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THE PASSING OF THE PILL-ROLLING CHEMIST.
794
Annotations. " Ne quid nimis."
THE
.
PASSING
OF THE PILL-ROLLING CHEMIST.
TIME was when every pill and potion was concocted on the spot by a chemist skilled in the handicraft as well as the theories of his calling. During the last decades a great and rapid change has taken place in the duties of the dispensing chemist, who is becoming more and more a salesman of ready-made drugs, and less and less of a dispenser weighing out and compounding remedies from a doctor’s prescription. No doubt a good deal depends upon the class of practice, and there are still many dispensers who are kept quite busy at their proper work. Opinion may vary whether the change described is or is not for the better, but it is certainly proceeding steadily and irrevocably, and it is well to take stock of it, to see whither it is leading us, and in what ways, if any, it may be modified or diverted for the public good. This subject has lately been under discussion in the Danish medical press, and it is possible by a study of conditions in Denmark to obtain a bird’s-eye view of some aspects of the problem as it presents itself in England. The Danish regulations controlling the dispensing of drugs in chemists’ shops are numerous and farreaching. The chemist is liable to unexpected visits of inspection, and the cleanliness of his hands, the weight of his aspirin powders, and the confinement of poisons to the poison cupboard are all matters over which he may come to grief. It is one of the anomalies of the present changing state of affairs that while the small dispensing chemist is thus carefully policed, the wholesale manufacturing chemist, whether he be a native of Denmark or a foreigner, is under only lax control. His compounds may, and probably do, contain the exact quantities of the drugs indicated on his labels. It is, of course, in his own interests that his wholesale dispensing should be conducted on the most accurate and reliable lines, and it is probable that the chances of errors of dosage are smaller in his hands than in those of the retail dispensing chemist. But it is safe to venture the forecast that the time is not far distant when the wholesale manufacturing chemist will be under as close official supervision as his small competitors. From the point of view of the public’s purse the change to which we have referred may be for the better. The hand-rolled pill made to order must inevitably cost more than any manufactures turned II out in thousands. Recent advances in physical chemistry have greatly strengthened the hands of the manufacturing chemist, and now that such considerations as osmotic pressure, sterility and hydrogen-ion concentration of drugs for parenteral injection have come to the fore, it is inevitable that the old-time dispensing chemist should be unable to fulfil all that may be required of him. He is not, and it would be unfair to expect him to be, a bacteriologist. But, being neither a bacteriologist nor a machine capable of mass production, it is inevitable that he must sooner or later become a connecting link between the manufacturing chemist and the public. As regards the manufacturing chemists it is I evidently desirable that his products shall be under as close control and supervision as those of the small dispensing chemist whom he is displacing. Even the
No doubt such cases are rare and probably a vanishing quantity in regard to firms of high and established reputation, which have nothing to fear and, indeed, to gain from the inspection which is required to keep up the standard of the laggard. The old order of dispensing is giving place to new, but let us make sure that the new order is of the best.
