New York Medical College - Fleuroscope Yearbook (Valhalla, NY)

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to 2 to l the odds increase to about 22 to 1, and with a ratio of 3 to 1 the odds are about 400 to 1, etc. Thus by computing our observed difference with its standard deviation we can calculate the probability that it is real and not accidental, i. e. that it is statistically significant. As an approach to homo- geneity and heterogeneity of statistical groups one finds a good approach in the Chisquare test of homogeneity as employed by Eisenhart 131. An attempt has been made to expose some of the fundamental and glar- ing inaccuracies of research work, and the remedies necessary to effect a cure. There remains, yet, one conspicuous factor that, more than anything else, has been not only a hindrance-but an actual menace to the advance of Medicine. The greater part of American physicians were graduated from medical schools with a burning ambition to really practise the Art of Medicine, with the under- lying implication that they devoutly hoped to keep in touch with the modern theories in Medicine. Two outstanding methods of maintaining knowledge of new facts and new theories are the attendance at lectures, and the reading of medical literature. Unfortunately physicians in small towns do not have the opportunity of deriving first hand information from prominent lecturers, and many of the doctors in the larger cities fail to take advantage of their facilities. What remains? Medical journals become the only methods that the physician has to prevent inevitable decay. Were journals filled with the thoughtful research work of competent observers all would be well. But such is not the case. In the hundreds of journals published there is startlingly little of real scientific worth, remarkably little worth remembering or even consid- ering. Fortunate indeed is the author whose article is remembered after sev- eral years. Amidst all the gibberish and nonesenical articles written, the physician loses all confidence in learning, concludes that reading journals is a waste of time, and ends up by being just another physician. And who can blame him? His good intentions were blasted by bad literature. So, we are forced to conclude that not only must there be more accurate scientific articles, but there must also be a concomitant increase of articles of real scientific merit, and an abolition of much of the mess which now passes for modern developments of Medicine. Until medical journals have adopted such a program, of restricting articles, there must be eternal vigilance on the part of the doctor to protect himself against inaccurate conclusions drawn from faulty data, and there must also be a concerted campaign to force journals to publish only really scientific material so that Medicine will progress under the stimulus of real Physicians. References: ill Galton, 1889: Natural Inheritance CLondon and New Yorkl. 121 Fisher, 1934: Statistical Methods of Research Workers fLondonl. C31 Eisenhart, 1935: I. Sedimentery Petrology, 5:l37. Two hundred one

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reports. This difficulty may be surmounted by utilization of methods which involve not only oxygen consumption but the carbon dioxide output: thus de- termining the actual R. Q. for each individual. As a point of constructive criticism more specialization among hospital laboratory technicians, more duplicate determinations and more frequent checks on our methods, is rec- ommended. A second source of error lies in the word statistics. Sir Francis Galton ill some 50 years ago expressed a very apt thought which can be best expressed in his actual Words. Some people hate the very name of statistics, but I find them full of beauty and interest. Whenever they are not brutalized, but delicately han- dled by the higher methods, and are warily interpreted, their power of dealing with complicated phenomena is extraordinary. They are the only tools by which an opening can be cut through the formidable thicket of difficulties that bar the path of those who persue the Science of Man. Thus when one makes the statement- There are liars, damn liars and statistics, the capacity of that individuals to deal with his material should be questioned and not the statistical method itself . To the clinical investigator and the laboratory worker who constantly deal with variables affected by a multiplicity of factors, a knowledge and understanding of certain fundamental statistical procedures is invaluable. It may be not amiss here to include a few notes which will enable the reader to realize the order'of magnitude of. the errors for which he must be prepared to make allowances for, and to understand the limitations as well as the uses, of the usual statistical criteria of significance. For example, in a consideration of a form of therapy such as routine digitalization of patients with lobar pneu- monia, one may express his results as xW: death rate in c number of control cases, and WZ: death rate in t number of treated patients. The question that now arises is the difference between xfk and yfk significance. The approach is as follows: the ratio of a particular difference to the standard deviation enables us to calculate, on certain assumptions, how often this difference would appear in the two groups under comparison if they were identical, that is statistically homogenous, in all relavent characteristics, and was the result solely of chance in the statistical sense. The method of determining the stand- ard deviation may be found in many treatises dealing with statistical methods of study such as in R. A. Fisher's C29 book. Thus if our observed difference is equal to about 2X3 of its own standard deviation it will likely as not that this difference might appear, even though our experimental procedure has been without influence on the results. However, if the difference is IW times as great as the standard deviation, the odds against it being due to errors of random sampling or chance becomes about 5 to l. When the ratio increases Two hundred

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AN EMB12 vos VIEW or HOMEOPATHY THE physician, who, after many years. of experience, has become well ac- quainted with the use of the similar principle in therapeutics, could hardly be expected to be materially influenced one way or the other, by the critical chirpings of one who is just emerging from the shell of the medical educational egg. Nevertheless, we of this new brood, have spent years in development, and naturally, have formed a few ideas relative to the past, present and future of that method of medical treatment that has been added to our knowledge . . . the similia. So you sages of homeopathic therapeutics, take these candid remarks, from an embryo, for what they are worth. The similia principle of drug action, from Hippocratic roots, through Hahne- manian budding to its present blossoming, has retained life because it con- tains and makes use of the basic action of all drugs. Anyone who takes advantage of his scientific knowledge and sincerely investigates the principle, could hardly fail to recognize the fundamental truths included therein. - Hippocrates noted two distinct modes of .drug action, and indelibly im- pressed those observations in medical thought. One was contrara, the other the similia. This was no vague dream of Hippocratesp it was evolved from an observant and thinking mind-a mind that was not afforded the advantages of modern science in investigating such complex and diametrically opposed effects. We are obliged to seriously consider and investigate the statements uttered by such a profound observer. Samuel Hahnemann was the next one to flare up the smouldering fire of similia .... many centuries later. Great changes had taken place in the interim. Scientific knowledge had developed markedly. The basic sciences were rapidly developing toward perfection. Proof of scientific discoveries were more easily obtainable. With these advantageous circumstances at hand, Samuel Hahnemann put forth his tenets. The reaction elicited from the medical minds of the day, was explosive and far-reaching. A revolution in science had begun: sides were taken. Hippocrates turned over in his grave. All great discoveries are startling, and homeopathy was no exception. At first, the natural results were profound. Physicians by the thousands promptly dropped their then used methods of treatment and became radical converts. Volumes were written on the subject. The most intense and laborious investi- gations were instituted, and homeopathy soared to heights of great repute. The enthusiasm displayed by some, was truly remarkable . . . One might say over-enthusiasm. I remember my father telling me of one noble convert who became very rabid on the subject of contaminated dilutions, and posi- tively forbade any drug salesman to enter his office for fear that the mere presence of one so tainted with numerous compounds, would ruin the doctor's pure drug armamentarium. All dealings of such nature were held in the hall outside the office. To this day, there are some hyper-enthusiasts who are just about one jump away from this ridiculousness. Some still hold the opinion that the action of homeopathic medicaments, is wholly spiritual! lt isn't chemical-it isn't psychical, and it isn't physical, stated one lecturer. These are the false thoughts we, as modern scientists, must wipe out in order to clear the path to systematic investigation and to facilitate the securing of irrefutable proof as to the true value of the method. We cannot argue our- selves right by a variety of logical contortions and sophisticationsu as one critic has written. The burden of obtaining scientific proof is at present weigh- ing heavily on the shoulders of a few men. Such ardent and caeable investi- gators as Boyd and McGavack are examples of this group. They deserve Two hundred two