W MEDICAL PHARMACY. ITH the increase of the practice of dispensing by physicians it becomes desirable to add to the pharmaceutical knowledge and skill of the medical practitioner. And even where the doctor does not dispense his own remedies, a better acquaintance with pharmacy will enhance both his ability to prescribe and his realization of the responsibility which rests upon the shoulders of the druggist who dispenses his prescriptions. We therefore propose to conduct, each month, for the benefit of our readers, a brief but meaty department devoted to the pharmaceutical side of prescribing and dispensing. In this, as in all of our efforts, we are moved solely by a desire to render real practical help to the practicing physician; and we invite from our readers both criticisms and contributions, queries and answers, on any and every point of interest in this phase of the doctor's work. Administering Medicine to Children. The modern pharmacist, by his many delectable preparations, has robbed the prescription of drugs to children of half its difficulty, but a very short experience of young patients will be sufficient to show that many methods of administering drugs to adult patients are not readily tolerated by the young. Solid preparations (e. g., pills) that require to be swallowed whole, should be avoided; cachets and capsules are liked but little better. Mixtures probably need less persuasion for their reception than any other preparation, but the volume of each dose should be kept as small as possible. Syrups are readily taken, though they have the disadvantage that in hot weather they may turn sour; glycerin or saccharin in place of sugar may do away with this difficulty. Powders form a very convenient preparation, provided their bulk is kept small. An objection to their use is that some tend to cling about the mouth, thus prolonging any unpleasantness of flavor and increasing the risk of vomiting. Compound liquorice powder, for example, is apt to adhere objectionably to the palate, but this can be obviated by throwing the powder on to the surface of a wineglass ful of water a quarter of an hour before bedtime. At first it floats upon the surface, but gradually sinks to the bottom, and becoming well moistened, is free from all lumpiness. If milk is used instead of water, a somewhat longer time must be allowed for the powder to settle. The use of jam for covering small quantities of powder is, of course, well known, but it is open to question whether wholesome articles of food should be associated in the child's mind with unpleasant experiences. Another successful vehicle, especially with infants, is butter; a small lump of this enveloping, for example, some calomel and placed at the back of the mouth soon melts and is swallowed without trouble. Solvent for Corrosive Sublimate. When corrosive sublimate is brought into a solution of potassium iodide, we have a reaction producing biniodide of mercury and potassium chloride. As to the medicinal value of the mercury, one has only to recall the medicinal properties, action and uses of the two substances to answer this question. The best solvent for corrosive sublimate in prescriptions is alcohol, when this is permissible, three parts of this substance dissolving one part of sublimate. Water may also be used, a drachm of it at ordinary temperature dissolving four grains. of bichloride. The addition of a little common salt to the water greatly increases its power to solve the bichloride. Cutaneous Absorption of Iodine It is well known, says Ménigault, that methylene blue taken by the mouth colors the patient's urine blue, the coloration persisting even after discontinuance of the treatment. If, however, during the treatment, tincture of iodine is applied to any part of the body, and especially the spinal column, the urine emitted is no longer colored. On heating a little of this urine in a test-tube, the liquid at once becomes blue, the reason being due to the iodine having been driven off by the heat, and thus thrown out of reaction with the methylene blue. The experiment is claimed as a means of detecting the cutaneous absorption of iodine in alcoholic solution, a question which has frequently been doubted. Physicians Neglect Their Therapeutic Resources. It is true, says, Parrish, that many skillful physicians employ a very restricted materia medica; there are hundreds in the United States who carry the weapons they use for treating the usual forms of disease in some twenty or thirty vials, carried about their person or enclosed in a pair of saddle-bags; while, for unusual cases, they keep perhaps as many more on their office shelves. Though the frequent success of such, through skill and experience, can not be questioned, we can draw no inferences from this fact to disparage the employment of an extended and varied assortment of remedies. To what purpose has the bounty of nature spread everywhere plants of such varied and unsuspected properties; and why is art, from the exhaustless mine of COMMUNICATIONS. Physiology and Hygiene for Schools. Editor MEDICAL BRIEF: After devoting a