everything
THE BENZOATE TEST FOR RENAL FUNCTION. THE interest in tests devised for showing renal inefficiency has grown considerably of late years. Undoubtedly the opportunities provided by the war acted as an important stimulus for research into kidney function tests ; the work of Prof. H. Maclean can be quoted as perhaps the best example of the use made of systematic examination of soldiers. Tests of renal function can be divided into three headings : Firstly those in which the partition of various substances between blood and urine is examined ; secondly, those depending on the administration of some foreign substance, such as a dye, and observing how rapidly and completely the kidney excretes it ; and finally, the renal function can be tested by determining the excretion of some substance native to the individual. The blood-urea test is an example of the first group, the phenolsulphonephthalein test is typical of the second group, whilst Prof. Maclean’s urea-concentration test is perhaps the best known instance of the third group. The benzoate test of Swanson and Kingsbury also belongs to the last-named category. In their original paper, published in the form of a report to the Society of Biological Chemists in December of 1920, these authors called attention to the fact that hippuric acid is the only urinary constituent synthesised by the kidney. As is well known, the kidney conjugates benzoic acid with glycine and the resulting hippuric acid is excreted into the urine. That the greater part of the hippuric acid occurring normally in the urine depends on the amount of benzoic acid ingested in the food had been proved previously by other workers and was confirmed by the authors. These physiological facts suggested a new test for renal functions, and in a more recent paper1 Dr. F. B. Kingsbury describes some of the results obtained with it. The test proper is performed on the patient as soon as he rises from his bed in the morning. The only preparation necessary is that he must be forbidden to eat fruit of any kind, since the amount of benzoic acid contained is quite enough to upset the interpretation of the test. On rising the patient empties his bladder, and immediately drinks a solution of 2-4 g. of sodium benzoate in about 100 c.cm. of water. The container is rinsed out with about 200 c.cm. of water and this is also drunk. After an hour has passed another 200 c.cm. of water is taken, making a total of 500 c.cm. of fluid in all. The bladder is emptied at the end of the second hour and also at the end of the third hour, both specimens being preserved for subsequent analysis by the addition of 10 drops of a 10 per cent. solution of thymol in chloroform, and 15 c.cm. of 2 per cent.. nitric acid. The volume of each specimen is measured and an aliquot specimen is taken for analysis. The author, working with medical students, found that 82 per cent. of the ingested sodium benzoate was excreted in the two-hourly specimen and that 16 per cent. was the average for the third-hour specimen. A series of pathological cases are given by Dr. Kingsbury, and it is shown that in cases of impairment of renal function the excretion of hippuric acid under the above conditions is markedly decreased. It is also claimed that the test gives positive information in very early conditions, when other well-known tests, such as Maclean’s urea-concentration test and Volhard’s water-excretion test, indicate little or no impairment of the renal function. Positive results are said to be obtained in cases having normal blood
manufacturing chemist may, like Homer, be caught nodding, and a case has recently been reported in which a firm of manufacturing chemists with a world-wide reputation sold a preparation supposed to contain a ferment of such-and-such potency and capable of withstanding the action of the hydrochloric acid of the gastric juice. Tests showed this preparation to contain the ferment indicated on the label, but this The Benzoate Test for Renal Function, 11. Minneapolis: ferment was destroyed in a few minutes by n/100 HCI.I1 Archives of Internal Medicine. Vol. xxxii., No. 2.
Annotations. " Ne quid nimis."
THE
.
PASSING
OF THE PILL-ROLLING CHEMIST.
TIME was when every pill and potion was concocted on the spot by a chemist skilled in the handicraft as well as the theories of his calling. During the last decades a great and rapid change has taken place in the duties of the dispensing chemist, who is becoming more and more a salesman of ready-made drugs, and less and less of a dispenser weighing out and compounding remedies from a doctor’s prescription. No doubt a good deal depends upon the class of practice, and there are still many dispensers who are kept quite busy at their proper work. Opinion may vary whether the change described is or is not for the better, but it is certainly proceeding steadily and irrevocably, and it is well to take stock of it, to see whither it is leading us, and in what ways, if any, it may be modified or diverted for the public good. This subject has lately been under discussion in the Danish medical press, and it is possible by a study of conditions in Denmark to obtain a bird’s-eye view of some aspects of the problem as it presents itself in England. The Danish regulations controlling the dispensing of drugs in chemists’ shops are numerous and farreaching. The chemist is liable to unexpected visits of inspection, and the cleanliness of his hands, the weight of his aspirin powders, and the confinement of poisons to the poison cupboard are all matters over which he may come to grief. It is one of the anomalies of the present changing state of affairs that while the small dispensing chemist is thus carefully policed, the wholesale manufacturing chemist, whether he be a native of Denmark or a foreigner, is under only lax control. His compounds may, and probably do, contain the exact quantities of the drugs indicated on his labels. It is, of course, in his own interests that his wholesale dispensing should be conducted on the most accurate and reliable lines, and it is probable that the chances of errors of dosage are smaller in his hands than in those of the retail dispensing chemist. But it is safe to venture the forecast that the time is not far distant when the wholesale manufacturing chemist will be under as close official supervision as his small competitors. From the point of view of the public’s purse the change to which we have referred may be for the better. The hand-rolled pill made to order must inevitably cost more than any manufactures turned II out in thousands. Recent advances in physical chemistry have greatly strengthened the hands of the manufacturing chemist, and now that such considerations as osmotic pressure, sterility and hydrogen-ion concentration of drugs for parenteral injection have come to the fore, it is inevitable that the old-time dispensing chemist should be unable to fulfil all that may be required of him. He is not, and it would be unfair to expect him to be, a bacteriologist. But, being neither a bacteriologist nor a machine capable of mass production, it is inevitable that he must sooner or later become a connecting link between the manufacturing chemist and the public. As regards the manufacturing chemists it is I evidently desirable that his products shall be under as close control and supervision as those of the small dispensing chemist whom he is displacing. Even the
No doubt such cases are rare and probably a vanishing quantity in regard to firms of high and established reputation, which have nothing to fear and, indeed, to gain from the inspection which is required to keep up the standard of the laggard. The old order of dispensing is giving place to new, but let us make sure that the new order is of the best.
