The Secrets of Specialists/Chapter 1

A medical specialist has been defined as a physician or a surgeon who knows something about every disease and everything about some disease, but we find that this definition is not applicable to all physicians who are in special practice, for we find men at the highest pinnacle of the profession adding the title of specialist to their names while the caption is also adopted by the boldest kind of an advertising quack.

We therefore find that under the above title we could discuss many types of medical men, but inasmuch as every general practitioner is familiar with the work of the Regular Medical Specialist, we shall first discuss this subject from an advertising and non-ethical standpoint. What is to be said regarding advertising is to explain the method rather than to encourage the practice.

These specialists might be classed as the itinerant advertising specialist; the local advertising specialist; the special disease advertising specialist; the mail order specialist; the ethical specialist; the office specialist; the observing specialist, etc.

All of these except the ethical and the office specialist are considered irregular practitioners, whose methods we wish to briefly outline. Those who think all advertising physicians are destitute of a sound knowledge of medicine are entertaining an erroneous idea, which should be released as soon as possible. While I must admit that there are a great many advertising physicians who are nothing more than medical ignoramuses, and are justly entitled to the name "quack" which best identifies them, on the other hand we find among them some of the best therapeutists we have ever had the ​pleasure of meeting. These physicians are advertising purely from choice, as they are better remunerated for their services and their labors are not so hard.

Many advanced methods of treatment have originated with the irregular practitioner. Many condemnable, demoralizing influences have also come from the same source. In all other lines of business, if a man makes a discovery he can have it patented and his rights protected, but if a physician holds his special method of treatment a secret, or sells the right to use it, he is at once denounced by the regular physicians.

The estates of Drs. Keeley and Brinkerhoff, and the promoters of the various injection treatments for hernia and other methods, would not have been so large if they had made their treatments publicly known. Fortunately the tricks of medicine will out," and I doubt if there is a secret in the practice of medicine today which cannot be exposed or duplicated with equal therapeutic results. I shall endeavor to throw some light on the subject in the following pages, but I will scarcely be able to begin to tell what might be said.

There has been many discussions at medical societies as to the best methods of eliminating the quack, but to my knowledge there has never been any definite decision. My answer to this perplexing question would be, to adopt his methods, whenever they are worthy of recognition.

Advertising physicians are, generally speaking, good financiers and business men. They advertise as specialists for revenue instead of for the honor of practicing medicine. Oftentimes they depend upon their business ability more than on their knowledge of medicine to make a success. At least, I have seen many cases in which their skill was not apparent, even if they possessed any.

Of the advertising specialists I have met, I would say that fifty per cent. of them have a medical education equal to that of the average general practitioner. Twenty per cent. have a superior knowledge of certain diseases; the remaining ​thirty per cent are far below the average, and why they should class themselves as specialists is beyond my comprehension.

The inducements from a financial standpoint are certainly such as to encourage one to enter the advertising arena, for advertising specialists often receive more money for one day's labor than many physicians do in a year. You may think this is an overdrawn statement, but it is a fact.

I believe that there comes a time in life when a large percentage of physicians feel that they would like to enter the advertising field, but owing either to a lack of confidence in themselves, or to the fear of being called a quack by their brother practitioners they confine themselves to the code of ethics, and it is well that these objections are considered, for advertising practices are not all sunshine, and they have been the means of ruining both the reputation and financial standing of many physicians.

Many of the most successful advertisers will tell you that if they had their lives to live over again they would prefer the general practice of medicine, wherein they could enjoy the esteem, confidence and respect of their patients and the many social functions of which the advertiser knows very little. I do not mean to say that advertising physicians have no grateful patients, but there is not the same friendly and respectful feeling towards them that there is between the general practitioner and his patients.

These specialists travel from town to town and generally plan their circuit so as to make each point either once a month or once in two months. They advertise either to treat all chronic diseases or else they limit their practice to one or more diseases, such as piles, rupture, etc.

​Most of the chronic disease specialists who travel have a deficient knowledge of medicine, and could not make a living if they had a permanent residence. It is rather discouraging for the local physician, who labors night and day for the good of his patients, and does more work for sweet charity's sake than any one else in the community, to read the advertisements of one of these specialists and witness the financial success of his visit, for, no doubt, he has received more cash in his pocket for his day's work than the local practitioner could book in a month.

It is rather amusing to read the headlines of some of the advertising circulars issued by the traveling doctor. I once picked up a bill on the street in a neighboring town with the bold faced headlines, "The President is coming." This certainly was a very "catchy" caption and everybody was wondering at first sight if the Chief Executive of the United States was going to make them a visit, but by reading a little farther it was Dr. Gordon, a traveling specialist, who was President of some Medical Institute.

