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CLINICAL AND CRITICAL CONTRIBUTIONS TO OBSTETRIC SCIENCE AND PRACTICE.
613
generally found in feeble, ill-fed people, and such irritation of the bladder as to giverise to a frequent particularly in children, not, however, of a strumous diathesis. desire to pass urine. During the last year her general health It may be not inappropriately termed the "starvation ulcer." has been suffering greatly; she has complained of loss of appeAgcÜn, we find cases that are in all respects the antithesis of tite, nausea, flatulence, cardialgia, and irregular action of the what I have just described; here the reparative process is bowels. She has lost flesh, suffers from headache and giddi.carried to excess, the conjunctiva is highly injected, the ness. Her feet swell at times; her complexion has become surface of the ulcer instead of being excavated is raised some- sallow; she is easily agitated by the slightest cause; any exerwhat abovethe natural level of the cornea, and one or two tion produces palpitation, shortness of breath, and exhaustion. vessels, carrying red blood, may be distinctly seen passing over All these symptoms havebeen increasing in urgency within the the cornea to the lymph, filling up the ulcer. There is also, last few months. The loss of blood especially has been more in such cases, a considerable amount of infiltrated opacity from profuse, frequently passing in clots, and she can no longer disdeposit between the laminx of the cornea surrounding the tinguish the catamenial periods. The pulse is 90, feeble; there ulcer. There seems, in such cases, to be a false membrane, is marked anaemia. She has undergone various kinds of general organized with red vessels, overlaying the ulcer in the cornea, treatment, but without benefit. No local examination has been and analogous to the membrane found after ulceration of made. cartilage, and supposed, by the late Mr. Aston Key and z, On Dec. 9th I instituted a careful examination. The toucher others, to be the cause of ulceration of this tissue, though now caused great pain; the cervix was somewhat enlarged, low known to be the result. The usual condition, after an ulcer down in the pelvis, smooth and round; the os was open so as is healed, is a dense white opacity, gradually shaded off into to admit the tip of the finger; in the centre was felt a soft the transparent cornea, the centre being the cicatrix of the rolling body, of the size of a large pea; it did not project as far ulcer, and the margin interstitial deposit. The former is as the os. I at once recognised a small polypus. The speculum indelible but capable of diminution by a slow contractile was then used, and the cervix was seen to be highly inflamed; process, the latter is capable of being absorbed. Each stage the internal surface of the os and the cavity of the cervix, as and condition that I have described requires some modification far as it could be exposed by opening the valves of the specuof treatment, which will be dwelt upon in the next lecture. lum, was also intensely inflamed, a copious muco-purulent discharge escaping. The body which had been previously felt rolling under the finger was seen in the middle of the os; it did not project so far as the margin of the os, and might have CLINICAL AND CRITICAL CONTRIBUTIONS TO escaped observation had not a bivalvespeculum been employed. OBSTETRIC SCIENCE AND PRACTICE. The appearance exhibited by the tumour when seen at this time is represented in BY ROBERT BARNES, M.D. Lond., FIG. 1.
This state of things is
MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, PHYSICIAN-ACCOUCHEUR TO THE WESTERN GENERAL DISPENSARY, PHYSICIAN TO THE METROPOLITAS FREE HOSPITAL, LECTURER ON MIDWIFERY, ETC.