everything
THE BENZOATE TEST FOR RENAL FUNCTION. THE interest in tests devised for showing renal inefficiency has grown considerably of late years. Undoubtedly the opportunities provided by the war acted as an important stimulus for research into kidney function tests ; the work of Prof. H. Maclean can be quoted as perhaps the best example of the use made of systematic examination of soldiers. Tests of renal function can be divided into three headings : Firstly those in which the partition of various substances between blood and urine is examined ; secondly, those depending on the administration of some foreign substance, such as a dye, and observing how rapidly and completely the kidney excretes it ; and finally, the renal function can be tested by determining the excretion of some substance native to the individual. The blood-urea test is an example of the first group, the phenolsulphonephthalein test is typical of the second group, whilst Prof. Maclean’s urea-concentration test is perhaps the best known instance of the third group. The benzoate test of Swanson and Kingsbury also belongs to the last-named category. In their original paper, published in the form of a report to the Society of Biological Chemists in December of 1920, these authors called attention to the fact that hippuric acid is the only urinary constituent synthesised by the kidney. As is well known, the kidney conjugates benzoic acid with glycine and the resulting hippuric acid is excreted into the urine. That the greater part of the hippuric acid occurring normally in the urine depends on the amount of benzoic acid ingested in the food had been proved previously by other workers and was confirmed by the authors. These physiological facts suggested a new test for renal functions, and in a more recent paper1 Dr. F. B. Kingsbury describes some of the results obtained with it. The test proper is performed on the patient as soon as he rises from his bed in the morning. The only preparation necessary is that he must be forbidden to eat fruit of any kind, since the amount of benzoic acid contained is quite enough to upset the interpretation of the test. On rising the patient empties his bladder, and immediately drinks a solution of 2-4 g. of sodium benzoate in about 100 c.cm. of water. The container is rinsed out with about 200 c.cm. of water and this is also drunk. After an hour has passed another 200 c.cm. of water is taken, making a total of 500 c.cm. of fluid in all. The bladder is emptied at the end of the second hour and also at the end of the third hour, both specimens being preserved for subsequent analysis by the addition of 10 drops of a 10 per cent. solution of thymol in chloroform, and 15 c.cm. of 2 per cent.. nitric acid. The volume of each specimen is measured and an aliquot specimen is taken for analysis. The author, working with medical students, found that 82 per cent. of the ingested sodium benzoate was excreted in the two-hourly specimen and that 16 per cent. was the average for the third-hour specimen. A series of pathological cases are given by Dr. Kingsbury, and it is shown that in cases of impairment of renal function the excretion of hippuric acid under the above conditions is markedly decreased. It is also claimed that the test gives positive information in very early conditions, when other well-known tests, such as Maclean’s urea-concentration test and Volhard’s water-excretion test, indicate little or no impairment of the renal function. Positive results are said to be obtained in cases having normal blood
manufacturing chemist may, like Homer, be caught nodding, and a case has recently been reported in which a firm of manufacturing chemists with a world-wide reputation sold a preparation supposed to contain a ferment of such-and-such potency and capable of withstanding the action of the hydrochloric acid of the gastric juice. Tests showed this preparation to contain the ferment indicated on the label, but this The Benzoate Test for Renal Function, 11. Minneapolis: ferment was destroyed in a few minutes by n/100 HCI.I1 Archives of Internal Medicine. Vol. xxxii., No. 2.