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Incompatibility of Medicines.-Simplicity in prescribing will do much toward avoiding the dangers of incompatibility of medicines. When possible remedies should be prescribed singly. It is better to prescribe in this way, and when more than one remedy is needed give the medicines in alternation. When combinations are necessary they should consist of as few agents as possible, and a definite indication for each remedy should always be apparent.
The following rules have proven to be of value as a means of refreshing the memory:
Never use strong mineral acids in combination with other agents, unless you know exactly what reaction will ensue. They decompose salts of the weaker acids and form ethers with Alcohol.
Never combine Free Acids with Hydrates or Carbonates.
The following more or less insoluble salts are formed whenever the materials of which they are composed are brought together in solutions: the Hydrates, Carbonates, Phosphates, Borates, Arseniates and Tannates of most earthy and heavy metals and alkaloids, and the metallic Sulphides; the Sulphates of Calcium, of Lead, and of the subsalts of Mercury; the Chlorides, Iodides, and Bromides of Bismuth, Silver, Lead, and subsalts of Mercury; the Iodides of Quinine, Morphine and most alkaloids.
Alkalies precipitate the alkaloids and the soluble non-alkaline metallic salts, and (as also metallic Hydrates and Carbonates) neutralize free acids.
Silver Nitrate, Lead Acetate, Corrosive Sublimate, and Potassium Iodide should, in almost all cases, be prescribed alone. The first with Creosote forms an explosive compound.
Aconite should never be given in any vehicle except water.
Silver Nitrate and Lead Acetate and Subacetate are incompatible with almost everything, but they may be combined with Opium. The Subacetate of Lead with Opium forms an insoluble compound, but the compound is active as a lotion.
Tannic Acid and substances containing it are incompatible with Albumen and Gelatin. Tannic Acid, Iodine, and the soluble Iodides are incompatible with the Alkaloids and substances containing them, and with most soluble metallic salts. Vegetable infusions are generally incompatible with metallic Salts.
Glucosides should not be prescribed with free acids.
Potassic Iodide with Potassic Chlorate, Hydrocyanic Acid or Potassium Cyanide with Metallic Hydrates, Carbonates, Subnitrates or Sub-Chlorides, as Bismuth Carbonate or Nitrate, or Calomel, all form dangerously poisonous compounds.
Explosions result from the combination of powerful oxidizers with readily oxidizable substances, as Potassium Chlorate or Potassium Permanganate with Tannin, Sugar, Sulphur, Sulphides, Vegetable Powders, Glycerine, Alcohol, Tinctures or Ether. The Chlorate of Potash must never be associated with any organic substances; it is decomposed easily by a slight elevation of temperature, giving off its Oxygen to the organic matter, which is made up of Carbon, Hydrogen, Oxygen, and sometimes Nitrogen, and forms products of oxidation, with a setting free of such an amount of heat that the mixture may be hurled, together with the vessel that contains it, in the face of the person who is so thoughtless or ignorant as to attempt the preparation of so dangerous a combination. Not only does the Chlorate of Potash give explosive mixtures with organic substances, but it has the same effect when combined with the Hypophosphites of Lime, Nitrates, and the Salts of Iron.
Every precaution expressed about the Chlorate of Potash is equally applicable to the Permanganate of Potash. The association of Iodine with a liquid containing large quantities of Ammonia will result in the formation of an explosive mixture. Iodine combined with the yellow Oxide of Mercury and Vaseline might serve as an eye salve if the man attempting its preparation was not blown up before completing the labor. Violent explosions have resulted from mixing Iodine with essences. Chromic acid is such an energetic oxidizer that it should only be used in crystals or dissolved in water. Bromine should never be combined with either Alcohol or Oil, and Nitric Acid should not be prescribed with organic compounds. The facts here given show in a measure the importance of handling the most common drugs with the utmost caution.
Diseases.-A disease is usually composed of several distinct abnormal conditions that frequently occur together. The arranging of these frequently occurring phenomena under a general head and giving them a name more or less indicative of their nature constitutes a convenient arrangement, as it is desirable to have a name for each of these combinations of pathological conditions. It materially aids in the classification of diseases, and also serves many other wise purposes.
Diagnosis.When called to a patient, the physician should first carefully and correctly diagnose the case in accordance with the nosology now accepted by all scientific physicians. He should do this for the benefit of medical science, and also for his own personal benefit. A single mistake in this form of diagnosis may prove extremely detrimental to the reputation of the physician making it. Such diagnosis, however, should have but little influence in the treatment of the patient. This should be governed entirely by the symptoms or disease expressions. Before a prescription is made the case should be thoroughly examined as to its compound parts. In this latter examination it has been found wise, in diseases liable to affect different parts of the body, to commence the examination by considering the symptoms—disease expressions—manifested in and about the head; then those affecting the throat, the lungs, the pleuræ, the heart, the stomach, the liver, the spleen, the intestines, and so on downward to all parts liable to be involved.