I. ON UTERINE POLYPUS; ITS NATURE; EARLY DETECTION AND TREATMENT. THE cases I am about to relate, as the foundation for some more general observations upon the nature and treatment of uterine polypus, belong to a class not perhaps rare in their occurrence, but certainly sometimes escaping recognition, if not altogether, at least until long after the most favourable opportunity for treatment has gone by, and when the health of the patient has been deeply injured. When polypus of the I applied the solid nitrate of silver freely to the os and uterus has attained a large size, and has descended into the cervix, and admitted her into the Metropolitan Free Hospital, vagina, it commonly produces such symptoms as call impera- in order to remove the polypus. On the 16th, an examination was made; the inflammation tively for a local examination. A digital exploration of the vagina, carried up to the os uteri, can scarcely fail in clearing was diminished, but indications of approaching menstruation up the nature of the case. But when. the polypus is still in obliged me to defer the operation. By rest, astringent injecthe early period of its growth, whilst it is still so small as not tions, and salines, the inflammation subsided still more; but on to have emerged from the uterus or the cavity ofthe cervix, the occurrence of menstruation the loss of blood was great, severe local disease and the most serious and the inflammation returned. When the catamenia ceased, although theofmost the constitution may be produced, the cause I again applied the nitrate of silver, and prescribed astringent impairment that entertains this local disease, and continues to exhaust the injections. On the 26th, the inflammation being in my opinion sufficiently powers of nature, may escape detection. One of the cases I am about to relate supplies an illustration of this position, and I removed the polypus by torsion, having first drawn subdued, points to the importance cf instituting a careful examination it gently out of the cavity of the cervix, so as to enable myself of the uterus in every case of local disease attended by symp- to grasp the pedicle firmly. When thus drawn out of the toms which cannot be clearly referred to an intelligible cause. cervix it was found to consist of three lobes, and was very soft The other case not only illustrates the same point in practice and red. The operation was attended by a trifling loss of as the first, but also throws a clear light upon the nature and blood, but some pain. On the second night after the operation origin of one form of uterine polypus. I also propose to offer some hysterical excitement appeared; the pulse was 110; she some observations upon the classification of polypi, founded complained of acute spasmodic pain in the region of the womb, upon a consideration of their structure; to seek to determine with bearing-down; there was a moderate degree of febrile the means of detecting the presence of polypi in the early movement, with sickness; a distressing cough came on. On the following day a small clot came away, and the sympstage of their formation before they have cleared the os uteri; and to discuss briefly the method of treatment. toms were relieved, excepting the pain. Pressure behind the CASE 1.-Catharine B-, aged forty-six, a single woman, pubis seemed-to-cause pain, and she complained of great sorenaturally healthy and robust, applied to me at the Western ness on sitting up. By the use of emollient injections, sedaGeneral Dispensary early in December last. I gathered from tives, with hydrocyanic acid, she got gradually better. her the following history :-She had menstruated easily, and On the 2nd of January, all febrile excitation having subsided, without marked excess or deficiency in quantity, and had as well as symptoms of acate inflammation, I ordered her suffered no serious illness up to the age of forty-four. For the mineral acids and lead inje ;tions. last two years, however, she has suffered greatly from lumbar, On the 9tb, an examination by speculum showed the cervix sacral, and uterine pains, a sense of dragging and bearing- in a more healthy condition; the vivid injection had faded, and down, and pain in the left iliac region, extending down the there was but little discharge from the cavity. On the 26th, I added sme tincture of iron to the mineral thighs. All these pains were greatly aggravated at the periods of menstruation; the flow became more abundant in quantity, acids. She had now recovered tolerable health; her appetite lasting for ten, twelve, and fourteen days, leaving her very was good; she could walkabout without pain; the bearingweak In the intervals between the menstrual periods there down had disappeared; the leucorrhaea was almost gone; she has been a leucorrhcea.1 discharge, copious, sometimes gelatinous, felt strong and well. On examination now the os was found sometimes muco-purulent, and sometimes, especially of late, perfectly natural, and the womb had ri3en to its proper place tinged with blood. There has also been pain on passing stools, in the pelvis. *
