THE

LAW MAGAZINE AND REVIEW.

No. CCCLXVII.-FEBRUARY, 1913.

I. THE LEGISLATIVE CONTROL OF THE SALE OF POTENT DRUGS.

TH

'HE appointment of a Parliamentary Committee to inquire into the whole subject of the sale and advertising of "patent medicines," as well as the number of fatalities which have occurred of recent years through the injudicious or deliberate use of certain powerful drugs, particularly soporifics, whereby at the inquest either the coroner, jury or a doctor, had occasion to deplore the facility with which such preparations could be obtained, render it a matter of some interest at the present moment to compare the legislative safeguards provided in Great Britain with those of other countries for preventing indiscriminate self-drugging. In this respect the conditions prevailing in the United Kingdom differ materially from those in existence in Continental countries, the fundamental difference lying in the fact that, whereas the British Poisons and Pharmacy Act merely prescribes the observance of certain formalities on the part of a pharmacist selling a scheduled poison, and does not otherwise restrict their sale in any way, on the Continent, on the contrary, the sale of quite a large number of remedial agents, many of which may be sold in Great Britain by any shopkeeper, are only delivered by the chemist on the production of a qualified

medical man's prescription. Thus, acetanilide and phenacetin, two favourite components of "headache powders," may be sold in Great Britain by any tradesman, whereas in a number of Continental countries the pharmacist is permitted to supply either preparation only on the production of a prescription.

The British Poisons and Pharmacy Act, 1908, makes no distinction between the sale for technical and for medicinal purposes of the poisons enumerated in its two schedules, and the monopoly formerly enjoyed by the qualified pharmacist of being the sole legal purveyor of scheduled poisons to the public, a duty for which he is eminently qualified by his training, has been seriously undermined by the provision contained in the new Act, empowering local authorities to license persons other than pharmacists to sell poisonous substances used exclusively in agriculture or horticulture as insecticides, &c.

The formalities to be observed when selling a poison in Great Britain may be summarised as follows:-In the case of a substance contained in Part I, which includes arsenic, the poisonous alkaloids, corrosive sublimate, cyanide of potassium, &c., the purchaser must be known to the seller or must be introduced by some person known to the latter. An entry of the sale has to be made by the pharmacist in his poison book, giving the date of the sale, name and address of the purchaser, name and quantity of the poison. sold, and purpose for which it is required. The purchaser has then to sign the poison book. The poison itself must be labelled with the name of the article, the word "poison," the name and address of the seller.

In the case of a poison contained in Part II, the procedure is considerably more simple, and it might be said that the only restriction attached to the sale of these substances consists in prohibiting their sale by any person other than a qualified pharmacist. The only formality attached is the

requirement of labelling the article with its name, the word "poison," and the name and address of the seller. This list includes, inter alia, such potent drugs as chloral hydrate, digitalis, sulphonal, and all preparations containing less than one per cent. of morphine. In most Continental countries. none of these preparations may be supplied except upon a prescription; in Great Britain, on the other hand, their sale is not restricted by a similar safeguard, and the public is at liberty to indulge in the use of a powerful drug, capable of doing considerable harm if injudiciously employed, or of satisfying the craving for a certain preparation without the advice and sanction of a doctor. It is particularly in the case of mixtures sold under special names, as in the case of "patent medicines," that the absence of any legal restrictions regarding the sale of more or less potent drugs, or of drugs which through prolonged use may prove injurious to the system, may lead to disastrous results. For in the case of a mixture containing a poison enumerated in Part II of the Act, it is not necessary to disclose the nature of the substance present; as long as the label bears the word. " poison and the name and address of the seller-which in this case must be a qualified pharmacist-the legal requirements have been satisfied, and the responsibility of the pharmacist ceases. This refers merely to those substances which are included in the poison schedules, and yet there are in common use quite a large number of potent drugs which do not come within the meaning of the Act, and which may even be sold by any tradesman however ignorant of their properties. In the medical evidence given before the Parliamentary Committee on Patent Medicines the lack of control over the sale of such powerful or habit-forming drugs was specially emphasised.

Turning to a consideration of the conditions abroad, we find that, in the first place, a strict distinction is made. between the sale of poisons for technical and for medicinal

purposes. The sale of poisons for industrial uses is usually made the object of special legislation, which extends not only to the formalities to be complied with by the purchaser, usually taking the form of obtaining a permit from the local authorities prior to each purchase, but also prescribes the manner in which the poisons are to be stored and handled by the seller; in some cases the use of special utensils marked with the name of the poison have to be employed for weighing or mixing, and minute instructions regarding the storage of certain substances are not omitted.

As regards the sale of poisons for medicinal purposes, we strike a fundamental difference between our conditions and those prevailing in Continental countries. In most of the latter the pharmacist is the sole legal purveyor to the public of all medicines in whatever form, and, with the exception of a few Swiss cantons, doctors are forbidden to dispense their own medicines. In this way the sale of remedial agents is easily controlled, and it is the pharmacist who is entrusted with the task of seeing that the public does not indulge in indiscriminate self-drugging in any form.

In Germany the Government has drawn up a list of substances none of which may be sold except upon the production of a qualified medical man's prescription, or of a prescription written by a qualified dental surgeon or veterinary surgeon (only in the case of drugs for animals). This list naturally includes all the powerful poisons, but in addition it contains a large number of drugs the sale of which in Great Britain is not hampered by any restrictions whatever. Among these figure, to quote but a few examples :—

Acetanilide, Amyl Nitrite, Antipyrine, Caffeine and its Salts, Extract of Male Fern, Chloral Hydrate, Calomel, Migraenin, Paraldehyde, Phenacetin, Jalap Resin, Sulphonal, Tartar Emetic, Sodium Salicylate, Tincture of Opium, Trional, Veronal, Ipecacuanha Wine, and Zinc Sulphate.

Nor is the scope of this list exhausted with the sole enumeration of drugs which may not be sold except on a prescription-it also serves to regulate the vexed question of repeating prescriptions. British doctors frequently voice the complaint that their patients continue having a prescription made up without their knowledge when other conditions have supervened, or that their prescriptions are lent to friends suffering apparently from the same symptoms as the patient who benefited at the time by the medicine prescribed. There are no regulations in England regarding the repeating of prescriptions, but this is automatically solved by the above-mentioned list as far as Germany is concerned. Against each drug on the list is also stated the maximum single dose which will permit a prescription calling for that preparation as an ingredient to be repeated without formality. If the single dose exceeds the amount stated, then the patient must each time obtain the signature, with the date, of a doctor (or dental surgeon, or veterinarian, according to the case) before the pharmacist is permitted to make up the medicine again. For instance, a prescription containing any of the following drugs may be repeated without formality (unless it bears a remark to the contrary by the prescriber) if the single dose does not exceed the amount stated against each:

If the single dose is not apparent from the directions on the prescription, the pharmacist is not permitted to