A Defense of Therapeutic Methods.
Also see: Professional Ignorance.
In the April number of this journal I reviewed an article published in the Journal of the American Medical Association by Mr. Bok, editor of The Ladies Home Journal, in which he makes the statement that in 1905 out of five thousand prescriptions found in Philadelphia drug stores forty-one percent called for remedies of unknown composition, and in 1906 forty-seven percent. He says that he has not the slightest hesitation in saying that "except a very small minority, the average practitioner of today has become dependent on ready made hand me down preparations which he prescribes without any accurate knowledge of what he is prescribing."
This is certainly a statement to rouse the ire of the Regular profession. The Critic and Guide of New York takes up Mr. Bok's statement and undertakes to give him a "walloping" in proportion to the severity of his statements. He makes this straight statement:
"Anybody who makes the charge that a large or considerable portion of the medical profession is in the habit of prescribing preparations of unknown composition is either a pitiable ignoramus or a deliberate liar. And it makes no difference who makes the charge, a druggist, a doctor or a layman." This is stated, certainly, in plain words. It shows that the profession resents the statement of Mr. Bok. At the same time there is but little to prove that the profession is studying therapeutics as Mr. Bok and every other intelligent layman thinks they ought to study it.
As I have repeatedly stated, to cure disease a man must know his remedies. The more thoroughly he knows them, the more perfect his success is. The more thoroughly he knows them, the more perfect is the confidence of the people in him. The editor of The Critic and Guide names as remedies which are fully sanctioned by the profession a long list of the synthetic preparations, coal tar derivatives and some others, nearly all of which have a proprietary ownership and many of them a proprietary name, and with these he undertakes to defeat Mr. Bok's argument.
It is true that careful pharmacy is necessary, but the class of remedies which the general profession use today, many of them of foreign manufacture and protected by a law, is not consistent with a thorough and intelligent knowledge of the rational action of drugs, although they may be highly scientific. The most rational, the most consistent, the most successful, the most reasonable class of remedies today are not compounds of chemicals, or remedies of intricate organic or inorganic chemical construction, they are simple organic drugs of vegetable origin and simple inorganic compounds, largely of the alkaline earths, and some few direct mineral compounds. This includes the alkaloids and concentrations of the well known galenicals.
All of these remedies are rational in their action and are in most cases of a chemical construction similar to that of the body itself. They are of ready appropriation and rapid elimination. With this class of remedies properly studied the profession is not opened to the charges made by Mr. Bok. With this class of remedies rejected, the charges of Mr. Bok are readily sustained, notwithstanding many editors might argue to the contrary.
If the Critic and Guide's contention is correct, why is it that nearly all of the regular colleges are so deplorably deficient in the teaching of the clinical action of drugs? Why is it that examination in Materia Medica and Therapeutics is excluded by the ruling of nearly all of the State Examining Boards? Why is it that but one or two hours a week in any of the colleges are devoted to the bedside study of disease. These are practical essentials in the knowledge of Therapeutics
I cannot fail to see that Mr. Bok has a strong argument and that the profession is exceedingly weak in its knowledge of drugs, and that unless they do more studying, unless they "reconstruct their therapeutics and lift it out of the commercial mire into which it has sunk," because the profession depend upon whatever preparation the pharmacist may give them, they must submit to these charges as justifiable and true. The doctor does not study the drug the manufacturing pharmacist gives him, he accepts the pharmacist's statement as to what the drug will do and uses it in that line. The physician is thus depending not on his own knowledge but on that of the pharmacist, and in so doing he is certainly open to the severe arraignment Mr. Bok makes against him.