THE
Necessity
and
Usefulness
OF THE DISPENSARIES Lately set up by the
College
of
Physicians
in
LONDON,
For the Use of the SICK POOR.
Together with An ANSWER to all the
Objections
rais'd against them by the
Apothecaries,
Or Others.
THE
Necessity
and
Usefulness
OF THE DISPENSARIES.
THE Practice of
Physick
in
London
and seven miles round, being for near two hundred Years setled by Law wholly in the
College of Physicians
in
London,
and such as they approve of upon Examination, and License; 'tis worth the while to enquire by what means they come to enjoy so small a part of it. Chymists and Distillers, Astrologers and Mountebanks, Midwives and Nurses, and the whole Train of Broken-Tradesmen-Doctors have every one their share. There are not a few that are their own Doctors, and practise upon themselves; and there is hardly any one so unkind, as not to recommend to his sick Friend what has done himself good. The College can only blame these last for Indiscretion: And the former are the most of them hardly worth the charge of a Prosecution: yet the College have been ever and anon making an example of one or other of them, to strike terror into the rest.
But when I have reckoned up these and as many more such as these, they have hardly all of them invaded the tenth part of the practice that one single sort of Men have usurpt,
viz.
the Apothecaries. And these not only practise, but pretend to a
Right,
and to a
Necessity
so to do. As to their
Right,
tho' the Honourable Court of Kings Bench have more than once quasht that pretence, and have sufficiently determined the matter against them; yet I shall presume to give a touch at it, afterwards in this Paper. But as to the
Necessity
which they plead, I will consider that here.
They plead a
Necessity
to practise upon the
Rich,
because many times they cannot persuade these to send for a Physician, when yet 'tis necessary that something should be done, and therefore
they must
do it. Now this seems a very odd way of arguing, That if the Patient will not send for a Physician, the Apothecary
must needs
undertake the Cure. For if the Patient be covetous, or fool-hardy, or will not believe himself ill enough to have the advice of a Physician, what's that to the Apothecary? Yes, for if one Apothecary will not give him something, another will; and so the first shall lose a Patient. This I must confess is a kind of necessity,
se defendendo,
for one Apothecary to defend himself from the invasion of another: But this is far from proving a
Necessity
with respect to the Patient, who I dare say had generally much better be without any of them.
Another
Necessity
to practise upon the
Rich,
is, when they are taken suddenly ill, and no Physician can be met with. As to Practising in this case of necessity, so long as such necessity lasts, I dare secure the Apothecaries, or any other person that does his best in such urgent Cases, that they shall never be troubled for it by the College. But this Necessity is far from justifying the Apothecaries continuing to practise even upon such Patients from day to day, when better advice may be had.
These two Cases, I think, are the only ones for which they can plead
Necessity,
with respect to their practising upon the
Rich;
and how far they are from excusing or justifying their practising upon any
such
for Weeks or Months together (as they commonly do) is too obvious to be farther examin'd.
But then how shall I get over the other
Necessity,
the
great Necessity,
with respect to the
Poor,
who, if you will believe the Apothecaries, would all perish for want of looking to, if
they
did not take care of them: for the Physicians (of the College) they say, will only visit the Rich that can Fee them well.
I believe, this accusation of the College-Physicians was
never true:
But that for
several Years
by-past it has been notoriously
false,
is known to the whole Town. For, that the Physicians might clear themselves of this
false charge,
they have been obliged to set their care of the Poor more in the eyes of the World than heretofore; not only giving advice
gratis
to the Poor at their own and the Patients Lodgings, but appointing publick Dispensaries also for the Poor to resort to every day of the week (except Sundays) where they may both have the best advice
gratis,
and also proper Medicins for their respective Cases at the lowest value: whereby the Poor are at once delivered from the danger of the Apothecaries ignorance in practice, and also from the oppressive charge of his Medicins.
And the College have been forced to take this Course, not only to clear themselves of the aspersions cast upon them, but also to make their charity in advising
gratis,
truly serviceable to the Poor: For unless Physicians could teach the Poor to make something themselves, their advice was seldom followed; because the Apothecaries used to make them pay so dear for their Physick, and could by no Overtures or Arguments be induced to abate of their prices, tho' often prest to it by the Physicians, as clearly appears in a Paper some years ago published under the Title of
A short Account of the proceedings of the College of Physicians,
London,
in relation to the sick Poor of the said City,
&c.