614 CASE 2. -W-,single woman, aged thirty-six. This patient under my care at the Western General Dispensary. She had enjoyed good health, and had always menstruated regularly and normally until between two and three years ago. About this time the catamenia began to exhibit a disposition to profuseness not before observed. Soon the flow at the menstrual period passed altogether the bounds of natural menstruation; it lasted for from ten days to a fortnight; blood came away copiously and in clots, and the loss left her so weak that she had barely time to recruit a little strength before she was again exhausted by its recurrence. In the short intervals between the menstrual periods, there has latterly been an increasing leucorrhoeal discharge, and this is sometimes tinged with blood. Since January last the haemorrhage has increased to an alarming extent; there has been scarcely any remission to mark the intervals between the menstrual epochs, so that for the last four weeks she has been obliged to keep her bed. She has never suffered any pain. A fortnight back she came under the care of Mr. Evans, the house-surgeon to the Western General Dispensary. She took quassia and tincture of iron, but this had scarcely any effect in restraining the flooding. When I saw her on the 21st of March the flooding still continued ; the degree of ancemia was extreme; and it was obvious that her life was in imminent danger. No local examination to ascertain the cause of the haemorrhage had ever been made. On examining by the toucher, I at once detected a tumour the size of a large filbert projecting into the vagina, and partly encircled by the os uteri. With the view of arresting the haemorrhage until I could make arrangements to remove the polypus, I prescribed two drachms of oil of turpentine with four ounces of mucilage, and eight of water, ordering a wineglassful to be taken every three hours. She took two doses, and the haemorrhage almost entirely subsided. On the 23rd of March I admitted her into the Metropolitan Free Hospital. Finding, on minute examination, that the tumour arose by a large basis from the margin of the os uteri,
FIRST QUARTERLY METEOROLOGICAL AND CHEMICAL REPORT FOR 1854 ON ST. THOMAS’S HOSPITAL.
came
BY ROBERT DUNDAS
REPORT
Fig. 2 represents the appearance and attachment of the tumour. I determined to apply a ligature by the aid of Gooch’s instrument. I did this through the speculum, a method I always prefer whenever the polypus is not so large as to render its use inconvenient. I had presently reason to congratulate myself that I had done so in this case. On tightening the ligature, it
through the neck of the tumour. When this was removed, opening the os uteri, which was remarkably flaccid, so as to obtain a good view into the cavity of the cervix, I observed another polypus springing from the inside of the posterior lip, so minute in size that it would almost certainly have escaped detection by the finger. Yet, small as it was, it would in all probability have kept up the flooding, and rendered nugatory the removal of the larger polypus. I broke up this polypus with the speculum-forceps. There was no secondary disease of the os or cervix. For three days subsequently to the operation there was no haemorrhage. On the fourth day the catamenia appeared, and lasted for four days, the quantity lost not being greater than natural. A slight return took place on the 2nd of April, but soon ceased. She was ordered ammoniocitrate of iron and nourishing diet. On the 5th she had gained strength, and, being anxious to go home, was discharged. On
cut on
os and cervix presented a natural appearance; from which the polypus had been removed was perfectly healed. I think it useful to remark upon this case, that, from the! seat of the polypus upon the edge of the os uteri, an examination by the finger or speculum at the very earliest period could not have failed to have disclosed the cause of the flooding, and to have saved the patient two years of exhausting illness.
examination, the
spot
.
Devonshire-square, June,
1854.
THOMAS’S
HOSPITAL COLLEGE.
1 the present attempt to supply a statement of the condition of the climate of the more densely populated part of the metropolis, due attention has been given to the accuracy of the instruments. The barometer and thermometers were constructed by Barrow, and have been compared by Mr. Glaisher with the standards at Greenwich; allowance has therefore been made for the index errors; the proper corrections have also been applied to the barometer for temperature and capillarity, and ’, to the thermometers for diurnal range. The present report includes the first quarter of the year, the mean barometric pressure of dry air during that period (after correction) being 30 ’186, and the mean pressure of the vapour being ’237. The mean temperature of the quarter was 40°’5. The highest reading of the thermometer was 610’5; the lowest 15°’5, on the morning of the 3rd of January. So far as the records of the hospital are concerned, the weather does not appear to have been characterized by any peculiar maladies. I am indebted for valuable aid in constructing the accompanying tables, to my assistant, Mr. David Walker.
FIG. 2,
the
THOMSON, M.D., F.R.S. L. & E.,
PROFESSOR OF CHEMISTRY IN ST.
