H. MEDICAL PHARMACY. DEFINITENESS OF DRUG STRENGTH. B. HEMENWAY, in the Medical Council, states that there are certain elements of indefiniteness in the use of drugs for remedial purposes which have not received as much attention as they deserve. While combinations are often advisable, the dosage of the individual drugs should be varied independently. He who constantly uses a ready-made combination loses sight of the effect of the individual drugs in the mixture, and not infrequently he gives in such a mixture a drug which is contraindicated in the case under treat ment. Definiteness as to strength is essential for surety of action. If a drug contains 50 per cent of impurities, the size of dose must be doubled for the same result. If the impurity is harmful, the ill-effect may more than counterbalance the beneficent action of the remedy. The pharmacopeia fixes a standard of strength. This does not, by any means, indicate that the drug which you purchase will be of that strength. In glancing through the reports found in the Bulletin of the Indiana State Board of Health, for example, one is struck with the fact that not seldom the strength of the drugs tested is less than 60 per cent of that required. Physicians who do their own dispensing are especially liable to be thus victimized. They are the prey of cheap supply houses, and cheap prices mean cheap goods. Nor is the fault thus confined to firms ranked as doubtful. One very prominent firm, whose name is supposed to be a guaranty of purity, has in its price list often two grades of drugs. One is marked "pure" and the other "highest purity." There is nothing in the price list which. I have seen indicating that the "pure" drugs are below the U. S. P. standard, and many honest persons are misled into supposing that the cheaper drug is of standard strength. A tablet, especially if old, is of slower absorption than a solution. The effect of the same dose of sodium salicylate in solution or in tablet form, therefore, differs. Indefiniteness in action, therefore, results from lack of care as to the form in which a drug is used. Again, because phenol salicylate (salol) is insoluble in the stomach under normal conditions, a pill composed largely of that ingredient will be of little use in the stomach. Even "when tightly corked," both organic and inorganic drugs may frequently undergo chemical changes. Drugs may, therefore, vary in therapeutic effect with age. A drug a year old must be considered of uncertain value, generally speaking. Unfortunately, one of the most com mon sources of unsatisfactory therapeusis is a lack of clearness in perception as to what is needed-a lack of scientific basis for the art. It is useless to give pepsin in amylaceous dyspepsia. Likewise, when the fault is in the intestine, results are not so sure if a remedy be given which is absorbed in the stomach. The treatment for thrombosic apoplexy should be the reverse from that for hemorrhagic apoplexy, yet I have seen patients suffering with cerebral thrombosis, with heads raised, and treated with cardiac depressants. RE-FILLING PRESCRIPTIONS. Notes, the organ of the National Association Retail Druggists, takes the ground that a druggist is warranted in refilling a prescription unless the physician writes upon the prescription "Non Repetatur." They place the responsibility upon the physician. They complain that "our physician friends evidently want the pharmacist to shoulder the burden of refusing to refill a prescription and explain to the owner thereof why he will not refill it. It seems to us that this is an unfair proposition, because the pharmacist is not in charge of the case. It is not for him to say why the patient should not have the medicine which the prescription calls for one or two weeks after the prescription has first been filled. It is the province of the physician to determine what medicine the patient shall have and whether the patient shall continue to order this same medicine after the quantity specified in the original prescription has been used." The Physicians' Drug News thinks the view Notes takes of this matter is correct, and their suggestion that "when you write a prescription, decide then and there whether the prescription should be refilled or not. If you are willing to have your patient continue the medicine after the original quantity prescribed has been taken, no definite instructions are necessary. If you feel that a new prescription will be required or that the case will be cured when the first prescription has been used, then write the words, "Non Repetatur," at the bottom of it and it will not be "refilled," is good. But will all pharmacists respect the physician's "Non Repetatur"? asks our contemporary. It fears a great many will not, though it has no evidence to the contrary. However, when the doctor fills his own prescriptions, it is immaterial to him whether a druggist will or will not refill. He knows the patient will come back when the medicine is gone and he can refill or change the prescription as he sees fit. Dispensing benefits the patient as well as the doctor. We cannot blame the druggists for complaining, but they really cannot blame the doctor for dispensing. MAKING SUPPOSITORIES. Directions for manufacture and cuts of suppository machines are given in Maltbie's Practical Pharmacy, from which we extract the following: Suppositories of cacao butter are prepared according to the following formula: The medicinal substance, the prescribed quantity. Oil of theobroma, grated, a sufficient quantity. The quantity of cacao butter is determined by the desired weight wanted in each suppository: Example: I the weight desired. in each suppository is 2 Gm. (30 grains). and it contains 7 grains of medicinal substance, then the difference, 11⁄2 Gm. (23 grains) is cacao butter. Suppositories may be molded by hand in a manner similar to that in preparing pill masses, being rolled out and cut in desired lengths. The more satisfactory way, however, is to melt the mixture and pour it into cooled molds, or they may be pressed into shape by suitable presses. In preparing suppositories containing softening substances like phenol and chloral, about 10 per cent of spermaceti may be added to the mass. Considerable skill is required in the manufacture of suppositories, particularly if they contain extracts or the weather is hot (in the latter event ice is necessary), and we would not advise you to undertake their manufacture in small quantity. heat the dry mass to fusion at a temperature not exceeding 239° F. Let it cool, and dissolve it in a sufficient amount of distilled water to make the product measure 16 fluidounces. Then add the zinc carbonate, agitate the mixture occasionally during 24 hours, and then set it aside until it has become clear by subsidence. Finally separate the clear solution by decantation or by means of a siphon. EPSOM SALTS. The Physicians' Drug News thinks that after all the storm over granular and effervescent salts, of unknown number and with names ingenious and otherwise, there's nothing better than good old epsom