The most preferred approach to medicine at the time was what was sometimes called "active medication", in which therapies were given acutely and would be expected to have dramatic effects. Active medication represented, to some degree, the cutting edge of existing medical thought, which also led to assumptions and inaccuracies. For example, when cocaine was first discovered, it was described in medical literature to be useful in conditions ranging from gastralgia, to childbirth (as a local anaesthetic), to migraine, to shingles, to nasal hemorrhage (due to its vasoconstrictive properties). This was in contrast to "routine therapy", where the patient took the same medication consistently. Culturally, doctors were considered heroic figures when active medication worked while unsuccessful cases could be labeled as unfortunate and dismissed. Robert Bartholow, a contemporary physician, said "the science of therapeutics should be made more certain" and that the "true knowledge of drug action is not widely enough diffused." When faced with everyday exigencies, many physicians were left clueless. The medical community shared these concerns: in 1888, the president of the American Medical Association was quoted as saying that there were "odious defects in the American medical education system" and expressed concern that the ratio of medical practitioners to the US population (1 per 580 persons) was both excessive relative to actual need, and founded on a plethora of low-quality graduates of lower-quality medical schools who were looking only for an income, leading to supply-driven overuse of medical therapy.