There seems to be no way to suppress the practice of the itinerants, unless it is done by legislation. The laws of many states are so rigid that it prevents their operations to a certain extent.

The itinerant specialist treats his patients by the month; his charges range from five dollars to as much as he can get for each month's treatment, which, of course, includes all medicine. He always tries to bind them by a contract to take several months' treatment for a certain consideration; for this he takes their notes, which are indorsed by responsible parties. These notes are made payable each month as he visits the city. If possible, he will dispose of the notes at the bank and leave the city with cash on hand.

The traveling specialist's principle field is in the treatment of chronic, obscure and long standing diseases, the thus afflicted are pseudonymed by them as "rounders" for nearly all patients consulting them have gone the rounds of the local ​physicians, and when they see the advertisements of these specialists, appearing in their local papers, they are attracted to them, as a boy is to the aroma of sawdust at a circus.

These specialists always dispense their own medicines which necessitates a road equipment and dispensary, which can be obtained in as portable and compact form as possible. In these days of compressed tablets, tablet triturates, pills and alkaloid granules. Such an equipment is an easy way of dispensing, but experience has taught them in many instances, in order to secure large fees they must "give their patients their money's worth," and dispense large packages; they therefore cannot be weaned from the bottle and liquid medications; with this object in view many of these specialists have become quite expert extemporaneous dispensors.

There is no prescription writing done by the traveling specialists; he exercises sufficient judgment to keep his knowledge to himself and fatten his purse by direct prescribing. In order to carry a reasonably well equipped outfit from town to town, it is necessary that such remedies be selected as will occupy as little space as possible. Fluid extracts and Lloyd Brother's specific tinctures, which represent one grain of the drug to the minum are selected. Lloyd's tinctures are often preferred for this purpose, as they mix more readily with water and do not allow the resin to separate and be deposited on the side of the bottle or float on top of the mixture. The principal menstruum in their prescriptions is water or simple syrup which is preserved with about 10 per cent. of alcohol or sufficient resorcin or salicylic acid to keep their mixtures from decomposing or deteriorating in their therapeutic value, as will be illustrated in the following prescriptions, Resorcin seems to be in greatest favor as a preservative. A few grains of this remedy added to any mixture will preserve the preparation indefinitely and is one of the best gastric and intestinal antiseptics the physician can select and is always followed with good results in all fermentations and decompositions within the digestive tract. Many times a ​concentrated aromatic elixir is added in small quantities to flavor the preparation, extract of licorice is made from the common commercial stick licorice by adding water and heat and condensing the product to a semi-solid mass. This is used to disguise the taste of many of their bitter mixtures. Caramel is the principal coloring matter used where a rich brown color is desired. Simple syrup is made by simply filling the dispensing bottle about one-third full of granulated sugar into which aqua and the other ingredients are added.

In selecting remedies for the road you must bear in mind that you have exclusive chronic diseases to deal with, and the medications required are not such as are always used in the treatment of acute diseases, but incorporate medicines known in therapeutic classification as tonics, alteratives, stimulants, aphrodisiacs, diuretics, restoratives, etc. Of the entire list nux vomica and its alkaloid strychnine, perhaps heads the list and is added to nearly all of their tonic mixtures, however the entire list of "multum in parvo remedies" enter into their prescriptions, that is such remedies as will make large dispensing packages, by the addition of a small amount of the more active remedies or such remedies as the maximum dose is from one to five minums, such as the fluid extracts of nux vomica, hyoscyamus, Cannabis Indica and nitrohydrochloric acid, etc. To illustrate their methods of dispensing, I will briefly outline a case, and also give one of the extemporaneous prescriptions, which entered into the treatment, which was taken from a case book of a traveling specialist.

Mrs. H. —— aged 28, living in a malarious district, been sick for three years, the beginning was ushered in with intermittent fever, which lasted four weeks, from which she never fully regained her health and strength; when consulted the patient was extremely emaciated, and constipated by the use of cathartic pills, her bowels would move every third day, with clay-colored stools, occasional attacks of sick headache, the appetite was poor, the complexion was pale and rather yellow, indicating an impairment of the blood, hepatic and digestive ​functions. It was plain to observe that she had a case of chronic malarial toxemia to deal with; the following prescription was one of several which entered into the treatment:

Sig. A teaspoonful in a wine-glass two-thirds full of old port wine after each meal.

In compounding this prescription the sixteen-ounce bottle is filled two-thirds full of water, into which the arsenious acid, nitrohydrochloride acid and resoreine is dissolved, the sugar is now added and when partly dissolved the other ingredients added. Shake the bottle until all are thoroughly dissolved. The finished product makes a beautiful brown mixture, which is easily prepared in a minute's time and offers all the advantages of an intestinal antiseptic, antiperiodic gastro-intestinal and hepatic stimulant, and as a general tonic, although iron in the form of Blaud's pills and other adjunct medication was administered, the principal credit in restoring the health of the above patient was given to the above prescription.

