A Librarian's Open Shelf: Essays on Various Subjects

by Arthur E. Bostwick

I am dwelling on these unpleasant possibilities partly for the reason that the Egyptians displayed a skeleton at their banquets—because warnings are a tonic to the soul—but also because, if we are to credit much that we see in general literature, including especially the daily paper and the popular magazine, all druggists are malemployed. And if it would really be better for the community that you should not enter upon the profession for which you have been trained, now, of course, is the time for you to know it.

There seems to be a widespread impression—an assumption—that the day of the drug is over—that the therapeutics of the future are to be concerned along with hygiene and sanitation, with physical exercise, diet, and mechanical operations. The very word “drug” has come to have an objectionable connection that did not belong to it fifty years ago. Even some of the druggists themselves, it seems to me, are a little ashamed of the drug part of their occupation. Their places of business appear to be news-agencies, refreshment parlors, stationery stores—the drugs are “on the side,” or rather in the rear. Sometimes, I am told, the proprietors of these places know nothing at all about pharmacy, but employ a prescription clerk who is a capable pharmacist. Here the druggist has stepped down from his former position as the manager of a business and has become a servant. All of which looks to me as if the pharmacist himself might be beginning to accept the valuation that some people are putting upon his services to the community.

Now these things affect me, not as a physician nor as a pharmacist, for I am neither, but they do touch me as a student of physics and chemistry and as one whose business and pleasure it has been for many years to watch the development of these and other sciences. The fact that I am addressing you this evening may be taken, I suppose, as evidence that you may be interested in this point of view. The action of most substances on the human organism is a function of their chemical constitution. Has that chemical constitution changed? It is one of the most astonishing discoveries of our age that many, perhaps all, substances undergo spontaneous disintegration, giving rise to the phenomena now well known as “radio-activity.” No substances ordinarily known and used in pharmacy, however, possess this quality in measurable degree, and we have no reason to suppose that the alkaloids, for instance, or the salts of potash or iron, differ today in any respect from those of a century ago. How about the other factor in the reaction—the human organism and its properties? That our bodily properties have changed in the past admits of no doubt. We have developed up to the point where we are at present. Here, however, evolution seems to have left us, and it is now devoting its attention exclusively to our mental and moral progress. Judging from what is now going on upon the continent of Europe, much remains to be accomplished. But there is no reason to believe that if Caesar or Hannibal had taken a dose of opium, or ipecac, or aspirin, the effect would have been different from that experienced today by one of you. This is what a physicist or a chemist would expect. If the action of a drug on the organism is chemical, and if neither the drug nor the organism has changed, the action must be the same. If we still desire to bring about the action and if there is no better way to do it, we must use the drug, and there is still need for the druggist. As a matter of fact, the number of drugs at your disposal today is vastly greater than ever before, largely owing to the labor, and the ingenuity, of the analytical chemist. And there are still great classes of compounds of whose existence the chemist is assured, but which he has not even had time to form, much less to investigate. Among these may lurk remedies more valuable than any at our disposal today. It does not look, at any rate, as if the druggist were going to be driven out of business from lack of stock, whether we regard quantity or variety. To what, then, must we attribute the growth of the feeling that the treatment of disease by the administration of drugs is on the decline? From the standpoint of a layman it seems to be due to two facts, or at least to have been strongly affected by them: (1) The discovery and rapid development of other therapeutic measures, such as those dependent on surgical methods, or on the use of immunizing serums, or on manipulations such as massage, or on diet, or even on mental suggestion; and (2) the very increase in the number and variety of available drugs alluded to above, which has introduced to the public many new and only partially tried substances, the results of whose use has often been unexpectedly injurious, including a considerable number of new habit-forming drugs whose ravages are becoming known to the public.

The development of therapeutic measures that are independent of drugs has been coincident with popular emancipation from the mere superstition of drug-administration. The older lists of approved remedies were loaded with items that had no curative properties at all, except by suggestion. They were purely magical—the thumb-nails of executed criminals, the hair of black cats, the ashes of burned toads and so on. Even at this moment your pharmacopoeia contains scores of remedies that are without effect or that do not produce the effects credited to them. I am relying on high therapeutical authority for this statement. Now when the sick man is told by his own physician to discard angleworm poultices, and herbs plucked in the dark of the moon, on which he had formerly relied, it is any wonder that he has ended by being suspicious also of calomel and ipecac, with which they were formerly classed? And when the man who believed that he received benefit from some of these magical remedies is told that the result was due to auto-suggestion, is it remarkable that he should fall an easy prey next day to the Christian Scientist who tells him that the effects of calomel and ipecac are due to nothing else than this same suggestion? The increased use and undoubted value of special diets, serums, aseptic surgery, baths, massage, electrical treatment, radio-therapeutics, and so on, makes it easy for him to discard drugs altogether, and further, it creates, even among those who continue to use drugs, an atmosphere favorable to the belief that they are back numbers, on the road to disuse. Just here comes in the second factor to persuade the layman, from what has come under his own observation, that drugs are injurious, dangerous, even fatal. Newly discovered chemical compounds with valuable properties, have been adopted and used in medicine before the necessary time had elapsed to disclose the fact that they possessed also other properties, more elusive than the first, but as potent for harm as these were for good. Many were narcotics or valuable anesthetics, local or otherwise, which have proved to be the creators of habits more terrible than the age-long enemies of mankind, alcohol and opium. When the man whose wife takes a coal-tar derivative for headache finds that it stills her heart forever, the incident affects his whole opinion of drugs. When the patient for whom one of the new drugs has been prescribed by a practitioner without knowledge of his idiosyncrasies reacts to it fatally, it is slight consolation to his survivors that his case is described in print under the heading, “A Curious Case of Umptiol Poisoning.” When a mother sees her son go to the bad by taking cocaine, or heroin, or some other drug of whose existence she was ignorant a dozen years ago, she may be pardoned for believing that all drugs, or at least all newly discovered drugs, are tools of the devil.