And notwithstanding that the Physicians, as appears in the said Paper, were so forward to advise the Poor
gratis,
and the Apothecaries so backward in contributing their part; yet these did not only continue to insinuate to the Town, that the care of the Poor lay wholly upon them; but when about seven years ago they petitioned the High Court of Parliament to be exempted from Offices as the Physicians are, they had the confidence to suggest the same
there
also, and endeavoured to get a Clause in their Bill, that they might have liberty to give Physick to the Poor, who otherwise were like to perish for want of due care to be taken of them.
The Physicians being thus unjustly calumniated before the whole Nation, 'twas high time for them to think of an effectual remedy. Wherefore
Dec.
22. 1696. a Proposal was made in the publick College for a subscription by the several Members thereof, to raise a Fund for the furnishing a Repository of Medicins for the use of the Poor: which Proposal was then approved of, and a subscription immediately made to the effect following.
"Whereas the several Orders of the College of Physicians
London,
for prescribing Medicins
gratis
to the Poor Sick of the Cities of
London
and
Westminster
and parts adjacent, as also the Proposals made by the said College to the Lord Mayor, Court of Aldermen and Common Council of
London,
in pursuance thereof, have hitherto been ineffectual, for that no Method hath been taken to furnish the Poor with Medicins for their Cure at low and reasonable rates: We therefore whose Names are here underwritten, Fellows or Members of the said College, being willing effectually to promote so great a Charity, by the counsel and good liking of the President and College declared in their
Comitia,
hereby (to wit, each of us severally and apart, and not the one for the other of us) do oblige our selves to pay to Dr.
Thomas Burwel,
Fellow and Elect of the said College, the summ of Ten Pounds apiece of Lawful money of
England,
by such proportions, and at such times as to the major part of the Subscribers hereto shall seem most convenient: Which Money when received by the said Dr.
Thomas Burwel,
is to be by him expended in preparing and delivering Medicins to the Poor at their intrinsick value, in such manner, and at such times, and by such Orders and Directions, as by the major part of the Subscribers hereto, shall in writing be hereafter appointed and directed for that purpose. In Witness whereof we have hereunto set our hands and Seals this 22.
December
1696."
This was in a few days subscribed by above
forty,
(and has by several more, since.)
The Subscription being made, a College was called, That a Grant might be forthwith made by way of Lease to the Subscribers, of the College-Laboratory, and other Rooms and conveniencies necessary for executing the intended Charitable design: And a Grant was accordingly made and Sealed in open College. Whereupon the Subscribers presently chose a Committee of twelve to manage this affair, who were so diligent in it, that in about half a year they got it into a serviceable condition and method.
But this design being wholly new, no wonder if at first it was not brought to that degree of Serviceableness it is now improved to. At first those Poor only were supplied with Medicins that repaired for advice to the several Subscribers Lodgings, or those whom they were called to in their respective Neighbourhoods; which in comparison were but few: for the Apothecaries still made a shift to keep most of them in their own hands, so loth were they to part with their objects of Charity, for reasons best known to themselves. Wherefore the Subscribers thought it adviseable for the inlarging of their Charity, to appoint certain days wherein two Physicians (by turns) should attend at the College, to give advice
gratis
to all the Poor that would resort thither; and to give notice of this not only in the publick Prints, but also by Papers which they printed and gave away for the information of the Town. By this means far greater Numbers flocked for advice, and many from the remotest parts of the Town; for whose conveniency it has been thought fit not only to continue the Attendance (with the Dispensary for Medicins) at the College; but also to erect two Dispensaries more, one in S.
Martin
's Lane in the Fields, and the other in
Grace-Church street,
that the sick Poor might not have too far to go for relief; and might at one or other of these Places have advice any day in the Week, and Medicins every day at all of them. Thus two Physicians attend in the afternoons on
Monday
in S.
Martin
's, on
Tuesday
in
Grace-Church-street,
on
Wednesday
at the College; and so on
Thursday
in S.
Martin
's, on
Friday
in
Grace-Church-street,
and on
Saturday
at the College. And the Physicians attendance at these Places, is not intended at all to excuse any Subscriber from giving advice
gratis
at his own House or in his Neighbourhood: But because a Physicians hours are uncertain, being obliged to be abroad whenever called; that the Poor who can ill lose time, may not be disappointed when they seek for advice,
certain
provision is made for them by these fixed
days
and
places.
By this means 'tis hoped the Physicians have sufficiently wiped off the Scandal they lay so long unjustly under, and the Poor have that care taken of them, and kindness shew'd them, that we challenge any City in
Europe
to parallel.
