[Written for the CRITIC & GUIDE.] EXAMINATIONS IN TOXICOLOGY.

By the Editor.

THE HE EDITOR takes great satisfaction in the fact that he has been largely instrumental in modifying the examinations of the various Boards of Pharmacy. Both by word and by pen, I have been for many years advocating improvements in the direction of saner, more common sense, more practical and more useful questions. And the agitation has borne fruit. We no more-or very seldom-find such silly questions as I had to criticise in the Druggists Circular some four years ago. But there are a few flaws left, and of these I wish to speak. Among the questions. on Toxicology, many are inappropriate and utterly unjustifiable. I refer particularly to the physiologic antidotes. In the name of common sense, what object do such questions serve? Why must a pharmacist know the physiologic antagonist of this or that poison? Is he going to treat the patient? Can he ever possess the knowledge of the proper antidotal doses? Can he ever understand the symptomatic indications and contraindications? I would not object to such knowledge, if Toxicology were a real science. But it is not. It is in its very infancy. The most experienced physicians consider cases of organic poisoning among the hardest and most thankless tasks. We must grope in the dark and merely meet indications as they arise. So what sense has it to ask such questions of young fellows, who haven't the least idea of physiology or anatomy? I said that Toxicology was not science, and I repeat it. Many of the statements

which have been accepted as correct, have lately been shown to be false. For instance, it has been current as gospel truth that atropine was the physiologic antidote of morphine. And woe to the candidate who failed to answer this question at the examination. But nevertheless, Prof. Reichert's (of the University of Pennsylvania) recent researches have shown that atropine is positively injurious in morphine poisoning, and he felt constrained to make the amazing statement, that he was sure that in cases of morphine poisoning, "more people died of the antidote-atropine-than of the poison." And even the value of the official arsenic antidote is now in serious doubt, according to the experiments of Prof. de Buscher. In poisoning with Fowler's solution, the ferric hydrate seemed even to increase and accelerate the intoxication symptoms.

I despise spurious quasi-knowledge. Knowledge of which the possessor can make no practical application, which-thru the limitations of his education he can not even clearly comprehend and which he must acquire by rote, is worse than useless. And I plead against questions, the answers to which must be based on such spurious and spuriously acquired

knowledge. Suppose a drug clerk has committed to memory, that physostigmine is the physiologic antidote of strychnine (it is theoretically, but not practically) what good is it to him or to anybody else? Can he on that account undertake the treatment of strychnine poisoning? Does he know the proper antidotal dose? Does he know the technique of a hypodermic injection? So what's the use?

Now, a few words about doses. The knowledge of posology is of great importance to the pharmacist; he must be thoroly conversant with the average and maximum doses of all official and most non-official products. The pharmacist stands guard over the physician's prescription, and the pharmacist's knowledge of doses has saved many a life, which might have been lost thru the physician's carelessness or ignorance. And questions on the average and maximum doses should play an important rôle in the pharmacist's examination. But to ask the minimum doses is silly, very

silly, and silly for two reasons. First it is entirely useless: if a physician prescribe an exceedingly small dose-less than the supposed minimum— the pharmacist will not go and increase it; second, there is no such thing as a minimum dose. What is the minimum dose to one physician, is not at all the minimum dose to another. And nobody knows, or can know, the exact minimum. We are not so thoroly familiar with the biologic mysteries, with the mechanism of organic life, as to be able to say: Such a drug in such and such a dose can have no action whatever. Even the instruments of precision-the sphygmograph, the hemoglobinometer, the tonometer, etc-cannot give us a positive answer. And Prof. Kravkof's recent pharmacologic researches, — which are attracting such wide attention just now-fully support the above statements. It would lead us too far to give here a resume of his wonderful research work; I will allude to one point only which is very suggestive. He has shown that such small doses of atropine as are not sufficient to produce toxic or even pronounced physiologic symptoms, are nevertheless sufficient to influence tissue metabolism and cellular respiration. So what becomes of our minimum doses? But even in the average and maximum doses a good deal of latitude should be allowed the candidate. It is a misfortune that so few examiners on posology and toxicology are physicians. Only a physician in active practice can have a real idea of doses. The majority of the examiners are men who have acquired their knowledge of doses from books-sometimes pretty old books, and notoriously unreliable ones-and I am certain that they often mark "wrong", when the candidate is right, and it is they who are wrong. From several examples, let me give you two: A candidate who was sure that he was not rated correctly in toxicology, asked to be shown his paper. Among the maximum doses the candidate gave, was

digitalin, amorphous gr. This the examiner said was wrong and added, "You must have ten points taken off for giving such a dangerous dose". The candidate insisted, but the examiner poo poohed the idea that gr. of German digitalin was the correct maximum dose. The case was submitted to me. It took me sometime; I had to send several clippings form medical journals, a copy of a paper by Dr. Henry Beates, before the examiner gave in. And the following case occured but a few days ago. On going over the paper with an examiner, the candidate was told that his maximum dose for atropine of gr. was wrong! The candidate knew better, a heated argument ensued, and again, I had to take the case in hand. Only after I showed the examiner that doses even of and gr. were given, after I showed him that Batsch and his followers, in the treatment of intussusception, gave hypodermically as much as gr.—equivalent to gr. per os-did the examiner apologize for his "oversight." And therefore I say: Give candidates more latitude in the matter of doses. And I would respectfully make the following suggestion to the examiners: Be perfectly sure that you are right, before you mark a candidate "wrong. Some candidates know their subjects pretty thoroly. And further remember that the U. S. Dispensatory is not an infallible authority. Some of its statements are incorrect, and a student is not necessarily wrong if his answer differs in some particulars from that authority.

