THE ABUSE OF DRUGS

C. R. CHRISTENSON, M. D.

Starbuck

Ever since the beginning of history the unknown and mysterious has had special attraction to the human mind. The occult sciences of ancient times were idols before which men bowed down and worshipped until research revealed the truth, when they turned again to the incomprehensible and abstruse to offer sacrifices.

The science of medicine, with its attendant halo of mystery, has had its large number of devotees in all ages. Disease, similarly mysterious, of unknown origin, and with its inexplicable manifestations, early became the subject of investigation and subsequent treatment. The remedy, in accordance with the supposed cause and various theories of the times, was either of a spiritual nature, including incantations, the wearing of charms or amulets, or the administration of drugs, not to mention surgery, which had early attained a comparatively high degree of excellence.

Gradually with the course of progress of other sciences the development of the healing art kept pace. Diseases were classified; anatomy, physiology and pathology were revived, and these sciences placed on a permanent basis, forming an organized school of medical knowledge. Then for centuries through the dark ages practically all efforts were spent in finding drugs to combat disease symptomatically. In this period of progress and retrogression no advancement of any importance was made till the last century.

The use of the miscroscope opened a vast field for in

vestigation. Histology, embryology, and pathology became at once important factors in medical schools. The discoveries of Pasteur and Koch marked a new era in scientific medicine. Bacteriology, with the evolution of serum therapy, greatly facilitated the diagnosis, prevention, and cure of certain diseases. With the knowledge at hand, laboratory and chemical facilities, instruments of precision, the advancement of medical knowledge has doubled and trebled itself in the last quarter century.

Proportionately, our pharmacopeia has also increased in bulk and in spite of the therapeutic nihilism prevailing a few years ago, and yet to some extent, is steadily expanding.

Although medical men know that outside of a few specifics, the action of drugs is very uncertain, the drug, in many cases useless, and in still more injurious, yet they are prescribing them in as large quantities as ever. In out boasted knowledge of disease we are still doing no more for the cure of human ills, by these means than the ancients and barbarians did centuries ago, and perhaps they even did better than we.

Rejoicing in our strength and power to cope with the morbid. conditions of the human anatomy, we are apt to ignore nature's methods that our superior (?) skill may be proven. Why are physicians prescribing drugs in so many of the acute, infectious, self-limiting diseases when they know in their hearts, or ought to know, that they are seldom needed? Why is it more rational to administer antipyretics in such cases than for an engineer to turn back the indicator on the steam gauge to reduce pressure in the boiler? In what does the so-called symptomatic treatment consist? Mostly in opposing nature's process of cure, when we consider that symptoms are simply efforts to relieve the system of disease. For example, taken an ordinary case of pneumonia. The pain, temperature, increased pulse-rate, cough, expectoration, etc., are the attempts of the human economy to rid itself of the invading enemy, and any drug administered for the purpose of removing any of the above symptoms is

interfering with a natural cure, besides introducing a foreign and possibly injurious substance, often in heroic doses, for an already overloaded and clogged system to eliminate.

What is true of pneumonia can be said of practically all the acute infectious diseases: they are bound to run a certain course in spite of all medication, and any attempt to abort or cure them is a snare and a delusion.

There is a prevalent belief that internal medication is indicated in a number of diseases where pathological bacteria are present, or may be the causative factors. In tuberculosis we have exhausted our list of bactericidal remedies in the vain hope of their reaching the seat of disease with sufficient potency to destroy the bacilli, after having passed through digestive and absorbing organs, and being changed by the action of all the fluids of the body with which they come in contact, to say nothing of the injury done to all the tissues and fluids, healthy or otherwise, destroying their natural resistance and immunity.

Typhoid, another example of this group, has been and is similarly treated. In cases of doubtful diagnosis where shot-gun mixtures are given in the fond hope of hitting some of the conditions present, it is well to bear in mind that if medicine is powerful enough to do good it will do an equal amount of harm, if not indicated or suitable in every respect.

During the writer's school days he was taught that a saline laxative in acute cases of appendicitis was a correct form of treatment. Theoretically it might seem so at first sight, but practically it does not seem to benefit the patient in any way. Now we see the absurdity of such treatment by observing that in this disorder where there are accompanying symptoms of pain and cessation of peristalsis, unless there co-exists enteritis, we have an indication to keep the intestinal tract at rest and prevent spreading of infection. Vomiting and loss of desire for food indicate that no food should be given. The treat

ment naturally resolves itself into letting the patient alone, as far as medication is concerned, which experience has proven to give the best results.

Equally absurd has been the indiscriminate treating of all forms of gastric or intestinal indigestion with digestive ferments, predigested food, and artificial digestive juices. Imagine how much stronger a weakened digestive organ will become by having its secretion supplied artificially for months, besides feeding the sufferer on so-called predigested foods, and its functions left idle all this time. With more time spent on differential diagnosis and less on experimental drugging many cases of so-called indigestion will be found to be caused by diseased appendices or gall-bladders, or by gastric or duodenal ulcers. As these cases do not entirely belong to the internist, and nervous dyspepsia is treated centrally, but very few are left for direct medical treatment. Diabetes, from its peculiar symptoms, cannot be treated! with any hope of permanent cure. Likewise chronic Bright's disease. Still patients afflicted with the above two diseases consume enormous quantities of drugs with little or no benefit.

Lister made possible antiseptic surgery, and that which evolved from it, aseptic surgery. We have passed through the period of irrigating tissues with antiseptic solutions, and now give them at least a fighting chance to use their native resisting power against septic invasion. The surgeon has learned from experience to depend upon asepsis and native immunity for his success. Even in pus cases there is less faith in the efficacy of loc?! drugs, and more in the inherent resistance of tissues.

There have been no new theories advanced, nor any original thought brought out in this paper. Every physician knows in his heart that in the class of diseases mentioned, and in many others, he often prescribes without expecting to derive any benefit therefrom, except its moral effect upon the patient or his friends, whose blind

faith in the magic drops and powder is sometimes astounding.

But perhaps our greatest sin lies not so much in prescribing the simpler remedies as in leaving our father's deities and wandering after strange gods in the form of proprietary medicines, the ingredients of which we do not know or are unfamiliar with. These so-called ethical preparations for the profession only, put up in attractive forms by the Tom, Dick, or Harry's pharmacal or chemical company, and exploited in the advertising columns of medical publications, are prescribed by physicians at an alarming rate, and bought by the patient without even consulting the doctor. Such preparations as Pepto-mangan, Cascara, Glyco-Thymoline, Tongaline, etc., are as familiar to the public as Ward's Liniment, St. Jacob's Oil, or Rocky Mountain Tea. Many of these firms also send out to their patrons printed prescriptions for baby's colic or grandpa's corns.

This subject of proprietary medicine has been discussed ably and at length in our medical journals and at meetings, and needs no further comment except endorsement of the strongest condemnation of the practice.

The abuse of antipyretics, hypnotics, narcotics, and patent medicines by the laity, so long as such are not advised by the regular physician, need not be considered here.

Perhaps the day will soon come when thorough and scientific investigation will reveal that the human body s a perfect organism, with its own laboratory for elaborating its own remedies and supplying them to the system in proper quantities and strength. This we know to be true in acute infectious diseases, which produce their own antitoxic sera, and why not to a certain extent in other pathological conditions? When research has cleared away the mystery surrounding the causation of disease, when we open our eyes to what nature does, we shall cease to treat empirically. In proportion as we understand all the conditions present in a disease we shall