It is a well recognized fact that minimum doses of Cascara Sagrada combined with Nux Vomica will often accomplish better results in the treatment of chronic constipation and inactivity of the bowels than the maximum dose of Cascara Sagrada alone. The following prescription is a great favorite for this most common complaint and shows the way licorice may be used to partially disguise the bitter taste of the other ingredients.

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Dropsy is a frequent complication of chronic discases of the heart, liver and kidneys. The following mixture is a great favorite as an adjunct treatment for the relief of this condition:

Sig. A teaspoonful every three hours.

There are hundreds of similar formulæs which could be given, but the above examples will be sufficient to give the reader an idea in which some of their mixtures are compounded in a few moments' time in the parlors they occupy at the hotel where they are temporarily domiciled.

This man advertises either under his own name or under the name of a Medical Institute, or both. His business methods are conducted very much like those of the itinerant. Many of these specialists advertise to treat all diseases in general; others confine their advertising to eye and ear, throat, nose and lungs, catarrh and catarrhal deafness, hemorrhoids, hernia, etc., but the advertisement most frequently seen in the daily papers is one concerning the discase of the sexual system.

​I once asked a physician, who had a large experience in advertising and treating all general diseases, why he finally confined his advertising to treatment of diseases of the sexual organs. He replied that in his experience he has found that people would pay more money for the treatment of diseases in that part of their anatomy than in any other. He also stated that if he had a patient who was suffering with both consumption and impoteney he would be requested to cure him of impotency first.

There is a world of truth in what he said, for people will neglect every other discase longer than they will any disorder of the sexual system. Another reason which makes sexual diseases a profitable specialty is, that most people do not care to consult their family physician in such matters, and, seeing the advertisement of a specialist will drift into his hands.

Many of these specialists endeavor to advertise in a modest way, but the majority are bold and offensive, for the louder they shout the more victims they will secure. Their advertisements are often decidedly misleading, with bold headlines of "Free Until Cured," "One Month's Treatment Free," etc. Such advertisements are, of course, only to decoy the patient to call at the office and the process of landing them is an easy one, for instead of giving them one month treatment free, they tell the patient that they only offer their services free, but they will expect the patient to pay for the medicine for which they will only charge from five to fifty dollars a month. Their medicines are, of course, very expensive (?). They also issue circulars depicting the despairing future of the masturbator. These are illustrated with pictures of a brainless child born of a masturbator, or a half-naked man behind the bars, made insane by self-abuse.

No words can tell the demoralizing influence that such publications have on the half-educated youth who gets hold of them. They are led to believe if they have one or two emissions a month they are afflicted with some incurable disease. It is this state of mind that is desired by the advertisers, ​for the more morbidness and despair, the more money in their pockets. This systematized method of attempting to create disease and to fatten on the distress of their victims is the foulest possible prostitution of medicine.

This class of physicians also treat syphilis, gonorrhoea, and other venereal diseases. When business gets a little dull they buy a list of letters from some mail order man who is in the same business, and get a new list of patients. They often exchange names in order that each may work the discarded or discontented patients of the other and thus keep the machinery running. Some of the methods of treatment used by these specialists will be discussed in the chapter on genitourinary diseases.

We find that these men are of a more refined nature, and generally very skillful in the special branch of medicine or surgery which they are practicing. They are entitled in every sense of the word to be called specialists. They are conscientious and are interested in the welfare of their patients; they believe that their methods of treatment are the best and they demonstrate in many cases that they are. Under this class we find rectal, hernia, diseases of the stomach, cancer and other specialists, many of whom would be shining lights in the medical fraternity if it were not for their advertising, which is devoid, however, of objectionable matter. Whether or not advertising by such men should be allowed by the medical profession I am not in a position to say, but it seems to me that if a man devotes his time in perfecting a treatment for some special disease, which his brother practitioner has failed to cure or recognize as incurable, he should for the sake of humanity let the world know it, and the easiest way is through printer's ink, unless he teaches his method to the profession, the members of which often do not care to spend the time to learn.

​This has been illustrated hundreds of times by rectal, hernia, and cancer specialists. I have seen many patients with cancer and hernia cured by these specialists, who were offered little or no encouragement from their family physician.

In the following pages I will give several methods of treatment used by these specialists which are worthy of adopting in your practice, and by making use of them you will receive large financial returns.

Most physicians have very little conception of the amount of business done by the mail-order specialist. Up to a few years ago, if any one had told you that he could establish a large medical practice through the mail, you would have thought that he was a fit subject for the lunatic asylum; but at the present time there are hundreds of thousands of dollars spent every year in advertising, and many more thousands of dollars received by the advertisers.