OX
DRUGS
ST. THOllfAS’S HOSPITAL. trade is at present anomalous. It
SUPPLIED TO
The condition of the drug appears to be undergoing a decided improvement. But it is only yet emerging, and has not by any means escaped from the trammels of the grocery business. The time is, however, fast approaching when even the grocer will require the aid of chemistry, and when the detailed composition of many of the articles which he sells must accompany the sample. The period, however, is now present when this accompaniment should never be neglected in the case of the druggists’ sales. It is indispensable, if the druggist desires to keep himself on a level with the manure merchant; and it is absolutely required, in order that the prescriber may thoroughly depend on the dose which is administered. It is to the neglect of the appliances of chemical analysis in this curative department of the profession that we must attribute the influence of many species of empiricism; for the reasoning of the infinitesimalist, founded on the large amount of foreign matters present in so many of our drugs, appears to be after this fashion. If substances be mixed with curative agents, in large or small proportions, without impairing their efficacy, why may not the adulteration be pushed so far as to render the amount of the genuine article infinitesimal-that is, undemonstrable (or non-existent), since we can have no physical evidence of a globuiist dose? Physical, in the arch empiricism of Hahnemann, is replaced by moral science, which, even if admissible as the sole basis of demonstration in a purely material question, would require the capability of the most searching investigation, and the quality of the most unchallangeable integrity. But such an arrangement would be a retrogression to the alchemistical era. And it is this system which has too long pervaded the commercial accompaniments of medical science. It is a matter of notoriety that the standards, as fixed by the Pharmacopoeia, are very frequently departed from; and in such cases it is but just that the buyer and prescriber should be advertised of the amount of difference and the nature of the body which, having been added or not removed, interferes with the genuine and honest character of the transaction. In the following notes respecting some of the drugs and chemicals lately supplied to St. Thomas’s Hospital, it will be at once obvious that the prescriber may in some cases be able to account for the absence of any effect in some of his attempts to cure disease. 1. Acid Hydl’ocyanicum ZKM
generally found in feeble, ill-fed people, and such irritation of the bladder as to giverise to a frequent particularly in children, not, however, of a strumous diathesis. desire to pass urine. During the last year her general health It may be not inappropriately termed the "starvation ulcer." has been suffering greatly; she has complained of loss of appeAgcÜn, we find cases that are in all respects the antithesis of tite, nausea, flatulence, cardialgia, and irregular action of the what I have just described; here the reparative process is bowels. She has lost flesh, suffers from headache and giddi.carried to excess, the conjunctiva is highly injected, the ness. Her feet swell at times; her complexion has become surface of the ulcer instead of being excavated is raised some- sallow; she is easily agitated by the slightest cause; any exerwhat abovethe natural level of the cornea, and one or two tion produces palpitation, shortness of breath, and exhaustion. vessels, carrying red blood, may be distinctly seen passing over All these symptoms havebeen increasing in urgency within the the cornea to the lymph, filling up the ulcer. There is also, last few months. The loss of blood especially has been more in such cases, a considerable amount of infiltrated opacity from profuse, frequently passing in clots, and she can no longer disdeposit between the laminx of the cornea surrounding the tinguish the catamenial periods. The pulse is 90, feeble; there ulcer. There seems, in such cases, to be a false membrane, is marked anaemia. She has undergone various kinds of general organized with red vessels, overlaying the ulcer in the cornea, treatment, but without benefit. No local examination has been and analogous to the membrane found after ulceration of made. cartilage, and supposed, by the late Mr. Aston Key and z, On Dec. 9th I instituted a careful examination. The toucher others, to be the cause of ulceration of this tissue, though now caused great pain; the cervix was somewhat enlarged, low known to be the result. The usual condition, after an ulcer down in the pelvis, smooth and round; the os was open so as is healed, is a dense white opacity, gradually shaded off into to admit the tip of the finger; in the centre was felt a soft the transparent cornea, the centre being the cicatrix of the rolling body, of the size of a large pea; it did not project as far ulcer, and the margin interstitial deposit. The former is as the os. I at once recognised a small polypus. The speculum indelible but capable of diminution by a slow contractile was then used, and the cervix was seen to be highly inflamed; process, the latter is capable of being absorbed. Each stage the internal surface of the os and the cavity of the cervix, as and condition that I have described requires some modification far as it could be exposed by opening the valves of the specuof treatment, which will be dwelt upon in the next lecture. lum, was also intensely inflamed, a copious muco-purulent discharge escaping. The body which had been previously felt rolling under the finger was seen in the middle of the os; it did not project so far as the margin of the os, and might have CLINICAL AND CRITICAL CONTRIBUTIONS TO escaped observation had not a bivalvespeculum been employed. OBSTETRIC SCIENCE AND PRACTICE. The appearance exhibited by the tumour when seen at this time is represented in BY ROBERT BARNES, M.D. Lond., FIG. 1.
