_Of the Conduct of Physicians towards Apothecaries._
§ 1. In the present state of Physic in this country, where the Profession
is properly divided into three distinct branches, a connection peculiarly
intimate subsists between the Physician and the Apothecary; and various
obligations necessarily result from it. On the knowledge, skill, and
fidelity of the Apothecary depend in a very considerable degree the
reputation, the success, and usefulness of the Physician. As these
qualities, therefore, justly claim his attention and encouragement, the
possessor of them merits his respect and patronage.
§ 2. The Apothecary is in almost every instance the precursor of the
Physician; and, being acquainted with the rise and progress of the
disease, with the hereditary constitution, habits, and disposition of
the patient, he may furnish very important information. It is in general
therefore expedient (and, when health or life are at stake, expediency
becomes a moral duty,) to confer with the Apothecary before any decisive
plan of treatment is adopted, to hear his account of the malady, of the
remedies which have been administered, of the effects produced by them,
and of his whole experience concerning the _juvantia_ and _laedentia_
in the case. Nor should the future attendance of the Apothecary be
superseded by the Physician; for, if he be a man of honour, judgement,
and propriety of behaviour, he will be a most valuable auxiliary through
the whole course of the disorder, by his attention to varying symptoms,
by the enforcement of Medical directions, by obviating misapprehensions
in the patient or his family, by strengthening the authority of the
Physician, and by being at all times an easy and friendly medium of
communication. To subserve these important purposes, the Physician
should occasionally make his visits in conjunction with the Apothecary,
and regulate by circumstances the frequency of such interviews; for, if
they be often repeated, little substantial aid can be expected from the
Apothecary, because he will have no intelligence to offer which does not
fall under the observation of the Physician himself, nor any opportunity
of executing his peculiar trust, without becoming burdensome to the
patient by multiplied calls and unseasonable assiduity.
§ 3. This amicable intercourse and co-operation of the Physician and
Apothecary, if conducted with the decorum and attention to etiquette
which should always be steadily observed by professional men, will add
to the authority of the one, to the respectability of the other, and
to the usefulness of both. The patient will find himself the object of
watchful and unremitting care, and will experience that he is connected
with his Physician, not only personally, but by a sedulous representative
and coadjutor. The Apothecary will regard the free communication of the
Physician as a privilege and mean of improvement, he will have a deeper
interest in the success of the curative plans pursued, and his honour
and reputation will be directly involved in the purity and excellence of
the medicines dispensed, and in the skill and care with which they are
compounded.
§ 4. The duty and responsibility of the Physician, however, are so
intimately connected with these points, that no dependence on the probity
of the Apothecary should prevent the occasional inspection of the drugs
which he prescribes. In London the law not only authorizes, but enjoins,
a stated examination of the simple and compound medicines kept in the
shops; and the policy that is just and reasonable in the metropolis, must
be proportionably so in every provincial town throughout the kingdom.
Nor will any respectable Apothecary object to this necessary office, when
performed with delicacy and at seasonable times; since his reputation
and emolument will be increased by it, probably in the exact ratio, thus
ascertained, of professional merit and integrity.
§ 5. A Physician called to visit a patient in the country, should
not only be minute in his directions, but should communicate to the
Apothecary the particular view which he takes of the case; that the
indications of cure may be afterwards pursued with precision and
steadiness, and that the Apothecary may use the discretionary power
committed to him, with as little deviation as possible from the
general plan prescribed. To so valuable a class of men as the country
Apothecaries great attention and respect is due; and, as they are the
guardians of health through large districts, no opportunities should
be neglected of promoting their improvement, or contributing to their
stock of knowledge, either by the loan of books, the direction of their
studies, or by unreserved information on Medical subjects. When such
occasions present themselves, the maxim of our judicious poet[34] is
strictly true,
“The worst avarice is that of sense;”
for practical improvements usually originate in towns, and often remain
unknown or disregarded in situations where gentlemen of the Faculty have
little intercourse, and where sufficient authority is wanting to sanction
innovation.
