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The Indiscriminate Use of Drugs.

THE LANCET.

.LON-DON: SATURDAY, MARCH 1, 1913.

THE principles of therapeutics are very little under-

-stood and appreciated by the laity. The most supreme

ignorance is generally demonstrated in regard to the nature

.and action of drugs, the sole idea of treatment amongstthe public seeming to be that certain preparations relievecertain symptoms, and that when particular phenomena

present themselves, such as pain, cough, or insomnia, the

same remedies must be used, no matter what the origin of

those symptoms. Taking drugs without consultation with

a medical practitioner is undoubtedly on the increase,

.and it is the delight of some individuals to advise their

friends to take certain things for the relief of their ills.

Excellent preparations have been issued by pharmaceutical.chemists, and many of them form convenient combinations

for administering remedies ; but the danger of using themwithout a prescription is a real one. The subject has been

dwelt on in these columns very often, but it is as topical as

ever, and we strongly advise all our readers, when puzzled

by some of the manifestations of their patients, to take intoaccount the possibility that they are self-druggers. Manyof the popular preparations are, of course, harmless, only

.containing simple ingredients such as bicarbonate of soda

and carminatives ; but when more potent remedies are used,for example narcotics, the risk becomes imminent. Slight

ailments, vague aches and pains, are borne with a varying.amount of patience by different individuals. In many the

least departure from health is a signal for the self-

administration of drugs. Insomnia is a more terrible thingfor one man than .for another ; but the habit of taking

soporifics is always dangerous, whatever the preparationselected be. The inquests held from time to time clearlyprove the easy manner in which large quantities of narcotic

<drugs can be obtained and their result.

This danger has been considerably increased by the

.. medical column" " in the lay press, generally, we

regret to say, written by "a physician" or by "a phy-sician and surgeon." It is fair to say that words

to the effect, "you should consult a medical man," are

frequently inserted, but, nevertheless, no approval can begiven to prescribing on the mere relation of symptoms. We

particularly insist on the injunction that remedies for

insomnia should never be suggested in this manner. As

an illustration of the false ideas that may be engendered

in the public mind, we may draw attention to an articlewhich appeared in the Daily Mail recently under the

heading of "The Veronal Habit-Increasing ’ Strain of

Modern Life. By a Physician." The author of this article

rightly draws attention to the fatal results which have

followed "not their use but their gross abuse" of such

drugs as chloral and the bromides, but he then proceeds toextol the virtues of veronal as a hypnotic. His remarks are

misleading and show a want of judgment that is greatly tobe regretted. He first states that the weak-minded

persons who can use no judgment ought not to be

allowed to have in his possession medicines of any kind,whether on a doctor’s prescription or not." There is

much truth in that remark, but there is nothing to preventsuch a person from reading the article, and if he suffers

from insomnia purchasing some veronal and using it with

alarming results. The friends of the sufferer may knowthat he is weak-minded ; but his own idea of himself is

likely to be that he is a brave, shrewd fellow. Veronal

may be among the safer hypnotics, but this is not the

unanimous opinion of physicians. Eight grains have beenknown to prove fatal to an adult, and 10 grains not

uncommonly give rise to alarming symptoms. From the

article we are referring to, however, the lay reader wouldbe justified in believing that veronal may be taken byanybody in from doses of 5 to 15 grains without dangerand without the risk of acquiring a drug habit, the onlywarning given being that it should not be used if the

kidneys are diseased.The instruction of the public in drug-taking in this

manner must be strongly condemned. There is to-day a

genuine demand for a "medical column" in the laypress, and not infrequently the public now receive throughthe medium of their morning paper quite sound informa-tion upon medical happenings. But there are two

main dangers in the issue of medical information in

the lay press. First, drugs to which a distinct risk is

attached may be prescribed, such as the cardiac depressantsand the hypnotics ;. also, amongst the public there is a strongimpression that temperature may be reduceci by means of

drugs, and consequently dangerous doses of antefebrin or

the salicylates are often taken without personal advice asto the cause of the temperature. The second danger is thatthe medical column" should turn itself into the medium

for medical advice by correspondence. Symptoms are thendescribed by the patient which, although not apparentlyof great import, may be the early manifestation of

serious organic disease. Their meaning can only be

detected by careful clinical examination, and the true

nature of the malady not being recognised at a stagewhen treatment would be most successful delay maygreatly influence the prognosis. The j.ouinalist who presumesto give therapeutic advice upon written information is a

dangerous and unsound person. The journalist who explainsto the public our real aims and the right attitude in

professional circumstances, who stimulates public interestin medical affairs by a just appreciation of our progress,

and who possesses a broad-minded ability with which to

criticise our shortcomings, and anomalies is a valuable

writer.