physicians’ prescriptions. 
53 
and an account of which will be found in another part of this Journal, affords 
a striking illustration of the danger attending the too prevalent practice of pre¬ 
scribing concentrated medicines. We append an article from the ‘ British 
Medical Journal,’ referring to this case, in which the subject is discussed from 
a medical point of view. 
PHYSICIANS’ PRESCRIPTIONS. 
There may be some doubt as to the propriety of deducing from the melancholy case 
of accidental poisoning by strychnia this week the rule that poisonous medicines should 
only be dispensed in “danger bottles but there can, we think, be very little as to the 
moral which should be drawn from it by prescribers who have adopted the prevalent 
modern fashion of ordering medicines in highly concentrated forms, so that a very few 
drops only constitute an ordinary dose. The administration of medicine thus becomes 
almost a nice manipulation of the laboratory, for which nurses, careless women, and 
ignorant servants are left responsible ; while the smallness of the total bulk of medicine 
ordered easily leads to terrible catastrophes. We have before drawn attention to this 
danger ; the sad fate of Miss Campbell will enforce the warning, and that it may not 
be supposed that this incident is the result of any very unusual form of prescription, we 
have selected the following examples of such prescription from the current books of one 
dispensing firm. One prescription before us contains one grain of strychnia in a fluid 
ounce of water, ten drops for a dose; another contains two grains of strychnia in an 
ounce and a half mixture, the order being to take ten minims every morning and increase 
the dose up to fifteen minims. Each of these small “ draught ” bottles would, of course, 
prove poisonous if the contents were swallowed under the same kind of mistake as that 
into which Miss Campbell fell; and the excessive concentration of the medicines makes 
the measurement of the dose a matter of undue nicety. But even these are less danger¬ 
ous forms of prescription than two others presented at the same house (but privately 
referred to the physician for dilution before dispensing them)—the one being simply for 
two drachms of dilute prussic acid, without written directions, and undiluted, the direc¬ 
tions having been given to the patient verbally ; the other ordering half an ounce of 
dilute prussic acid, pure and simple, with the direction that “ five drops are to be taken 
three times a day in water.” There are in this book many other prescriptions which 
have had to be revised by their authors owing to the caution of the chemist, including 
very large quantities of arsenic in a concentrated colourless solution ; bromide of potas¬ 
sium ordered by the ounce, and to be measured unmixed by the patient by the “ quarter- 
teaspoonful.” This is a mode of prescribing which has obvious danger and inconvenience 
to the patient, and, of course, no advantage to the physician. It is adopted chiefly, we 
believe, with a view to economy for the patient, who gets more for his money from the 
chemist when the concentrated solutions, or crude medicines, are ordered than when a 
duly diluted mixture is prescribed. As a matter of fact, however, we believe that the 
average net trade profits of pharmaceutical chemists are small, although the apparent 
and immediate profit on the drug is large. There are very few fortunes made in that 
business ; there are very few large incomes among retail dispensing chemists. The 
public, at our instance, and with the consent of their own body, are requiring from them 
a long apprenticeship, and a good knowledge of the scientific part of their business, and 
their customers have to rely much on their conscientiousness, skill in compounding, care, 
and watchfulness. They work hard, they are required to exercise unceasing vigilance 
in their business, and are liable to heavy damages for blunders dangerous to life. All 
this ought to be considered when people talk of the profits of chemists,—when medicines 
are ordered in a very concentrated form, to the evident risk and discomfort of the patient, 
but that he may get the largest amount of material for the smallest amount of money. 
A few more prescriptions from the same book will exemplify the kind of care which a 
vigilant chemist is bound to exercise. One prescription orders a dose of the solution of arse- 
niate of potash,amounting to fifteen drops three times a day; another orders four grains of 
opium in a pill; and so on through a long catalogue. There are few physicians who are not 
conscious of having little accidental slips of prescribing corrected by the dispenser ; and 
we all look to the dispenser to note and represent or remedy any such accidental and 