There are about one hundred and seventy periodicals published for the sole convenience of the advertisers. These are called Mail Order Journals or Magazines. The rates for advertising in these publications range all the way from ten cents to six dollars a line. A four-line advertisement inserted once in the entire list, would cost $529.20.

This will give you an idea of the enormous amount of money that can be spent in advertising. A four-line advertisement is the smallest space some papers will allow you to take.

A Mail Order Medical Specialist who uses only four inches of space each month is considered rather a small advertiser, although he is paying $6,350.40 each year for his advertising, if he uses the entire list. There are many specialists who appropriate $100,000.00 each year for their advertising. ​By advertising in the so-called Mail Order Journals, you reach patients in the most remote parts of the country. You will have no idea from what country you may receive a reply from your advertisement. You may receive letters from Australia, Japan or Iceland, or from a mining or logging camp, which is many miles from the nearest railroad. On the other hand, you may receive a reply from your own or from a distant city. Of all the medical advertising business, the mail order business is the most fascinating, for when one once gets into it, it is hard for him to get out.

The specialists who are following the mail order industry generally confine their practice to one disease or to one remedy and advertise a specific treatment for Kidney complaint, Rheumatism, Catarrh, Obesity, Deafness, Diseases of the Eye, Impotency, Female Complaints, Consumption, Asthma, Epilepsy, etc.

The remedies for the cure of these diseases are generally first furnished to the patient in the way of free samples. If the remedy has any merit, the patient is quite sure to order a supply. In this way he is induced to continue the treatment for several months.

There are two important things to be considered in remedies to be sent through the mail. They should possess a certain degree of merit, and should contain no poisonous ingredients, as poisonous and narcotic drugs are strictly forbidden to be carried by mail, but this rule is not always adhered to, as will be seen by the formulas which are to follow.

The physician who treats all chronic diseases, supplies his patients with question blanks which the patient can fill out and send to the doctor, together with a description of his case in his own language. The physician may then prepare any treatment he deems the case requires. The fees for such treatments are from one to ten or more dollars a month. Mail order specialists generally treat their patients by the month, as do other advertising specialists.

Mail order patients should be treated with the same integrity and respect as local patients, and, under all circum​stances the specialist should endeavor to hold the esteem and good-will of his patients. If a patient should write a tart, pointed, or impudent letter, it should never be answered by one of the same character, although the specialist may feel justified in doing so. No good can be accomplished from such correspondence, and much harm is often done. If one can succeed in holding the confidence of his patient and the treatment benefits him, he is sure to send other patients, but if the treatment is absolutely worthless, he will not hesitate to denounce it as a fraud. This is oftentimes done very unjustly, for no physician can expect as great a number of cures in a mail order practice as he can in patients who are constantly under his observation.

Although there are several preparations given throughout this book which have or can be used in mail order practice, I will add several more which have come to my notice and which can be used successfully by the general practitioner.

Remedies for this distressing disease have always found a steady and increasing sale. I know of one gentleman who has made a large fortune through the sale of the following Asthma cure, which is compounded after the formula of Dr. Covert. The formula is a good one and has been published in several Medical Journals:

Dose—Teaspoonful three times a day; extra doses during a paroxysm.

A few years ago the Slocum system of treatment for consumption established quite a reputation, and the company was among the largest of mail order advertisers. I sent for a sample of their preparations, which consist of a bottle of Psychine, Ozomulsion, Coltsfoot Expectorant and Ozojell.

The Ozomulsion was about a twenty per cent. cod liver oil emulsion with the addition of guaiacol. Psychine, the greatest of all tonics," is a decoction of nux vomica and cinnamon, which is to be taken in a wine-glass full of whiskey before each meal to build up the appetite. The Coltsfoot Expectorant is a preparation very much resembling Ayer's Cherry Pectoral, given on another page. This treatment will cost from five dollars to ten dollars a month.

These are also freely advertised and the patient liberally sampled. A gentleman who had the management of a large mail order Rheumatism Cure Co., said that they only used one drug and that was prepared as follows in large quantities:

Mix.—A teaspoonful from three to six times a day.

Each teaspoonful of the above mixture represents twenty grains of ammonium chloride, and it is often surprising to note the influence which this drug has in controlling muscular rheumatism. The cheapness of the drug makes it a very profitable remedy to handle, and it is a preparation that will establish a reputation upon its own merits, as the thousands of testimonials which this company possesses will attest.

