me just here as an important means of diagnosis to quote the more modern method employed for its recognition:

Scrape off a piece of the necrosed membrane with a sterilized cotton swab or a platinum loop, and at once transfer it to a sterilized test tube and close with a pledget of sterile absorbent cotton; then with a platinum loop or wire which has been made sterile by heating with Bunsen or spirit lamp flame, spread a particle of the membrane in a thin film upon a cover glass; as soon as this has dried, pass it through the burner flame three or four times, in order that it may become fixed when it is ready for staining. The alkaline solution of Loeffler is convenient for use; it consists of 30 c.c. of a concentrated solution of methylene blue in 100 c.c. of a 1 to 10,000 watery solution of kalii hydrat. The specimen should be stained for seven or eight minutes, after which the surplus staining fluid is rinsed off, the excess of water is removed by cigarette or filter paper, and then the specimen is ready for examination with a oil immersion lense.

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The most common form present after this preparation has the appearance of granules being deeply stained, in bacilli faintly stained. The average length of the bacillus is about 2.8", its breadth about 0.7; its peculiar morphology makes it comparatively easy to identify.

To more fully make the diagnosis, cultures should also be made; blood serum and bouillon are preferred by Loeffler; however, alkaline bouillon, agar, gelatine, coagulated egg albumin and milk make good soils. The colonies are elevated, are of a grayish color, more opaque in the center, and the surface of the colony assumes a dry appearance after a day or two; they are produced rapidly upon the culture fluid recommended by Loeffler, being plainly seen in from twenty-four to thirty hours, at which time no other colonies are present, macroscopically speaking. Thus the examination of the membrane, the cultivation of the colonies, and one step further, the inoculation of an animal which results in causing the disease under consideration, clears up all doubt as to diagnosis.

Vissmann thinks: "This lesion of a mucous membrane is frequently found with as well as without the Loeffler bacillus; e.g., in the fauces the bacillus is found in nearly every case, while in conjunctival sacs, nose, ear, gut, bladder, and uterus the bacillus is not found in the majority of cases;" or as he says, " in other words, I do not believe that a person who harbors Loeffler bacilli is always to be said to have diphtheria, nor do I believe this bacillus is always necessary to make a case

of diphtheria; however, I do think a person harboring true diphtheria bacilli should be considered as capable of becoming dangerous as a possible source of infection for other persons."

Spronck, after reviewing the literature regarding true and false diphtheria bacilli, concludes:

"1. A macroscopic and microscopic examination of the colonies developed on serum is insufficient for a certain diagnosis.

"2. Inoculation of an animal is indispensable in all cases of diphtheria unless severe or during an epidemic.

"3. Fraenkel confirms Spronck in that if 2 c.cm. of recent broth culture hypodermically injected does not kill a guinea pig weighing 300 g., but causes more or less edema, in the majority of cases one has to deal with a pseudo-diphtheritic bacillus. To make sure, however, of the test, they recommend that another pig be injected with antidiphtheritic serum, then use the broth culture as above named, and if there is no occurrence of local edema, then this establishes that it is an attenuated true diphtheria bacillus. These attenuated diphtheria bacilli are common except during epidemics.

"4. He has never met with a single example of pathogenic short bacillus which turned out to be so under the anti-diphtheritic serum. test.

"5. Diphtheria is never produced by non-virulent bacilli such as are found in the mouths of many individuals. These saprophytes belong to several varieties of bacilli quite distinct from Loeffler's."

These conclusions, to my mind, do much toward harmonizing the various views held by different investigators, and is a means of bringing the clinician to a more correct understanding of the cases with which he meets at the bedside. When physicians are not prepared to do culture and microscopic work, doubt can be cleared up by mailing a properly prepared test tube to the bacteriologist of the State Board of Health, who can report quickly to most any part of our State as soon as our legislature makes appropriations for such work. As a closing admonition, examine the throats of all your little patients and of the older ones when any symptoms point thereto. If you expect to see cases of diphtheria, look where the lesion is usually found.

FLEMINGSBURG, KY.

THE TRUE RELATION BETWEEN THE PHARMACIST AND THE

PHYSICIAN.*

BY GARRETT D. SMOCK, M. D.

Every institution extant in the world to-day has been called into existence to serve the necessities of mankind. The existence of the institution of government itself is due to this cause. The necessity for law and order, for the peaceful dwelling together of mankind, made it necessary that a power should be created to which all would submit. Every other institution when investigated will be found to have originated to serve man's necessities and comforts. Also every institution when investigated will be found to have originated from a chaotic state, and to have been evolved gradually from small beginnings to a state of more or less perfection.