This state of things is
MEMBER OF THE ROYAL COLLEGE OF PHYSICIANS, PHYSICIAN-ACCOUCHEUR TO THE WESTERN GENERAL DISPENSARY, PHYSICIAN TO THE METROPOLITAS FREE HOSPITAL, LECTURER ON MIDWIFERY, ETC.
I. ON UTERINE POLYPUS; ITS NATURE; EARLY DETECTION AND TREATMENT. THE cases I am about to relate, as the foundation for some more general observations upon the nature and treatment of uterine polypus, belong to a class not perhaps rare in their occurrence, but certainly sometimes escaping recognition, if not altogether, at least until long after the most favourable opportunity for treatment has gone by, and when the health of the patient has been deeply injured. When polypus of the I applied the solid nitrate of silver freely to the os and uterus has attained a large size, and has descended into the cervix, and admitted her into the Metropolitan Free Hospital, vagina, it commonly produces such symptoms as call impera- in order to remove the polypus. On the 16th, an examination was made; the inflammation tively for a local examination. A digital exploration of the vagina, carried up to the os uteri, can scarcely fail in clearing was diminished, but indications of approaching menstruation up the nature of the case. But when. the polypus is still in obliged me to defer the operation. By rest, astringent injecthe early period of its growth, whilst it is still so small as not tions, and salines, the inflammation subsided still more; but on to have emerged from the uterus or the cavity ofthe cervix, the occurrence of menstruation the loss of blood was great, severe local disease and the most serious and the inflammation returned. When the catamenia ceased, although theofmost the constitution may be produced, the cause I again applied the nitrate of silver, and prescribed astringent impairment that entertains this local disease, and continues to exhaust the injections. On the 26th, the inflammation being in my opinion sufficiently powers of nature, may escape detection. One of the cases I am about to relate supplies an illustration of this position, and I removed the polypus by torsion, having first drawn subdued, points to the importance cf instituting a careful examination it gently out of the cavity of the cervix, so as to enable myself of the uterus in every case of local disease attended by symp- to grasp the pedicle firmly. When thus drawn out of the toms which cannot be clearly referred to an intelligible cause. cervix it was found to consist of three lobes, and was very soft The other case not only illustrates the same point in practice and red. The operation was attended by a trifling loss of as the first, but also throws a clear light upon the nature and blood, but some pain. On the second night after the operation origin of one form of uterine polypus. I also propose to offer some hysterical excitement appeared; the pulse was 110; she some observations upon the classification of polypi, founded complained of acute spasmodic pain in the region of the womb, upon a consideration of their structure; to seek to determine with bearing-down; there was a moderate degree of febrile the means of detecting the presence of polypi in the early movement, with sickness; a distressing cough came on. On the following day a small clot came away, and the sympstage of their formation before they have cleared the os uteri; and to discuss briefly the method of treatment. toms were relieved, excepting the pain. Pressure behind the CASE 1.