state and federal.

Before the days of Pasteur the science of medicine was little more than a mosaic of superstition. The physician had learned to recognize certain diseases and often obtained definite results in treatment, but the causes of disease, its progress and the reactions of the body, were obscured. Of all the applied sciences, medicine was the most backward. With the discovery of germ life, and its relation to pathogeny, a new era commenced. One after another, the organisms which are the cause of our various diseases were isolated. And this knowledge was closely followed by the discovery of the curative forces, of the body itself. A wonderful and supremely important field of research was opening before the eyes of the scientific world.

No one can take even a casual glance into the maze of serum therapy without being impressed by its intricacies and the tremendous amount of labor necessary for its exploration. Especially is this true of the body's own curative forces. Little by little, and only after the most painstaking research, was the knowledge of these forces obtained, one truth, found after years of study and experiment, leading on to another until finally nature's marvellous mechanism was revealed in its entirety.

This work was accomplished by the scientists of Europe. The names of Pasteur, Metchnikoff, Bordet, Ehrlich, Behring, Pfeiffer, Wright and Douglas, will always be associated with the great achievement. The fact that America, though leading the world in other lines of effort through the inventive genius of her scientists and mechanicians, nevertheless played so inconsiderable a part in medical development was due to the code of ethics originally foisted upon American practitioners by their European brethren. Well-meaning in principle, this code was fatal in practice. It was found depressing even in the environment of its birth. Here, it was impossible.

The economic situation was an important factor. America was then in the midst of a tremendous industrial boom. The great corporations were offering large financial inducements for the best brains that the country could produce. The natural law of supply and demand will apply whether the commodity is the brains of a scientist or a sack of potatoes. The medical code required — and still requires — that any discovery or invention for the more effective treatment of disease should be given to the world for its free use. It is this old world theory, denying the right of the skilled practitioner to the product of his labor, which has done more than anything else to retard the advance of medicine in the United States. Deprived of its legitimate rewards in the medical field, genius was inevitably diverted into other channels. There was too much competition for it to remain where it would only stultify itself. The laborer is worthy of his hire, and for priceless labor it seems rather ironic to receive no price at all.

I have recently had an opportunity of discussing this question with a bacteriologist of international reputation. In explaining his point of view he told the following story. When Behring perfected his antitoxin for diphtheria, he attempted to patent it. He was prevented from doing so because his colleagues did not think, in view of the work which others had done and by which he had profited, that he alone should reap the reward; for although they had failed, his success was built upon foundations which they had established. If a reward was to be given it should be distributed among all (or on behalf of all), living or dead, who had contributed to his final triumph. That may seem to some a counsel of perfection; to me it seems simply a plea of ineptitude. Our civilization would be in a curious state if the creators of our steam engines and automobiles had been denied patents, because someone in a prehistoric age had used the wheel on the oxcart; or if perfecting the open-hearth furnace had brought no reward from the steel industry because some antediluvian ancestor had employed fire in broiling a steak.

As a result of the success of the foreign investigators, the practising physician became dependent upon Europe for his medical knowledge. It must be remembered that during this period the science of medicine was making tremendous strides. More was being accomplished than in all the years since

Hippocrates. Our institutions were kept busy testing the theories of the European schools and passing them on to the practitioners. These institutions of research thus became clearing houses and distributing points for the new medical facts, and the control of medicine centered in the hands of the few who were able to speak with authority. With such a foundation it was a comparatively easy matter to build up a political machine whose power has never been exceeded, unless by the religious organizations of the Middle Ages.

And then occurred the very thing which the code of medical ethics was intended to prevent — the commercializing of medical knowledge. Our medical authorities embarked upon the manufacture of the newly discovered biological products, some openly, others sub rosa through the medium of their more venturesome associates. And although many of these vaccines and serums proved complete failures, they were marketed in large quantities.

With the completion of their organization, one of the first movements undertaken by the medical ring was a campaign against the patent medicines. There had grown up in the country a great business, the manufacture of nostrums. Some of these were utterly worthless, others contained drugs which anyone could procure from the corner pharmacy. They were prepared in fancy packages, under high-sounding titles, and sold to the credulous and unwary. They had already been condemned by the practising physician because in many instances the beneficial effect was at best illusory, while they were often definitely detrimental either through harmful ingredients or through the ignorance and improper use of the buyers — "addicts" as many of them could justly be called, for the patent medicine habit has a tendency to become chronic. The campaign against these nostrums unquestionably strengthened the hands of the medical authorities, both with the sensible portion of the lay public and with the general body of practitioners, who naturally did not wish to see their lawful practices thus cut into, to their own loss and the manifest danger of their patients.

The campaign was conducted along two lines, the education of the public and the passage of inhibitory legislation. The association leaders attempted to stop self-medication by making it necessary for the layman to obtain a doctor's prescription before he could purchase even the simplest form of drug. Failing in this, they tried to force the publication of the formulas of all proprietaries. The necessary legislation was pushed in every state and in Congress; the bills are part of our legislative records. In this campaign we see the first leaning of Organized Medicine towards prohibition. Speaking before a meeting of the Women's Christian Ternperance Union at Nashville, Tennessee, the spokesman of the American Medical Association said: "The average drug-store in the United States is little more than a saloon for the sale of disguised alcohol and 'dope' under the pretence of patent medicines."

The drive against the proprietary preparations had a very important though unforeseen effect, and the American practising physician became the chief sufferer. The campaign was conducted on such broad lines that not only was it directed against the fake nostrum, but even the legitimate proprietary was attacked. Improvement in drugs was thus discouraged and the physician had to look for his medicines to the countries, particularly Germany, whose laws encouraged pharmaceutical chemistry.

This was not the only result. The propaganda against drugs was pushed so vigorously that it began to create a doubt in the minds of the public as to the value of drugs in the treatment of disease. This idea was supported for financial reasons by the manufacturers of the various biological products, who were aided by their partners in official positions. As a consequence the regular school of medicine, which had relied on drugs from time immemorial, suddenly found itself confronted by a new and virile cult, the school of drugless medicine. How serious a menace this has become to the prestige of the regular practitioner is shown by the fact that these "physicians of health" — the osteopath, the chiropractor, the dietician — are now able to claim that their clients number twenty-eight millions.

It must not be supposed that the regular physicians were satisfied to see their patients slip away from them. There was much criticism, even ridicule, of their leaders, and in some instances open rebellion. But in the majority of cases the practitioner decided that it was politic to retain his membership in the association. However, it began to dawn upon him that some of the medical authorities were lining their pockets at his expense.