The Committee who are new chosen every Year, meet twice every Week for the looking after the due management of this Undertaking: and they chuse two Curators Monthly, whose peculiar business it is to buy in the best Drugs they can meet with, and to see that the Compositions for the Dispensaries be duly prepared. And that these may be the better inspected, they are all ordered to be made at the College, and to be conveyed from thence to the other two Dispensaries as they are wanted.
And as the Medicins at all the Dispensaries are the best that can be made: So they are sold out for no greater gains than will just bear the Charge,
viz.
of House-Rent and Servants wages. So that the Price is ordinarily 8
d.
or 9
d.
in the Shilling less than the Apothecaries use to exact.
And now that the Poor are so very well taken care of by the Subscribers to the Dispensaries, one would think the Apothecaries should be very thankful that so much trouble is taken off their hands: But instead of that, (to shew that their
gains
by Practising upon the Poor, is more in their eye, than
their relief
) they rail every where against the Subscribers as men that would undo them, and have entred into a Combination to hinder them of all the business they possibly can: while they caress and bring into business such Physicians as have refused to be concerned in the Subscription. They make it their business also in all Companies, to raise Objections against the Dispensaries, as well as to misrepresent the designs of those that have set them up. As I have therefore plainly shewn the Subscribers design to be the most Laudable that can be; and that they were necessitated to erect them, as well for the relief of the Poor, as in their own vindication: So to prevent all groundless prejudices, I will give a full Answer to all such Objections as the Apothecaries have raised against them.
These
Objections
may, I think, be reduced to six.
I. They say,
That Physicians ought not to give Physick, but only prescribe it.
II.
That they have no right to erect publick Dispensaries.
III.
That if the Dispensaries be suffered, the Apothecaries will all be undone.
IV.
That Physicians Fees are as unreasonable and oppressive, as the Apothecaries prices.
V.
That the Rich are supplyed with Medicins from the Dispensaries as well as the Poor.
VI.
That the Dispensaries sell Medicins as dear as the Apothecaries.
Obj. 1.
That Physicians ought not to give Physick, but only prescribe it.
Answ.
It might suffice in answer to this to say, that it is as little the Apothecaries province to
advise
the sick, as they can suppose it to be the Physicians to
give
them
Physick:
and yet where is the Apothecary that does not do this every day? How unfit then are the Apothecaries to impute that as a Crime to Physicians, which they are so notoriously guilty of themselves,
viz.
of intruding into other Mens business? I say, this might suffice as an Answer to
them:
but I shall consider the accusation
it self,
and demonstrate, that Physicians when they give Physick, are in their own lawful proper business; and that Apothecaries are not so, when they prescribe it.
When a Physician has arrived at the skill to know Diseases and their Symptoms, and to take Indications for their Cure as to the
quid agendum;
he must then proceed to find out the
quo, i. e.
Operations, or Medicins, to satisfie those Indications: And when he has found these out, can any Man think it reasonable, that he should be obliged to communicate all his skill in every particular Cure, to what person soever the Patient is pleased to call in for an Apothecary, so as to make him presently Master of all those Secrets that by long study and observation he has arrived at the knowledg of? Whosoever is the Author but of one Invention useful to the Publick, has a right by Law to the sole benefit of it for many years: And shall Physicians that are continually inventing new and more effectual Remedies for the Diseases of Mankind, be bound to divulge and prostitute all their Inventions to Men, that if
they
can help it, will never let the Inventors have twice the benefit of the same Prescription, but presently usurp the use of it themselves, and leave the Physicians at leisure to invent more? I know the Apothecary that is ignorant of the Reasons and Natures of things, by
unfitly applying
good Remedies shall never perform the same Cures that the learned Physician can: but while the Apothecaries pretend to do it, and give those remedies to Patients, tho' these receive no benefit, the Physician is no less injur'd. I say then, 'tis against all the reason and justice in the World, to hinder the Physician himself from administring to the sick such remedies as he has invented. 'Tis as absurd, as to hinder a Workman from using his own Tools which he has invented, and which he alone knows the right use of. And the Parliament of 32
H.
8. for this, and other weighty reasons, did wisely enact,
"That any Physician being admitted by the President and Fellowship of Physicians in
London,
may any where within this Realm practise and exercise the Science of Physick in all and every its members and parts."
Which Clause is plainly applied to making and giving Medicins, in the Charter granted to the Apothecaries by K.