§ 6. It has been observed by a political and moral writer of great
authority[35], that “Apothecaries’ profit is become a bye-word, denoting
something uncommonly extravagant. This great apparent profit, however,
is frequently no more than the reasonable wages of labour. The skill of
an Apothecary is a much nicer and more delicate matter than that of any
artificer whatever, and the trust which is reposed in him is of much
greater importance. He is the Physician of the poor in all cases, and
of the rich when the distress or danger is not very great. His reward
therefore ought to be suitable to his skill and his trust, and it arises
generally from the price at which he sells his drugs. But the whole drugs
which the best employed Apothecary in a large market town will sell in a
year, may not perhaps cost him above thirty or forty pounds. Though he
should sell them, therefore, for three or four hundred, or at a thousand
per cent. profit, this may frequently be no more than the reasonable
wages of his labour, charged, in the only way in which he can charge
them, upon the price of his drugs.” The statement here given exceeds the
emoluments of the generality of Apothecaries in country districts. And a
Physician, who knows the education, skill, and persevering attention, as
well as the sacrifice of ease, health, and sometimes even of life, which
this profession requires, should regard it as a duty not to withdraw from
those who exercise it any sources of reasonable profit, or the honourable
means of advancement in fortune. Two practices prevail in some places
injurious to the interest of this branch of the Faculty, and which ought
to be discouraged: one consists in suffering prescriptions to be sent to
the druggist, for the sake of a small saving in expense; the other in
receiving an annual stipend (usually degrading in its amount, and in the
services it imposes,) for being consulted on the slighter indispositions
to which all families are incident, and which properly fall within the
province of the Apothecary.
§ 7. Physicians are sometimes requested to visit the patients of the
Apothecary in his absence. Compliance in such cases should always be
refused, when it is likely to interfere with the consultation of the
Medical gentleman ordinarily employed by the sick person or his family.
Indeed this practice is so liable to abuse, and requires in its exercise
so much caution and delicacy, that it would be for the interest and
honour of the Faculty to have it altogether interdicted. Physicians are
the only proper substitutes for Physicians, Surgeons for Surgeons, and
Apothecaries for Apothecaries.
§ 8. When the aid of a Physician is required, the Apothecary to the
family is frequently called upon to recommend one. It will then
behove him to learn fully whether the patient or his friends have any
preference or partiality; and this he ought to consult, if it lead not
to an improper choice; for the maxim of Celsus is strictly applicable
on such an occasion, “Ubi par scientia, melior est amicus medicus quam
extraneus[36].” But if the parties concerned be entirely indifferent,
the Apothecary is bound to decide according to his best judgement, with
a conscientious and exclusive regard to the good of the person for whom
he is commissioned to act. It is not even sufficient that he selects the
person on whom in sickness he reposes his own trust; for in this case
friendship justly gives preponderancy, because it may be supposed to
excite a degree of zeal and attention, which might overbalance superior
science or abilities. Without favour or regard to any personal, family,
or professional connections, he should recommend the Physician whom
he conscientiously believes, all circumstances considered, to be best
qualified to accomplish the recovery of the patient.
§ 9. In the county of Norfolk, and in the city of London, benevolent
institutions have been lately formed, for providing funds to relieve the
widows and children of Apothecaries, and occasionally also members of
the Profession who become indigent[37]. Such schemes merit the sanction
and encouragement of every liberal Physician and Surgeon; and were they
thus extended, their usefulness would be greatly increased, and their
permanency almost with certainty secured. Medical subscribers from every
part of Great Britain should be admitted, if they offer satisfactory
testimonials of their qualifications. One comprehensive establishment
seems to be more eligible than many on a smaller scale; for it would be
conducted with superior dignity, regularity, and efficiency, with fewer
obstacles from interest, prejudice, or rivalship, with considerable
saving in the aggregate of time, trouble, and expence, with more accuracy
in the calculations relative to its funds, and consequently with the
utmost practicable extension of its dividends.
FOOTNOTES:
[34] [Pope’s _Essay on Criticism_, pt. iii.]
[35] See Adam Smith’s _Wealth of Nations_, bk. i. ch. 10. pt. 1.
[36] [“Ideoque [conjicio], cum par scientia sit, utiliorem tamen
medicum esse amicum, quam extraneum.” Cels. _De Medic._ i. præf.]
[37] [Of these Societies (besides several whose benefits are confined
to certain counties and districts,) there are in England the four
following:—1. “Society for Relief of Widows and Orphans of Medical Men
in London and its Vicinity,” instituted in 1788; 2. “Medical Benevolent
Society, for the Relief of its distressed Members,” instituted in 1816;
3. “Benevolent Fund of the Provincial Medical and Surgical Association,”
instituted in 1836, for the relief of distressed Medical Men, and their
widows and orphans; and 4. “General Medical Annuity Fund,” instituted in
1845, for the relief of distressed members, and their widows and orphans.]