"I cure fits," is a headline seen in all mail order publications, and several men have accumulated large estates by ​selling remedies for epilepsy. A very convenient and profitable remedy for epilepsy and the neuroses is hydrocyanate of iron. Although this remedy has been used by a few physicians for several years, it has never gained the confidence of the profession which it fully deserves. It will seldom disappoint reasonable expectations and has the advantage for mail order purposes that it can be dispensed in pill form, each pill composed of the following:

Sig. A pill morning and night, gradually increasing.

The frequency of diseases of the heart has created a demand for a "heart cure." The accompanying formula is used by one firm and I am told that they have the tablets manufactured in car-load lots. The formula is an old one and extensively used by the medical profession. Each tablet represents:

A physician who has a large local and mail order practice and advertises as a stomach specialist, claims he can cure ninety per cent. of all cases of dyspepsia by confining his patient to a raw or very slightly cooked beef diet. In connection with this diet, his favorite stomach or digestive tablet is as follows:

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This treatment is certainly a very successful one and the raw meat diet should never be overlooked in treating stomach diseases, as it has a very soothing influence on the stomach when it is in an irritable or a diseased state.

A western physician has extensively advertised a cure for "bed wetting," which is put up in tablet form according to this formula:

The directions which accompany the treatment instruct children to retain their urine as long as possible during the day and not to drink any liquid for two hours before going to bed.

The following formula makes a preparation very much like Cascarets, which has had a remarkable sale:

Mix the first six remedies and add sufficient water to make a paste, then divide into tablets of thirty grains each.

Pills for redueing weight have found a great demand. These pills are made from the active principles of the phytolacca berry and bladder wrack, and put on the market under different names.

Every mail order journal contains advertisements for selling recipes; this is particularly so with toilet articles, household preparations, etc. These recipes are sold at prices ranging from twenty-five cents to ten or more dollars. I give the following as illustrations of this class, the former representing a $1.00 hair restorative recipe and the latter recipe for making artificial maple syrup, which has been sold many times to manufacturers from $10.00 up:

Put one pint of boiling water on the above, and set it aside to cool for one hour. Then strain through a cloth and add one ounce of glycerine and two ounces of alcohol (or bay rum). It is then ready for use.

If your hair is naturally oily, you may omit the glycerine.

After shaking the bottle, pour a few spoonfuls into a vessel. Take a sponge, moisten with compound, and rub the scalp thoroughly. Do this every other morning and evening until the hair has resumed its natural color, and then apply once a week thereafter. It will not stain the scalp, and contains no poisons.

Dissolve the Pyrogallic Acid in the Alcohol, and the Sulphite Soda in the water. Mix the two (2) solutions together, and then it is ready to use.

Before using, the hair should be thoroughly washed with soap and water. It can be so applied as to color the hair either black or the lighter shade of brown. If black is the color desired, the preparation should be applied while the hair is moist, and for brown it should not be used till the hair is perfectly dry. To apply, dip the points of a fine tooth comb into the compound, and gently draw the comb through the hair, commencing at the roots, till the dye has perceptibly taken effect. When the hair is entirely dry, oil and brush it as usual.

I send two recipes—The first is my own original recipe, and the one I recommend. The second one is given because of its easy use, and combining both black and brown according to the way applied. It is excellent for dyeing the whiskers. Ingredients for the first recipe (except Alcohol and Glycerine) sent post-paid for twenty-five cents. Ingredients for the Harmless Dye (except Alcohol and Water) sent post-paid for thirty-five cents.

NOTE.—It will be noticed that their object is not only to sell the recipes but also to supply the ingredients.

Although this formula is a deviation from the theme of this publication, the product is a useful household article, and the process of manufacture is so simple and valued so highly, that I feel justified in giving it, as much of the maple syrup ​bought at stores is made by this or a similar process and produces an article which is hard to detect from the genuine. The simple process of manufacture is as follows: Crack two quarts of hickory nut shells, remove the meat; tie the shells in cheese cloth and boil for about one-half hour in one gallon of water. When the solution becomes brown, add sufficient sugar to make the syrup the right consistency, and strain while hot.

Another way of introducing proprietary medicines is to advertise for agents and give premiums. The applicant answering the advertisement is at once forwarded fifteen packages of headache powders which he sells at ten cents a package. He remits the full amount, $1.50, and receives, as a remuneration for his services, jewelry and other articles. This is a very successful scheme and rather an honorable way of introducing remedies. If the remedy has merit the medical company receives many orders, as their address is printed on each package.

