their peculiarities are due to the temperament of the American librarian.
We make a similar assumption when we discuss British libraries. I do not
deny that the librarians on both sides have had something to do with it,
but the determining factor has been the social and temperamental
differences between the two peoples. Americans are fluid, experimental,
eclectic, and this finds expression in the character of their institutions
and in the way these are administered and used.
Take if you please the reaction of the library on the two sides of the
water to the inevitable result of opening it to home-circulation--the
necessity of knowing whether a given book is or is not on the shelves. The
American response was to open the shelves, the British, to create an
additional piece of machinery--the indicator. These two results might have
been predicted in advance by one familiar with the temper of the two
peoples. It has shown itself in scores of instances, in the front yards of
residences, for instance--walled off in England and open to the street in
the United States.
I shall be reminded, I suppose, that there are plenty of open shelves in
English libraries and that the open shelf is gaining in favor. True;
England is becoming "Americanized" in more respects than this one. But I
am speaking of the immediate reaction to the stimulus of popular demand,
and this was as I have stated it. In each case the reaction, temporarily
at least, satisfied the demand; showing that the difference was not of
administrative habit alone, but of community feeling.
This rapid review of modern American tendencies, however confusing the
impression that it may give, will at any rate convince us, I think, of one
thing--the absurdity of objecting to anything whatever on the ground that
it is un-American. We are the most receptive people in the world. We "take
our good things where we find them," and what we take becomes "American"
as soon as it gets into our hands. And yet, if anything new does not
happen to suit any of us, the favorite method of attack is to denounce it
as "un-American." Pretty nearly every element of our present social fabric
has been thus denounced, at one time or another, and as it goes on
changing, every change is similarly attacked.
The makers of our Constitution were good conservative Americans--much too
conservative, some of our modern radicals say--yet they provided for
altering that Constitution, and set absolutely no limits on the
alterations that might be made, provided that they were made in the manner
specified in the instrument. We can make over our government into a
monarchy tomorrow, if we want, or decree that no one in Chicago shall wear
a silk hat on New Year's Day. It was recently the fashion to complain that
the amendment of the Constitution has become so difficult as to be now
practically a dead letter. And yet we have done so radical a thing as to
change absolutely the method of electing senators of the United States;
and we did it as easily and quietly as buying a hat--vastly more easily
than changing a cook. The only obstacle to changing our Constitution, no
matter how radically and fundamentally, is the opposition of the people
themselves. As soon as they want the change, it comes quickly and simply.
Changes like these are not un-American if the American people like them
well enough to make them. They, and they alone, are the judges of what
peculiarities they shall adopt as their own customs and characteristics.
So that when we hear that this or that is un-American, we may agree only
in so far as it is not yet an American characteristic. That we do not care
for it today is no sign that we may not take up with it tomorrow, and it
is no legitimate argument against our doing so, if we think proper.
And now what does this all mean? The pessimist will tell us, doubtless,
that it is a sign of decadence. It does remind us a little of the later
days of the Roman empire when the peoples of the remotest parts of the
known world, with their arts, customs and manners, were all to be found in
the imperial city--when the gods of Greece, Syria and Egypt were
worshipped side by side with those of old Rome, where all sorts of exotic
art, philosophy, literature and politics took root and flourished. That is
usually regarded as a period of decadence, and it was certainly a
precursor of the empire's fall. When we consider that it was
contemporaneous with great material prosperity and with the spread of
luxury and a certain loosening of the moral fiber, such as we are
experiencing in America today, we can not help feeling a little perturbed.
Yet there is another way of looking at it. A period of this sort is often
only a period of readjustment. The Roman empire as a political entity went
out of existence long ago, but Rome's influence on our art, law,
literature and government is still powerful. Her so-called "fall" was
really not a fall but a changing into something else. In fact, if we take
Bergson's view-point--which it seems to me is undoubtedly the true one,
the thing we call Rome was never anything else but a process of change. At
the time of which we speak the visible part of the change was
accelerated--that is all. In like manner each one of you as an individual
is not a fixed entity. You are changing every instant and the reality
about you is the change, not what you see with the eye or photograph with
the camera--that is merely a stage through which you pass and in which you
do not stay--not for the thousand millionth part of the smallest
recognizable instant. So our current American life and thought is not
something that stands still long enough for us to describe it. Even as we
write the description it has changed to another phase. And the phenomena
of transition just now are particularly noticeable--that is all. We may
call them decadent or we may look upon them as the beginnings of a new and
more glorious national life.
"The size and intricacy which we have to deal with," says Walter Lippmann,
"have done more than anything else, I imagine, to wreck the simple
generalizations of our ancestors."
