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LIFE-TABLES.
932 way
Annotations. "Ne quid nimis."
LIFE-TABLES. IN the fifth annual report of the Registrar-General, published 83 years ago, there is a remarkable panegyric on life-tables. The report is, indeed, signed " George Graham," but a belief that-" By these comparisons (i.e., of National Life-Tables) a noble national emulation might be excited : and rival nations would read of sickness diminished, deformity banished, life saved-of victories over death and the grave-with as much enthusiasm as of victories over each other’s armies in the field ; " argues a robuster faith in the saving virtues of vital statistics than anybody but William Farr has ever possessed. Farr, life-table as a indeed, was the pioneer in using the " biometer, holding it to be as indispensable in sanitary inquiries as the barometer or thermometer and other instruments in physical research." No doubt there was exaggeration in this, but the experience of three generations has proved that, for some important purposes, the life-table is a statistical instrument of medical value. A practical difficulty was that, to the ordinary medical man, the methods of construction, even those of Farr, who knew how little algebra most medical men knew, were more than a trifle perplexing. To Sir Arthur Newsholme belongs the credit of having pointed out to medical men that the (to them) most perplexing stage of the process of construction could be carried out without any resort to algebra. Newsholme and Stevenson proved that a graphical method was quite satisfactory, but there is reason to suppose that students still believe that graduation by formula is, in some mysterious way, more scientific than graduation by the graphic method. On that account we are glad to publish a further illustration, from the pen of Miss H. M. Woods, of the London School of Hygiene and Tropical Medicine, of the simplicity and success of the process. It is true that the use of this method does not dispense the worker from some hours of arithmetical calculation ; but the virtue of it is that a medical man, after a very little practice, can confidently perform all the operations intelligently and easily without having to carry in his head, or in a notebook, formulae the derivation of which he does not understand. There are enough inherent difficulties in statistical work for it to be very desirable that unessential oostacles should be removed. We hope that by recalling the attention of readers to Sir Arthur Newshoime’s work, Miss Woods may induce others besides professed students of public health to use Farr’s beloved instrument.
DANGEROUS DRUGS ACTS REQUIREMENTS. THE Home Office has issued a third edition of its memorandum on the duties of doctors and dentists in respect of the Dangerous Drugs Acts and the Regulations made thereunder. It is probably common knowledge by this time that any duly qualified medical practitioner and any registered dentist is authorised " so far as is necessary for the practice of his profession " to be in possession of dangerous
and to supply them to his patients by personal administration or by administration under his direct personal supervision and in his presence. The doctor -but not the dentist-may also dispense dangerous drugs for his patient’s use and may be in possession of the raw materials for use in the compounding of medicines though he may not supply the raw materials to a patient. Probably the two most important aspects of the law are those which concern prescriptions and the keeping of records. There are some 17 specified drugs which, though they come within the Dangerous Drugs Acts, are specially exempted by the regulations and are purchaseable in Great Britain in the same
drugs
Acts.
"
"
ordinary poisons under the Pharmacy Apart from these specified drugs (which are
as
listed in the Third Schedule of the Consolidated Regulations issued last December) any other dangerous
drug (if prescribed in sufficient strength to bring it within the Dangerous Drugs Acts) involves the following duties on the part of the prescriber. The prescribing doctor or dentist must write his prescription, date it, sign it with his usual signature and-except in the case of health insurance prescriptions issued on the official form-must add his address ; he must also give the patient’s name and address and must specify the total amount of morphine, cocaine, or other druer to be supplied. The only exception to this last requirement is that, where a preparation is prescribed which is contained in the British Pharmacopoeia, the British Pharmaceutical Codex, or the Minister of Health’s health insurance drug tariff, only the total amount of that preparation need be specified. The Home Office, perhaps not unreasonably, explains that chemists are not allowed to dispense a prescription which does not comply with the foregoing require ments, and the memorandum hints that irregularities do occur, and that doctors must not take offence if chemists ask them to correct an irregularity. A chemist cannot dispense a prescription containing a dangerous drug unless (a) he knows the prescriber’s signature and has no doubt of the genuineness of the prescription, or (b) he has taken reasonably