Throughout his life, Samuel Clemens invested in “get rich quick” schemes, none of which paid off.  In old age (before Social Security) he made ends meet by working quite successfully as a traveling lecturer.  After his death in 1910 there were a couple of actors who impersonated him.  One of these came to Monroe in about 1960 and that is where I heard about the “moral pauper”. 


According to Mark Twain, the woman in his story died because she was a moral pauper.  She was quite ill and the doctor told her she would have to give up drinking and smoking.  Unfortunately, she didn’t smoke or drink so she didn’t have anything to give up.  She ended up dying.  Mark Twain remarked that he would never let that happen to him.  He would always have some vices to fall back on so the doctors could help him.  He would not die a moral pauper because he had no vices to give up.


Obviously, Mark Twain was joking.  But, as a physician, it occurred to me that he might be on to something with regard to stomach ulcers.  I can think of several patients with intractable ulcer problems who were moral paupers and therefore very difficult to treat because they had no vices to give up.  One of a physician’s first thoughts with ulcers is that there is a bad habit that must go.  A Sunday school teacher type who doesn’t smoke or drink might as well be referred to the surgeon right away.


In a way, Mark Twain was right on, though he was only trying to be funny.  Another subtle point is that moral paupers are likely to stay healthy later in life until they are more willing to shake off this mortal coil.  By the way, I have nothing against Sunday school teachers.  I have been one myself.


I am frequently asked, “What do you think about annual check-ups?”  Of course I am in favor of them and get checked up myself.  This, in my case, does indeed have something to do with my continued mobility and involvement in the world.  However, we physicians sometimes raise our eyebrows when a Mark Twain type comes for a check-up apparently just to make sure that nothing bad has started to happen yet, but obviously not open to making any changes.  It is a challenge to preach to the “heathen”, but especially rewarding when suggestions about lifestyle changes are actually heeded.


Bureaucratically impelled exams such as truck driver physicals and immigrant exams are an opportunity to influence healthy people and few of them have a Mark Twain complex.


If you have read this carefully, I hope you will think of some questions about health and lifestyle and either make needed changes right away or take them up with your physician next time you see him/her.


John A. Frantz, M.D.                              An adventure is

Monroe Board of Health                              only an

June 20, 2002                                           inconvenience

                                                               rightly considered.

                                                                               G. K. Chesterton