CHAPTER III.. _of the Conduct of Physicians Towards Apothecaries._

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 Nor should the future attendance of the Apothecary be superseded by the Physician; for, if he be a man of honour, judgement, and propriety of behaviour, he will be a most valuable auxiliary through the whole course of the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 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, 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.” 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. 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:

See Adam Smith’s Wealth of Nations, bk. i. ch. 10. pt. 1.