James
I. For after the Charter had granted them divers Immunities, Powers and Privileges, particularly the sole making and vending of internal remedies,
&c.
at length there is this Clause added:
Et deni
que
volumus — quod Fraesideus & Communitas Medicor. (Civit. Lond.) omnes
que
& singuli Medici de eodem Collegio sive Communitate, & successores sui, sicut & Medici Regis, Reginae & Principum imposterum debeant, & pro arbitrio suo possint artem medicam in omnibus suis partibus exercere,
&c.
i. e.
"And lastly we will — That the President and Commonalty of Physicians (in the City of
London
) and all and every the Physicians of the same College or Commonalty, and their Successors, as also the Physicians of the King, Queen and Princes, hereafter ought, and at their pleasure may exercise the Art of Physick in all its parts."
And to drive the matter yet further out of all dispute, it is immediately added,
& insuper gaudebunt, utentur & fruentur, & gaudere, uti & frui valeant & possint eisdem & consimil. jurisdictionibus, authoritat. supervis. & correctionibus, ac omnibus aliis
potestatibus, privileg.
& libertat. qualibus unquam antehac Pharmacopolae usi & gavisi fuerunt,
&c.
i. e.
"And shall moreover enjoy and use, and have a right to enjoy and use the same and like Jurisdictions, Authorities, Supervisings and Corrections, and all other POWERS, PRIVILEDGES and Liberties which the Apothecaries have ever hitherto used and enjoyed,
&c.
"
What words can be more comprehensive and full to continue in the Physicians of the College an equal
power
and
priviledge
with Apothecaries themselves, to make and vend Medicins?
But where is the clause in any Statute or Charter (even their own) that gives or reserves a power to the Apothecaries to practise Physick, and to dispense out all the Medicins in their Shops to Patients without the prescription or advice of any Physician? If they can shew none, then I affirm, that they do this against plain positive Law, while Physicians have Law as plain and positive to empower them to prepare and give Physick.
Obj. 2.
That Physicians have no right to erect publick Dispensaries.
Answ.
To this I answer, that it seems strange, if each particular Physician have power by Law to prepare and give his own Physick, (as has been shewn) that two or three, or any number of these Physicians, may not for their own convenience prepare their Medicins together, and have one common place from whence to dispense them; especially when all the benefit of such conveniency accrues to the Patient, who by that means has his Medicins considerably cheaper than they could be afforded, if every Physician were at the charge to keep Servants and a Dispensary of his own. But suppose there were any weight in this Objection, of what advantage would it be to the Apothecaries to have the Physicians debarr'd from this convenience? There would perhaps in such Case be as many Dispensaries as there are now Subscribers to the three in being: And whereas each Subscriber sends in comparison but few of his Patients at present to the Dispensaries; if he had one at his own House, he would probably supply all his Patients with his own Medicins. The Objectors therefore had much better, in my opinion, quietly endure three common Dispensaries set up for the use of the Poor, than by endeavouring to pull these down, to give occasion to set up forty or fifty private ones, for the use of the Rich as well as the Poor.
Obj. 3.
That if the Dispensaries are suffered, the Apothecaries will all be undone.
Ans.
It must be confest, that part of their business, especially that relating to the Poor, must indeed be abated; and that business which they retain, will hardly be so profitable to them as formerly, when the Rich understand how unreasonable their gains have been. But if the Apothecaries please, they may in good part make up these Losses by contenting themselves to live in Houses of less Rent, to bear only the port of Labouring or handy-crafts-men (as indeed they are) but especially by keeping fewer Servants, and putting their own hands to their own work, and by making such Bylaws to their Company in relation to taking Apprentices, as may lessen the number of Apothecaries, who are now grown so over numerous. And if notwithstanding, they cannot get so much by their Trade as they
have
done, every unprejudic'd Man will conclude it more reasonable and just, that a few Men should be lessen'd in their gains and grandeur, than that a thousand times their number should be oppress'd for the support of them. And all must confess, that the ambition of these Men is very Extravagant, that desire with an hundred pound Stock (many not with half so much) to vie with the best Shop-keepers or Merchants in their Neighbourhood, that employ fifty times as much in their business.
Obj. 4.
That Physicians Fees are as unreasonable and oppressive as the Apothecaries prices.
Answ.
