The universal practice among apothecaries of refilling prescriptions indefinitely, without the sanction of those who wrote them is frequently the subject of adverse criticism by physicians. “But,” says the pharmacist, “is not the prescription mine?” Probably the reply will be affirmative, though this is a question not entirely settled in the minds of those concerned. Granting, however, for the sake of the argument, that the apothecary is the rightful owner of the prescription, he triumphantly asks, “May not one do as he chooses with his own?” Not always, by any means, unless he elects to use his property in a way which will not imperil the welfare of others. The law puts many restrictions on the natural rights of ownership, for the purpose of shielding society from the ignorance, the malice, and the cupidity of proprietors. In the matter of prescriptions there are no such limitations; but in this, as in so many other affairs, we should be controlled not merely by considerations concerning our legal rights. The unwritten, but greater, law regards the question from a higher plane; and from this point of view one sees that there are moral reasons which should restrain the apothecary in these premises. Let us look at prescription-refilling in its remote as well as its immediate bearings.
The physician writes his prescription for one occasion and for one only. He designs it to fulfil the indications in a particular case at a given visit. It is often in the highest degree improbable that the conditions of the case will remain the same for a given length of time; and, when they change materially, another prescription is needed to satisfy the altered requirements. Of these things many patients and apparently, all apothecaries are accustomed to take no note; and, therefore, the prescription is refilled for the same person on many occasions, when something very different ought to be furnished, the expected improvement does not occur, and the physician is blamed for the failure. The prescription, intended for the treatment of a certain condition afforded relief and changed the state of affairs. Thereupon, further advice should have been sought by the patient, his physical condition investigated anew, and another recipe given by the physician, if he deemed it desirable. To hold the doctor responsible for the ill effect or lack of effect of his prescription in circumstances unlike those for which it was designed is obviously unjust. Yet this is done habitually, both in the case just supposed and in those other instances, quite as common, in which the recipe is compounded, not for whom it was written, but for some other person, who supposes (on what slender evidence it is appalling to contemplate), that his ailment is identical with that of the original patient. The refilling really amounts to the apothecary’s abetting the patient in self-treatment. There is a trite remark to the effect that he who undertakes to be his own lawyer is sure of a fool for a client. In legal actions the matters at stake mostly relate to property; in medical affairs, health and life are involved. Can anything better be said of the wisdom of him who, without adequate training, undertakes to settle questions in which his very existence is concerned, than of the sagacity of the man who, with no competent knowledge of law and the methods of the courts, presumes to manage a case in which merely a sum of money may be lost?
But undesirable as is the custom of pharmacists in this respect, it is unreasonable in physicians to grumble at it, until they reform a habit of their own, which encourages the practice which they deprecate. When a physician finds a sick man improving with a certain plan of treatment, and wishes the same medication continued, usually he simply tells the patient to have his bottle refilled at the apothecary’s. The latter, knowing that this is the usage of the medical profession, is accustomed to suppose—constructively, at least—that, when the bottle is returned to be replenished, it is brought at the desire of the doctor; and he again compounds the medicine, as he would not be justified in doing, if the method of physicians was different. If the latter would habitually rewrite their prescriptions, or indite orders for repetition, whenever they wish a continuance of treatment, apothecaries would have the best possible sanction for supplying medicines to patients a second or a thousandth time, and would have no moral warrant for such action without the written direction of the authors of the recipes. When the doctors adopt the plan suggested, a violation of their request that their prescriptions shall not be repeated without their written order will furnish abundant ground for complaint; until such change of method is established, the consistency of their protest does not conspicuously appear. By the practice proposed, the apothecaries would lose some business, indeed, but the community would experience an immeasurable gain.
The sale of so-called patent medicines by pharmacists is a continual irritant to doctors. Their objections have the same basis as in the preceding case, namely, that apothecaries ought not to encourage the people to prescribe for themselves. A distinguished physician once said that drugs do more harm than good—a statement which will not be disputed by those most conversant with the facts. But this is no argument against the employment of medicinal remedies in any proper way. Drugs taken by advice of educated, competent physicians do an immense amount of good; the injury comes almost altogether from their administration independently of the recommendation of qualified medical men. Concocted, not to benefit humanity, but to enrich their manufacturers, advertised as positive cures of diseases which the utmost skill of the medical profession cannot control, sometimes inert, sometimes dangerous from the poisons which they contain, pressed upon the attention of the people with impudent persistence and colossal mendacity, the infamous compounds, called patent medicines, are purchased by the credulous public in almost incredible amounts. Nobody knows as well as the pharmacist what quantities of drugs are sold in this form; nobody knows as fully as the physician the enormously baneful effects which they produce. If apothecaries would refuse to handle this class of goods, they would confer a wonderful blessing on humanity, by demonstrating their belief in the injuriousness of these articles, and thus bringing them into disrepute; and they would vastly dignify their profession by displaying its sense of moral obligation, even at the sacrifice of a lucrative part of its business.
Apothecaries complain that, to meet the demands of prescriptions, they are obliged, at great expense, to keep in stock a large number of whimsical preparations, and also many brands of the same standard medicines, when really one is practically as eligible as another. There is force in this complaint. As a rule, the former class of preparations has but an ephemeral popularity, and, as for the latter, there cannot often be need of specifying the goods of a particular manufacturer; for a worldly-wise, not to say honorable, pharmacist certainly may be trusted to furnish only fine articles, that he may keep the favor of those upon whose good-will his legitimate business depends. If a special brand is deemed necessary by the doctor, he can request a convenient apothecary to procure a quantity, and then can send to his shop the patients who require this article. Thoughtful consideration of this grievance will dictate some such course and effect its redress.
Occasionally, in places where apothecaries are accessible, physicians furnish their patients with medicines. This the pharmacist rightly regards with disfavor, as diminishing his legitimate business. The truly wise physician shuns this practice, perceiving that he cannot be as competent a pharmacist as is one who is nothing else, and furthermore, preferring to avoid the suspicion of administering medicines unnecessarily for the purpose of making a profit on them. Enlightened selfishness prompts him to encourage scientific pharmacy as a specialty.
BROOKLYN VITAL STATISTICS FOR JUNE, 1888.
By J. S. Young, Dep. Commissioner of Health.
Data of comparison:
| Population, estimated on July 1st, 1888 | 793,960 |
| Inhabited houses, about | 93,000 |
| Average birth-rate per 1,000 for ten years (returns incomplete). | |
| In the month of June, 1888, there were 1,513 deaths, the rate of mortality being 23.78 in every 1,000 of the population. | |
| The number of births reported was | 937 |
| The number of marriages reported was | 531 |
| The number of still-births reported was | 113 |