This is quite true, and so, in place of simplicity we are introducing
complexity, very largely by selection and combination of simple elements
evolved in former times to fit earlier conditions. Whether organic
relations can be established among these elements, so that there shall one
day issue from the welter something well-rounded, something American,
fitting American conditions and leading American aspirations forward and
upward, is yet on the knees of the gods. We, the men and women of America,
and may I not say, we, the Librarians of America, can do much to direct
the issue.
DRUGS AND THE MAN[14]
[14] A Commencement address to the graduating class of the School
of Pharmacy, St. Louis, May 19, 1915.
The graduation of a class of technically trained persons is an event of
special moment. When we send forth graduates from our schools and colleges
devoted to general education, while the thought of failure may be
disquieting or embarrassing, we know that no special danger can result,
except to the man who has failed. The college graduate who has neglected
his opportunities has thrown away a chance, but he is no menace to his
fellows. Affairs take on a different complexion in the technical or
professional school. The poorly trained engineer, physician or lawyer, is
an injury to the community. Failure to train an engineer may involve the
future failure of a structure, with the loss of many lives. Failure to
train a doctor means that we turn loose on the public one who will kill
oftener than he will cure. Failure to train a lawyer means wills that can
be broken, contracts that will not hold, needless litigation.
Congressman Kent, of California, has coined a satisfactory word for this
sort of thing--he calls it "mal-employment." Unemployment is a bad thing.
We have seen plenty of it here during the past winter. But Kent says, and
he is right, that malemployment is a worse thing. All these poor engineers
and doctors and lawyers are busily engaged, and every thing on the surface
seems to be going on well. But as a matter of fact, the world would be
better off if each one of them should stop working and never do another
stroke. It would pay the community to support them in idleness.
I have always considered pharmacy to be one of the occupations in which
malemployment is particularly objectionable. If you read Homer badly it
affects no one but yourself. If you think Vera Cruz is in Italy and that
the Amazon River runs into the Arctic Ocean, your neighbor is as well off
as before; but if you are under the impression that strychnine is aspirin,
you have failed in a way that is more than personal.
I am dwelling on these unpleasant possibilities partly for the reason that
the Egyptians displayed a skeleton at their banquets--because warnings are
a tonic to the soul--but also because, if we are to credit much that we
see in general literature, including especially the daily paper and the
popular magazine, _all_ druggists are malemployed. And if it would really
be better for the community that you should not enter upon the profession
for which you have been trained, now, of course, is the time for you to
know it.
There seems to be a widespread impression--an assumption--that the day of
the drug is over--that the therapeutics of the future are to be concerned
along with hygiene and sanitation, with physical exercise, diet, and
mechanical operations. The very word "drug" has come to have an
objectionable connection that did not belong to it fifty years ago. Even
some of the druggists themselves, it seems to me, are a little ashamed of
the drug part of their occupation. Their places of business appear to be
news-agencies, refreshment parlors, stationery stores--the drugs are "on
the side," or rather in the rear. Sometimes, I am told, the proprietors of
these places know nothing at all about pharmacy, but employ a prescription
clerk who is a capable pharmacist. Here the druggist has stepped down from
his former position as the manager of a business and has become a servant.
All of which looks to me as if the pharmacist himself might be beginning
to accept the valuation that some people are putting upon his services to
the community.
Now these things affect me, not as a physician nor as a pharmacist, for I
am neither, but they do touch me as a student of physics and chemistry and
as one whose business and pleasure it has been for many years to watch the
development of these and other sciences. The fact that I am addressing you
this evening may be taken, I suppose, as evidence that you may be
interested in this point of view. The action of most substances on the
human organism is a function of their chemical constitution. Has that
chemical constitution changed? It is one of the most astonishing
discoveries of our age that many, perhaps all, substances undergo
spontaneous disintegration, giving rise to the phenomena now well known as
"radio-activity." No substances ordinarily known and used in pharmacy,
however, possess this quality in measurable degree, and we have no reason
to suppose that the alkaloids, for instance, or the salts of potash or
iron, differ today in any respect from those of a century ago. How about
the other factor in the reaction--the human organism and its properties?
That our bodily properties have changed in the past admits of no doubt. We
have developed up to the point where we are at present. Here, however,
evolution seems to have left us, and it is now devoting its attention
exclusively to our mental and moral progress. Judging from what is now
going on upon the continent of Europe, much remains to be accomplished.