'Tis denied, that Physicians Fees are either unreasonable or oppressive: For how should they be so, when the Patient is at liberty to give what he pleases? Every one is the best judge of his own condition and ability: And accordingly some give a Guinea, some ten Shillings, some a Crown and some nothing: And whatever other Physicians do, the Subscribers to the Dispensaries profess themselves as ready to serve the two last as the two first. And take these one with another, how far short will Physicians Fees come of those of Lawyers, which yet are not disputed? And the disproportion will still appear the greater, when it is considered, that for one Client the Lawyers have
in forma pauperis,
the Subscribers to the Dispensaries have fifty or an hundred
gratis
Patients, there being several hundreds of them every Week. So that take one Patient with another, Rich and Poor, and I dare confidently aver, that no Physician that duly attends at the Dispensaries, has a Crown a Bill for all the Bills he writes through the Year; nay I can be positive, that some have not half a Crown. And what ground then can there be for this great cry against Physicians Fees?
But supposing they were indeed unreasonable, this Objection would only argue, that Physicians were not fit persons to accuse the Apothecaries of excessive gains; but it does no way excuse or justifie
them.
And I will make it appear, that there is no proportion between
their
gains and Physicians
Fees.
In Chronical Cases, when the Patient can come to the Physician, he ordinarily gives him but half a Fee; for which he expects to be put into a course of Physick that shall cure him, which generally lasts several Weeks. In this time the Physick commonly comes to several pounds; of which, three parts in four at least shall be gains, (as I will undertake to prove, if it be denied.) And if the same Patient chance to relapse into the same Disease, he shall repeat the course
toties quoties
without ever consulting his Physician again. So that by such a Patient the Apothecary shall get (at time and time) perhaps twenty times as much as the Physician.
Yea tho' the Patients Case be acute and require the daily attendance of the Physician, the Apothecary's gains shall far exceed
his
Fees, especially if the Physician be one of the Apothecaries Friends, and have the knack of
writing well,
as their cant is. I could give Instances enow of this: But I appeal to the experience of most that have been sick of Fevers (for instance) wherein they have had an Apothecary, with a Physician of
his
recommending: Let them cast up the Physician's Fees, and compute three parts in four (at least) of the Apothecaries Bill to be gains, and they shall generally find the latter greatly to outbalance the former. Only I must here except two or three Physicians (not concerned in the Dispensaries) who have got a way (under the specious pretence of being
careful
Men) to visit their Patients twice or thrice a day, when once would serve, only to Multiply their Fees. I am not writing an Apology for such; but am content they should fall under the same censure with the Apothecaries, of being unreasonable and oppressive.
Obj. 5.
That the Rich are supplyed with Medicins from the Dispensaries, as well as the Poor.
Answ.
The prime reason of setting up the Dispensaries was (as has been shewed) the supplying the
Poor
with Medicins at a low rate: And that the Subscribers do still put them to this use, hundreds of
poor
People can Weekly testifie. And if there are any
Rich
supplyed with Medicins from thence, the Apothecaries may thank themselves for it. For this I will affirm, that whatsoever Physicians (Subscribers to the Dispensaries) send their Rich Patients thither for Physick, it is for one or more of these following Reasons. Either
first,
because of the general Combination of the Apothecaries to keep out or turn out the Subscribers from all Patients where they have an interest to do it, in order to bring in those Physicians that will not be concerned in the subscription. And so the Subscribers find this the only way to retain some of those they have left. Or
secondly,
because the Apothecaries by sending in ill prepared Medicins disappoint them in their Practice, on purpose to make the Patients question their Physician's skill, and to send for some other of
their
recommendation. (Which I have often known to be done.) Or
Thirdly,
when the Patients themselves complain not only of the dearness but of the badness of their Apothecaries Medicins, and desire they may be supplyed from the Dispensaries, where they are not only cheap, but good. Or
fourthly,
when the Apothecary has for many days together (even in dangerous and acute Diseases) kept the Patient in his own hands, till almost all opportunity of benefiting him is lost: For in such Cases the Subscribers think it just, that the Apothecaries should receive some check, to deter them from such unfair and dangerous Practices. Or
Lastly,
when the Physician prescribes some secret Medicin that is kept at the Dispensaries, which he thinks not fit to make known to the Apothecaries, lest they should presently (as is usual with them) fall a practising therewith themselves to his disadvantage. And to these I may add a
Sixth
reason, which is only accidental,
viz.
When Persons of Condition come to the Dispensaries for
gratis
advice on the usual days,
in forma pauperum,
and the Physicians attending are ignorant of their quality, and so are imposed upon.
These Reasons I alledge in answer to this
fifth
Objection, not that the Subscribers need give a reason for what they do in this particular (for they have an undoubted right to give Physick to whom they please, as I have proved before in the answer to
Obj.
