the essential elements of Day Book, Monthly Journal, and Journal of Statistics. The second Part, is the Cash Book and Ledger in index form posted from the first. Being intended as a book of original entry, it fulfils the requirements of the law as affecting disputed accounts in cases before the courts. By the use of this book, time, labor, and money may be saved, and the luxury of an instantaneous knowledge of one's financial standing is gained after very little effort. The physician may learn also the exact number of his unintended charities and unsubstantial villas, paid for in short instalments of mental solicitude. We heartily commend the Diary to the profession for its comprehensiveness and convenience.

Correspondence.

PHYSICIANS AND APOTHECARIES, IN RELA-
TION TO THE REPETITION OF PRESCRIP-
TIONS WITHOUT AUTHORITY.

TO THE EDITOR OF THE MEDICAL RECORD.

sician himself. And, as we pursue the inquiry, we shall see that the remedy has always lain within easy reach of the medical practitioner, who, having too often been negligent of duty to himself, expects another person, and in a different calling, to repair that negligence. Is this reasonable? We think not. As a presumption in law founded upon the habitual conduct of rational beings, every man is supposed to be watchful of his own rights, whether those rights are associated with life, health, reputation, or property. But if he slumbers upon them, so as to invite, if not permit, another to encroach upon their limits, he cannot avoid dividing the responsibility for his own injury with him who may have been the instrument for inflicting it. That this is the view which should be taken, in most instances, of the subject-matter now under discussion, will appear by a more critical investigation of the principles underlying the tri-partite relations of physician, patient, and apothecary. If it can be shown, as is easily demonstrable, that the physician, in giving a prescription, has a duty to discharge to himself, as well as to the patient who employs him, and that the apothecary, on his part, can no more re-issue a prescription without a renewed authority from the physician originating it, than he can give professional advice in his name, or use that name in any transaction of life, then the whole question will be resolved into a simple one touching the proprietary right of physicians in their own prescriptions. And, first of all,

WHAT IS A PRESCRIPTION?

SIR-At the last meeting of the New York State Medical Society, Dr. John P. Gray, as President, called attention, in his introductory discourse, to the necessity of some legislation upon the subject of the indiscriminate sale of medicines by incompetent apothecaries; as also of drugs calculated to produce abortion, though advertised with an ironical caution against their use, intended to mask in a legal way their predeter- Counsel or advice, as given by a physician or lawmined purpose. Of the wisdom and justice of Dr. yer, is, in the language of political economists, an imGray's suggestions none can entertain any doubt, nor material product, which is consumed in its very producdoes the subject deserve less consideration because of tion. Whether reduced to writing or not, it is the its frequent mention heretofore in various medical as- property of its author, and its usufruct may be sold to semblages, both local as well as national. It is one any one, though the right of property in the thing which appeals to the best interests of society in the itself is not thereby dissevered from its original author. future, as well as in the present, and should be recog- Now a prescription is professional advice in the nature nized by legislators as forming part of that great de- of an order for the compounding of certain drugs inpartment of the common weal known as STATE MEDI- tended to be used under specific conditions, and those CINE. Whatever legal reforms may flow from such only, viz.-First, as to time; second, as to individuals. well-timed and apposite counsel as that given by the And in order to guarantee the good faith of the predistinguished President of our State Medical Society, scriber it should bear his name. The specific conditions whether they be immediate or remote, all will agree above recited form an implied contract between the that in the frequent ventilation of a great source of physician and patient, consisting of two elements: first, wrong-doing, other topics germane in character, if not that the prescription exhibits ordinary skill in its comof direct consanguinity, are invariably dragged into the position; and, second, that it is, according to the best light of observation, and placed beneath the eye of judgment of the physician, suited to the necessities of criticism, so as to secure ultimately some minor good in a particular patient at a particular time. The unities of various directions, even though the parent evil should skill, present or contingent pathological necessity, continue to resist the vigorous assaults of a scientific coupled to individual wants, must all reveal themselves siege. It is through this law of association that the in the prescription. For, unless without a date, or attention of the profession has of late been called to a without a patient's name, no prescription implies unigreat and growing evil committed by apothecaries, versality of use, or illimitability of time. Again, as the probably without intention of wrong-doing, and yet physician's reputation is involved as much in his premilitating seriously against the rights of medical practi- scriptions as in his treatment, of which they, in fact, tioners, in renewing prescriptions without permission of form a part; and, in case of a suit for malpractice, his their authors first had and obtained. The subject has ordinary skill will be tested no less by the one than the been largely discussed in England; and in our own other, it is important that he should sign his prescripAcademy of Medicine has given occasion to the passage tions, since it is only in this way that their paternity of some very significant resolutions. But, as something can be verified. A patient has a right to refuse receivmore than resolutions is needed to give a definite solu- ing a prescription from a physician who will not sign tion to the question, I venture to offer the following it; nor should an apothecary be allowed to compound suggestions as the readiest road to a permanent remedy. an anonymous one. The refusal to sign, of itself, casts The wrong alluded to, though practically committed suspicion upon its merits, and practitioners should bear by the apothecary, has its foundation in a different in mind that a man's reputation for judgment and selfcause than the mere pharmaceutical incompetency of, reliance, as well as skill, may turn on precisely such or the negligent disregard of, another's rights by the trivialities as these. In reality, however, these are not dispenser of drugs. However true it may be, it is still trivialities, for they constitute safe-guards precisely as painful to be compelled to admit that the blame should no one would accept a check unsigned, nor would the often be divided between the apothecary and the phy-teller of a bank pay one, even though the drawer pre

