50 Years of Medicine As Seen, May 1907 in Washington, D.C.

EIGHTH ANNUAL MEETING OF THE AMERICAN THERAPEUTIC SOCIETY

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Held At Washington, D. C, May 4, 6 And 7,1907.

The address of welcome was delivered by Hon. Henry B. F. Mcfarland, president of the Board of Commissioners for the District of Columbia. Dr. Reynold Webb Wilcox, New York, responded for the visiting members.

Address by the president, Dr. Robert Reyburn, Washington, D. C.

Fifty Years In The Practice Of Medicine.

After speaking of his early medical career, Dr. Reyburn describes the methods of treatment used in the period following the year of his graduation, 1856. Vaccination was performed by pulverizing vaccine crusts and inserting the moistened powder into the arm. The antiphlogistic method of treating inflammation was still in vogue, bleeding, blistering, purging. While no one would wish to revive bleeding after the old methods, yet he had seen cases in which prompt venesection had saved life. In eclampsia, threatened apoplexy and even acute pneumonia, he had seen prompt relief afforded in this way. The antiphlogistic method was followed by a reaction, and in 1860 and 1862, stimulants were given in inflammatory conditions. In 1862 Dr. Reyburn entered the Union Army, and from this point the paper deals largely with surgery. After describing surgical methods in vogue prior to the war, and contrasting them with those of the present day, he interestingly describes his army experiences. »He contrasts the high mortality from gunshot wounds in the Civil War with the low mortality in the SpanishAmerican war. In the latter the universal use of first aid by antiseptic dressings did more than anything else to lessen the mortality. Also, the rifles used were more humane in that they carried a small bullet of high velocity, which penetrated the tissues more readily and caused less shattering than did those of the Civil War. The paper then deals with personal recollections of President Lincoln and of the scenes following his assassination. The address closes with an interesting account of the assassination, illness and death of President Garfield, Dr. Reyburn having been one of the physicians in attendance.

PURE DRUGS.

Dr. Harvey W. Wiley, Washington: After referring to the different classes of therapeutic agents, Dr. Wiley discusses the attempts that have been made to control the purity of drugs used as medicines. Such attempts have been made for many years. The United States Pharmacopeia, National Formulary and United States Dispensatory are efforts along this line. As early as 1848 a federal law was enacted governing the importation of adulterated and spurious medicines. Prior to this there had been established at the port of New York an examiner of drugs. His testimony before the Congressional Committee shows that the character of the drugs imported a half-century ago was far from satisfactory. At least one half of those which entered New York was adulterated or had deteriorated in value. Under the inspection of drugs their character has materially improved. Dr. Wiley was unable to say how far the new Food and Drugs Act will be applied to the inspection of drugs. The question is now before the Attorney-General for decision. If he adopts the common principle of construction, inspection by the Treasury Department will continue as before, with an additional inspection as required by the Act of June 30. 1906. It is probable that at least 20% of the dm trade will be affected by the provisions of the new law. This leaves about forty thousand articles of drugs to which the law does not apply except as to misbranding. He considers the subject of misbranding, the evils which attend the promiscuous sale of preparations of uncertain, unknown, or even questionable composition, and the beneficial effects which have followed proper and correct branding. Individuals who have not the most elementary knowledge of pharmacy or medicine are permitted, under the state and national law, to concoct almost any agent and sell it directly to the consumer. This is in marked contrast with the qualifications necessary for the practice of medicine and pharmacy. He suggests the following as the most effective method of control in this regard: that no one should be allowed to advertise or offer for sale to the pubhV in any community any remedy of any kind who has no: passed an examination before a medical examining board and received a license to dispense medicines and prescribe for patients in the locality mentioned. Thus, the patent medicine trade would be much restricted. After discussing the subject of standardization, the paper closes with an appeal to physicians to write original prescriptions rather than order t he ready-made medicinal preparations.

DISCUSSION.

Db. Reynold Webb Wilcox, New York, spoke of the standards set forth in the Pharmacopeia. Seven years ago he was appointed a member of the revision committee. The aim of the committee had always been to maintain the necessary efficiency and purity of drugs without making the standards so high that manufacturers could not come up to them. They were established after careful study and conferences with manufacturers. After the enactment of the new Pure Food and Drugs Act there came in a flood of protests from manufacturers, who claimed that they could not come up to certain of the standards. This necessitated a reconsideration of the subject, which resulted in revision of the standard in over four hundred instances. Never had the committee failed to lower the standard when it was conclusively shown that it was unreasonably high. He commended Dr. Wiley's work. The aew law was a godsend to the physician, the pharmacist and the public.

Dr. E. H. Long, Buffalo, said that the profession could well rejoice that it had the aid of the government in the matter of drug control. He commended the suggestion by Dr. Wiley relating to a license requirement for those who wish to sell medicinal preparations. He commented upon the prevailing neglect of medical schools to furnish adequate instruction in the art of prescribing and the use of reliable and wellknown remedies. Much could be done along this line to hasten the era of pure drugs.