1.) but that all the World may see, how
every way
justifiable the Subscribers are, as to any complaint the Apothecaries make against them. And after all the noise of sending the Rich to the Dispensaries for Medicins, I dare say, take all the Subscribers together, and they do not send one Bill in thirty (that they write for the Rich) thither: And if some send more than others, it is upon account of greater injuries and affronts they have met with from the Apothecaries, for appearing more forward than their Brethren in this charitable Undertaking.
Obj. 6. The last
Objection
is,
That the Dispensaries sell Medicins as dear as the Apothecaries.
Answ.
'Tis confest, that some Apothecaries, especially the Wholesale ones, do sell some Medicins as cheap as the Dispensaries can afford them. But pray what Medicins are they? They are either simple Medicins and Drugs, the nature and value whereof most people know; or such single compound Medicins as are kept ready prepared in Shops, to be sold out when call'd for, by their proper and peculiar names, the value whereof is as commonly known as that of Drugs and Simples. As for instance, Venice Treacle, Mithridate,
Diascordium,
&c. tho' very compounded Medicins, are sold as cheap (I will not say so good) by the Wholesale Apothecaries as at the Dispensaries; and the reason is, the Buyer understands what he buys, and the current price of it, and so cannot be imposed upon by the Apothecary. And the gains the Apothecary has by these Medicins thus sold, was never called unreasonable and excessive by the Subscribers to the Dispensaries. But the gain complain'd of as unreasonable and oppressive, is, when Medicins either simple or compound are mixt together, or disguised, and have a new name put upon them, denoting only their form, or their use and virtue, and the Patient is ignorant what they consist of. As for instance, a Cordial
bolus
shall be priced at 1
s.
6
d.
(by some at 2
s.
6
d.
) when the Ingredients of it are not worth 2
d.
A dose of purging Pills at the same price with the Cordial
bolus,
when they are only half a dram of
extract. Rudii, Pil. Ruffi,
or
Cochiae,
worth 2
d.
A Cordial draught shall be 1
s.
6
d.
when the Waters and Syrup of which it consists, are dear of 3
d.
A Vomit is 1
s.
6
d.
(or 2
s.
6
d.
) when it is not intrinsecally worth above 1
d.
or 2
d.
A Stomachick Apozem of a quart is never rated at less than 2
s.
6
d.
when the Ingredients that are boil'd in the water are bought for 3
d.
or less, as in the bitter Decoction. And many Apothecaries are so void of all Conscience, as to make eight Shillings of such an Apozem, by dividing the quart into eight parts, and sending it in to the Patient for so many draughts (with some cramp name annexed) at 1
s. per
draught. The like extravagant way of increasing the price do they very often take, by dividing an Electuary worth (it may be) 1
s.
into twelve parts or more, and sending in the parts so divided to the Patient under the name of
bolus
's at 1
s.
a piece at least. And so if a Physician prescribe a powder of an ounce, to be taken by half a dram at a time: Though the whole ounce be dear of a Shilling, as consisting only of testaceous Powders,
Sal prunellae,
Sugar of Roses,
&c.
yet the Apothecary by officiously dividing the ounce into sixteen Papers, shall make 8
s.
of it,
viz.
6
d.
a Paper. Now whosoever will take the pains to enquire, at what rate the very same
bolus
's, Pills, Vomits, Cordial draughts, Apozems, Powders,
&c.
are priced at the Dispensaries, he will see that they are generally at least 9
d.
in the Shilling cheaper than what the Apothecaries fell them for. Who then does not see a notorious fallacy in the Objection, when they affirm, that
they
sell Medicins as cheap as the Dispensaries, when it holds not true in a fiftieth part? And only in those, wherein the People cannot be imposed upon?
And besides, there is another circumstance that makes it yet exceedingly dearer to have Physick from the Apothecaries, than from the Dispensaries; and that is, that if either the Apothecary be Doctor himself and send in Medicins to the sick of his own head; or if he be able to bring in a Favourite Physician that is an Enemy to the Dispensaries, they shall either of them pour in upon the Patient three times as much Physick as the Subscribers to the Dispensaries usually prescribe in like Cases, the greatest part whereof, I dare be bold to say, is nothing to the purpose of the Cure, but serves only for Pomp and to raise the Apothecaries Bill, or perhaps does the Patient a great deal of harm.
