416 ANNUAL REPORT SMITHSONIAN INSTITUTION, 1937 



has cured a cancer, it is well to remember the possibility that the 

 diagnosis was wrong. 



Cures that won't work twice. — And here is yet another type of case. 

 Recently I saw a woman with severe arthritis. She told me that 5 

 years before, when the disease first flared up and put her in a wheel 

 chair, she went to a quack who cured her with the help of an herb 

 tea. Naturally, I asked her why she wasn't back taking the same 

 treatment again, and her answer was that she had gone but that this 

 time the tea wouldn't work. The chances are, then, that the first 

 spectacular cure was not a cure at all but only one of those spontaneous 

 remissions which are so common in the course of a lifelong disease. 



THE DIFFICULTIES INVOLVED IN JUDGING OF THE VALUE OF A 



TREATMENT 



The average layman has no conception of the pitfalls which lie in the 

 path of the man who would appraise the value of some particular 

 treatment, especially for a self-limited disease. For instance, last 

 October some of you doubtless took "cold shots" to protect you through 

 the winter. If when summer comes you are still without a cold, will 

 that prove that the vaccine was helpful? Not at all; you may be 

 delighted with what seems to you a miracle, but I can assure you 

 that the reports of dozens of such successful cases mean nothing to the 

 medical statistician. The only way in which to learn anything 

 definite about such a treatment is to do as the Metropolitan Life 

 Insurance Co. did several years ago. They took, as I remember, some 

 5,000 of their employees and vaccinated half of them, leaving the 

 other half to serve as what we physicians call a "control series." At 

 the end of the year they checked up and found that the 2,500 who 

 had been vaccinated had had just as many colds as did those who 

 weren't vaccinated; the only difference was in the severity of the colds, 

 the vaccinated men and women getting back to work on the average 

 several days sooner than the others did. 



Sometime ago, Dr. Diehl, of the University of Minnesota, made a 

 splendid study of colds among the students, trying out on hundreds 

 of them several of the drugs that are commonly used in this disease. 

 He found to his surprise that one out of every three colds cleared up 

 in a day or two without any treatment at all, and others cleared up so 

 rapidly or ran so mild a course that it was impossible to say whether 

 or not the remedy given had anything to do ^^dth the prompt recovery. 



No wonder, then, that practically everyone thinks he can cure a 

 cold. Hasn't he cured many of them with liis pet method? To be 

 sure, some of the colds treated hung on stubbornly, but following the 

 convenient rule of humankind, he forgot these and remembered only 

 those which he "cured." And if he, who has had no trainmg in 

 medicine, can have had such splendid success in his Httle practice, 



