The quack relies largely upon advertisement in newspapers and magazines and most publications of repute exercise scrupulous care in the admission or total exclusion of such advertisements. He is aided, too, by the reluctance of those who have consulted him with disadvantage to acknowledge their action and by the magnification of his successes or apparent successes. Moreover, his powers of diagnosis are negligible and upon strict examination a case of cancer, for example, reported to have been cured always fails because there is no evidence, either that the case was truly cancer or else that it was truly cured. The one requires micro scopical evidence, the other the lapse, according to medical stand ards, of a period of years—three, five or more.
Quackery flourishes in certain parts more than others. In respect of cancer the mining districts of Northumberland, Durham and South Wales, South Africa, Australia and to a less extent Canada are the source of the greater number of so-called "cancer cures" met with in England, but the proportion is trivial com pared with what occurs in Prussia, where it is said that there is one quack to every three orthodox medical practitioners. Re course to quackery is not the foible of any particular class of society and is compatible with a high level of general intellect. In the case of the wealthy and intelligent it is difficult to feel sympathy for the sufferer in his action, but for the poor and ill educated who often waste time and money only to find themselves at the end in a hopeless condition, sympathy is great. Yet it is
difficult to see how they can be safeguarded. Legislation with regard to quacks and their medicines varies in different countries.
In England they are liable if they hold themselves out to be recognized medical practitioners or if death occurs in a person whom they are treating. On the other hand the law considers that a person consults a quack at his own risk; it does not actually forbid the quack from giving advice though he cannot charge for that advice; as a result the financial side is represented by the sale of ointments, apparatus, etc. Elsewhere (e.g. in Prussia) legislation has been tried and has failed. The real remedy lies in advancement of medical knowledge and in education.
A word may be said on patent medicines the sale of which is great in all countries. In England they pay a duty but otherwise their sale is unrestricted though limits are imposed upon their composition. The British Medical Association for years has made a practice of analysing patent medicines and attaching to the report of their composition a statement as to the cost of the ingredients; all return to the proprietor a very large margin of profit. Copies of the reports issued from time to time are pub lished under the authority of the Association. Many of these patent medicines are harmless, some are useful; actual fraud, as a rule, is absent. This cannot be said for the quack and his wares.