sented it himself. It is here that physicians too often neglect the first duty which they owe to themselves when prescribing, viz. that of investing the prescription with a character of scientific accuracy commensurate with their own, and a legal precision indicative of the responsibility they assume in issuing it. In the majority of instances, as all will testify, no signature is appended to a prescription, for let it be remembered that initials do not constitute a legal signature. Here is the first and fatal omission. Next, a date is rarely appended to a prescription, although no one would pretend that any prescription, however good to-day, is applicable to all time or circumstances, irrespective of a renewal by the physician after investigation of the patient's condition. And, lastly, the patient's name is not usually stated in it, thus omitting the most important evidence of its having been issued in favor of a particular person. Let any one who doubts this universal omission of self-protection on the part of physicians, step into any one of our large druggists and examine their prescription book, and he will acknowledge that we have not overstated the facts. Under these circumstances, therefore, and since prescriptions are so often signed by initials alone, which are equivalent to no signature; without date, which limits them to no time; and without name of person, which restricts them to no individual in particular, why blame a druggist for renewing a prescription, or even originally compounding it, since he may never have seen the prescription before, and cannot be presumed to know that it had previously been compounded? Why blame him exclusively?

and

pounding prescriptions, it would be difficult to trace the delinquent. The apothecary being responsible for want of skill in his art, as well as the physician, should exercise equal caution in compounding, as the latter is required to in prescribing, drugs. Hence it is not only proper, but his duty also, to keep a copy of every prescription, with date and names of physician and patient. Or, if he will not do this, then some law should be passed requiring apothecaries to keep a cancelling stamp to be struck upon every prescription compounded by them, under a penalty for each omission. This stamp, like those used in post-offices, might be of any form (or writing might be used alone), and contain name of apothecary and date of compounding; and without mutilating or defacing a prescription, would thus simply record upon it two important facts in its history. The same law should contain a second clause, forbidding any apothecary to renew a prescription once cancelled, without a fresh signature from the physician originally issuing it. Now, if the physician thinks the patient may need the same prescription a second time, let him fill out the blank space headed "renewable"with either the words "at pleasure of Mr. upon his order," thus throwing the future responsibility for its use upon the patient, or limit the renewal to some particular date, as in the first issue. But where, as is now so commonly the case, the physician neither signs his name, nor affixes any date or the name of any patient to his prescription, there seems to be no valid reason why the apothecary should not renew it just as often as it is called for. Like a bank bill thrown into the street, it is good in any one's hands who picks it up. If the physician's name be not attached to it, it is not his property, for he can claim no exclusive property in drugs, as drugs, but only in the formula which he has designed for a particular occasion. And if he does not patent it, as no respectable physician will, and as no respectable government should permit, then, he cannot legally prevent any one from using it, who simply uses the prescription without his name. Dr. Squibb, for example, can undoubtedly enjoin any one from manufacturing and selling his Diarrhoea Mixture under his In order to promote such a reform, let our station-name without permission, for his name is his trade-mark; ers publish for the use of physicians blank-books like but he cannot prevent any pharmaceutical pirate from check-books, printed in some such form as this:

The perfunctory way in which too many physicians write their prescriptions, is the fertile source of the evil so greatly complained of; and whenever, with a better and more realizing sense of the responsibility attached to the art of prescribing, practitioners shall ennoble their orders upon druggists, by giving them at least as much legal accuracy as belongs to an order upon a grocer, the opportunity and the disposition to renew prescriptions without authority by druggists, will both disappear.

..R. Galen, M.D.

.186. ...186.

manufacturing and selling it, under the name of
Smith's Intestinal Anodyne, or Great Sympathetic
Restorer. And if Dr. Dover, or Dr. James, or Dr.
N. Y......186. Lugol, had chosen to manufacture the celebrated com-
pounds which bear their names, no one could have sold
them under their names without permission, though
any one could use their formulæ, wherever unpatented,
under any other name-since there can be no exclusive
in that which has once become the common
property
possession of mankind; and this principle may be predi-
cated in relation to nearly the whole pharmacopoeia.
With such a statute in existence as has been fore-
shadowed, no apothecary could renew, without au-
thority, any physician's prescription; for, if he did, he
would incur the penalty specially affixed to such mis-
conduct. On the other hand, I am aware that many
physicians would look upon the prescription book as an
unnecessary piece of formalism, and like the ceremonial
law, calculated to increase rather than diminish profes-
sional cares; but if they would consider it in its proper
light of a legal guarantee of their professional compe-
tency, able to be of immense advantage to them as
evidence, in some moment of supreme necessity, they
would no longer hesitate as to its acceptance, nor
have occasion to complain that some remedy was not
within their reach.

