948 THE PRESENT CONDITION OF PHARMACY.

THE LANCET.

LONDON: SATURDAY, SEPTEMBER 26, 1908.

The Present Condition of

Pharmacy.PHARMACY still forms one of the subjects of the ordinary

medical curriculum and it is obvious that a knowledge of thevarious mineral and vegetable preparations which are usedas drugs is essential for every practitioner of medicine. At

the present time, however, the same intimate knowledge of

pharmacy is not required as was the case in past generationsof medical men. The evolution of the pharmacist has

gradually introduced a new element into medical practice,many practitioners confining themselves to writing prescrip-tions and leaving the actual compounding of the ingredientsto the pharmacist or, to use a more familiar term, the

druggist. At the meeting of the British Pharmaceutical Con-ference recently held in Aberdeen the President, Mr. ROBERT

WRIGHT, delivered an interesting address on ’’ Pharmacy—its Rise, Province, and Present Condition," in which heconsidered in detail many points which are constantly arisingin connexion with the preparation and the compounding of

drugs, dealing, however, with the ethical side and not withthe scientific.

Having sketched in brief outline the rise of pharmacy,Mr. WRIGHT proceeded to make a few remarks upon its

province. He correctly maintained that pharmacy includedwithin its range the provision and supplying to the public of

everything capable of employment for the relief or cure of

any ailment or disease to which human beings are subject.As regards drugs, this includes their collection and the

investigation of their botanical character, their chemical

and physical properties, and their composition ; also their

elaboration and exhibition in the form of galenical pre-

parations of approved type, and their distribution to the

public, either directly or indirectly. This consideration

at once raises the much disputed question of the re-

lationship which should exist between the medical practi-tioner and the druggist. Mr. WRIGHT stated the ideal

condition in a few words : ’’ The proper sphere of

medicine lies in the diagnosis of disease and its treatment,including the prescribing of remedies ; that of pharmacyin the compounding of drugs and the dispensing of medi-cines." Could this principle be always and everywherecarried out in practice no difficulties would arise ; but Mr.WRIGHT recognises the complexity of the situation and inhis address gave his opinion freely on the subject. With

most of his remarks we are in accord. He stated the case

for the pharmacist with fairness and exactness and uttereda note of warning to those of his colleagues who

from "mercenary motives ...... should be tempted to

transgress the laws of prudence., and;, common, sense, and

to administer remedies in cases with which only the

trained practitioner should deal." He then went on to

remark : " We claim that the counter-prescribing of simpleremedies for simple ailments is quite in harmony with

the general fitness of things, and an educated and con-

scientious pharmacist, knowing by experience the difficultiesoften met with in diagnosing even simple’ ailments, will

in any case of doubt at once draw the line and refuse to

prescribe." The important point in this dictum is that everypharmacist should clearly know where to ’’ draw the line"

"

and there is every temptation to extend the limit of counter-

prescribing rather than to lessen it. To take an example.It is a daily event for a customer to enter a druggist’sshop and to ask for a remedy against constipation. A

pill or draught is given but unless some discrimination is usedserious results may follow. It would be impossible for thedruggist to diagnose between simple constipation, intestinalobstruction in any form, or ambulatory enteric fever, and thecareless use of purgatives might thus prove a great danger.We agree with Mr. WRIGHT that there is another side to the

question-namely, the dispensing of drugs by medical

practitioners. But we venture to suggest that he puts thecase too strongly when he speaks about the doctor who for

complaints which he is supposed to be able to diagnosecorrectly administers drugs of the proper methods of

exhibiting which he is totally, or almost totally, ignorant."We regret that he should have made such a condemna-

tion in an address which was otherwise so moderatelyexpressed. The medical student is now compelledto attend lectures on materia medica and to go

through a course of instruction in pharmacy which giveshim a fair knowledge of the subject. This is essential, for

although, as has been ably argued in our columns, it

would be advantageous to the medical profession if medicalmen prescribed their medicine, leaving the making up of theformulas to the dispensing chemist, yet such a course is not

practicable. There are many neighbourhoods which are too

poor and too sparsely populated to support a dispensingchemist and hence the practitioners residing in that districtare obliged to dispense their own drugs.

Mr. WRIGHT expressed himself in no doubtful terms in

regard to the sale of patent or quack medicines. He quotedfigures which amply proved that notwithstanding the widediffusion of knowledge, the spread of education, and the

raising of the standard of intelligence among the people,the appeal of the quack and the charlatan to the credulityof the public meets with a readier response than ever. We

have again and again protested against the exploiting ofsuch preparations by the lay press but with very little

success. Mr. WRIGHT was pessimistic in regard to the partwhich the pharmacist could play in helping to mitigatethe evil, for he remarked: "What the public demandsin the shape of medicine we ought, I think, unquestion-ably to supply." We doubt the propriety of this remark;nevertheless, he is probably correct in thinking that thedispensing chemist can do but little and that the real andonly effective remedy lies with the legislature, and he in-dicated the direction which he considered such legislationshould take. He suggested that the cost of the patent