This scheme has formerly been used by the "Lost Manhood" fakirs, and consists of advertising a free prescription for lost vitality. The prescription is sent to the applicant as ordered, in due time, and contains the fictitious names of many remedies. The patient also receives a flowery letter stating that these remedies are imported from Central Africa, South America or some other foreign country, and thinking perhaps, their local druggists might not carry them in stock, they decide to send them one complete month's treatment, by express C. O. D., $6.00. If the prospective patient is slow in accepting the package, he is frequently written to by what is known as the "follow up system," which consists of a series of letters extolling the valuable properties of the treatment. The price of the treatment is also gradually reduced during ​the correspondence from $6.00 to $1.50; in the meantime the express company is notified if the package is not accepted, it can be destroyed, as its value is less than the express charges to return it. This has proven to be a very successful scheme, as fully three-fourths of the packages are accepted. There were no less than twelve of these medical companies in operation at one time. The postoffice authorities have refused them the use of the mail, however, and they have closed out their business.

This is a new feature which is being practiced by many advertising specialists, and, although this method cannot be applied to all cases, it is surprising to note how often they will hit the nail on the head.

I had occasion to visit one of those physicians for the purpose of learning his secret if possible, and was somewhat surprised at the accuracy in which he would often describe symptoms, and the weight it had in gaining the confidence of the patients, which is a very important feature from a financial standpoint. People generally think that if a physician can tell their ailments without asking any questions he must be a healer of wonderful skill and ability.

This physician had charge of one of the largest medical and surgical institutes in our country, which afforded him an opportunity to examine from twenty to seventy-five patients a day, and after watching him take cases, I am thoroughly convinced that the face will map out many diseases and the physician who is the least observing and familiar with the symptoms of disease, can tell many of them by studying the physiognomy of his patients.

​The expression and the color of the face, temperament, the carriage of the body, conversation, breathing, eye, the pulse, tongue, and the occupation, are the principal things upon which these "physiognomy diagnostitions" locate disease.

There are only three questions which are asked the patient, namely: To see the tongue, his age, and his occupation.

During my stay with this physician I watched him take many interesting cases, and I think it will be of sufficient interest to outline the ones which are quite familiar to every physician.

The first patient was a gentleman, forty-six years old, who entered the consulting room rather slowly and took a seat. There was an expression of melancholy on his face; he looked sad and friendless; the skin and complexion was slightly yellow, but not decidedly noticeable; the doctor looked at his tongue, which had a brown coat, and told him he had disease of the liver; a feeling of fullness in the right side, laying his hand on the right hypochondriac region; he also told him that he had a pain under the right shoulder blade; at times would feel drowsy; had no ambition; the urine at times was scanty and high-colored; was troubled with indigestion. He also mentioned other symptoms which are generally associated with diseases of the liver. In this case you will see that his diagnosis was founded upon the color of the skin, the general torpidness of the body and the coating of the tongue.

The next case was still less difficult. A young lady, eighteen years old, whose face at once would explain her symptoms, for she had a pronounced case of anaemia. The doctor immediately told her her disease was due to lack of red blood corpuscles in the blood; that her menstrual periods were scanty and irregular; that her heart would palpitate on the least exertion; that she would get dizzy when rising from a recumbent position, etc.

The next patient was a lady thirty-seven years old, mother of four children; was nearly as pale and anaemic as the former ​patient. The doctor examined her carefully and told her that she was suffering with female troubles; that her menses were too profuse and appeared oftener than they should; that this excessive loss of blood would not allow her body the proper nourishment, and at times she was extremely nervous and irritable; and also that her digestive organs were feeble, due to lack of nourishment from the excessive loss of blood, and that like the former anaemic patient, she had palpitation of the heart, faintness, etc., all of which she admitted to be true.

After the patient was dismissed, I asked the doctor why he should diagnose her disease as originating in the female organs. He discussed the temperament of the patient; the tissues of the body were sleazy in texture and would readily yield to the congestion in the parts during the menstruation, and owing to this excessive loss of blood would naturally bring other organs into sympathetic suffering.

The next patient was a man, fifty-one years old, who apparently seemed to be enjoying the best of health, but, after examining the tongue, he was immediately told that he had dyspepsia. The tongue had a heavy white coat, which indicated that an excessive amount of acid was being secreted by the stomach and that he would have sour eructations, heartburn, occasionally, pain in the pit of the stomach and soreness on pressure, etc.

In this case it was plain to see that the tongue told the story.

The next case was a man sixty-one years old, with rather a plethoric temperament. After the doctor felt of his pulse, he at once advised him that he had a valvular disease of the heart. He called my attention to the receding pulse which was particularly characteristic with its forcible impulse, which rapidly declined; the so-called "water-hammer" pulse. The blood vessels throughout the body would pulsate so that they were visible to the eye. The use of the stethoscope showed plainly that the patient was suffering from aortic regurgitation.

