66 said that there is nothing unprofessional or derogatory in the dispensing of his own medicines by the physician. In England it has been the universal practice for centuries in all places except the largest cities, and it has only been given up by a part of the medical profession as a matter of convenience, not as a right. The homoeopaths fought for the reclamation of this practice as a right belonging to the medical profession, and succeeded in its legal establishment, but not from a worthy motive. They dispense their own medicines in order to cover up the many frauds of which they are daily guilty, and to give them the power of administering full doses of powerful drugs in a form which is apparently homœopathic," with no tell-tale prescription on file in a drug-store to give mute but dangerous evidence against their honesty. In this way they administer several grains of Calomel or eighth-grain doses of Morphine, or correspondingly large quantities of active alkaloids, triturated with sugar of milk, or dissolved, as many of the latter may be, in alcohol. Chemistry, by isolating the active principles of plants, and furnishing them. to commerce in the form of soluble salts, has enabled the homoeopath to practice this fraudulent method of dispensing drugs, which the innocent and ignorant patient, who believes in the power of the minimum dose, supposes to be infinitesimal in amount. But the physician of the regular profession is too apt to think that if he adopts a practice which these quacks have appropriated to themselves, he may be classed with them by his professional competitors. Hence, many regular physicians are absolutely afraid to use such drugs as Aconite, Belladonna, Gelsemium, Arnica, Rhus, etc., all of which are official, and most of which are older than homoeopathy in medicine; and avoid pocket-cases, drachmvials and triturations, as badges of charlatanism. It is high time that we asserted our independence in all these matters, and made use freely of those means which are recommended by our individual judgments as promotive of the best results to our patients and to ourselves. With a small stock of reliable fluid extracts, such as are manufactured by Parke, Davis & Co., of Detroit, or Dr. Edward R. Squibb, of Brooklyn,-an equally moderate supply of gelatin-coated pills and compressed tablets from the best houses, such as McKesson & Robbins, Schieffelin & Co., Warner & Co., Wyeth & Co., physicians could check-mate the unscrupulous practices of many druggists to a great extent, save their patients many dollars, and retain many a dollar for their own pockets, which under the present system goes to their enemies. The homoeopaths understand the money part of the argument well. When their patients' medicine is exhausted, the doctor must be seen for a fresh supply, meaning of course another consultation about symptoms, a change perhaps from Mercurius Dulcis to Mercurius Vivus, and another fee. The expense is nothing, sugar of milk being cheap, and there is no prescription in the patient's pocket-book, to be renewed scores of times (paying toll however every time to the druggist), and finally to be copied by aunts, mothers and friends, as a sovereign remedy for a cough, or a really wonderful receipt in a case of croup. Filling a Prescription means a combination of operations which requires great care, undivided attention, and a special practical apprenticeship at the dispensing desk. In the following discussion of extemporaneous preparations such hints are incorporated as are particularly applicable to the compounding of each article under consideration; and they may be prefaced by a few general suggestions which will serve to point out the most approved method of dealing with this important part of the druggist's work. The prescription should first be slowly read over in a critical spirit, but no word or action of unfavorable criticism should reach the ears or eyes of the messenger. To shrug the shoulders while scanning the items, to laugh or even smile at the phraseology, to question the person offering it as to whom it is for, or what complaint it is given for, are instances of such flagrant treason to the prescriber as would justify his kicking the offender with a copper-toed boot. The compounder has no business whatever with the propriety of the recipe for its purpose. It might have been given as a placebo for reasons eminently wise and judicious; or if not so constituted it has at least been ordered by one who is in possession of facts which the druggist knows nothing about, even if by education and experience he were competent to judge in the matter, which he seldom is. His criticism should be directed only to the dosage and the pharmaceutical compatibility of the ingredients. Even in the latter case he must remember that incompatibles are often prescribed with the view of forming another agent from the chemical reaction produced. If he thinks that there is any mistake, and the drugs ordered are in any degree poisonous, it is his duty to make an excuse for delay to the messenger and at once communicate with the physician. This course, in these days of telephones, is nearly always practicable. After reading the prescription, it is well to number it and write the label. This gives time for the label to dry, and avoids the use of blotting paper, which often mars the writing and renders the directions all but illegible. A clearly defined method should next be decided on by which to compound the prescription. Directions for such plans of procedure will be found in the succeeding pages under the titles of the various preparations. Next, the ingredients should be carefully weighed or measured out, each one being checked off so as to avoid the danger of its being duplicated. In many cases the excipient is not specified, its choice being left to the druggist; but in all such a note should be made on the prescription to show the article used, in order that in the event of a renewal there may be no difference perceptible. No alteration or addition should ever be made which would in any degree affect the medicinal action of the prescription, or interfere with the obvious intention of the prescriber. The labelling of the package and the numbering and filing of the prescription are matters