1 THE LANCET, April 1st, 1905, p. 878.

949

medicine licence should be raised very considerably, a pro-position which we heartily endorse. He further pro-

posed that a board of control, consisting largely of

recognised authorities in the different branches of medi-

cine, should be constituted, to which it should be made

compulsory for the composition of every secret remedy tobe submitted for registration before permission could be

given for its public advertisement or the imprimaturof the Government stamp. This proposal, however, wouldhave to be considered carefully, for we doubt both its

advisability and practicability. We have from time to

time published analyses of many of the quack medicineswhich are on the market and have demonstrated how useless

they are, but a certain section of the public appears to enjoybeing victimised and nothing short of stringent legislationwill diminish the profits of the patent medicine vendor.Mr. WRIGHT’S remarks on the various matters connected

with pharmacy are well worth careful consideration ; the

pharmacists working loyally with the members of the

medical profession, as he urged them to do, can performinestimable service to the public. There are much room and

need for pharmaceutical research but this can only be

successfully accomplished if those engaged in that under-

taking are willing to give themselves unselfishly to the workand to labour diligently for the good of the community.

The Sanitary Defence of the HedjazRailway.

THE present situation in the East, whether Near East,Middle East, or Far East, is one of absorbing interest. No

publicist, be his sphere of activity never so specialised, canstand by unconcerned, unmoved by the spectacle of the

dramatic series of events that have unrolled themselves in

the last few years in one Oriental country after another.The volcanic upheaval of Japan as a first-class " European

"

power, the domestic troubles in the vast Russian empire,the " unrest " in India and in Egypt, the reign of anarchyin Persia-these events have succeeded each other with

almost breathless rapidity. And now, most recent in

this closely linked chain, has come the peaceful revolu-

tion in Turkey, where, after 30 years of Palace rule, the

people have forced their ruler to grant them liberty anda constitution, have put to ignominious flight the Palace

clique, and are now rejoicing in their newly acquiredfreedom. No one can withhold his meed of admiration at

the manner in which this tremendous change has been

brought about by the Turkish people themselves and at thewonderful restraint and self-control which they have shownin circumstances such as, in other countries in the

past, have too often led to anarchy and bloodshed. That

the occurrences briefly enumerated above, which have

marked the recent history of so many eastern countries, areclosely inter-connected, each with the others, it is impossiblenot to believe; and they afford abundant material for thephilosopher anxious to find in them some guiding and con-necting principle, and endeavouring to draw from them

conclusions that may help to raise, be it by ever so little,the veil that hides the near future. Is the East reallywaking from its age-long sleep ? Are we on the eve of

great secular events, where East and West shall at last" meet" ? Shall that meeting take the form of a friendlyrivalry and a treading side by side the paths marked out by" I western civilisation, or will it end in the shock of arms

and the ghastly carnage of a modern Armageddon ? Or,

finally, will another and a different form of civilisation be

ultimately evolved, face to face with which that particularform of it which we call western " may find it hard to

hold its own and may have to yield and to modify itself

beyond recognition ? Almost simultaneously with the granting of the con-

stitution in Turkey the railway which unites Damascus

with Medina has been completed and formally opened.This alone would at any other time have appealedirresistibly to the imagination and have justified specu-lations almost as far-reaching as those in which we have justventured to indulge. Coming as it does at this particularmoment it acquires an added significance and appeals withincreased force to the imagination of all thinking people. Inthis brief column, however, we cannot follow further the

fascinating lines of speculative thought which such an eventas this inevitably opens up. The completion of the Hedjazrailway may, indeed, be considered from so many different

aspects that it could well furnish themes for innumerable

articles, but we must content ourselves here with consideringit from one aspect only-the influence which the line must

inevitably have on the spread of disease and the means bywhich this new danger will have to be met. We publishto-day the first of a short series of articles on this subjectwhich has been sent to us by the British Delegate on the

Constantinople Board of Health. The writer has recentlyreturned from a journey down the Hedjaz Railway asfar as Medaini-Salih, only some 180 miles north of

Medina. As perhaps the first English medical man

who has ever visited those regions (to which, indeed,few Europeans of any kind have hitherto penetrated)his articles offer a special interest. The journey was

accomplished as member of a Commission sent by the

Constantinople Board of Health, with the general mandate to

study on the spot the sanitary defence of the line, and the

special mandate to select the best site for a lazaret, in which

pilgrims returning from Mecca and Medina will undergo dis-infection, and if necessary quarantine, before reachingDamascus. The results of the Commission’s labours are set

forth at length in the articles in question. Tebuk, a placeabout half-way between Damascus and Medina, but rathernearer the latter, has been chosen as the site for the

quarantine station; and a series of definite proposals havebeen made by the Commission for the sanitary defence of theline, the execution of which is now seriously occupying theinternational sanitary board above referred to. The questionof ’’ ways and means " is also, we gather, being consideredin the proper quarters and will sooner or later form the

subject of a new agreement between the Porte and the

Powers interested.

To the measures proposed by the Commission in questionwe may perhaps refer again and in more detail in a laterissue. We would only say now that a thorough scheme ofdefence of this new channel of communication is of first-

rate importance in the interests of the public health of all