DR. J. B. MATTISON.

Dr. Mattison recently spent several weeks in Bermuda, and the British Med. Journal in reporting a meeting of the British Med. Association, held in the Town Hall at Hamilton, says:

By request of the Society, Dr. J. B. Mattison, of Brooklyn, gave an address on the subject of narcotic inebriety. Attention was called to the extensive use of opium, chloral, and cocaine, notably in France, Germany and America. The genesis of the disease was a physical necessity in many cases. The speaker said in proper cases his plan—an original one—was to secure an entire narcotic disuse by regular reduction, in ten days, meantime bringing the nervous system under the sedative influence of bromide of sodium, in initial doses of thirty grains, at twelve-hour intervals, increasing the dose ten grains daily, and reaching, if required, a maximum of one hundred and twenty grains at the end of the withdrawal period. The resultant reflex irritation was treated by hot baths, cannabis indica, hyoscyamus, coca, and electricity, with a subsequent tonic regime. The prognosis was good as to recovery, but in most cases, sooner or later, there was a return to the narcotic, due to a renewal of the original cause, or to other conditions beyond control. A vote of thanks to Dr. Mattison closed the meeting.

Dr. Mattison is translating Erlenmeyer’s Die Morphiumsucht und ihre Behandlung—the Morphia Disease and its Treatment; third and last German edition, the latest and largest work on the subject, which, with notes and comments by the translator, will be brought out the coming autumn.

LONG ISLAND COLLEGE HOSPITAL TRAINING SCHOOL FOR NURSES.

The graduating exercises of this training school took place on June 12th, at the hospital. Prof. Jarvis S. Wight presented the diplomas, and Dr. George G. Hopkins delivered the address. The following are the graduates of the class of 1888: Mrs. Elizabeth Raifstanger, Nellie E. Russell, Elizabeth Munday, Abigail Collins, Lucy Wood, Elizabeth Ritchie, Ellen Enright, Florence Jackson, Jennie E. Stuart, Minnie M. Flower, Florence Crompton, Signa Johnson, Eleanor Mary Senkler.

Originally every physician was his own apothecary, and at the present time probably a majority of medical practitioners dispense their own medicines, very rarely writing a prescription. These will have but a languid interest in the subject of this essay, which deeply concerns all physicians who are not their own apothecaries, and all compounding pharmacists.

In medical, as in every other science, the increase of knowledge so widened the field that it became impossible for one mind to grasp all the facts, and a division of labor took place, the part of the work which related to the collection, preservation and dispensing of drugs being assigned to a class of men who had displayed peculiar aptitude for that branch. Thus was constituted as a distinct occupation, the specialty of the apothecary, which, beginning as a department of medical science, is inherently honorable, and has been so developed that it gives scope for a lifetime of fascinating research, elevating study, and profitable endeavor, independently of any proper work of the modern physician. The two callings are, for the purposes of this discussion, as in their best actual operation, practically distinct; and yet they are not independent, but interdependent. The greater part of the physician’s labor would be vainly spent, were it not supplemented by the service of the pharmacist; the latter’s business would cease to have a reason for existence but for the vocation of the former.

In this paper it will be taken for granted that the physician is well educated and experienced in his profession, that the apothecary knows his business thoroughly, and that both are actuated by high moral purposes. The grievance of neither, therefore, will result from the intentional wrong-doing of the other, but from his thoughtlessness or conservative adherence to long-established custom. The honesty of each being presupposed, such a charge as the substitution of an inferior article for some ingredient in a prescription, or the false insinuation that a mistake in the medicine is due to the compounder’s carelessness need not be raised. Let us consider the grievances of each against the other.

The physician complains that the apothecary exceeds his function by prescribing for the sick. A person applies to the pharmacist for a remedy for a specified disease. The latter consults the dispensatory, finds a number of medicines mentioned in the therapeutical index under the name of that malady, selects one, and sells the article to the patient. He regards the protest of the doctor merely as the wail of one who is disappointed at not getting a fee for prescribing. The physician has a right to complain of those who prescribe for any but the indigent without a professional fee, for this makes it vastly harder for him to collect the charges to which he is entitled; but he has higher ground than this. With him the first step in every case of disease is diagnosis, without which prescribing is simply drawing a bow at a venture, with small probability of penetrating a joint of the harness; and he insists that neither the apothecary nor the patient is qualified to make a diagnosis. The determination of the character of a disease is not a simple matter, often baffling the profoundest learning and the broadest experience, and, in most cases, requiring special knowledge and discriminating judgment. The most obtrusive symptoms are by no means necessarily the most characteristic; a given symptom may be the accompaniment of different diseases, and sometimes attends pathological changes of diametrically opposite nature. But one who is uninstructed in this branch has nothing but symptoms to guide him, and therefore frequently, if not commonly, is led into error, which may produce the gravest results. The educated physician is the only person who is equipped to solve the problems of disease; and it is, in the long run, cheapest, even from the financial point of view, for one who is ill to obtain competent medical advice. Therefore, considering merely the welfare of the patient, the physician deplores the custom of counter-prescribing.