So that take all considerations together, and who sees not, that the Dispensaries are the greatest relief to the Poor that can be imagined, when, for it may be, five Shillings they shall have as much help in their respective Cases, as the Rich who are supplied with Medicins from the Apothecaries, can have for five pounds? and at the same time have the ease of taking only a few necessary Medicins, when the others are cramm'd and drench'd all day and night long with one slap or other?
And now that I have given a full Answer to all the
Apothecaries
Objections against the
Dispensaries,
I should have put an end to this Paper, were there not two
Objections
more, commonly to be met with in the Town, which it may be necessary to say something to,
viz.
One on the Apothecaries behalf, against Physicians having the whole advising part of Physick; and the other against one particular in the present Management of the Dispensaries.
1. On the Apothecaries behalf people argue,
That an Apothecary who has for many Years made up Physicians Prescriptions for Patients, and has observed their Operations and effects, ought to have a right to administer such Medicins as have had good effects, to other Patients in like Cases, when he is desired, without consulting any Physician.
Ans.
In answer to this, we will first suppose, that the Apothecary is of a capacity to make observations, and to know when a like Case occurs; And yet in such case I affirm, that he ought not of his own head to administer the most successful remedy to any other Patient than him for whom such remedy, was first prescribed, unless in case of urgent necessity, and when the Physician that prescribed it cannot be had. For a Physician has a
double property
in his Prescriptions:
First,
in that when a Physician prescribes for a Patient, he prescribes only
pro hoc & nunc,
for this Man and at this time; and for doing that alone he receives his Fee. He does not sell his Prescription by way of alienation, so that it should be to his Patient and to his Heirs or Assigns for ever; much less does he pass any title over to the Apothecary, who is only employed by the Patient to make it up, and who ought to return the Bill when he is paid for it, either to the Patient, or to the Physician that writ it: and if he either detain it, or transcribe it, in order to make use of it to other Patients, without the first Prescribers lieve or direction, he is manifestly guilty of fraudulently usurping anothers Property.
Secondly,
a Physician has another
property
in his Prescriptions, in that no Man yb Law has a right to prescribe but himself: And as I take it, there is as real a property in
Practice,
as in
Estate.
No Man ought to meddle in that
profession,
that he is not brought up to, or has not a Legal admission into. Not to mention the
Ministry;
this is plain in the
Law,
wherein no Sollicitor or Attorney, how long soever they have practised, and how well soever versed in their business, can take upon them the practice of a Lawyer either in the Chamber or in Court. Preparing of Medicins is but one, and that the meanest and most mechanick part of Physick: this part is committed to the Apothecaries by such Physicians as will not undergo the more servile and toilsome part of their Profession, or through multitude of business are not at leisure for it; but still it remains inseparable from it, and whatsoever Physician will, may exercise it. But the Apothecary, whose sole Trade is to prepare Medicins according to the Dispensatories, or Recipe's put into his hands by Physicians, has no more a right to invade the advising and prescribing part, than the Sollicitor or Attorney the practice of Councel learned in the Law.
But letting pass this argument from
property,
I will in further Answer to the
Objection
demonstrate,
that Apothecaries are not capable of making observations, nor of judging of like Cases,
and therefore ought not to have the
Right
contended for.
Every one knows an Apothecary's Education to be, to come to the Trade from a Grammar School, where he has learned to construe or to make a little Latin; 'Tis very rare that any designed for that employment, have any smattering in the Greek. Thus qualified he comes Prentice, and is presently set to the Pestil and Mortar, to run of errands, &c. And after a Year or two when he has learned to know one thing in the Shop from another, and to read a Physicians Bill, he begins to be employed in making up Medicins and carrying them out to Patients, and continues so to do till his time runs out. All this while he has neither time to read, nor can have capacity to understand such Books as teach the Art of Physick: Nor can he know any thing (to any purpose) of the Diseases for which the Medicins he carries out are administred. For any Patient would reckon it Sanciness in Boys to be inquisitive about their Cases, in the enquiry whereinto a Man must be very nice and particular, or he shall be never the wiser. And during this time of his Apprenticeship he generally loses the little Latin that he had when he came from School, saving what the Physicians Bills preserve.
Well, now he is out of his time, what must he do but set up? excellently qualified for the Practice of Physick no doubt! Yes, there were such and such famous Doctors writ to his Master's Shop, and he saw all their Bills, and made many of them up and carried them out to Patients, of whom he saw some live, and some die; and so he must needs know something of the matter! Well, to judge of that, let us consider what the matter is, viz.