I would summarize this paper as follows:

(1) In Toxicology for pharmacists let us limit ourselves to chemical antidotes. Questions on physiologic antidotes are unfair, irrational and useless.

(2) Let no questions be asked on "minimum" doses. simply ridiculous.

The thing is

(3) In maximum and average doses considerable latitude should be given candidates. The examiner should keep.up with the latest advances in toxicology and posology, so as not to do an injustice to the examineé, and mark answers which are decidedly right as decidedly wrong.

Take a bit of cheerful thinking

A GOOD REMEDY.

Add a portion of content,
And with both let glad endeavor
Mixed with earnestness be blent:

These with care and skill compounded,

Will produce a magic oil

That is bound to cure, if taken
With a lot of earnest toil.

If your heart is dull and heavy,
If your hope is pale with doubt,
Try this wondrous Oil of Promise,
For 'twill drive the evil out.

Who will mix it? Not the druggist
From the bottles on his shelf;

The ingredients required

You must find within yourself.

DR. GOODCHEER'S REMEDY.-" Success."

Ths is a frequent combination, intended, as is seen from the directions, for a horse. Great care must be taken not to add the iodine first to the turpentine, as great heat is evolved and the mixture may take fire or explode; the iodine is thereby volatilized as a violet vapor. The right procedure is to dissolve the iodine in the alcohol, and then mix it with the turpentine oil, very gradually added. The mixture is not homogeneous, but separates in two layers; there is not enuf alcohol to dissolve the turpentine, the latter requiring three volumes of alcohol for solutica. The upper layer consists of turpentine oil. Dispense with "shake" label.

132-Sodii Sulphitis.......

Ac. Hydrochl. Dil............................................
Tr. Nuc. Vom.......

Aquæ, ad...........

Teaspoonful after meals.

This prescription is incompatible.

.3vi

3ij-3iv

..3iij

.ziv

Sodium sulphite and a

mineral acid should never be prescribed together, and if prescribed the druggist, if he knows enuf, should call the doctor's attention to the incompatibility. The bad odor is due to the fact that sulphur dioxide, or sulphurous acid gas, is evolved thru the action of the acid on the sulphite. The equation is as follows: Na2SO3+2 HCI 2 NaCl + SO2 + H2O

Of course, the peculiar antifermentative action of the sulphite is also lost, because the SO2 gradually volatilizes, while a portion of it is oxidized to sulphuric acid.

Who does not know the incompatibility in this prescription? It is mentioned in some text-books; it has been discussed time and again in the pharmaceutical journals, and, presumably, every pharmacist should know it; but there are hundreds of pharmacists. and no novices either, who do not know it. Here is how a pharmacist put up the above prescription not so very long ago: He

ROBINSON'S PRESCRIPTION INCOMPATIBILITIES.

15

mixed the tincture of iron with the mucilage in a mortar, and to the dense gelatinous mass he added and added hydrochloric acid until the precipitate redissolved; he then mixed the solution with the syrup and the water. What a mess it was! On inquiry I learned that he was taught that way by another pharmacist, who was quite proud of his knowledge as to how to dissolve the precipitate formed by tincture of iron with acacia. That there is a much easier and nicer way never seemed to have entered the mind of either teacher or pupil. It shows how lack of interest in one's work will deaden the thinking faculties and take away all desire for experimentation or initiative of any kind. The above prescription can be made up without the least trouble, so as to give a clear, transparent solution, by simply mixing first the tincture with the syrup, the mucilage with the water, and then the two solutions together.

The remarks made in regard to the previous prescription apply to this one as well.

Salol is, chemically, phenyl salicylate, C6H5C7H503. When added to the spirit of nitrous ether it dissolves; on now adding the tincture of iron a deep violet-blue solution results, due to the formation of ferric salicylate, and partly also to the action of the phenyl radicle on the ferric salt. On adding the glycerin no change is noticed; if anything, the mixture gets still darker. On adding the water, the mixture becomes at once very turbid, and the deep-violet color is changed to a dirty yellowish-white. The turbidity is due to the precipitation of the salol by the water, in which menstruum salol is insoluble. The mixture does not remain permanently the same, but undergoes a notable change on standing the salol precipitates, sticking to the sides and bottom of the bottle, while the supernatant liquid is perfectly transparent and of a pale-violet color. The prescription should not be dispensed until the prescriber has been made acquainted with the difficulty.