The universal practice among apothecaries of refilling prescriptions indefinitely, without the sanction of those who wrote them is frequently the subject of adverse criticism by physicians. “But,” says the pharmacist, “is not the prescription mine?” Probably the reply will be affirmative, though this is a question not entirely settled in the minds of those concerned. Granting, however, for the sake of the argument, that the apothecary is the rightful owner of the prescription, he triumphantly asks, “May not one do as he chooses with his own?” Not always, by any means, unless he elects to use his property in a way which will not imperil the welfare of others. The law puts many restrictions on the natural rights of ownership, for the purpose of shielding society from the ignorance, the malice, and the cupidity of proprietors. In the matter of prescriptions there are no such limitations; but in this, as in so many other affairs, we should be controlled not merely by considerations concerning our legal rights. The unwritten, but greater, law regards the question from a higher plane; and from this point of view one sees that there are moral reasons which should restrain the apothecary in these premises. Let us look at prescription-refilling in its remote as well as its immediate bearings.

The physician writes his prescription for one occasion and for one only. He designs it to fulfil the indications in a particular case at a given visit. It is often in the highest degree improbable that the conditions of the case will remain the same for a given length of time; and, when they change materially, another prescription is needed to satisfy the altered requirements. Of these things many patients and apparently, all apothecaries are accustomed to take no note; and, therefore, the prescription is refilled for the same person on many occasions, when something very different ought to be furnished, the expected improvement does not occur, and the physician is blamed for the failure. The prescription, intended for the treatment of a certain condition afforded relief and changed the state of affairs. Thereupon, further advice should have been sought by the patient, his physical condition investigated anew, and another recipe given by the physician, if he deemed it desirable. To hold the doctor responsible for the ill effect or lack of effect of his prescription in circumstances unlike those for which it was designed is obviously unjust. Yet this is done habitually, both in the case just supposed and in those other instances, quite as common, in which the recipe is compounded, not for whom it was written, but for some other person, who supposes (on what slender evidence it is appalling to contemplate), that his ailment is identical with that of the original patient. The refilling really amounts to the apothecary’s abetting the patient in self-treatment. There is a trite remark to the effect that he who undertakes to be his own lawyer is sure of a fool for a client. In legal actions the matters at stake mostly relate to property; in medical affairs, health and life are involved. Can anything better be said of the wisdom of him who, without adequate training, undertakes to settle questions in which his very existence is concerned, than of the sagacity of the man who, with no competent knowledge of law and the methods of the courts, presumes to manage a case in which merely a sum of money may be lost?

But undesirable as is the custom of pharmacists in this respect, it is unreasonable in physicians to grumble at it, until they reform a habit of their own, which encourages the practice which they deprecate. When a physician finds a sick man improving with a certain plan of treatment, and wishes the same medication continued, usually he simply tells the patient to have his bottle refilled at the apothecary’s. The latter, knowing that this is the usage of the medical profession, is accustomed to suppose—constructively, at least—that, when the bottle is returned to be replenished, it is brought at the desire of the doctor; and he again compounds the medicine, as he would not be justified in doing, if the method of physicians was different. If the latter would habitually rewrite their prescriptions, or indite orders for repetition, whenever they wish a continuance of treatment, apothecaries would have the best possible sanction for supplying medicines to patients a second or a thousandth time, and would have no moral warrant for such action without the written direction of the authors of the recipes. When the doctors adopt the plan suggested, a violation of their request that their prescriptions shall not be repeated without their written order will furnish abundant ground for complaint; until such change of method is established, the consistency of their protest does not conspicuously appear. By the practice proposed, the apothecaries would lose some business, indeed, but the community would experience an immeasurable gain.

