THE USE AND ABUSE OF DRUGS

725THE USE AND ABUSE OF DRUGS.

of all parties Parliament has given agricultural landa 75 per cent. exemption from various rates. The

object-and a very proper one--is to preserve ouragricultural system from extinction even at the riskof putting private profit in the farmer’s pocket. Isnot our hospital system worth preserving, where noquestion of private profit can possibly arise ? ’?, Thecase for the London Fever Hospital is strong. Foundedas long ago as 1802, it has played its part in freeingLondon from serious epidemics ; it has trained genera-tions of expert fever nurses ; and its expenses are

necessarily high because it must maintain its resourcesat full strength to meet emergencies. If it asks forrelief from the burden of the rates, a debating pointmay be made against the request. The hospitalprides itself on the facilities it offers to those patientswho prefer to contribute towards the cost of theirtreatment rather than to become inmates of a rate-supported institution. A hospital which exists forthose who prefer not to throw themselves upon thecharity of the rates is in a dialectical difficulty insoliciting relief from local taxation. Meanwhile, the boot is on the other leg, for the

London Fever Hospital as a ratepayer is at presentcontributing to the cost of running the institutionsof the Metropolitan Asylums Board. Local authorities,of course, are hardly in a position to be generous.If they had both the means and the will to relieve ahospital, the legal doctrine of ultra vires and thethreat of an auditor’s surcharge stand athwart theirpurpose. Parliament should consider the question.Institutions which play an honourable part in thepublic health scheme of the country, and which areadministered on sound lines and without extravagance,should not be allowed to be crushed out of existencebeneath the weight of either local or imperialtaxation.

BRITISH CONGRESS OF OBSTETRICS ANDGYNÆCOLOGY.

WE publish elsewhere the detailed informationconcerning the fifth British Congress of Obstetricsand Gynaecology which will be held in London fromApril 22nd to 24th inclusive. These gatheringsfrom their inception have endeavoured to promotecooperation in clinical research among obstetriciansand gynaecologists in Great Britain and Ireland, andthose who know our " Extra Number " dealingwith modern methods in abnormal and difficultlabour will recogniee how many points in diagnosisand in treatment remain matters of opinion, evenwhere general lines of practice are accepted. Thisis particularly the case with puerperal fever, eclampsia,and dysmenorrhoea, and local committees have beenformed by the constituent societies of the Congress,charged with the duty of preparing reports uponone of these subjects yearly, the first beingthe subject for this year. The result of suchcooperative effort, and of the periodical confer-

ences, has been undoubtedly to develop a spiritof unity and a desire to promote serious work, andalready many questions have been settled. We maycontrast the position to-day with that of some 20or 25 years ago, when a paralysing discord prevailed,England and Wales, Scotland and Ireland havingdiverse views, while the same might be said not onlyof metropolitan and provincial schools, but of schoolsin the metropolis itself. A far greater unity existsto-day in the development of our midwifery service,and if the things which remain for settlement arenumerous every advance in our scientific knowledgeadds to the list. There will always be work ahead,and the influence of the impending Congress, likethat of its predecessors, will be towards the establish-ment of views which represent accord between theobstetrical teachers of Great Britain and Ireland.

Annotations."Ne quid nimis."

THE USE AND ABUSE OF DRUGS.IN the middle of last century the doctrine of thera-

peutic nihilism found its chief exponent in JosefSkoda, a leader of a new school of thought in Vienna,who declared that while we can diagnose and describedisease we dare not expect by any means to cure it.In this country up to the present day the influence ofthat doctrine persists-diagnosis is taught in ourmedical schools as the essential equipment of theyoung practitioner, and the student hears too oftenthat a physician must be judged, not by the success ofhis treatment, but by the extent of his knowledge.medicine as the art of healing the sick giving place tomedicine as the study, per se, of the disease. Butthe tide of opinion is turning against therapeuticnihilism, and Prof. W. E. Dixon, at a meeting of theHunterian Society on Monday, March 30th, statedas one of the reasons which have altered our viewson the action of drugs, that we have now learned thatthe body itself works by means of drugs of its ownmanufacture. It manufactures alkaloids, just as

plants do, for its own needs. In emergencies ourinternal secretions may provide us with drugs requiredfor our well-being-in rage or fear a rush of adrenalinwill produce the conditions required for fight or

flight. Chemotherapy is also opening up a new out-look in medicine with regard to specificity, and, whileincreasing specificity in pharmacology widens thefield of successful treatment of disease, it also increasesthe possibilities of the abuse of drugs. It is a difficultmatter to draw the line between use and abuse of adrug. For example, quinine is a specific for malaria,but its use to treat a cold may be classed as an abuseso long as there is no definite organism susceptible toquinine and ætiologically connected with the cold.Dr. H. H. Dale, speaking at the same meeting, definedthe abuse of drugs as their reckless and unintelligentuse. Intelligent use of a drug, he explained, did notmean that the practitioner must have a full scientificappreciation of a drug’s action; were that necessarymany valuable drugs would require to be discarded.But it was essential to make close and accurate clinicalobservations, and not to rely on vague impressions andrule-of-thumb restrictions. Enlightened empiricismhe described as being often a better procedure thanbasing treatment on a supposedly scientific foundation.Much is now being published both by scientific andlay writers concerning the rationale of the action ofcertain pharmaceutical products, and it is couchedin scientific or pseudo-scientific terms whose maincharacteristic is extreme plausibility. Many of these" scientific" explanations contained in pharmaco-logical " literature " Dr. Dale considered to bedangerous, the danger lying, in his opinion, in theexcessive modesty of the medical profession who wereinclined to look on what they could not quite under-stand as being very deep and possibly very true. It wasimpossible, he pointed out, for anyone to know morethan his own corner of the scientific world, and suchan attitude of accessibility to mysterious dicta comingfrom another corner was to be deprecated. As aninstance of this Dr. Dale quoted several statementsthat had been made on the one hand with perfectlygenuine intent by a leader of the medical professionwith regard to the value of colloidal substances, and onthe other by a firm of commercial chemists, perhapsnot so ingenuously ; but both sets of utterances wereentirely misleading. It was time, he said, that some-thing was done to rescue what might be valuable intreatment from what might be manifest abuse, butthe difficulties in differentiation are considerable.This should not, however, cause them to be heldinsuperable. We congratulate the Hunterian Societyupon having elicited at their last dinner meeting suchwise speaking on an important topic. The dinnerwas held at Simpson’s Restaurant, Cheapside, and waswell attended.