Physicians who carefully examine their cases in this systematic manner soon acquire a habit of great thoughtfulness and keen observation, and seldom fail to quickly comprehend the true import of every disease expression in any given case coming under their care.
The case being carefully and fully analyzed in the foregoing manner, the basic symptoms should then be clearly decided upon before any medicines are prescribed, as these are the symptoms upon which all rational treatment should be based. In a given case of any disease, as diseases are classified and named, there are usually manifested many symptoms of the abnormal condition, but a remedy is not needed for eaeh of them. Only the basic symptoms should be prescribed for, and when these are removed the symptoms depending upon the abnormal condition which produced the basic symptoms will also disappear. As an illustration, we will refer to the prominent symptoms of a given case of simple fever, and say that in the case we have selected the pulse is small and frequent, the temperature increased, the pupils dilated, the patient dull and drowsy, the skin dry and hot, the urine highcolored and scanty, and that there are many other symptoms of an unpleasant nature. A thoughtful review of these symptoms makes it apparent that the small and frequent pulse, increased temperature and dilated pupils are the disease expressions which demand attention; or, in other words, that they are the basic symptoms. They call for Aconite and Belladonna in small doses. In this instance Aconite and Belladonna will lower the temperature, lessen the frequency of the pulse, remove the abnormal condition of the brain, and in this way cause all of the dependent unpleasant conditions to disappear.
In the case of simple fever here selected for illustration Aconite and Belladonna have proved curative, and therefore the only needed remedies. From this fact, however, it must not be thought that these remedies will cure all cases of simple fever, for in many cases of this disease they are contra-indicated. In the treatment of diseased conditions the physician should always be guided in his selection of remedies by the symptoms—disease expressionsand if a remedy is clearly indicated by a symptom, or group of symptoms, that remedy should be employed, regardless of the name of the disease being treated.
[TO BE CONTINUED.]
CIGARS AND CIGARETTES-A COUNTERBLAST.
BY W. F. CURRYER, M.D., INDIANAPOLIS, IND. At the meeting of the National Medical Association, held at Waukesha, Wisconsin, in June, 1895, the following resolution submitted by the president was discussed at some length by the persons whom he had selected :
"Resolved, That a law forbidding the sale of cigars and cigarettes to minors should be enacted and enforced.”
The tobacco-habit may appropriately and with strict justice be described as a relic of barbarism. It was copied and adopted from the vicious and ignorant savages who lived in the West Indies, where they were discovered by Columbus. The result has been that, while the European powers by treachery and force
of arms subjected the tribes and peoples of the western hemisphere, these in their turn have conquered and debased the populations of the eastern continent by tobacco.
So universal and so popular has the use of this article become, that to take any decided stand against it, and proclaim the facts in regard to it, requires an unusual degree of moral courage. It is easier by far to keep silent and float quietly with the current, even of a river execrably filthy. There are very many now who will freely acknowledge everything that can be said respecting the pernicious effect of this banerul drug, yet they will inculcate a far different doctrine by their example. They will affirm unequivocally that the use of tobacco is disgusting and degrading to the moral nature as well as injurious to bodily health ; and yet, in the presence of the very audience where they have borne this sweeping testimony, will continue the practice--chew and spit, smoke and puff, snuff and sneeze-as if it were perfectly proper and becoming. It is a grave problem how they can under such a state of facts reasonably expect to convince others, and in particular the law-makers, that they are themselves sincere or that their declarations are true.
There is no narcotic of ancient or modern times which has been so extensively used ; and no drug about which there exists so great diversity of feeling and opinion, both among the people generally and the members of the medical profession. While the use of alcoholic beverages is very generally looked upon as debasing and often exposes the individual to social ostracism, most persons will condone the offense of tobacco. Many individuals imagine that they possess some pent-up nervous energy, a deranged mental equilibrium, which tobacco serves as a safety-valve to benumb or goad into a normal condition. In this way it has gained some degree of toleration and even of public approval. The habit must be regarded as one of the greatest evils of the age. I do not except alcohol even with its long, murderous record. The use of tobacco is worse than alcohol, because it is more general, because its moral status is considered as higher, and be cause its pernicious results are more gradual and less obvious to view.
Legislation in Behalf of Minors.—The destructive effects of