The Art of Physick.
This Noble
Art
consists of five parts, of which the preparing of Medicins is but the
least
part of
one.
There is I. the
Physiologick,
which treats of the Subject and the end of Physick, and so includes the Anatomy of an humane Body, and explains its constitution and that of all its parts, with their uses and actions, and the faculties of the Animal Soul.
II. The
Pathologick,
which treats of the nature, differences and causes of Diseases and their Symptoms, and explains every Particular wherein an humane Body departs from its natural constitution.
III. The
Semiotick,
which teaches the signs whereby it may be known whether a Man is well or ill, and how diseases latent in the body, with their causes, and events, may be discovered: Which signs are commonly called Diagnosticks and Prognosticks.
IV. The 4
th
part contains the knowledge of those things which are as it were the matter of health, and are usually called Non-naturals; as Air, Meat and Drink, Affections of the mind, exercise and rest, Venery, Sleep and Watching, with Excrements and Retents: And it contains also the knowledge of the right use of these Non-natural things, so as that health may be preserv'd thereby.
And V. the fifth part, called the
Therapeutick,
shews how loft health may be restored, and diseases with their causes and Symptoms removed. And to this end 'tis necessary to be instructed, first in
Method,
whereby according to indications one may find out due
helps;
and then in the
matter
of such helps, whether contained under Diet, Surgery, or Pharmacy.
Now this very last thing (viz.
Pharmacy
) is all that an Apothecary by his education can pretend to the knowledge of: And it is but the least part of this neither that he can have such pretence to. For the
Pharmaceutick
part contains not only the preparing of Medicins, but the knowledge of the Natures and Virtues of all those things that are the matter of Medicins, whether Vegetables, Animals, or Minerals, and this knowledge he is a stranger to.
With what patience then can a Man animadvert upon the assuming confidence of these Men, who will set up for Practisers in such a difficult and mysterious Art, that understand not any one part of it? A man is like to make
special Observations
that neither knows the Subject affected, nor the nature nor cause of the Disease, nor the nature of the Medicins that cure it. And he must needs be a Witch at judging of
like
Cases, that for the mentioned defects could never be a competent judge of any one Case.
The Case in short is this: An Apothecary when he learns his Trade, is taught to know one Drug from another, can tell which will melt, and which will powder, nay may observe which will purge, which vomit,
&c.
He learns also to make them up into different forms according to the prescripts of Physicians; and I will grant he has opportunity to observe, that some are given most commonly in Fevers, others in Consumptions, others in Dropsies,
&c.
But will any Man conclude, that because an Apothecary knows and may have observed these things, that therefore he can judge with due accurateness either of these Diseases, or the Methods or Reasons of their Cure? There is no general Remedy nor Method for any one Disease: different Medicins and different Methods must be made use of in different Subjects, tho' the Disease in the main be the same. And hereof no Man can be a fit Judge, but one who is well versed in all the parts of Physick. And therefore if there were no Law to restrain Apothecaries from practising, their undeniabl
gnorance ought to keep all who value their Health or Lives, from depending on their advice.
2. The other
Objection
that the People make, is against one particular thing in the present management of the Dispensaries, and is to this purpose:
If,
say they,
the Dispensaries sell Medicins so cheap and so good, why may not any body have such Medicins there as they have occasion for, without the trouble of going to one of the Subscribers for a Note?
I answer, 1. that People are not competent Judges of what they ail, or what will help them; and so the Physicians are willing to prevent their doing themselves a mischief by taking improper things.
2. Unless the Subscribers be still more provok't by the Apothecaries in juries, they are very unwilling to make that of common use, which was purely designed for the relief of the Poor only. For they have no intention to injure the Apothecaries in their proper Calling, if they will keep themselves to that, will make good Medicins, and be content with moderate gains.
But 3. the Principal reason is, that Medicins are given out from the Dispensaries by Servants, who are (generally) directed what to take for every Medicin, by him that prescribes it. And it might be very prejudical as well to Patients, as to the Subscribers themselves, if the Servants might sell out what they pleas'd without order, and might take of the Patient what they pleas'd for it. For they would be under a great temptation to sell things and either never bring them to account at all; or to take more of the Patient then the stated price, and to put the Overplus into their own Pockets. And therefore how inconvenient soever it may seem to such as would be their own Doctors, not to have from the Dispensaries what they think would do them good, the Subscribers can by no means, for these reasons, recede from their establish'd method in this Particular.
LONDON,
Printed in the Year 1702.