-Catharine B-, aged forty-six, a single woman, pubis seemed-to-cause pain, and she complained of great sorenaturally healthy and robust, applied to me at the Western ness on sitting up. By the use of emollient injections, sedaGeneral Dispensary early in December last. I gathered from tives, with hydrocyanic acid, she got gradually better. her the following history :-She had menstruated easily, and On the 2nd of January, all febrile excitation having subsided, without marked excess or deficiency in quantity, and had as well as symptoms of acate inflammation, I ordered her suffered no serious illness up to the age of forty-four. For the mineral acids and lead inje ;tions. last two years, however, she has suffered greatly from lumbar, On the 9tb, an examination by speculum showed the cervix sacral, and uterine pains, a sense of dragging and bearing- in a more healthy condition; the vivid injection had faded, and down, and pain in the left iliac region, extending down the there was but little discharge from the cavity. On the 26th, I added sme tincture of iron to the mineral thighs. All these pains were greatly aggravated at the periods of menstruation; the flow became more abundant in quantity, acids. She had now recovered tolerable health; her appetite lasting for ten, twelve, and fourteen days, leaving her very was good; she could walkabout without pain; the bearingweak In the intervals between the menstrual periods there down had disappeared; the leucorrhaea was almost gone; she has been a leucorrhcea.1 discharge, copious, sometimes gelatinous, felt strong and well. On examination now the os was found sometimes muco-purulent, and sometimes, especially of late, perfectly natural, and the womb had ri3en to its proper place tinged with blood. There has also been pain on passing stools, in the pelvis. *
614 CASE 2. -W-,single woman, aged thirty-six. This patient under my care at the Western General Dispensary. She had enjoyed good health, and had always menstruated regularly and normally until between two and three years ago. About this time the catamenia began to exhibit a disposition to profuseness not before observed. Soon the flow at the menstrual period passed altogether the bounds of natural menstruation; it lasted for from ten days to a fortnight; blood came away copiously and in clots, and the loss left her so weak that she had barely time to recruit a little strength before she was again exhausted by its recurrence. In the short intervals between the menstrual periods, there has latterly been an increasing leucorrhoeal discharge, and this is sometimes tinged with blood. Since January last the haemorrhage has increased to an alarming extent; there has been scarcely any remission to mark the intervals between the menstrual epochs, so that for the last four weeks she has been obliged to keep her bed. She has never suffered any pain. A fortnight back she came under the care of Mr. Evans, the house-surgeon to the Western General Dispensary. She took quassia and tincture of iron, but this had scarcely any effect in restraining the flooding. When I saw her on the 21st of March the flooding still continued ; the degree of ancemia was extreme; and it was obvious that her life was in imminent danger. No local examination to ascertain the cause of the haemorrhage had ever been made. On examining by the toucher, I at once detected a tumour the size of a large filbert projecting into the vagina, and partly encircled by the os uteri. With the view of arresting the haemorrhage until I could make arrangements to remove the polypus, I prescribed two drachms of oil of turpentine with four ounces of mucilage, and eight of water, ordering a wineglassful to be taken every three hours. She took two doses, and the haemorrhage almost entirely subsided. On the 23rd of March I admitted her into the Metropolitan Free Hospital. Finding, on minute examination, that the tumour arose by a large basis from the margin of the os uteri,
FIRST QUARTERLY METEOROLOGICAL AND CHEMICAL REPORT FOR 1854 ON ST. THOMAS’S HOSPITAL.