The above only illustrate a small number of cases met with and, although he made many failures, he was reasonably ​successful in the majority of cases. I have seen him locate diseased organs by finding a sore spot on the spinal column, and relieve pain by making pressure on this spot and desensitizing the nerve supply, which is the method used by the osteopaths. He would locate rectal diseases by the position which the patient sits in the chair. Kidney troubles can also be located by the condition of the eye, and the desire of the patient to press the small of his back upon some hard substance. The color of the skin will point out diseases of the blood and liver; the character of a cough will locate disease of the throat, bronchial tubes or lungs by its volume.

Acna rosacea is not always due to the use of alcohol, but is frequently associated with disease of the stomach and bowels. Falling out of hair is also connected with diseases of the kidneys. Dark circles and discolorations under the eyes are associated with disturbances within the pelvic cavity, female diseases, etc. Masturbators and those who indulge in sexual excesses can often be identified by the sheepish expression of their faces. Notched teeth are often a symptom of hereditary syphilis, etc.

Pain in the form of reflex headaches is one of the most frequent symptoms referred to. The accompanying diagram given by the late Dr. Nicholas Senn, will illustrate the methods ​in which many diseases of the internal organs are located through this reflex neurosis.

The late Dr. J. K. Seudder, of Cincinnati, was among the first to call attention to the different coatings of the tongue and their relation to diseases of the stomach, bowels and blood. The doctor says, "If the tongue is heavily coated at its base with a yellowish white fur, we know that there are morbid accumulations in the stomach. If the tongue is uniformly coated from base to tip with a yellowish fur, rather full, and moist, we have the history of atony of the small intestines. If the tongue is elongated and pointed, red at tip and edges, ​papillæ elongated and red, we have evidence of irritations of the stomach with deterioration of the blood.

"Again, we have a tongue that might be designated as 'slick.'" It is variously colored, but it looks as if a fly should light on it he would slip up and break his neck. It is evidence of a want of functional power, not only of the stomach and the bowels, but of all parts supplied by the sympathetic nerves.

"The tongue tells us of acidity and alkalinity of the blood in language so plain that it cannot be mistaken. The pallid tongue with white fur is an index of acidity of the stomach and blood and it is surprising to note how rapidly these conditions can be cured by the use of sulphite of soda. A deep red tongue indicates alkalinity and is readily cured by the employment of an acid.

"Impoverishment of the blood (sepsis) is indicated by a dirty dark colored fur, and requires a treatment that will antagonize this septic process."

You will notice that this "unruly member" alone tells us a good deal and by careful study might tell us more. It is with these objective and semi-objective symptoms, together with the sense of touch, that these specialists become familiar and use as a foundation for their diagnosis. Although I have only given you a rough sketch of the subject and present this article only as good material for thought, hoping that it may prove of some assistance to you in locating diseases by observation.

We find that medical men, even of this description, often like to see their names in print, which will react to a financial advantage on their part, but these men differ from the regular advertisers inasmuch as they do not pay for their advertising. There is hardly an edition of a local paper that does not contain an account of the discovery of some physician or the dexterity of some surgeon in a certain operation.

​The detailed copy was, no doubt, handed to the editor by the physician himself, with a request that it should be printed. This, of course, is profitable advertising for the practitioner, but the editor is led to believe that the article was written for the advancement of science.

This is well illustrated in the world-wide advertising which Professors Koch and Brown-Sequard have received out of their consumption lymph and the "elixir of life." Although they were only scientific bubbles, the advertising these gentlemen received has had much to do in bringing their names before the public.

In smaller towns local items of births, fractures, etc., are handed to the editor with the name of the doctor attached as being the attending physician. This is a very judicious way of advertising.

I remember once meeting a young physician, who had just located in a small city, who was called to adjust a fracture. The papers wished to encourage the young man and devoted a half column to praising his success. He afterwards told me that the editorial was instrumental in placing several cases of fracture in his hands that year.

Accoucheurs have also established a large obstetric practice by having their names published in connection with births.

The mention of a physician's name in connection with any case, medical or surgical, will be of more or less advantage to the physician and is considered legitimate advertising.

Perhaps the most dangerous member of the Medical Profession is the ethical medical hypocrite. We can have some respect for the bold-faced advertiser, as he makes no pretentions other than what he is, but the tricks practiced by many physicians under the cloak of ethics, would make many advertising physicians hang their heads in shame.

I once employed a stenographer who formerly was in the employ of a surgeon who was the shining light of the community. From this source I learned many of his business tactics, which will outstrip the methods of the lowest forms of quackery. This surgeon's principle object was money mak​ing, and it made no difference from what source. A lady wrote to him that she was afflicted with uterine cancer; he advised her that he could cure her by undergoing an operation and removing the organs. The fee asked was $200.00; she replied the only possessions she had in the world to secure money was to sell her cow and piano, which, she was advised to do. She finally secured $90.00 and her hospital fees; she entered the hospital with the understanding that she was to have her uterus and ovaries removed, but instead the surgeon simply curetted the ulcerated surface. She left the hospital at the end of a week, thinking she had departed with her diseased organs. She continued to menstruate, which created much suspicion. She finally consulted another physician, who told her she was still in possession of both her organs and disease. The patient finally died. But the brother still preserves the organs, pending legal action against the surgeon for mistrust.