The sale of so-called patent medicines by pharmacists is a continual irritant to doctors. Their objections have the same basis as in the preceding case, namely, that apothecaries ought not to encourage the people to prescribe for themselves. A distinguished physician once said that drugs do more harm than good—a statement which will not be disputed by those most conversant with the facts. But this is no argument against the employment of medicinal remedies in any proper way. Drugs taken by advice of educated, competent physicians do an immense amount of good; the injury comes almost altogether from their administration independently of the recommendation of qualified medical men. Concocted, not to benefit humanity, but to enrich their manufacturers, advertised as positive cures of diseases which the utmost skill of the medical profession cannot control, sometimes inert, sometimes dangerous from the poisons which they contain, pressed upon the attention of the people with impudent persistence and colossal mendacity, the infamous compounds, called patent medicines, are purchased by the credulous public in almost incredible amounts. Nobody knows as well as the pharmacist what quantities of drugs are sold in this form; nobody knows as fully as the physician the enormously baneful effects which they produce. If apothecaries would refuse to handle this class of goods, they would confer a wonderful blessing on humanity, by demonstrating their belief in the injuriousness of these articles, and thus bringing them into disrepute; and they would vastly dignify their profession by displaying its sense of moral obligation, even at the sacrifice of a lucrative part of its business.

Apothecaries complain that, to meet the demands of prescriptions, they are obliged, at great expense, to keep in stock a large number of whimsical preparations, and also many brands of the same standard medicines, when really one is practically as eligible as another. There is force in this complaint. As a rule, the former class of preparations has but an ephemeral popularity, and, as for the latter, there cannot often be need of specifying the goods of a particular manufacturer; for a worldly-wise, not to say honorable, pharmacist certainly may be trusted to furnish only fine articles, that he may keep the favor of those upon whose good-will his legitimate business depends. If a special brand is deemed necessary by the doctor, he can request a convenient apothecary to procure a quantity, and then can send to his shop the patients who require this article. Thoughtful consideration of this grievance will dictate some such course and effect its redress.

Occasionally, in places where apothecaries are accessible, physicians furnish their patients with medicines. This the pharmacist rightly regards with disfavor, as diminishing his legitimate business. The truly wise physician shuns this practice, perceiving that he cannot be as competent a pharmacist as is one who is nothing else, and furthermore, preferring to avoid the suspicion of administering medicines unnecessarily for the purpose of making a profit on them. Enlightened selfishness prompts him to encourage scientific pharmacy as a specialty.

BROOKLYN VITAL STATISTICS FOR JUNE, 1888.

Data of comparison:

The mortality by classes and by certain of the more important diseases was as follows:

Causes:

Reported cases:

During the month 13 cases of small-pox were reported, of which number 13 were confirmed as small-pox. 13 cases of small-pox were sent to hospital. No deaths from small-pox occurred in the city and 2 in the hospital.

Deaths by sex, color, and social condition were as follows:

Still-births (excluded from list of deaths) were as follows:

Age Periods:

Certain foreign and American cities show the following death-rate for the month of June:

NEW INSTRUMENTS.

This is a bulletin of inventions and improvements of interest to the physician and surgeon, and is published quarterly by Leach and Greene, Boston, Mass. It is mailed free to any address.

ANTIFEBRINE.

Antifebrine as a proprietary name is controlled by patents, and when bought under this name it costs about thirty cents per ounce. The name acetanilide, for exactly the same substance, is not and cannot be controlled in any way, and under this name it can be bought for about fifteen cents per ounce. As acetanilide is about one-eighth the price of antipyrine, and effective in half the dose, it is far more economical to the patient.—Pittsburgh Medical Review.

ENEMA LESIONS.

“Dr. Achilles Nordmann, of Basle,” says the Lancet, “has published a description of twenty-five bowel lesions due to the operation of administering enemata. They include three complete perforations and ulcers, and wounds of various depths and sizes. The causes of these lesions seem to have been the use of defective instruments, ignorance of the direction of the rectum, catching of the transverse fold on the tube, extreme irritation of the mucous membrane of the bowel, and obstructions caused by certain conditions of the uterus, the foetal head, or an enlarged prostate. As a rule, these lesions are to be found on the anterior wall of the rectum, from one to seven centimetres from the anus. They are not always easy to diagnose, as other foreign bodies or caustics may produce similar appearances. Tubercular and hÆmorrhoidal ulcers may be mistaken for them; these are, however, generally higher up. A perforating wound gives rise to paraproctitis, but this is not necessarily fatal, though a stricture generally results.”—N. Y. Medical Journal.