number of years to teaching, after giving the average texts in physiology a careful study, and after examining many of the texts published, I have concluded that our schools are not getting the good from the study of physiology and hygiene that they should, and what is contained in the ordinary texts does not teach the essentials. As a matter of fact, "prevention" is the best cure for disease, and “sanitation" is of vital importance to prevention. No small space is given in the ordinary text to a discussion of alcoholism, and this subject should be fully treated, but it should not be handled to the exclusion of far greater matter. Not everyone is an inebriate, but every child in the room is constantly in jeopardy of flying germs, communication at the drinking fountains, or inhibition from osculation. It is useful for a child to know that consumption may be transmitted by absorbing the germs, but it is just as useful to know that dandruff may be communicated by using combs and brushes of those having the scalp disease. I have often seen pupils recite readily the names of organs, tissues and bones, etc., but I have seen few who could define the principles of keeping their body. free from contagion. In the South, where malaria is prevalent, cleanliness and diet is sufficient to prevent serious trouble from that source, yet our textbooks rarely mention it. In traveling over Arkansas, Mississippi and Louisiana, I have been struck by the unsanitary conditions of the smaller towns and the homes of many of the rural residents. We can not say that this is due to carelessness or laziness, but to indifference, caused by lack of education along these lines. What I have said of these three States is also true of many others. If the subject is to be taught in our public schools, it is just as easy to have a text that deals primarily with the laws of health, and secondarily with physiology and anatomy. There is an open field waiting for the touch of someone qualified to do it jus tice; and such a work as above described, prepared by some good physician, told in comprehensible style, will be welcomed. I have broached this matter in teachers' meetings and teachers' journals, but feel that the best place to reach the men capable is the columns of the MEDICAL BRIEF, and other journals devoted to such literature. Permit me to state that the writer undertook this task, but not having sufficient experience, nor knowledge of diseases could not accurately handle his subject. Respectfully, M. L. MILNER. Dewitt, Ark., March 5, 1910. Carbonic Acid Baths. Dr. Bishop Replies to Dr. Achilles Rose. Editor MEDICAL BRIEF: I have noticed the letter of my friend, Dr. Achilles Rose, concerning the report of my lecture in your journal on "The Nauheim Treatment of Heart Disease." I was just as shocked as Dr. Rose when I saw in print the statements which he criticised. The fact is that the lecture was reported and printed without my having an opportunity to revise the copy or the proof. Years ago when I lectured on chemistry at the preparatory school at Prince ton, one of the most familiar demonstrations was the precipitation and resolution of calcium carbonate on passing a stream of carbonic acid gas through lime water; and I supposed the precipitation of lime salts, held in suspension by carbonic acid gas, when the gas is driven off, was a familiar matter of household chemistry, demonstrated by the precipitation of lime by boiling wherever hard water is used. Naturally, it is an absurdity to say in one breath that the water has lost its carbonic acid gas and in the next breath that bubbles form on the skin. What I said was that "the water, on standing, has lost carbonic acid gas," instead of "the water, on standing, had lost the carbonic acid gas." As to the carbonic acid gas bath (without water) that Dr. Rose mentioned, it seems to me to be of great interest and worthy of study. My intention was to insist on the fact that the saline elements are essential to the Nauheim bath. A verbatim report of a lecture, given in the course of instruction to students, when committed to cold print, should not be subject to the same standards of accuracy as a formal paper, where the emphasis of the voice is lacking. Beneke, not "Banaeker," was the early exponent of the Nauheim methods in heart disease. I want to congratulate the MEDICAL BRIEF on the great interest of its recent numbers. Yours very truly, LOUIS F. BISHOP. New York, March 5, 1910. Untapped Reservoirs. Editor MEDICAL BRIEF: Mr. Elbert Hubbard, the sage of East Aurora, has this winter been traveling about the country delivering a lecture entitled "Untapped Reservoirs," the idea of his talk being that we all have within us undeveloped and unsuspected capacities. He says that, speaking intel lectually, we should continually advance from point to point, and that we never reach that point so near perfection that we can afford to stop thinking. Now, Mr. Hubbard can never express himself to a much greater length than three paragraphs without taking his customary rap at the medical profession. The way he does this in the above