1916 Journal of the American Medical Association  
There are a number of worthless therapeutic prac-tices\p=m-\some based on abandoned theories of pathology, some due to technical errors in pharmacologic investigations, some based on misinterpreted clinical observations, and some the mere relics of medieval superstition \p=m-\which still persist in common use. Some of these receive even today the sanction of authority; men whose acumen in many lines has won our respect occasionally lend the weight of their recommendation to measures which can
more » ... easures which can be defended on neither theoretical grounds nor clinical results. It has seemed to me that it might be worth while to call attention to the source of some of the more common superstitions of this character. First, however, it is necessary to establish the criteria on which we base our judgment as to the therapeutic value of a drug. Certainly the length of time during which a drug has been employed in medicine furnishes no measure of its usefulness. Ammoniac gum was described by Dioscorides in the first century, and for more than a thousand years was highly esteemed, but has fallen into such disuse that it is no longer recognized by the U. S. Pharmacopeia. In studying the materia medica of the first, tenth and fif¬ teenth centuries, one is struck by their similarity to each other and their difference from that of today. Remedies whose reputation was sustained unabated for 2,000 years have been unable to bear the light of modern knowledge, and within half a century have not only been completely discarded as worthless but their very names forgotten. The first edition of the U. S. Pharmacopeia was published less than a century ago.1 Of 624 drugs and preparations deemed by the editors of that work to be "those, the utility of which is most fully established," 305 have been already despoiled of their official rec¬ ognition. I have been surprised in looking over this interesting work, not so much, however, by the num¬ ber of ancient remedies which we have ceased to use, but by the absence of drugs today universally recog¬ nized as our most valuable weapons against disease. Neither iodin nor any of the iodids are in the first American Pharmacopeia ; one looks in vain for potas¬ sium bromid or any other preparation of bromin ; there is no form of salicylic acid except the oil of gaultheria, and that apparently was recognized only for its aro-1. Dec. 15, 1820. matic odor; one finds neither chloral nor any of our modern somnifacients; coca and cocain are both miss¬ ing, as are also santonica and santonin ; ether is rec¬ ognized, but chloroform was unknown ; nitroglycerin is not mentioned, the only form of nitrite recognized being sweet spirits of niter; the only mention of ergot is in the secondary list that is, drugs of doubtful worth where is listed Secale cornutum or spurred rye, but it was not deemed of sufficient impor¬ tance to have any preparation recognized. One is not surprised at the absence of our modern coal tar deriva¬ tives, such as acetanilid and phenol (carbolic acid), but that the usefulness of aspidium or pilocarpus should not have been earlier discovered seems worthy of comment. In the place of these remedies which the present day physician relies on in such a host of-conditions, we find horseradish, oatmeal, bar¬ ley, stag's horn, metallic gold and silver, cowhagewhose sharp bristles were used as a vermifuge on the theory that they would stab the worm to death and scores of remedies not even whose names would be known to many readers. Are we to gage the utility of a therapeutic agent by the clinical results we think we see? Wendell Phillips said in one of his famous orations, "You read history not with your eyes but with your prejudices." The thought might well be applied to the medical profes¬ sion. Practically all our experience is interpreted through the glasses of our prejudice. Never, since the days when the ancient Assyrian chanted his exorcisms of the pathogenic devil according to the phases of the moon, have men been able to free themselves in the choice of their remedies from the dominance of some theory concerning disease. Indeed, it cannot well be otherwise. The manifestations of disease are so pro¬ tean, and its development subject to such an infinitude of variation, that no simple collection of observations without interpretation is of the slightest value. If those who believe that empiricism should be the only guide in the treatment of the sick could read the his¬ tory of medicine "with their eyes," they would see what a feeble flickering light to the progress of medi¬ cal science experience has been ; nay, it has been a veritable will-o'-the-wisp, leading men astray farther and farther from the truth. For fifteen centuries the experiences of medical Europe were interpreted to suit the theories of the great Galen, and in these fif¬ teen hundred years, with their observations of millions of deaths, physicians learned absolutely nothing of how to relieve suffering or prolong life. A splendid illustration of the blindness of humanity to their sur¬ roundings is seen in the duration of the bloodletting superstition. For three centuries physicians with the best motives bled their patients to death, absolutely incapable of realizing that their venesection killed far
doi:10.1001/jama.1916.02580410001001 fatcat:uxvbkwudijd4bfvjr4wx3xyf7m