Another well-to-do patient write this surgeon regarding her case and the cost of an operation. He replied, "The price of the operation will be $400.00; if you are a pauper I will charge you only $100.00." It was a question in this case whether or not one could admit being a pauper for $300.00. I do not wish to be understood as entertaining pessimistic ideas regarding the ethical surgeon or specialist, for as a general rule they are noble, conscientious and charitable practitioners, but occasionally we find one whose trickiness surpasses that of the regular advertiser, still he is protected under the wings of ethics. Of all the specialties, those which incorporate surgery in its different branches are the most compensative. The shrewd and unscrupulous physician realizes this after he has been in practice but few years and never allows an opportunity to pass where an operation can be justly (or perhaps, unjustly), performed. You will observe that as a rule specialists who have the largest income are classed as surgeons, are practicing some specialty involving some of its branches. This often has a tendency to produce a narrower type of medical men by exaggerating the minute and advising ​operations when unnecessary. When you hear of a physician repeatedly saying, "he just arrived in time to save her life," or an "operation will be absolutely necessary," he can generally be regarded as a medical or surgical "grafter."

I fully realize that most physicians do not care to advertise, and as I have previously stated, I do not wish to be understood as advocating the practice, but owing to the purpose of this book I thought it would not be out of place to briefly outline some of the methods of medical advertising which are in use at the present day. With justice to all and malice toward none, we have now come to the point where we can consider one of the most greatly neglected features of a general practitioner's work—office practice and office specialties.

Of all the professions, the Medical Profession is the most overcrowded, and still our 155 Medical Colleges are turning out Physicians at the rate of about 6,000 a year.

Referring to Polk's directory, we find there are over 135,000 physicians in the United States, which, according to the population, makes one physician to every 655 inhabitants, with an average income of about $1,000.00 a year, or $2.73 a day, which is about equal to ordinary skilled labor. There are thousands of learned and skillful physicians in the United States who scarcely make a living and there is no profession in the world which has so many side issues as medicine, and the general practitioner finds as competitors all kinds of speculative medical philosophers. When we stop to think that there are over one million Christian Scientists, to say nothing of the various healers, hypnotists, mind curers, self-inspired medical pretenders, patent medicines, etc., on the illegitimate side, while in legitimate medicine our cities are crowded with free clinics, dispensaries, hospitals, etc., which are visited by many people, who are perfectly able to pay for their medical services.

It is rather discouraging for the young physician who has ​spent four years in medical college and several hundred dollars, to confront the world with a laborious profession, which does not offer him a yearly income much greater than ordinary labor. The question arises, what can be done to make the practice of medicine remunerative in proportion to the amount of skill required, capital and time expended in obtaining the knowledge? It has been said that this is the age of specialists, which is quite true, and with this we find the general practitioner leaning towards a tendency to become sort of a general advisor and distributing agent, we find him sending his surgical patients to the surgeon, female patients to the gynaecologist, eye patients to the occulist, ear patients to the aurist, and throat and nose patients to the laryngologist, etc. While this is often advisable in many cases they could often receive as effective treatment in his hands if he would provide himself with the proper instruments and equipment to treat them and thus receive the credit of curing them. If there is any credit or glory in the practice of medicine he will keep it within his bounds. The physician who walks the street with his office in his hat and depends upon writing prescriptions and visiting the bedside of the sick for one dollar a visit, is generally a physician who is always financially embarrassed; while on the other hand, we find the physician who has a well-equipped and regulated office, with a working library and endeavoring to keep abreast with the times by subscribing for the leading medical journals and providing himself with suitable instruments, we find a physician who is progressive and prosperous and who no doubt is receiving the cream of the medical practice, which he justly deserves, for he is better able to combat with disease, as he has every modern appliance at hand for the benefit of his patients. This brings us up to the point of what may be considered a properly equipped office and what is the best way to make the practice of medicine remunerative in a legitimate ethical way. This depends upon two things, a reasonable amount of tact and skill and a proper office equipment, and utilizing office specialties which has formerly been monopolized by other specialists.

​In the following chapters, we will endeavor to give the details of several specialties, many of which have made fame and fortune for their promoters, and can be as successfully used today as ever before, but in order to successfully conduct that much neglected part of the general practitioner's work—office practice—requires the expenditure of a small sum of money for equipment, the more extensive the equipment, the greater his success and income.