Not long ago as a bottle was placed upon the counter of a pharmacist to
be refilled, its inner walls were observed to be richly decorated with
the active principles of the compound. A witch-hazel doctor standing by
declared the decorated walls to be the secret of the patient's recovery,
but upon inquiry it was found that the patient was no better. Still they
had decided to try another bottle, and the apothecary was not the one to
object. The investigation was carried no farther, but if it had been the
same old story of _incompatibles_ would have been retold. To the aqueous
solutions containing oleoresinous tinctures or extracts (such as
cannabis indica, guaiac, benzoin, lupulin, ginger, myrrh, cubeb,
eucalyptus, sumbul, and many others) a sufficient quantity of carbonate
or calcined magnesia should be added. A few grains (say three to twenty)
to the prescribed dose will suffice for a good suspension, and will be
found in most cases unobjectionable of course in an acid mixture.
There are many conflicting reports of this class of medicines, owing to
unscientific prescribing as well as unreliable preparations. The
activity of this class of medicines demands nothing short of strong
alcohol for their extraction. Yet many weak and worthless preparations
may be found in the market. If the unscientific observers would look
more to the quality of their goods, these conflicting reports would
begin to subside.
A physician once told an apothecary that he prescribed fluid extracts
because he found them more reliable than the tinctures. This was not
true, and could not be proven. Upon investigation it was found that his
prescribed dose of fluid extract of digitalis was equivalent to
fifty-five drops of the tincture, a dose larger than he intended to
prescribe. With such science the witch-hazel doctor will ride a high
horse, and come in on the home stretch with flying colors. No singer can
sing well who sings too many songs, and no beginner will prescribe well
who prescribes too many medicines. This song has been sung much but not
half enough, for it is not borne in mind. Many fail with a remedy simply
because they have failed to master it.
Mastering the few is said to be the key to success, and the writer
believes it, for he has seen it proven. An eminent physician from New
York was once called in consultation to a western city. His prescription
was mercury iodide, potassium iodide, and infus. gentian. He stated (and
the other physician said, “I see”) that the only object of the potassium
was to dissolve the mercury iodide. But potassium's great affinity for
iodide accepted it, at once dropped the free mercury to the bottom,
likely to be taken all at the last dose, equal to fifteen or twenty
grains of blue pill. He had failed to master this remedy.
The witch-hazel doctor could not declare this time that the untaken
medicine saved the patient's life, for he died before taking it. But he
could smile at the prescription appropriately, were none of his own to
be found on file.
Another phase of fashion reminds one of the old saying “distance lends
enchantment;” for there is just as good sense in going to New Brunswick
to have a boil lanced as there is in bringing syrup hypophosphates from
that place.
The present pharmacopœia contains a splendid formula for this syrup—one,
too, with which phosphoric acid, quinine and strychnine are perfectly
compatible. A pharmacist that will not exert himself to furnish the very
best article for a physician's prescription is not entitled to the
physician's respect. But for a physician to expect a pharmacist to send
all over town for some foreign preparation that might, in almost all
cases, be better made at home, affords a weapon to retard medical
science and advance the nostrum manufacturer. The more scientific
physicians well know and admit that a good pharmacist can better judge
of a compound than a physician, who seldom stops to test it, but
prescribes it a few times and, in many cases, never thinks of it again,
or, perhaps, not until he presents his bill and finds the patient's
money all gone for semi-proprietary medicines that cost from fifty to
one hundred per cent. more than would have paid for better compounds.
Physicians will only have to examine these medicines after they have
stood a year or two, and in many cases a much less time, to see the
force of this argument.
Among these nostrums are found numerous preparations we could mention,
including many emulsions, elixirs, etc. It is comforting to see the
better class of physicians giving these nostrums a “wide berth.” Others
will follow their example if they investigate and master their remedies.
Having no time to continue this rehearsal, I close with a _plea for more
science, more investigation_, that we may not have to send to Buffalo
for syrups of Dover powder or farther east, west or south for nostrums,
but master the remedies we have, saving to the physician and patient
from fifty to one hundred per cent., thus mitigating the popular cry of
the high price of medicine. There should be a table of incompatibles in
every medical college as prominent as the multiplication table in the
schools, or pharmacists should be allowed more freedom to prepare
medicines properly, instead of being held to the letter.
The writer should not complain, for he has been liberally treated by the
profession in this respect; but he does not feel at liberty to add
magnesia to a mixture unless so ordered. A pharmacist did this at one
time in a tar-and-water mixture, gaining great praise from the
physician. (Making the tar quite thin with a little alcohol, then
absorbing the whole with magnesia, and emulsifying by adding the water
gradually.)