of mechanical detail which are best learned at the counter. Various devices for simplifying these operations are in vogue and may be seen in any well-appointed drug-store. Poisonous articles sold by the druggist should always be labelled" Poison," and the transaction entered in a book usually required by law to be kept for that purpose; but in the case of prescriptions the word "Poison" should not appear on the package or label unless so directed by the prescriber. Stock Solutions of the salts most frequently prescribed are kept in many establishments for convenience in dispensing. Those most generally used are the following: Alum-ijss in a quart of distilled water. Of this solution each fluidounce represents 3ss of the salt. Potassium Bicarbonate,-3j in fiv of distilled water; of which 3ss contains 3 of the salt. Potassium Chlorate,—1 in 24 of distilled water, will not crystallize as the temperature changes. Potassium Bromide,-1 in 3 of distilled water, makes a very convenient solution for dispensing purposes. Chloral Hydrate,—1 in 1 of distilled water: of which each minim contains a grain of chloral. Morphine Sulphate,-gr. xvj in 3j of distilled water, with a grain of Salicylic Acid or 3 drops of Carbolic Acid to prevent change. Of this solution, known as Magendie's, each minim contains gr. of the salt, and mx contain gr. 4. A safer solution is the Liquor Morphia Sulphatis of the U. S. P., 1870, which had one grain of the salt in each fluidounce. Carbolic Acid,-3j in fiv of glycerin, makes a convenient solution which will mix with water in all proportions. mivss represent gr. j of the acid. Tannic Acid,—Zj in fziv of glycerin, dissolved by the aid of a gentle heat. mivss represent gr. j of the acid. The following rules for the pharmaceutical student are quoted from the Chemist's and Druggist's Diary for 1885. They are well worth remembering. 1. Read through a prescription, rapidly and in a manner suggesting no suspicion of doubt. 2. Write directions invariably before dispensing. Avoid thus the use of blotting-paper; a good dispenser uses almost none. 3. If a mixture contains readily soluble ingredients, never use a mortar. 4. Avoid effecting solution by heat, for fear of recrystallization. 5. With syrups and also ingredients not water, arrange in dispensing to rinse out the measure and leave it clean; a skilled dispenser shows very little traces of his work. 6. Carefully clean and put away weights and scales after each operation. 7. Hold the scales firmly by the left hand, never lift them high above the counter, and judge of the weight as much by the indicator as by the position of the scale. 8. Select glass pans for scales, preferably of heavy make, and discard flimsy brass material, which corrodes speedily and becomes inaccurate. 9. Learn to judge of the quantity to be weighed with tolerable accuracy; train the eye as well as the hand. 10. If in doubt, always begin with that about which you have no doubt. 11. Be rapid in manipulation. Finish wrapping, tying, or sealing quickly. Slow dispensing is bad dispensing, and arises either from deficient practice or want of knowledge. 12. Never, when in a shadow of doubt, hesitate to ask advice from a fear of compromising your own dignity. INCOMPATIBILITY. Incompatibility may be Chemical, Pharmaceutical or Therapeutical, according as the prescribed combination results in chemical decomposition, physical disassociation or antagonistic action. In the first case the incompatibility may be unintentional or intentional on the part of the prescriber, for in many cases the result of the chemical action affords the substance desired. Instances of intentional incompatibility are the mixtures of Calomel and Corrosive Sublimate with Limewater, producing the Black and Yellow Oxides of Mercury respectively, and commonly known as " Black Wash" and "Yellow Wash." Such combinations should not be filtered (as a novice might suppose), but should be dispensed with a " Shake-label," that the precipitate may be uniformly distributed before using. Chemical Incompatibility generally results from neglect on the part of the prescriber of the most common chemical reactions, such as 1. Acids tend to combine with bases and to form salts. 2. Weak acids or bases are displaced from their combinations by stronger ones, so that salts in solution when brought together generally exchange their radicles, especially if by doing so an insoluble compound can be formed. 3. A salt in solution is easily decomposed by a strong alkali if the salt is one having a weak or volatile base. 4. A substance in solution may be decomposed by another without precipitation, the product being soluble in the solution. 5. Alkaloidal salts are precipitated from their solutions by the addition of alkalies, alkaline salts or salts which produce insoluble compounds. Oxides of the alkalies decompose salts of the metals proper, and those of the alkaloids, precipitating their bases; but the base may be soluble in an excess of the alkali. 6. Tannic or Gallic Acids and vegetable substances containing them precipitate albumen, alkaloids and most of the metallic oxides, and form inky solutions when brought into contact with the persalts of Iron. Tannic Acid precipitates gelatin. 7. Glocusides are incompatible with free acids or emulsions. Examples of the neglect of these principles are seen in the prescribing of Quinine Sulphate in mixture with Potassium Acetate, resulting in a volu minous precipitate of Quinine Acetate which could not be poured from the bottle;-Vinegars or Syrups containing Acetic Acid (Syr. Allii, Syr. Scillæ) added to a solution of alkaline carbonates, causing decomposition of the latter with evolution of CO,;-the addition of Liquor Potasse to a solution of Ammonia-alum, setting free gaseous ammonia;-the mixing of Strychnine Sulphate and Potassium Bromide in solution, causing the decomposition of the alkaloid sulphate and precipitation of Strychnine;-preparations of Cinchona with salts of Iron, forming an inky tannate of iron;-Elixir of Chloral with alkalies, causing the elimination of Chloroform and its subsequent evaporation, etc., etc. The following table shows the most important instances of solutions which mutually precipitate each meaning "forms a precipitate with " other, the letter P |