Medicine and pharmacy are no exceptions to this rule. We find them existing, after a sort, away back in very remote ages of the world's history, no doubt from the very infancy of the race. Man, from his very nature, physically, was created subject to disease and death. The commonly received notion that the eating of the fatal apple by our great progenitor, Adam, first introduced disease and death is, I think, very erroneous. The remedies used to alleviate human suffering in remote ages were necessarily few and simple, and medicine and pharmacy were both in the hands of the same person, most generally the priest. They were, in fact, looked upon as a part of religion, and as the materia medica was very brief, it was supplemented by prayers and incantations and sorcery, or witchcraft. I am sorry to have to say, too, that such modes of practice have not become altogether obsolete in the world at the present day.

Prescription writing seems to have been practiced at a very early day. Thousands of them have been exhumed from the ruins of Babylon, Nineveh, Persepolis, and other Asiatic cities. They were written upon baked clay tablets. Many of them are medical prescriptions conjoined with magical practices such as the incantations and exorcisms. repeated over the sick. Some contain directions for compounding magical drinks which would destroy the evil spirits by which the particular disease was caused. No doubt these drinks were merely

* Read before the Hardin County Medical Society.

antiseptics or germicides intended to destroy the microbes which were then called evil spirits. I have a fac-simile of a prescription four thousand years old, and said to be the oldest prescription extant. The original is in the British Museum. It is written in cuneiform characters, and although the language in which it is written has been dead for thousands of years, it is about as easy to read as a great many prescriptions which come into the hands of every druggist at the present day.

Both medicine and pharmacy continued in the hands of the same individual, who, as I have said, was generally the priest, until a comparatively recent time. Pharmacists finally in the reign of James the First obtained a charter for themselves apart from the practitioners of medicine, and although their charter included the grocers, the medical profession are in no position to sneer when it is remembered that at the same time barbers were the only recognized surgeons. Both pharmacy and surgery seem to have been at a discount long after they were divorced from the medical profession, and both had a long struggle before they were recognized as professions equally as honorable and as deserving as medicine. Indeed, surgery seems to have out-stripped medicine at the present day, for while formerly the most learned and ambitious practiced medicine, the tendency now is to ignore medicine as tame and commonplace, and to rush into surgery. The constant dream of every ambitious young doctor now is to become a great surgeon. The knife is resorted to in every case in which its use can possibly be justified, and I am afraid in a great many where it could not be justified.

The rapid strides made in the sciences of medicine and surgery as a result of a general revival of learning and original research made it absolutely impossible for physicians and surgeons to compound their remedies, now indefinitely multiplied in numbers, and make them available at the bedside. This work was necessarily entrusted to the pharmacists, and they have nobly responded to the trust. They have established colleges and training schools of their own in every civilized country where the science of pharmacy is taught as a profession, and scientific pharmacists are trained for their work. They have prosecuted original research until to-day scientific pharmacy stands fully abreast with the science of medicine, and physicians are under many obligations to scientific pharmacy for much of their success in the practice of the healing art. But the pharmacist is not the rival of the physician; he is an ally. It is in this capacity that the pharmacist finds his true place,

and the two their true relationship each to the other. Each is a true helpmeet to the other, working hand in hand, each in his own proper sphere; they each fill a place and work out a destiny equally honorable and equally useful. Neither can work out his highest destiny without the other, for neither can put his talents to the highest and best use without the other. The motto of our beloved Commonwealth was never more forcibly illustrated-"United they stand, divided they fall."

Since, then, the pharmacist and the physician stand in this close relationship the one to the other, there are certain duties which they owe the one to the other and which they should conscientiously discharge. The pharmacist owes it to the physician that he educate himself well in his profession, so that he will be able to compound the prescriptions of the physician in a scientific manner that the patient may derive the full therapeutic effects of the medicines prescribed for him. Ignorance is inexcusable anywhere; behind the prescription counter it is criminal. The preparation of his remedies is always a matter of grave moment to the physician, for what avails his skill if it is all to be neutralized by poorly prepared remedies? Too true it is perhaps that ignorance is sometimes found behind the prescription counter, and also too true that it is sometimes found at the bedside, as the prescriptions which sometimes emanate from thence too plainly show; not professional ignorance alone, but the King's English is sometimes treated in a very barbarous manner. The three R's are to some of them still among the mysteries. Gentlemen, whether we be physicians or pharmacists, let us act upon the last words of John Wesley to his followers, "Wherever you go, preach a crusade against ignorance."

It is the duty of the pharmacist also to keep himself well supplied with the remedies usually prescribed by physicians, and also the newer remedies, that the physician may have opportunity to test their value and avail himself of their virtues if found beneficial. On the other hand, the physician should not be too exacting in this matter. It is usually the case that one physician will want the article as made by a certain firm, another will want the same article bearing the label of a different firm, and so on. They should remember that to keep a stock of every manufacturer's make of pharmaceutical remedies would entail an expense which but few pharmacists could afford; but should they be able to do so, it would be entirely unnecessary. The article as made by any first-class manufacturer differs but little from that made by any other first-class house, and the physician, if called upon to state wherein the