salts, with its price about five cents a pound in strong contrast with others from 75 cents a pound up, mostly up. The only apparent object of a granular effervescent salt is to improve its palatability. This is done only at considerable expense, while the medicinal value is actually decreased. Our contemporary has worked out a formula for a solution of epsom salts based on one suggested by Dr. Burnett that it thinks you will like. It is as follows: A CRY FOR HELP. We are in receipt of the following pathetic appeal from a young man, which is typical of the same sort of plea that confronts the general practitioner every little while in the course of his family practice. We print it because of its commonness and typicality. Its frequency and typicality make it none the less urgent. For obvious reasons, we withhold the name of the correspondent. Editor MEDICAL BRIEF: About four years ago I began practicing a bad habit, which is ruining my life, and has resulted in sexual weakness. When I was converted about one and one-half years ago, or perhaps a little over time stated above, I began to realize the awfulness of the habit which I had practiced so long, and made an earnest effort to stop it, but all in vain. I have consulted doctors, but they seem to treat it as a common thing among men, and give me some pills, or perhaps prescribe washing off the afflicted parts with cold water, which has helped me but a very little, and now I appeal to you to give me advice concerning this disease. I am a young man nineteen years of age, have no bad habits with the exception of this one spoken of in this letter. Am at work every fair day and am tired at nights, and sleep well. Have taken medicines and drugs, also have tied my hands a number of times, but without good results. Will you kindly prescribe some medicine or treatment for me immediately? You may be assured your advice on this subject will be appreciated. G. L. G. There is little that we can say in our editorial capacity to this young man. The treatment of such cases, as every physician knows, is moral rather than physi We cal. The way to stop is to stop. would, however, recommend him, and all who are in like case with him, to seek out some honest, conscientious practitioner and confide in him absolutely. Such a man, especially if he be an older man, will know how to give the unfortunate youth the moral and mental support that he needs. For the rest, all that can be done is to lay out a healthful, rigorous, sufficiently busy course of life, cultivate the society of pure, wholesome men and women, and resolutely bring will power to bear upon the situation. But get the co-operation of a physician by all means. NERVOUS IRRITABILITY. Editor MEDICal Brief. I see by reading the "MEDICal Brief" that you have given advice to other unfortunates. So I thought I would write and ask you for advice in my case. I am forty-four years old, single, have no regular occupation, but am on the move most all the time; general health not very good. Masturbated from about thirteen to seventeen or eighteen years of age. After quitting the habit I began having nocturnal emissions, which have. continued without intermission until this day. At first they would occur from three to five times a month, but they have dwindled down until they don't occur one-third that often. My erections are weak and of short duration, and my ejaculations during sexual intercourse are either delayed or none at all. I am regular in all my habits, have a good appetite, but my food don't seem to give me any strength. I am weak and nervous and have an irritable temper. I am also suffering from a bad case of piles, tumors have formed which bleed very profusely when at stool. I believe that the piles are partially the cause of my sexual trouble. Now, after reading the above, if you think that you can advise me as to what course to pursue I will be very thankful. H. C. H. Here is a case of a man who has, happily, overcome the physical part of the masturbating habit, but seems to suffer still from the weakening mental and nervous effects. He still has, so to speak, the "masturbating mind", which is even more difficult to get rid of than the physical habit. We repeat to him the advice given the previous correspondent, namely, to seek the counsel and co-operation of some experienced and conscientious physician whom he can trust, and follow his directions. The strong probabilities are that the patient is worrying himself unnecessarily. Doubtless if he would "forget" his sexual life for a while, or at least cut down his sexual relations to normal, and have his hemorrhoids attended to, he would quickly recover his normal health and nerve. The piles are unquestionably keeping up a local irritation of the parts, and causing his mind to dwell upon the subject. The psychic element in these cases—which is practically all of the trouble-can only be adequately dealt with by the physician in person. OLIVE OIL FOR GALL STONES. Editor MEDICAL BRIEF. Olive oil is often prescribed by doctors for the cure, or prevention, of gall stones. Our physiologies teach us that oils do not pass into the circulation through the portal vein and liver, but through the thoracic duct. Will you please tell us, through your columns, how the oil acts on the liver, or bile, to prevent formation of stonesif it does it at all. MRS. G. S. MARVIN. It has been pretty well established that olive oil does not have any direct influence upon gall stones, either in preventing their formation or in dissolving them after they have formed. The appearance in the stools of what seem to be minute particles of calculus has been shown to be nothing but hardened particles of the oil itself, mixed with fecal debris. However, olive oil has the useful property of keeping the digestive tract in a healthy and patulous condition, thus indirectly ministering to the activity of the gall bladder and ducts, and in this way helps to prevent stone formation. It is also very nourishing. It is therefore often good treatment for these reasons. AN INCOMPATIBLE CHLORAL At a recent meeting of the Edinburgh branch of the Pharmaceutical Society of Great Britain, Mr. Donald McEwan brought the following prescription to the notice of the meeting: Syrup of chloral...... Tincture of belladonna. 1 drachm. 1 drachm. . 1 ounce. .1 drachm. 6 ounces. H setated that, on the day following that on which the medicine had been dis pensed, the prescriber brought the bottle to the pharmacist, saying that he had meant to give his patient syrup of chloral, but he feared that spirit of chloroform had been put into the mixture instead. Investigation showed that chloroform had been formed from reaction between the chloral hydrate and the magnesia, magnesium formate being also produced. When the prescriber was informed of this, he omitted the magnesia with satisfactory results. Mr. McEwan pointed out that the magnesia also liberates alkaloid from the belladonna and ipecac preparations. It is wise to emphasize that the newlyborn are subject to a variety of infections, not usually mentioned in textbooks. |