The Difficulties of Dispensing.

The Difficulties of Dispensing.

311 mortality as obtained in the rest of this country prevailed amongst the 21,000,000 to which the above figures relate there would have been 9959 fe...

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311 mortality as obtained in the rest of this country prevailed amongst the 21,000,000 to which the above figures relate there would have been 9959 fewer deaths than actually occurred. That the high infantile mortality which at present exists in many parts of the country can be very substantially reduced is a question which admits of no doubt whatever; and the work of Dr. E. W. HOPE, who found in Liverpool that the personnel of the parents was a very dominant factor in promoting or reducing infantile mortality, holds out promises in this direction. The Notification of Births Act-a measure which the medical profession

rate of infantile

The Difficulties of AT the conclusion of

Dispensing.

held on Jan. 4th at Fulham the jury asked the coroner to lay the facts of the case before the notice of the Home Secretary, 11 in order that

legislation providing

for

an

a

inquest

distinctive form of bottle

be brought about." Regulations as to the methods

of

might storing

dispensing poisons have been in existence more than 40 years. They were framed by the Pharmaceutical Society, with the consent of the Privy Council, and under an Act of Parliament it is an offence to fail to comply with those regulations. half The regulations are in all cases applicable to the shops of for with-and obvious reasons, be only can, pleased the systematic employment of tactful and well-trained dispensing chemists, but not to all medical practitioners For health visitors, will assist in the performance of these of medicine who may happen to dispense drugs. as all our of readers the Pharmacy Act, 1868, promises. And as to both these points, the report before Section XVI. ns contains some instructive details. Of the total popula- know, exempts from the first 15 sections of the Act any tion of 21,000,000 dealt with above, districts comprising "legally qualified apothecary," while shortly after this Act was passed, the question having been raised whether medical a population of nearly 13,000,000 have already adopted the statute in question, and in those districts which have done practitioners other than Licentiates of the Society of so there are at work some 115 health visitors. In the Apothecaries were comprehended by these words, in order to make the matter perfectly clear, an amending Bill was near future this number will no doubt undergo great exmore the of as, pansion, especially teaching hygiene introduced into Parliament and passed in 1869. The introthrough in schools and the work of medical inspection, the enormous duction of this Bill was mainly due to THE LANCET, and its importance of preventive medicine becomes more fully provisions specifically exempted all medical practitioners realised by the public. registered at the time of the passing of the Act, and those We refer now only to one more point dealt with by registered subsequently, who in order to obtain diplomas Dr. NEWSHOLME in his interesting report, and that is shall have passed an examination in pharmacy. It is the manner in which enteric fever has behaved in clear, therefore, that those practitioners are exempted Nottingham and Leicester respectively, for most important from the provisions of this Act who are Licentiates general lessons can be drawn from this comparison. of the Society of Apothecaries, who became registered Both towns some years ago possessed two features in before August llth, 1869, or who have become registered common: a conserving system of excrement disposal and since that date but have passed an examination in a high death-rate from enteric fever. has Nottingham pharmacy. There are comparatively few practitioners who made but slow progress in the adoption of the dispense their own medicines who have not passed such an water-carriage system; in Leicester the progress has been rapid. As examination. There are therefore few practitioners amenable to the regards enteric fever, the death-rate in Nottingham is still of the Pharmacy Act; but this fact in no in has a restrictions Leicester undergone very marked high, while that diminution. Dr. PHILIP BOOBBYER, the medical officer of !i way lessens the obligation of medical men who dishealth of Nottingham, has for many years past drawn pense to carry out the same methods of safety to the All attention to the association between enteric fever and public as if that Act was obligatory upon them. houses furnished with midden-privies or pail-closets as poisons should be properly stored and bottled, and eompared with those supplied with water-closets, but no poisonous preparations for external use should be But his appeals have met with only a very partial response ; issued to patients in any but proper poison bottles. and as to the history of these two towns Dr. NEWSHOLME ’, if the law imposes little "legal" responsibility on practiwrites: "A gigantic experiment has been performed on tioners in the important matter of dispensing poisons, it these two communities under circumstances which enable imposes none in the more difficult and responsible duty of fairly trustworthy comparison to be made ; and at the writing prescriptions. And while the medical man has direct present time it remains, then, that in Nottingham a large responsibilities with regard to dispensing, he has also indirect number of deaths from diarrhoea and from enteric fever are ones of equal importance. He has to prescribe many occurring year by year which would cease to occur were this poisons, and it is his duty to do so with all care and wity in every part of it to adopt, like Leicester, a more attention. Though there are traditional methods and forms cleanly system of disposal of excremental matter." We are for writing prescriptions, the former have become of glad to hear that during 1908 the Local Government Board late years too much neglected and the latter too much communicated with various urban sanitary authorities urging abbreviated. We received some time ago a paper upon them to use the powers which they possess for the conversion the subject from Mr. DONALD McEWAN, read by him .f conservancy systems into water-carriage systems ; and in before the Pharmaceutical Society of Great Britain, connext year’s report we are promised some valuable data as to taining many points bearing on this very situation upon The tke rapidity of conversion which has taken place in different which comment may be useful to our readers. towns. Many other matters of interest in the report will be relationship between the prescriber of a formula and its iiscasaed further in

our

columns.