But there is no reason to believe that if Caesar or Hannibal had taken a
dose of opium, or ipecac, or aspirin, the effect would have been different
from that experienced today by one of you. This is what a physicist or a
chemist would expect. If the action of a drug on the organism is chemical,
and if neither the drug nor the organism has changed, the action must be
the same. If we still desire to bring about the action and if there is no
better way to do it, we must use the drug, and there is still need for the
druggist. As a matter of fact, the number of drugs at your disposal today
is vastly greater than ever before, largely owing to the labor, and the
ingenuity, of the analytical chemist. And there are still great classes of
compounds of whose existence the chemist is assured, but which he has not
even had time to form, much less to investigate. Among these may lurk
remedies more valuable than any at our disposal today. It does not look,
at any rate, as if the druggist were going to be driven out of business
from lack of stock, whether we regard quantity or variety. To what, then,
must we attribute the growth of the feeling that the treatment of disease
by the administration of drugs is on the decline? From the standpoint of a
layman it seems to be due to two facts, or at least to have been strongly
affected by them: (1) The discovery and rapid development of other
therapeutic measures, such as those dependent on surgical methods, or on
the use of immunizing serums, or on manipulations such as massage, or on
diet, or even on mental suggestion; and (2) the very increase in the
number and variety of available drugs alluded to above, which has
introduced to the public many new and only partially tried substances, the
results of whose use has often been unexpectedly injurious, including a
considerable number of new habit-forming drugs whose ravages are becoming
known to the public.
The development of therapeutic measures that are independent of drugs has
been coincident with popular emancipation from the mere superstition of
drug-administration. The older lists of approved remedies were loaded with
items that had no curative properties at all, except by suggestion. They
were purely magical--the thumb-nails of executed criminals, the hair of
black cats, the ashes of burned toads and so on. Even at this moment your
pharmacopoeia contains scores of remedies that are without effect or that
do not produce the effects credited to them. I am relying on high
therapeutical authority for this statement. Now when the sick man is told
by his own physician to discard angleworm poultices, and herbs plucked in
the dark of the moon, on which he had formerly relied, it is any wonder
that he has ended by being suspicious also of calomel and ipecac, with
which they were formerly classed? And when the man who believed that he
received benefit from some of these magical remedies is told that the
result was due to auto-suggestion, is it remarkable that he should fall an
easy prey next day to the Christian Scientist who tells him that the
effects of calomel and ipecac are due to nothing else than this same
suggestion? The increased use and undoubted value of special diets,
serums, aseptic surgery, baths, massage, electrical treatment,
radio-therapeutics, and so on, makes it easy for him to discard drugs
altogether, and further, it creates, even among those who continue to use
drugs, an atmosphere favorable to the belief that they are back numbers,
on the road to disuse. Just here comes in the second factor to persuade
the layman, from what has come under his own observation, that drugs are
injurious, dangerous, even fatal. Newly discovered chemical compounds with
valuable properties, have been adopted and used in medicine before the
necessary time had elapsed to disclose the fact that they possessed also
other properties, more elusive than the first, but as potent for harm as
these were for good. Many were narcotics or valuable anesthetics, local or
otherwise, which have proved to be the creators of habits more terrible
than the age-long enemies of mankind, alcohol and opium. When the man
whose wife takes a coal-tar derivative for headache finds that it stills
her heart forever, the incident affects his whole opinion of drugs. When
the patient for whom one of the new drugs has been prescribed by a
practitioner without knowledge of his idiosyncrasies reacts to it fatally,
it is slight consolation to his survivors that his case is described in
print under the heading, "A Curious Case of Umptiol Poisoning." When a
mother sees her son go to the bad by taking cocaine, or heroin, or some
other drug of whose existence she was ignorant a dozen years ago, she may
be pardoned for believing that all drugs, or at least all newly discovered
drugs, are tools of the devil.
And this feeling is intensified by one of our national faults--the
tendency to jump at conclusions, to overdo things, to run from one evil to
its opposite, without stopping at the harmless mean. We think we are
brighter and quicker than the Englishman or the German. They think we are
more superficial. Whatever name you give the quality it causes us to
"catch on" sooner, to work a good thing to death more thoroughly and to
drop it more quickly for something else, than any other known people,
ancient or modern. Somebody devises a new form of skate roller that makes
roller-skating a good sport. We find it out before anyone else and in a
few months the land is plastered from Maine to California with huge
skating halls or sheds. Everybody is skating at once and the roar of the
rollers resounds across the oceans. We skate ourselves out in a year or
two, and then the roar ceases, the sheds decay and roller-skating is once
more a normal amusement. Then someone invents the safety bicycle, and in a
trice all America, man, woman and child, is awheel. And we run this good
horse to death, and throw his body aside in our haste to discover
something new. Shortly afterward someone invents a new dance, or imports
it from Spanish America, and there is hardly time to snap one's finger
before we are all dancing, grandparents and children, the cook in the
kitchen and the street-cleaner on the boulevard.