And this feeling is intensified by one of our national faults—the tendency to jump at conclusions, to overdo things, to run from one evil to its opposite, without stopping at the harmless mean. We think we are brighter and quicker than the Englishman or the German. They think we are more superficial. Whatever name you give the quality it causes us to “catch on” sooner, to work a good thing to death more thoroughly and to drop it more quickly for something else, than any other known people, ancient or modern. Somebody devises a new form of skate roller that makes roller-skating a good sport. We find it out before anyone else and in a few months the land is plastered from Maine to California with huge skating halls or sheds. Everybody is skating at once and the roar of the rollers resounds across the oceans. We skate ourselves out in a year or two, and then the roar ceases, the sheds decay and roller-skating is once more a normal amusement. Then someone invents the safety bicycle, and in a trice all America, man, woman and child, is awheel. And we run this good horse to death, and throw his body aside in our haste to discover something new. Shortly afterward someone invents a new dance, or imports it from Spanish America, and there is hardly time to snap one’s finger before we are all dancing, grandparents and children, the cook in the kitchen and the street-cleaner on the boulevard.

We display as little moderation in our therapeutics. We can not get over the idea that a remedy of proved value in a particular case may be good for all others. Our proprietary medicines will cure everything from tuberculosis to cancer. If massage has relieved rheumatism, why should it not be good also for typhoid? The Tumtum Springs did my uncle’s gout so much good; why doesn’t your cousin try them for her headaches? And even so, drugs must be all good or bad. Many of us remember the old household remedies, tonics or laxatives or what not, with which the children were all dosed at intervals, whether they were ill or not. That was in the days when all drugs were good: when one “took something” internally for everything that happened to him. Now the pendulum has swung to the other side—that is all. If we can ever settle down to the rational way of regarding these things, we shall discover, what sensible medical men have always known, and what druggists as well as mere laymen can not afford to neglect, that there is no such thing as a panacea, and that all rational therapeutics is based on common sense study of the disease—finding out what is the cause and endeavoring to abate that cause. The cause may be such that surgery is indicated, or serum, or regulation of diet, or change of scene. It may obviously indicate the administration of a drug. I once heard a clever lawyer in a poisoning case, in an endeavor to discredit a physician, whom we shall call Dr. Jones, tell the following anecdote: (Dr. Jones, who had been called in when the victim was about to expire, had recommended the application of ice). Said the lawyer:

“A workman was tamping a charge of blasting-powder with a crowbar, when the charge went off prematurely and the bar was driven through the unfortunate man’s body, so that part of it protruded on either side: A local physician was summoned, and after some study he pronounced as follows: ‘Now, if I let that bar stay there, you’ll die. If I pull it out, you’ll die. But I’ll give you a pill that may melt it where it is!’ In this emergency,” the lawyer went on to say, “Dr. Jones doubtless would have prescribed ice.”

Now the pill to melt the crowbar may stand for our former excessive and absurd regard for drugs. The application of ice in the same emergency may likewise represent a universal resort to hydrotherapy. Neither of them is logical. There is place for each, but there are emergencies that can not be met with either. Still, to abandon one method of treatment simply because additional methods have proved to be valuable, would be as absurd as to give up talking upon the invention of writing or to prohibit the raising of corn on land that will produce wheat.

No: we shall doubtless continue to use drugs and we shall continue to need the druggist. What can he do to make his business more valued and respected, more useful to the public and more profitable to himself? For there can be no doubt that he will finally succeed in attaining all these desirable results together, or fail in all. Here and there we may find a man who is making a fortune out of public credulity and ignorance, or, on the other hand, one who is giving the public more service than it pays for and ruining himself in the process; but in general and on the average personal and public interest run pretty well hand in hand. Henry Ford makes his millions because he is producing something that the people want. St. Jacob’s Oil, once the most widely advertised nostrum on the continent, cost its promoters a fortune because there was nothing in it that one might not find in some other oil or grease.

What then, I repeat, must the pharmacist do to succeed, personally and professionally? I welcome this opportunity to tell you what I think. My advice comes from the outside—often the most valuable source. I have so little to do with pharmacy, either as a profession or as a business that I stand far enough away to get a bird’s-eye view. And if you think that any advice, based on this view, is worthless, it will be a consolation to all of us to realize that no force on earth can compel you to take it.