386  An  Unusual  Case,  with  Comments.  {A%^tXmT' 
scription  was  as  follows  :  Take  of  acetate  of  morphia  one  grain  ;  let 
six  pills  be  made ;  one  directly,  and  repeated  every  four  hours  until 
free  from  pain  or  sickness. 
In  handing  this  to  the  dispensing  clerk,  the  prescriber  accompanied 
it  by  verbal  directions,  which  he  testifies  were  designed  to  convey  to 
his  mind  that  the  one  grain  was  to  be  divided  into  six  doses,  while 
the  testimony  of  the  dispensing  clerk  was  that  he  understood  the  ver- 
bal direction  to  be  that  each  dose  was  to  be  one  grain.  He,  however, 
qualified  this  statement  by  referring  to  the  verbal  directions  in  regard 
to  the  lotion,  as  what  he  wished  particularly  to  understand,  and  he 
wrote  them  down  before  making  the  pills.  He  did  not  put  up  this 
large  dose  inadvertently,  for  when  the  alarm  was  made  known  he  in- 
informed  his  employer  from  recollection  that  the  pills  contained  one 
grain  of  morphia  in  each. 
These  circumstances  are  worthy  of  note  in  this  unusual  case,  which 
may  serve  to  instruct  those  daily  dispensing  poisons. 
1st.  The  giving  of  verbal  directions  as  to  compounding  and  dis- 
pensing a  medicine,  is  an  unjustifiable  practice.  I  have  known  a 
physician  to  enter  the  door  of  a  dispensing  store,  and  rapidly  dictate 
a  prescription;  then  before  the  pharmacist  could  get  it  all  down  in 
black  and  white,  and,  of  course,  before  he  could  read  it  out  to  him, 
the  doctor  had  turned  on  his  heel  and  departed. 
In  the  case  under  consideration,  the  prescription  must  have  been 
hastily  written,  for  the  dispensing  clerk  was  first  asked  if  he  could 
"  make  it  out?"  to  which  he  answered  in  the  affirmative.  Then  fol- 
lowed the  verbal  directions,  which  seem  to  have  been  confusing,  and 
to  have  so  far  misled  the  young  man  as  that  he  adopted  the  very  un- 
usual course  of  putting  the  whole  amount  of  the  medicine  ordered 
into  each  of  the  six  doses. 
2d.  The  custom  of  some  physicians  of  writing  the  quantity  of  each 
ingredient  designed  for  a  single  pill,  and  then  directing  6,  12  or  24 
pills  to  be  made  accordingly,  is  calculated  to  introduce  confusion  and 
lead  to  mistakes.  A  few  physicians  in  Philadelphia,  and  probably 
elsewhere,  after  thus  indicating  on  the  prescription  the  composition 
of  a  single  dose,  add  the  letters  D.  t.  d.  xij— dentur  tales  doses  xij — let 
12  of  such  doses  be  given.  In  the  case  before  us,  there  was  an  ele- 
ment of  still  greater  uncertainty.  "  Let  six  pills  be  made,"  did  not 
indicate  whether  pills  of  one-sixth  of  a  grain  each,  or  of  one  grain 
eaeh,  were  intended ;  if  the  usual  form  had  been  adopted,  in  pil.  vi 
divid.,  or  divide  in  six  pills,  the  mistake  might  have  been  avoided. 
