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JAMA Revisited
July 14, 2020

Prohibition and the Medical Profession

JAMA. 2020;324(2):203. doi:10.1001/jama.2019.13521

Originally Published July 17, 1920 | JAMA. 1920;75(3):178.

If one were to take seriously the newspaper jokes and gibes regarding the prescribing of whisky by physicians one might assume that the medical profession had lost all honor. Any self-respecting physician must blush for shame at what he regards as slanders on his profession. Unfortunately, however, the charges are apparently true, so far as they apply to some physicians. The office of the Federal prohibition enforcement officer for Illinois contains sufficient evidence to establish the truth of the reports, so far as they concern a not inconsiderable number of physicians.

As is well known, the regulations governing the prescribing of intoxicating liquors require that prescriptions shall be written on regular blanks provided by the government, which are issued in book form. Each of the books contains 100 blanks, with corresponding stubs. On these stubs must be written the date, the name of the patient, the amount of whisky prescribed and the disease for which it is given. These stubs are a record of what the physician has prescribed during a certain period. Before obtaining a new book, the physician must return the stubs of the old one. Examination of these stubs reveals that some physicians have been writing from seventy-five to 100 prescriptions for whisky a month. The stubs of a dozen different books examined at random show that in no single instance was the prescription for less than the maximum quantity allowed by law—one pint, or sixteen ounces. An analysis of ten books—one thousand blanks—shows that the diseases given as the reason for prescribing whisky were: bronchitis, 354; general debility, 167; la grippe, 163. Boils, coryza, diabetes, nephritis, endocarditis, eyestrain and headache, hay-fever, nasal catarrh, rheumatism and urinary irritation were some of the other disease conditions for which whisky was given.

Undoubtedly, the conditions in Chicago are duplicated to a greater or less extent in other cities. Naturally, the proportional number of physicians who are selling their rights and privileges as members of an honorable profession for “a mess of pottage” is very small; but that even a small number of physicians could be so lacking in honor reflects on the profession as a whole. Our profession has always been regarded by the public as an honorable one. Its members are presumed, by the very nature of their calling, to be upright and dependable. Physicians are, in a sense, a privileged class, as is emphasized in the laws of all civilized nations. With the privileges go certain responsibilities and obligations which every physician, tacitly at least, assumes when he enters the profession. It is such a privilege that was conferred on him by the government, under the laws enforcing the principles of the Eighteenth Amendment to the Constitution of the United States. These privileges were granted on the assumption that there might be times when physicians would need to prescribe intoxicating liquor for sick persons. It is beside the question as to how many prescriptions for liquor any physician may need to write in a certain length of time. It is obvious—there is no denying the fact—that some physicians are grossly abusing their trust in this matter. The privileges were granted to physicians with the presumption that they would use them honorably, and would prescribe intoxicating liquor only when absolutely necessary—if such necessity ever exists.1

The whole question is a serious one which should be faced frankly by the organized profession. It is one which merits the immediate attention of county medical societies throughout the country. Already physicians in many communities have taken action defining their attitude toward those physicians who have traded an honorable name for the unworthy title of “bootlegger.” For the good name of our profession, it should be made known to the public in an emphatic manner that such disreputable practices, on the part of any physician, are not condoned. Noblesse oblige.

Section Editor: Jennifer Reiling, Assistant Editor.
Editor’s Note: JAMA Revisited is transcribed verbatim from articles published previously, unless otherwise noted.
In the words of the law, “No physician shall prescribe liquor unless after careful physical examination of the person for whose use such prescription is sought, or if such examination is found impracticable, then upon the best information obtainable, he in good faith believes that the use of such liquor as a medicine by such person is necessary and will afford relief to him from some known ailment.”