came
BY ROBERT DUNDAS
REPORT
Fig. 2 represents the appearance and attachment of the tumour. I determined to apply a ligature by the aid of Gooch’s instrument. I did this through the speculum, a method I always prefer whenever the polypus is not so large as to render its use inconvenient. I had presently reason to congratulate myself that I had done so in this case. On tightening the ligature, it
through the neck of the tumour. When this was removed, opening the os uteri, which was remarkably flaccid, so as to obtain a good view into the cavity of the cervix, I observed another polypus springing from the inside of the posterior lip, so minute in size that it would almost certainly have escaped detection by the finger. Yet, small as it was, it would in all probability have kept up the flooding, and rendered nugatory the removal of the larger polypus. I broke up this polypus with the speculum-forceps. There was no secondary disease of the os or cervix. For three days subsequently to the operation there was no haemorrhage. On the fourth day the catamenia appeared, and lasted for four days, the quantity lost not being greater than natural. A slight return took place on the 2nd of April, but soon ceased. She was ordered ammoniocitrate of iron and nourishing diet. On the 5th she had gained strength, and, being anxious to go home, was discharged. On
cut on
os and cervix presented a natural appearance; from which the polypus had been removed was perfectly healed. I think it useful to remark upon this case, that, from the! seat of the polypus upon the edge of the os uteri, an examination by the finger or speculum at the very earliest period could not have failed to have disclosed the cause of the flooding, and to have saved the patient two years of exhausting illness.
examination, the
spot
.
Devonshire-square, June,
1854.
THOMAS’S
HOSPITAL COLLEGE.
1 the present attempt to supply a statement of the condition of the climate of the more densely populated part of the metropolis, due attention has been given to the accuracy of the instruments. The barometer and thermometers were constructed by Barrow, and have been compared by Mr. Glaisher with the standards at Greenwich; allowance has therefore been made for the index errors; the proper corrections have also been applied to the barometer for temperature and capillarity, and ’, to the thermometers for diurnal range. The present report includes the first quarter of the year, the mean barometric pressure of dry air during that period (after correction) being 30 ’186, and the mean pressure of the vapour being ’237. The mean temperature of the quarter was 40°’5. The highest reading of the thermometer was 610’5; the lowest 15°’5, on the morning of the 3rd of January. So far as the records of the hospital are concerned, the weather does not appear to have been characterized by any peculiar maladies. I am indebted for valuable aid in constructing the accompanying tables, to my assistant, Mr. David Walker.
FIG. 2,
the
THOMSON, M.D., F.R.S. L. & E.,
PROFESSOR OF CHEMISTRY IN ST.
OX
DRUGS
ST. THOllfAS’S HOSPITAL. trade is at present anomalous. It
SUPPLIED TO
The condition of the drug appears to be undergoing a decided improvement. But it is only yet emerging, and has not by any means escaped from the trammels of the grocery business. The time is, however, fast approaching when even the grocer will require the aid of chemistry, and when the detailed composition of many of the articles which he sells must accompany the sample. The period, however, is now present when this accompaniment should never be neglected in the case of the druggists’ sales. It is indispensable, if the druggist desires to keep himself on a level with the manure merchant; and it is absolutely required, in order that the prescriber may thoroughly depend on the dose which is administered. It is to the neglect of the appliances of chemical analysis in this curative department of the profession that we must attribute the influence of many species of empiricism; for the reasoning of the infinitesimalist, founded on the large amount of foreign matters present in so many of our drugs, appears to be after this fashion. If substances be mixed with curative agents, in large or small proportions, without impairing their efficacy, why may not the adulteration be pushed so far as to render the amount of the genuine article infinitesimal-that is, undemonstrable (or non-existent), since we can have no physical evidence of a globuiist dose? Physical, in the arch empiricism of Hahnemann, is replaced by moral science, which, even if admissible as the sole basis of demonstration in a purely material question, would require the capability of the most searching investigation, and the quality of the most unchallangeable integrity. But such an arrangement would be a retrogression to the alchemistical era. And it is this system which has too long pervaded the commercial accompaniments of medical science. It is a matter of notoriety that the standards, as fixed by the Pharmacopoeia, are very frequently departed from; and in such cases it is but just that the buyer and prescriber should be advertised of the amount of difference and the nature of the body which, having been added or not removed, interferes with the genuine and honest character of the transaction. In the following notes respecting some of the drugs and chemicals lately supplied to St. Thomas’s Hospital, it will be at once obvious that the prescriber may in some cases be able to account for the absence of any effect in some of his attempts to cure disease. 1. Acid Hydl’ocyanicum ZKM