sufficient steps to satisfy himself that the prescription is genuine. As the Home Office points out, this situation can be uncomfortable for the chemist, who may find himself obliged either to delay the prescription (with the prospect of offending the prescribing practitioner) or to break the law. As to the requirement of recordkeeping, the memorandum draws attention to the obligation upon a medical practitioner to keep a record of all supplies of dangerous drugs to patients except only in cases where the drug is administered by the practitioner himself or under his direct super* vision and in his presence. The memorandum also reprints in an appendix paragraphs 50 to 60 of the report of the Departmental Committee (presided over by Sir Humphry Rolleston) on Morphine and Heroin Addiction. The passages are those which deal with the precautions necessary in administering these two drugs on the one hand in treating addicts and on the other hand in ordinary medical practice ; but, indeed, the whole of the Departmental Committee’s report (published in 1926 by H.M. Stationery Office at the price of Is.) is worth study. The special occasion of re-issuing the Home Office memorandum is the embodiment therein of certain changes in the law due to the operation of the Geneva Convention of 1925-changes which the Dangerous Drugs Act of 1925 was designed to implement. One result is an alteration of the list of drugs within the Dangerous Drugs Acts. The Geneva Convention amplifies the International Opium Convention signed at The Hague in 1912. Among other provisions it creates machinery (through the agency of the League of Nations) for varying the list of narcotics in Chapter III. of the Convention, a list which corresponds with that of the drugs to which Part III. of our Dangerous Drugs Act of 1920 applies. The new machinery will enable the exclusion of any narcotic which is found not to give rise to the drug habit. Part III. of our 1920 Act named morphine, cocaine, ecgonine, diamorphine (or heroin) and their respective salts, and also medicinal opium. Our 1925 Act has a fresh definition of ecgonine and medicinal opium; it explains that cocaine includes synthetic cocaine;;. and it adds to the list of narcotics in Part III. " any extract or tincture of Indian hemp." Subsequent regulations, however, show that medicinal preparations containing extract or tincture of Indian hemp as one of their ingredients do not come within the Dangerous Drugs Regulations. It remains to add that an Order in Council last August applied Part III. of our 1920 Act to benzoyl-morphine, dihydrooxycodeinone, dihydrocodeinone, and their respective salts. Subsequent regulations issued last
Annotations. "Ne quid nimis."
LIFE-TABLES. IN the fifth annual report of the Registrar-General, published 83 years ago, there is a remarkable panegyric on life-tables. The report is, indeed, signed " George Graham," but a belief that-" By these comparisons (i.e., of National Life-Tables) a noble national emulation might be excited : and rival nations would read of sickness diminished, deformity banished, life saved-of victories over death and the grave-with as much enthusiasm as of victories over each other’s armies in the field ; " argues a robuster faith in the saving virtues of vital statistics than anybody but William Farr has ever possessed. Farr, life-table as a indeed, was the pioneer in using the " biometer, holding it to be as indispensable in sanitary inquiries as the barometer or thermometer and other instruments in physical research." No doubt there was exaggeration in this, but the experience of three generations has proved that, for some important purposes, the life-table is a statistical instrument of medical value. A practical difficulty was that, to the ordinary medical man, the methods of construction, even those of Farr, who knew how little algebra most medical men knew, were more than a trifle perplexing. To Sir Arthur Newsholme belongs the credit of having pointed out to medical men that the (to them) most perplexing stage of the process of construction could be carried out without any resort to algebra. Newsholme and Stevenson proved that a graphical method was quite satisfactory, but there is reason to suppose that students still believe that graduation by formula is, in some mysterious way, more scientific than graduation by the graphic method. On that account we are glad to publish a further illustration, from the pen of Miss H. M. Woods, of the London School of Hygiene and Tropical Medicine, of the simplicity and success of the process. It is true that the use of this method does not dispense the worker from some hours of arithmetical calculation ; but the virtue of it is that a medical man, after a very little practice, can confidently perform all the operations intelligently and easily without having to carry in his head, or in a notebook, formulae the derivation of which he does not understand. There are enough inherent difficulties in statistical work for it to be very desirable that unessential oostacles should be removed. We hope that by recalling the attention of readers to Sir Arthur Newshoime’s work, Miss Woods may induce others besides professed students of public health to use Farr’s beloved instrument.