and

dispenser should

never

produce

any

difficulty,

but it is

312 obvious that occasionally this does happen, and the question arises first what ought the dispenser to do. As an example, if an unusually large dose of some drug is ordered without any statement or indication that the dose is unusual, should the dispenser merely take a careful note of the prescription, with a special comment, dispense the drug as ordered, and

Colour-Blindness and the Board of Trade. FOR long past there has been agitation in the medical world against the methods adopted by the Board of Trade in the examination in colour vision of candidates for certificates as master or mate in the Mercantile Marine. Most of the strictures have been passed upon the scientific methods

await what may prove to be a catastrophe ? Undoubtedly, if possible, the druggist should communicate with the prescriber, even at the risk of exciting suspicion in the mind of the patient or his friends, for it is unquestionable

adopted. Whether these are fundamentally erroneous or wrongly applied may be left out of discussion for

prescriber should indicate in some way that he has a good reason for ordering an unusual dose. This may be done in various ways, as by underlining the drug and dose, or by adding "(sic)"in brackets or by a footnote. It would undoubtedly be better if some uniform practice in this respect were adopted, and no better method could be employed than a short footnote. The dispenser may not be able to communicate with the physician-he may not even know the latter’s name. Many prescriptions are only signed with initials, and have no address stating where the prescriber lives. Both these omissions ought to be avoided ; all prescriptions should, in our opinion, be signed in full and the address of the signer given, unless the paper bears the patient’s address, when, of course, the prescriber can be readily traced. All pharmacists will probably agree with us that when it is absolutely necessary to modify a prescription the dispenser should exercise his own judgment in doing so, but that he should, if possible, communicate with the writer of it. We think that in most cases the medical practitioner will welcome that the

moment. an

TRATTLES is

TRATTLES, of which we give present issue of THE LANCET, proves

of Mr. JOHN

that there is serious fault somewhere. Mr. of exceptional ability, who has proved

a seaman

his

superior capacity in the technical details of his profession by passing the examinations for second and first mate after serving in the forecastle as an ordinary sailor. His colourvision has been examined on six occasions during the last six years ;

on

three occasions he

he failed. As the

passed and on three occasions Shipping Gazettesays : I Any system which

keeps a man on tenterhooks for four years as to whether he will be flung out of his profession and made to join the

in the interests of everyone concerned. dispenser must, however, be carefully and there is no doubt that this point is clearly

prudent

case

account in the

conclusively

this attention to his interests rather than resent it as an The prescriber should remember that the interference. pharmacist who refers back a prescription is following a safe and

The

are

the

course

The discretion of the

restricted, and honourably recognised by pharmacists. On the other hand, all medical practitioners should recognise with equal

crowd that loafs on the Thames Embankment stands wholly condemned. We clearly ought not to ffing a man about from tribunal to tribunal, until, declaring him first to be colourblind, then to be otherwise, and then to be colour-blind again, we run the risk of throwing him off his mental balance altogether." The Skipping Gazette goes on to discuss, or rather to ridicule in highly sarcastic fashion, the scientific evidence given by Sir WILLIAM ABNEY and others before It accepts as infallible Sir FRANCIS the special court. MOWATT’S opinion that the selection of wools by daylight, as he saw the test applied, does not afford a conclusive test. It records its respect for the lantern test if properly applied, but not for Sir WILLIAM ABNEY’S method of application. Much stress is naturally laid upon the "practical test " conducted by Commander WILSON-BARKER. We should have thought that the expense of this test might have been avoided in the face of the overwhelming evidence that Mr. TRATTLES had for many years acted as lookout man and second mate without mishap. As those

force the fact that the responsibility for a prescription rests ultimately with them, and that if a prescription presents doubt or difficulty that doubt or difficulty should be cleared up at the time of writing the prescription. competent to judge realise quite well, such a test is Serious mistakes in prescriptions are rare, but possibly no of no value unless carried out in atmospheric condiI tions which would render it one is such a good judge of their frequency as the dishighly dangerous to many The Gazette draws two conclusions from lives. a and is discreet holds Shipping person usually pensing chemist, who is that the One it I I sounds the death-knell of the inquiry. his tongue. In Mr. McEwAN’S paper is a collection of vicious of in itsimproved’ form." even system instances which have come under his personal cognisance, wool-testing, credit on the devisers of The other is that ’’the whole question of sight-testing must and do not reflect

certainly

great

these instances

be put on a higher plane." The first conclusion is controversial and need not be discussed at present. With the gist of the second we are in cordial agreement, though will be found that the weak spot is we think that it rather the system of examination and the mode in which it is conducted than the actual tests themselves. The Shipping Gazette very rightly says° ° What is obviously

sufficiently numerous to be alarming, though individually they would We can only cause embarrassment when they occurred. of pre what we have said above-the responsibility repeat a is serious and no one, scribing very practitioner should ever forget this. and when Hurry flurry prescribing should the

be

prescriptions ;

but

avoided, and carelessness is

a

are

not

crime.

medical subject must, at least to some extent, be regarded as such. Mr. CHURCHILL admits that no oculist or medical " man is included among the officers conducting these tests. a

THE WATER-SUPPLY

OF

WARMINSTER

(WILTS).

-The new water-supply for Warminster was formally on Jan. 20th in the presence of a large gathering.

opened ,

1 Shipping Gazette

and

Lloyds’ List,

Jan.

12th, 1910