Am'ulyr,'^9isrm'  )  Bricf  °f  Philadelphia  Drug  Exchange.  331 
sary  but  they  suffice  to  show  the  serious  possibilities  of  the  200 
poisons  out  of  the  nearly  600  drugs  contained  in  each  Army  drug 
store  and  the  imperative  necessity  of  placing  Army  pharmaceutical 
practice  in  the  hands  of  legally  qualified  pharmacists,  and  not  in  the 
hands  of  men  that  no  State  Board  of  Pharmacy  could  possibly  rec- 
ognize as  being  legally  competent. 
It  is  a  remarkable  fact  that,  in  the  Army  Medical  Department, 
there  is  no  "  regulation  "  that  physicians  must  use  trained  pharma- 
cists for'  the  performance  of  pharmaceutical  duties,  and  in  conse- 
quence they  may  and  do  delegate  the  preparation,  compounding, 
dispensing,  and  in  some  cases  the  administration  of  the  drugs  and 
poisons  they  order  for  their  soldier-patients  to  barbers,  blacksmiths, 
undertakers  and  the  like,  while  trained  pharmacists  in  the  same  hos- 
pital perform  non-pharmaceutical  duties. 
The  result  of  such  a  system,  or  lack  of  system,  is  that  mistakes 
must  occur,  even  if  not  recognized.  Physicians  are  not  pharma- 
cists. They  know  nothing  about  technical  pharmacy.  They  have 
not  been  trained  to  differentiate  between  poisons  and  non-poisons 
by  physical  and  chemical  tests,  although  they  should  be  competent 
to  do  so  clinically  (and  then  it  may  be  too  late),  and  when  their 
untrained  assistants  make  a  mistake  and  dispense  a  poison  for  a  non- 
poison,  the  patient  suffers  and  perhaps  dies  and  the  "  mistake  "  pos- 
sibly is  buried  with  him.  The  toxic  symptoms  of  certain  poisons 
resemble  the  symptoms  of  certain  diseases.  Thus :  The  symptoms 
of  arsenical  poisoning  may  be  mistaken  for  gastro-enteritis,  diarrhoea, 
etc.,  those  of  corrosive  sublimate  poisoning  for  dysentery,  those  of 
strychnine  sulphate  poisoning  for  tetanus,  spinal  meningitis,  etc., 
and  those  of  opium  poisoning  for  alcoholism,  uraemia,  etc. 
The  danger  of  such  untrained  service  is  not  only  one  of  commis- 
sion, but  also  one  of  omission.  Not  knowing  the  proper  methods 
of  preparing,  compounding  and  dispensing  drugs  and  not  having 
competent  pharmaceutical  help,  Army  physicians  go  in  the  direc- 
tion of  the  least  resistance  (and  safety)  and  "muddle  through"  by 
making  the  patient  fit  the  remedy  and  not  the  remedy  fit  the  patient. 
The  consequence  is  that  the  soldier-patient  fails  to  receive  adequate 
and  properly  individualized  treatment,  and  his  recovery  to  health, 
if  there  be  recovery,  is  more  or  less  seriously  delayed. 
The  Army  physician  is  not  to  be  blamed  for  this  condition  of 
affairs.  He  is  the  victim  of  an  antiquated  system  of  Army  phar- 
maceutical practice  such  as  is  not  tolerated  abroad  in  the  armies  of 
