Presidential Addresses Treatment by Drugs: A Dip in a General Practitioner's Tool-Kit

H. G. Dain
1926 BMJ (Clinical Research Edition)  
THI clhoice of the subject for tlle pre-;icidential address to Brancel of the British Medieal Associatioin hias in its timiie, I feel sure, been the cause of mutich searchlinlgs of iiiind or heart, whichever we prefer to consider the real seat of ainxieties and the like. For the specialist in some suibject or subjects it is possibly less difficutlt; but when a miatn has been in general-very general-practice for many vears he has been compelled to familiarize himself with numberless questions
more » ... subjects, and at the same time prevenited from becomiilg expert enough at any one to find material for a presidential address. I have found it the indre difficult because on this occasion I did not want to drag in my particular "Kling Charles's head"' by addressing you'on anythiing to do with National Health I Insurance, or, indeed, \any other medico-political subject. Ther e is, however, one question very much in evidence at tlie momiient. t refer to the tremendous consumption of. -drugs and their consequent unexpectedly great cost, aneV it has impressed itself upon me that perliaps something uIsefull might be said in consideration of the question of treatment by the use of drugs. Treatment of Diseasc by Drugs. To begin with it seems to be often assumed, or at anv rate inferred, whenever the subject is dealt with in the press, that drugs in the treatment of diseases are in the main unnecessary and useless, and that alien a doctor gives hiis patient medicine to drinik, or a prescription to get it with, he is simply panderinig to hiis patienit's desire to get his cure that way, when lhe really does niot want ana medicinie at all, but only requires advice. This is " the fetish of the bottle." I do not ill time least agree that this is true as a generalizationi, thiough I am ftully aware (cf cases in which it is true; and it cannot be denied that it is much easier and quicker to senid off a patient with a prescription, which is all he thiniks he wants, than to deal with him more faithfully with advice anid instructions as well. Again, there are among us tlhose a-lhose knowledge of drm,gs and their uses is, to say the least, elemiientary and limited to a very short list of comlnmon remedies-magnesium sulphate, sodium bicarbonate, rhubarb p)owv(ler, opium, and perhaps sodium salicylate. These doctors llave not taken much interest in drug treatment, and have not increased their repertoire by the useful methods of trial and error, and experience. They tend to assume tihat treatment bhmedicines is largely a process of faith healing, and they are encouraged and comforted in this belief by the fact thoroughly appreciated by us all, that the patient is curedl by natural processes in himself, and that time cure is not accomplished by the doctor or Iiis medicine. .On the other hand, if one has been interested iu tryinig out remiedies, the occasions become very numerous when the patient's troubles can be greatly diminished and the course of his disease favourably modified by appropriate remedies, andl I propose to relate here some of miay own experiences. In these I do not claim to have any explanation, scientific or otherwise, for the actions or effects observ-ed, but I claim the justification of experience. In our beginnings and before ,we qualify we have to learn of drugs and their uses, and we h1ave to know and be examined on the contents of that awoiderful publication the British Pharmacopoeia (the revision and reproduction of ,vyl)h is under consideration 'now'), foll of remedies £f greater or less pote1ncy for all sorts of conditions-manv, 1 am convinced, of very small potency inideed, though widely prescribed. Shall we take, for example-, that popular bitter tonic gentian? The value of this is well illustrated by a story of the late Dr. E. Rickards, wlhose wisdom was well known to many of you. It was obser-ved by onie of his students that he frequenitly ordered ani ammonia -and gentian mixtuire, and in search of kniowledge the studenit asked in whliat dircumstances tllis mlledicinle was pirescriied. Dr. Rickards's reply was that lhe gave that mixture wlhen he did not know what was the mnatter, wheni there was nothing the matter, w-hen it did niot matter. Other drugs there are of, great and well recoginized potency, but I have nio iinteiitioNn to dwell on the uses of such as are kniown to t.e specific in the treatment of particular diseases--for example, quiniine in malaria, mercury, iodide, anid arseniic in syphilis, emetine in am-oebic dysen-tery, salicylates in acutte rheumiiatisin, or opiuim in pain of different kinds. Diminis 7inigi yUse of Opiium. Perlhaps the first observation I wouild make is the steadily diminishing use I find for opiumn. No! this is not the resuilt of tile Dangerous Drugs Act. So nmany kinds of pain are better relieved by other drugs, and even in the pain of incurable malignant disease, when we aie in the elnd driven to it, I find that the morphine-relieved patient becomes so miserable and mentally altered, and requires so constantly increased a dose that I always expeliment with combinationis of other pain-relievers for as long as possible, in what I believe are the best interests of botl the patienit and his friends. While sp-eaking of cancer I am reminded that a mian whose wife had been found to have inoperable carcinoma of the cervix uteri once came to me with an old copy of the Lancet, in which a doctor recommended trial of a formula which containied magnesium carbonate 5 grains, potassium citrate 5 grains, alum sulphate 2 grains, tincturle of opiumll 2 minims, in cases of malignant disease, anid asked if it might be tried for his wife. I of course conisented, to finid to my suLrprise that in a few days the paii was relieved and the lhaemorrhage and discharges steadily diminiished, and for two years while shie took the medicine her symptoms disappeared. She could not be persuaded.to take it longer as she was satisfied she was cured. After leav-inig it off for a few miionlths her symptomiis returned and the medicine was this time powerless to stay the course of the disease. I have tried the formula since on many occasions, sonmetimes with apparently helpful results, but only in onie other case, and that a pelvic growvth, witl anytlhing like so surprising an effect. Catarr7hs: Aspirin. Of tlhe iiialny and varied conditions with which the genieral practitionier has to deal I suppose it will be agreed that the catarrhs, acute and chroniic, of all the various ImiucoUs memibranes easily outnumber every other complaiit, and perllaps there aire no other illnesses in whiclh the patient is iiiore grateful for relief. The catarrhs of the respiratory passages are, I suppose, specially and peetiliarly prevalenit and persistent in our English winter climate. Take tIme comiimon acute " cold -in the nose " witlh its violenit sneezing and profuse dripping-most uncomfortable anid very depressing. We all know that it will pass thlrough its various stages and disappear in due couLrse, but the effect, Uponl many people in the pouring stage, of a few doses of amiunonium chloride 10 grains, sodium salicylate 10 grainis, clmlorodyne 10 minims, is almost iagical, but if the forminula is taken to pieces and each constituent tried separately the same effect cannot be obtained. Anid when a catairh has become bronchial and tends to stick I find that I usually turn to creosote and am rarely disappointed in the restult. In combination with potassium iodide this remuedy will often benefit cases of chronic bronhehitis enormously. I have tried these two drugs in the treatment of acute pneumonia, but without any satisfying results. In the management and treatment of acute pneumiioniia I suppose that in the course of time we all evolve somiie general plan, and I am personally persuaded of two thinigs: first, that it is dangerous or even fatal to give salinie aperients, especially magnesium sulphate; anrd second, that expectorants are almost eqtially undesirable, DM.: 61 a ,IR2--,Mm -46i. -M-8HGSo'J 't. U -2, I,
doi:10.1136/bmj.2.3442.1219 fatcat:7o7thyhwrbfwrkun45mpvi7hue