DANGEROUS DRUGS ACTS REQUIREMENTS. THE Home Office has issued a third edition of its memorandum on the duties of doctors and dentists in respect of the Dangerous Drugs Acts and the Regulations made thereunder. It is probably common knowledge by this time that any duly qualified medical practitioner and any registered dentist is authorised " so far as is necessary for the practice of his profession " to be in possession of dangerous
and to supply them to his patients by personal administration or by administration under his direct personal supervision and in his presence. The doctor -but not the dentist-may also dispense dangerous drugs for his patient’s use and may be in possession of the raw materials for use in the compounding of medicines though he may not supply the raw materials to a patient. Probably the two most important aspects of the law are those which concern prescriptions and the keeping of records. There are some 17 specified drugs which, though they come within the Dangerous Drugs Acts, are specially exempted by the regulations and are purchaseable in Great Britain in the same
drugs
Acts.
"
"
ordinary poisons under the Pharmacy Apart from these specified drugs (which are
as
listed in the Third Schedule of the Consolidated Regulations issued last December) any other dangerous
drug (if prescribed in sufficient strength to bring it within the Dangerous Drugs Acts) involves the following duties on the part of the prescriber. The prescribing doctor or dentist must write his prescription, date it, sign it with his usual signature and-except in the case of health insurance prescriptions issued on the official form-must add his address ; he must also give the patient’s name and address and must specify the total amount of morphine, cocaine, or other druer to be supplied. The only exception to this last requirement is that, where a preparation is prescribed which is contained in the British Pharmacopoeia, the British Pharmaceutical Codex, or the Minister of Health’s health insurance drug tariff, only the total amount of that preparation need be specified. The Home Office, perhaps not unreasonably, explains that chemists are not allowed to dispense a prescription which does not comply with the foregoing require ments, and the memorandum hints that irregularities do occur, and that doctors must not take offence if chemists ask them to correct an irregularity. A chemist cannot dispense a prescription containing a dangerous drug unless (a) he knows the prescriber’s signature and has no doubt of the genuineness of the prescription, or (b) he has taken reasonably sufficient steps to satisfy himself that the prescription is genuine. As the Home Office points out, this situation can be uncomfortable for the chemist, who may find himself obliged either to delay the prescription (with the prospect of offending the prescribing practitioner) or to break the law. As to the requirement of recordkeeping, the memorandum draws attention to the obligation upon a medical practitioner to keep a record of all supplies of dangerous drugs to patients except only in cases where the drug is administered by the practitioner himself or under his direct super* vision and in his presence. The memorandum also reprints in an appendix paragraphs 50 to 60 of the report of the Departmental Committee (presided over by Sir Humphry Rolleston) on Morphine and Heroin Addiction. The passages are those which deal with the precautions necessary in administering these two drugs on the one hand in treating addicts and on the other hand in ordinary medical practice ; but, indeed, the whole of the Departmental Committee’s report (published in 1926 by H.M. Stationery Office at the price of Is.) is worth study. The special occasion of re-issuing the Home Office memorandum is the embodiment therein of certain changes in the law due to the operation of the Geneva Convention of 1925-changes which the Dangerous Drugs Act of 1925 was designed to implement. One result is an alteration of the list of drugs within the Dangerous Drugs Acts. The Geneva Convention amplifies the International Opium Convention signed at The Hague in 1912. Among other provisions it creates machinery (through the agency of the League of Nations) for varying the list of narcotics in Chapter III. of the Convention, a list which corresponds with that of the drugs to which Part III. of our Dangerous Drugs Act of 1920 applies. The new machinery will enable the exclusion of any narcotic which is found not to give rise to the drug habit. Part III. of our 1920 Act named morphine, cocaine, ecgonine, diamorphine (or heroin) and their respective salts, and also medicinal opium. Our 1925 Act has a fresh definition of ecgonine and medicinal opium; it explains that cocaine includes synthetic cocaine;;. and it adds to the list of narcotics in Part III. " any extract or tincture of Indian hemp." Subsequent regulations, however, show that medicinal preparations containing extract or tincture of Indian hemp as one of their ingredients do not come within the Dangerous Drugs Regulations. It remains to add that an Order in Council last August applied Part III. of our 1920 Act to benzoyl-morphine, dihydrooxycodeinone, dihydrocodeinone, and their respective salts. Subsequent regulations issued last