lecture is by the remark that his father was a doctor but that he never gave him (Fra Elbertus) any of his medicine, and that that explains why he is alive to tell the tale, etc. This would imply that his father was considerable of a hypocrite, for in his sixty-five years of practice he seems to have given medicine to his patients and accepted fees, yet at the same time thought that drugs were not fit to give to his son. Well, doubtless in the way that his father practiced medicine, the drugs he gave did do more harm than good. We willingly concede this much of the contention to Fra Elbertus. But there is one reservoir that Hubbard himself seems never to have untapped, that is the great reservoir of modern scientific medicine, and we may say, in particular, homeopathic medicine. His idea of medicine seems to be the medicine of fifty years ago. He has been led to see that the formerly prevailing system of drug therapeutics was built upon no scientific foundation, and hence he has lost faith in all curative power of drugs. At this point Mr. Hubbard stopped thinking. It is sad, indeed, as he says, to see a man stop thinking. Upon the subject of medicine Hubbard stopped thinking just about the time that Dr. Gould stopped his subscription to the Philistine. Since then he has contented himself with knocking. Hahnemann, more than one hundred years ago, reached exactly the point of therapeutic nihilism that Hubbard and many prominent physicians have reached only within the last ten years, but Hahemann at this point did not stop thinking, and as a consequence he discovered the only scientific method of drug application. The prevalent therapeutic nihilism of the dominant school of medicine is not a discouraging symptom. It is but the necessary preliminary to a new and better science of therapeutics, a science in which we believe the homeopathic law will receive general recognition. Radium and X-ray therapeutic fulguration, the Bier treatment and serum therapy are all fundamentally homeopathic in principle. It has been said that the medical department of Johns Hopkins University has eliminated the study of the materia medica from their curriculum. This is because, unlike Hahnemann, they have stopped thinking and hence have failed to recognize the beautiful law of similia similibus curanter that Hahnemann uncovered (tapped) and which lies ever within their grasp. It is only necessary to put aside prejudice and not stop thinking. T. E. REED, M. D. Middletown, Ohio. Glycosuria in Old Persons. Victor C. Vaughn, in the New York Medical Journal, makes three practical points in the management of this condition. First, the glycosuria of elderly life is due, in many instances at least, to excessive carbohydrate feeding; this excess is usually confined to some special carbohydrates, sugar and wheat starch; the early glycosuric of this class is often easily able to care for other carbohydrate foods; the harmful carbohydrates should be detected and eliminated from the food; those that can be assimilated should be determined and permitted; there is a specificity in the metabolism of carbohydrates, as there is in that of proteins; the presence of a small amount (0.5 to 2%) of sugar in the urine should not be regarded as a matter of trivial importance. The second point, which has probably been noticed by others, but the author has failed to find reference to it in a cursory examination of a few special articles on diabetes, is that in many persons the capacity of assimilating carbohydrates is largely determined by the time of day when the food is taken. Glycosurics who can not metabolize carbohydrates when taken for breakfast may dispose of one hundred grammes of bread taken at a 6 o'clock dinner. Why this is true the writer can not say, unless it is due to the more hurried way in which many things, both foods and medicines, pass through the body when taken in the morning. The third point is the value of the open-air treatment of this form of glycosuria. In a general way it is stated by most authorities on diabetes that life in the open air is beneficial, but Vaughn does not think that this has been sufficiently emphasized. He believes porch sleeping is quite as beneficial to the glycosuric as to the tuberculous. Chloral Hydrate as a Local Appli. cation. Heller, in the Münchener medicinische Wochenschrift, speaks of the value of chloral hydrate as a local application which possesses antiseptic and anesthetic properties, and so relieves pain. In cases of lacunar tonsillitis he recommends that a spray of chloral in watery solution shall be used for about twenty seconds to a minute three times a day. The strength employed is about 2%. He also finds it useful in treating diphtheria, Vincent's angina, and syphilitic ulceration. In nasal diphtheria when the secretion is profuse and purulent a solution of 1% of chloral hydrate dissolved in normal saline solution has proved very useful in his hands as a nasal wash. So, too, a 2% in spray is useful in ulcerative stomatitis. An additional advantage of this application is that it is not only antiseptic but deodorant. |