RELATIONS OF APOTHECARIES TO PHYSICIANS.

An apothecary is simply a vender of drugs, whether he compounds them personally or not; and at law he stands upon the same footing as any retailer of goods, except where, on account of the peculiar character of his commodities, and their relations to human life or the public health, special statutes restrict him in the manner of their sale. As to a prescription, it is plain at the outset, that the apothecary cannot retain it without the patient's permission, though he may copy it, if he please, as a voucher of the articles dispensed by him in obedience to its terms; otherwise, and in cases of error in com

In conclusion, and to add some legal artillery to this army of suggestions, I would recommend that our

State Medical Society request of the next Legislature and occasionally in a stream as "large as a knittingthe passage of some such act as the following, viz: Be it enacted, &c., &c. :—

due. Take an ordinary ivory napkin-ring and wind it (through the ring) into a strip of old muslin till it is well padded; four tapes about 18 inches long are to be sewed on the outside of the ring by their middle, at equal distances apart. The ring is then placed over the penis, close to the pubes. The two upper tapes are fastened in the eye of the catheter above, and the two lower ones below; those at the base of the penis are then fastened to a bandage around the body. By this means the patient is enabled to flex and extend the thighs, and the end of the catheter to be raised or lowered as may be wished, which cannot be done by the old method without moving the instrument in the bladder, thereby causing great irritation.

New Instruments.

IMPROVEMENT IN THE HANDLES OF OB-
STETRIC FORCEPS.

2

By WILLIAM READ, M.D.,

BOSTON, MASS.

I DESIRE to call to the notice of the profession an improvement in the handles of obstetric forceps, by which, without in the least impairing their strength or efficiency, they are made much more portable. By reference to Case 2.-Alvah Simmons, by occupation a paper the accompanying drawing, it will be seen, that the maker, aged 40, while grinding an axe caught the sleeve handles are disconnected from the blades by a parrotof his coat in the belting by which the stone was bill joint, which admits of instantaneous adjustment, and turned, producing a lacerated wound of the right hand, when adjusted, gives as much power and facility of use with a compound dislocation of the wrist joint. The as if each blade were in one solid piece. The improveinteguments on the anterior aspect of the forearm ment can be applied to any forceps at a very moderate were torn completely off, the muscles separated one cost, and is not limited in its application to them alone, from another, and the skin on the dorsal surface but may be used whenever it is desirable to shorten the loosened, and infiltrated with blood. The radial artery handles or reduce the length of any instrument for greater was intact. He had bled profusely before I saw him, economy of space in packing or transportation. and was much weakened. As there seemed no chance Reference to the figures in the plate :of saving the member, I amputated by skin flaps, and a circular cut through the muscles about three inches below the elbow; seven stitches and five ligatures were used. The stump was placed on a pillow, and covered with a cloth wrung out of cold water. On the fourth day the plasters were removed, and the whole line of incision was found firmly united. The stitches were nearly all removed at this time, and the remainder a few days after. Four weeks after, as the ligatures had not come away (though I had many times before used considerable traction upon them), I broke them off in the wound, and on his next visit home, a week after, the point at which they emerged had completely healed. From the beginning to the end there was not altogether more than one drachm of pus discharged, and this came from the point where the ligatures left the wound. No sign of inflammation was at any time present, nor could any difference in the temperature of the two limbs be discovered by the hand. The operation was done February 15th, 1868, and to-day, June 30th, the arm remains as sound as ever.

H. LYLE SMITH, M.D.,

Late House Surgeon, Bellevue Hospital.

HUDSON, N. Y., June 80th, 1868.

Nor so VERY BAD.-The authorized inspector of milk in Cincinnati, appointed by the Board of Health, made an inspection some days ago of the contents of that cans of the milkmen who supply the inhabitants of the city, and published the result for the information of the people. He gives the names of fifty-two milkmen who had pure milk, of ninety-eight who had milk and water, of nine who had pure and skimmed milk, and of four who had watered, skimmed, and pure milk.

THE RINDERPEST.-The English government has received official information of the outbreak of cattle plague in Egypt. It is reported to have broken out in Volhynia and other parts of Russia.

THE MEMORIAL HOSPITAL IN NEW SOUTH WALES.The fund for the hospital to be erected as a grateful memorial for the recovery of Prince Alfred of England has reached £15,000.

EUROPEAN SCIENTIFIC PERIODICALS.-The mere catalogue of scientific periodicals published in Europe during the present century, fills sixty-three closely printed

pages.

which hooks into
1. A parrot-bill projection at the end of the blade

2. A socket formed in the shank of the handle. When the joint is closed, a spring on the back of the shank catches into a notch in the blade and prevents the two parts from being disconnected while introducing them and fitting them to the head of the child.

admits of being released without delay by simply lifting burette; 13. two hundred grain measure; 14. six-ounce the catch from the pin which confines it.