Dr. Oliver T. Osborne, New Haven, said that now is the time to let the label tell. He related a recent experience at Hartford in an effort to get poison labels on bottles. There was much opposition from pharmacists and others, and finally two strenuous bills were brought before the legislature. Much to his satisfaction, however, the business men agreed at the preliminary hearing that they preferred the provisions of the new Food and Drugs Act. What can be done as to false and misleading advertisements? The Post-office Department must attend to this, as such advertisements are fraudulent and hence should be denied the use of the mails. He expressed regret that young physicians in the hospitals are prone to prescribe compounds which are kept upon the shelves ready-mixed for the sake of convenience. Thus they soon lose the ability to write their own prescriptions. After they leave the hospital they come into contact with the traveling salesman and his proprietary medicines. He made a plea for the writing of original and simple prescriptions.

Dr. F. E. Stewart, East Orange, commended Dr. Wiley's work. The medical profession and the public could not be too grateful for governmental aid. He commended Dr. Wiley's suggestion as to license requirement. Dr. Gould had said that any one can practice medicine without a license except a physician or a pharmacist.

Dr. L. F. Kebler, Washington, related interesting instances in which articles which were misbranded or falsely advertised were brought to the attention of the post-office authorities with the object of having them excluded from the mails. In many instances failure was due to the difference of opinion among the medical witnesses as to the efficacy of the " cure under consideration. He testified as to the dense ignorance of many of the promoters of these "cures and cited instances in illustration.

Dr. Wilet, in closing, said that the Post-office Department had accomplished all that it could under the law. He had always received from it sympathy and help in his work.

SOME CRITICISMS OF THE UNITED STATES PHARMACOPEIA.

Dr. Reynold Webb Wilcox, New York: Dr. Wilcox answers some of the criticisms that have appeared since the last revision became official in 1905:

1. "Many agents have been retained that are not in general use, while others much used have been omitted." As a matter of fact the changes were made only after the committee had consulted manufacturers, wholesale and retail druggists, and the members of the medical profession throughout the land. Every suggestion, no matter how humble its origin, was considered.

2. "More frequent revisions of the pharmacopeia are necessary." A greater frequency would not be possible, because time is needed for definite knowledge of medicinal substances. Active work for nearly five years was required for the present revision and this represents about the shortest time in which the work can be done.

3. "The time has come when the American Medical Association should take a hand in this work." Dr. Wilcox answers this criticism at some length, calling attention to the make-up of the revison committee. The medical profession is represented by 12 out of 26 members. The unfortunate showing which the Council on Pharmacy and Chemistry has made also demonstrates the utter unfitness of the American Medical Association to undertake the far more serious work of revision of the Pharmacopeia.

• DISCUSSION.

Dr. L. F. Kebler, Washington, agreed with Dr. Wilcox as to the status of the United States Pharmacopeia. He knew of none equal to our own. It unquestionably has faults, but they will be remedied as fast as practicable. He could not see the justice of the criticisms mentioned in the paper. He expressed regret that Dr. Wilcox had so severely criticised the Council. It had already accomplished something, and for this it deserved credit. It could reach some things that the federal law could not. Already it had exposed a number of frauds; the members were working harmoniously together for a good end.

Dr. F. E. Stewart, East Orange, also expressed regret that Dr. Wilcox had criticised the Council so severely. It was doing a good work and was attempting to solve some of the most difficult problems in existence.

Dr. S. L. Dawes, Albany, referred to the nomenclature used in the Pharmacopeia. The names of remedies are in many instances too long and complex. They could be simplified to good advantage. Students who are taught long and complex names for drugs soon discard them after graduation for simpler terms. After graduation young physicians are apt to lapse from the high standards set for them in the medical schools. He thought this a valid criticism of the Pharmacopeia. Simplify the nomenclature.

Dr. E. H. Long, Buffalo, said that we should not take the position of condemning the Council. We should remember the short time that it has been in existence. Though young, it has already done some . The Pharmacopeia, on the other hand, has in existence since 1820. It can stand severe criticism. The more one comes into contact with the members of the revision committee, the more he sympathizes with them in their work. He was in favor of a simpler nomenclature.

Dr. Oliver T. Osborne, New Haven, said he hardly found his prescription blanks long enough for some of the terms he had to use. He suggested that accent marks be used in the next Pharmacopeia in order to secure uniformity in pronunciation. He commended the work of the Council.

Dn. Wilcox, in closing, said that perhaps his criticism of the Council had been rather too severe. Destructive criticism is not always advisable; constructive criticism is often productive of good. His was intended to be of the latter type. He fully appreciated the magnitude of the task before the Council. It had simply undertaken to do more than it could. He favored a simpler nomenclature, and agreed that the matter of pronunciation should receive attention in the next Pharmacopeia.

LEGAL CONTROL NECESSARY IN THE TREATMENT OF DRUG HABITS.

Dr. Frederick H. Gerrish, Portland, Me.: After speaking of the wide prevalence of drug habits, Dr. Gerrish emphasizes the futility of depending upon the victim's will power. Physical restraint is necessary in almost every case. And yet if the physician interferes with the freedom of action of the victim, even with his consent, he makes himself liable to a subsequent suit for false imprisonment. The only way to reconcile the conflicting interests of physician and patient is by the enactment of a law by which the victim can relinquish his freedom long enough to ensure a cure. Such a law was enacted in Maine in 1905. Dr. Gerrish had heard no complaints that its workings were other than salutary. The paper closes with a statement of the law.

{To be continued.)