We display as little moderation in our therapeutics. We can not get over
the idea that a remedy of proved value in a particular case may be good
for all others. Our proprietary medicines will cure everything from
tuberculosis to cancer. If massage has relieved rheumatism, why should it
not be good also for typhoid? The Tumtum Springs did my uncle's gout so
much good; why doesn't your cousin try them for her headaches? And even
so, drugs must be all good or bad. Many of us remember the old household
remedies, tonics or laxatives or what not, with which the children were
all dosed at intervals, whether they were ill or not. That was in the days
when all drugs were good: when one "took something" internally for
everything that happened to him. Now the pendulum has swung to the other
side--that is all. If we can ever settle down to the rational way of
regarding these things, we shall discover, what sensible medical men have
always known, and what druggists as well as mere laymen can not afford to
neglect, that there is no such thing as a panacea, and that all rational
therapeutics is based on common sense study of the disease--finding out
what is the cause and endeavoring to abate that cause. The cause may be
such that surgery is indicated, or serum, or regulation of diet, or change
of scene. It may obviously indicate the administration of a drug. I once
heard a clever lawyer in a poisoning case, in an endeavor to discredit a
physician, whom we shall call Dr. Jones, tell the following anecdote: (Dr.
Jones, who had been called in when the victim was about to expire, had
recommended the application of ice). Said the lawyer:
"A workman was tamping a charge of blasting-powder with a crowbar, when
the charge went off prematurely and the bar was driven through the
unfortunate man's body, so that part of it protruded on either side: A
local physician was summoned, and after some study he pronounced as
follows: 'Now, if I let that bar stay there, you'll die. If I pull it out,
you'll die. But I'll give you a pill that may melt it where it is!' In
this emergency," the lawyer went on to say, "Dr. Jones doubtless would
have prescribed _ice_."
Now the pill to melt the crowbar may stand for our former excessive and
absurd regard for drugs. The application of ice in the same emergency may
likewise represent a universal resort to hydrotherapy. Neither of them is
logical. There is place for each, but there are emergencies that can not
be met with either. Still, to abandon one method of treatment simply
because additional methods have proved to be valuable, would be as absurd
as to give up talking upon the invention of writing or to prohibit the
raising of corn on land that will produce wheat.
No: we shall doubtless continue to use drugs and we shall continue to need
the druggist. What can he do to make his business more valued and
respected, more useful to the public and more profitable to himself? For
there can be no doubt that he will finally succeed in attaining all these
desirable results together, or fail in all. Here and there we may find a
man who is making a fortune out of public credulity and ignorance, or, on
the other hand, one who is giving the public more service than it pays for
and ruining himself in the process; but in general and on the average
personal and public interest run pretty well hand in hand. Henry Ford
makes his millions because he is producing something that the people want.
St. Jacob's Oil, once the most widely advertised nostrum on the continent,
cost its promoters a fortune because there was nothing in it that one
might not find in some other oil or grease.
What then, I repeat, must the pharmacist do to succeed, personally and
professionally? I welcome this opportunity to tell you what I think. My
advice comes from the outside--often the most valuable source. I have so
little to do with pharmacy, either as a profession or as a business that I
stand far enough away to get a bird's-eye view. And if you think that any
advice, based on this view, is worthless, it will be a consolation to all
of us to realize that no force on earth can compel you to take it.
It is doubtless too late to lament or try to resist the course of business
that has gone far to turn the pharmacy into a department store. But let me
urge you not to let this tendency run wild. There are side-lines that
belong properly to pharmacy, such as all those pertaining to hygiene or
sanitation; to the toilet, to bodily refreshment. I do not see why one
should not expect to find at his pharmacist's, soap, or tooth-brushes, or
sponges. I do not see why the thirsty man should not go there for mineral
water as well as the dyspeptic for pills. But I fail to see the connection
between pharmacy and magazines, or stationery or candy. By selling these
the druggist puts himself at once into competition with the department
stores. There can be no doubt about who will win out in any such
competition as that. But I believe there is still a place in the community
for any special line of business if its proprietor sticks to his specialty
and makes himself a recognized expert in it. The department store spreads
itself too thin--there is no room for intensive development at any point
of its vast expanse. Its general success is due to this very fact. I am
not now speaking of the rural community where there is room only for one
general store selling everything that the community needs. But my
statement holds good for the city and the large town.