The Way to Health by Eugene Yates Johnson, M. D.

Review and Herald Publishing Association · Tacoma Park Station, Washington, D. C. · Sep 1, 1910

The Way to Health

By Eugene Yates Johnson, M. D.

The Drug Clerk a Poor Doctor

An intelligent mother recently brought her five-year-old boy to my office, saying that she wanted me to do something for his malaria. The druggist had given her some quinin tablets, but they didn’t seem to be doing any good.

“How do you know that the boy has malaria?” I asked.

“Why, his bones ache, and he just feels bad all over.”

“But every ache isn’t malaria. How did it start?”

“He has been playing in the wet grass, caught cold, and it developed into malaria.”

“The only known thing that develops into malaria is the bite of an infected mosquito,” I answered. Then I began to examine the boy.

I found that all the joints of his hands and his feet were stiff and sore. Then I looked at his tonsils, and the diagnosis was plain.

“Your boy has acute rheumatism of the membranes that cover the joints,” I remarked. “Now let me examine his heart.”

The stethoscope revealed what I anticipated—an inflammation of the delicate membranes that line the heart and its valves.

“But how can rheumatism in the joints affect the heart?” the mother asked.

“Have you ever noticed the rounded end of a soup-bone, how glossy and satiny it looks?”

“Yes.”

“Well, that is what we call ‘the synovial membrane,’ and it covers the end of every bone that enters into the formation of a joint. When it becomes inflamed, the surfaces no longer glide over each other smoothly, and the friction results in heat and pain—in other words, rheumatism.”

“But there are no bones in the heart, surely?”

“No, but the inside and the outside linings of the heart and valves are made of the same shiny membrane. The infection probably began in his tonsils, and is gradually spreading to every part of the body that is supplied with that particular membrane.”

“Is the heart trouble serious?”

“Very serious. When the valves become inflamed and swollen, they do not close properly, and the heart leaks at every pulsation. You might have continued giving him quinin until he became deaf, and it would not have given him the slightest relief. The most important thing now is to check that inflammation of the heart. It kills a great many people, and those who pull through are generally left with damaged hearts.”

It had never occurred to this woman nor to the drug clerk that the boy might have rheumatism, and he might have died of heart failure if it had been neglected a few days longer. The drug clerk had no business to prescribe at all; it is his business to know the chemistry of drugs, not the symptoms of disease. Even if he had by chance recognized the rheumatism, he would doubtless have given him one of the rheumatic “cures” containing opium and salicylic acid. This would probably have affected his stomach, and thrown extra work on a heart that was already crippled. In the story of this boy you have one of the real reasons why the drug clerk is a poor substitute for the family physician.

The druggist who hands out a medicine that somebody a thousand miles away has put up for rheumatism overlooks the fact that there are several kinds of rheumatism, located in different kinds of tissue, and that what might be helpful in one variety is not the thing for another.

If the clerk had jumped at the conclusion that the pain was due to neuralgia

the boy would probably have been dosed with one of the coal-tar preparations, without any effort being made to find out whether he had a heart-murmur.

I remember a big, husky merchant, the picture of health, who came to me to be examined for life insurance. When I examined his heart, I was surprised at what I heard, and then he told me the story. He used to be a frequent sufferer from neuralgia, and a druggist had given him a certain coal-tar remedy. One night he took five doses, became blue in the face, and it took the doctors three or four days to get him out of danger. The experience left him with a dilated heart, and he has never been able to get a cent’s worth of life insurance, because he is liable to drop off at any moment.

One of the commonest habits of people is to run to the drug-store for cough remedies. They tell the clerk that their throats are sore from coughing, or that the baby keeps them awake all night, and that they want relief. The clerk, without knowing anything about the condition of throat, temperature, or bowels, hands out a “remedy.” Most of these cough remedies contain some preparation of morphin, chloroform, or belladonna—drugs which blunt sensibility and thereby mechanically interrupt the cough. The important fact that every cough is an indication of an irritation in the air-passages, and is nature’s effort to get rid of the cause, is ignored. The druggist furnishes a mixture that paralyzes the coughing muscles, and the patient drives complacently past the red flag of warning.

I was once called hurriedly to see a baby seven months old, one that had always been a strong, healthy infant. The mother said that it had been feeling bad for several days, and coughing a good deal. She had been giving it a certain cough mixture. I found the little fellow with blue lips and fingers, breathing three times as rapidly as usual, and it required but a moment to recognize a double-pneumonia of the worst type. I hastily ordered oxygen, and sat up all night with him; but the appeal from the drug clerk’s judgment had come too late.

People are altogether too quick to try any remedy that a friend may suggest—and intelligent people are about as bad as others. Just the other day a prominent man came to me, and said that he had sharp pains in his back; he thought that he had wrenched himself, but I told him that a jagged kidney-stone was traveling down a very sensitive tube, and causing all his suffering. I gave him some simple directions, and he left the office. On his way down the street he met a friend and told him his trouble; the friend then told him about a wonderful “German tea”—and the advice of the friend who knew nothing about the ailment overruled the judgment of the doctor. Now if I had been a lawyer and had given this man legal advice about the title to his home, and that same friend had met him on the street with different advice, my client would not

have done more than listen to him respectfully.

The alimentary canal has always been a great thoroughfare leading from the stomach to the drug-store. The clerk is supposed to be a person competent to minister to any form of diarrhea, regardless of its cause, and the bottles on his shelves have been filled perhaps by a manufacturer in a distant city. Here again the symptom is treated as if it were a disease, whereas diarrhea is simply nature’s effort to get rid of an irritation somewhere in the intestines. The obvious thing to do is to flush out the canal, get rid of the irritating substance, and then check the superabundance of secretion. The cordials which the drug-clerk supplies, however, usually contain opium, tannic acid, camphor, and capsicum—and the effect of these is to lock up the bowels with the irritating material still inside. Since typhoid fever often attracts attention to itself first by a diarrhea, it will be apparent to every one that there is real danger in carelessly locking up a bowel that contains an infection that is rapidly multiplying.

The pill-eating habit—for the opposite condition—is another sin that is laid at the door of the stomach, when it is really a sin of the intelligence. The bowel is a creature of habit, and it is just as easy for it to acquire the pill-habit as it is for a man to become addicted to smoking or to taking morphin. Many of these preparations are drastic cathartics, and an alimentary tract which gets in the habit of requiring their use, sooner or later loses much of the elasticity of its walls. By and by the patient hunts up his doctor, and expects him quickly to restore the function of an organ that is like a piece of rubber that has been on the stretch too long. Our problem then is the same as would be that of a tailor who is asked to restore the elasticity to a pair of old suspenders.

When I speak of remedies that are sold broadcast, I know what I am talking about; for I was for many years a druggist myself. Moreover, I have been guilty of making some of them myself; for anybody can put up a preparation, and call it anything that he likes. For instance, since I have been a physician, I once wrote a prescription for calomel combined with certain other drugs which were intended to meet a specific need of the patient’s condition. Some time afterward a druggist called me up, and asked if I wanted everybody to have my calomel prescription, and explained that several people had come to him and asked for “the calomel that Dr. Johnson prescribes.” Later still, I happened into a drug-store, and discovered a case containing five thousand of “Dr. Johnson’s Calomel Tablets.” During the period when I was a druggist, I was often called upon to make patent medicines for other people—and if those who have the habit of buying these remedies knew as much as I do about what they cost, there would be less confidence in their supposed virtues. For example, a customer once gave me a sample of a suppository,

and asked me to find out what was in it, and to see if I could duplicate it. It took me two years to solve the problem completely, which was that of making it out of a substance which would not melt in any climate, but which would dissolve at the temperature of the body. This preparation sold for $1, and the cost, as I remember it, was about seven eighths of a cent.

Some people justify their too-frequent use of ready-to-take remedies on the ground that physicians themselves often prescribe them. They think that any preparation with a pharmacist’s name on the label is a “patent” medicine—but that which the physician sometimes orders is a “proprietary” medicine. The difference is very great. A patent medicine is a secret nostrum whose exact composition may be known only to the manufacturer, and whose label is protected by copyright. A proprietary medicine, on the other hand, is a preparation compounded by a manufacturing pharmacist, in conformity with the United States Pharmacopeia, and whose exact formula is supplied to the physician.—Eugene Yates Johnson, M. D., in World’s Work for July.