Pharmacopoeia and the National Formulary. He says:

"Ignorance of the Pharmacopoeia and National Formulary is also applicable to the pharmacist.. Within the past week I saw a letter written by one of the leading wholesale and retail drug establishments, in a large city near the center of this enlightened commonwealth, to a pharmacist here in Philadelphia, asking him what Liquor Ceresolis Compositus was and who prepared it. Last fall, after the Pharmacopoeia had been official for over a year, the chief prescription clerk of one of the leading drug stores of Philadelphia called me on the phone and asked the same questions relative to this preparation. I could enumerate numerous instances of this kind, but these will suffice."

Now, even if doctors wanted to use the so-called official preparations exclusively, they would not take the risk of prescribing them if the druggists, even in a city like Philadelphia, who live right in the shadow of the best pharmaceutical college in the world, are so ignorant (as this writer says) as not even to recognize them when they are prescribed. And if they do not know them by name, how in the name of heaven can they be depended on to compound them? Physicians are well aware of the deficiencies of the druggists, according to our author, and regret it; and yet they must recognize it as one of the conditions of this commercial age, and the druggists can hardly be blamed for its existence. Why, how can a druggist be expected to know all the numerous official preparations and how to pound them? The fact is, it has reached the point when the medicine sold in the average drug store does not amount to over twenty-five per cent of its total sales. Medicine in a drug store has, indeed, gotten to be a "side line." The bulk of the sales is made up of soda-water, confectionery, toilet articles, stationery, postcards, and thousands of other articles in no way connected with medicine. Under these circumstances it would be folly to expect any one druggist to carry in stock all the drugs contained in the one thousand five hundred official preparations; or, if he carried them all, and kept them

com

in good condition, it would not be practicable for any one man to be able to skillfully compound so many preparations, and especially when the sale in them constitutes so small a proportion of his total business. But our author gives a still stronger reason why physicians can not afford to stick to the official preparations, for he tells us that: "A large number of pharmacists do not possess a copy of the last Pharmacopaia, and only a small number, comparatively, possess a copy of the third edition of the National Formu lary."

Now, in the name of common sense. how are they going to compound the prep arations named in these books when they have not even in their possession copies of them?

It is this state of affairs in the drug trade, and the consequent inability of the doctors to get their prescriptions compounded accurately and with uniformity, that has caused them to turn to and rely on the ethical proprietaries. These, he knows, are always the same; they are besides, prepared nicely and represent the greatest skill in elegant pharmacy, and can always be relied on. And when he finds one that gives good results he sticks to it, and he does not care how much he is criticised for doing so by the officials of the medical societies, for he realizes that they are only making a show of doing something in order to hold their jobs, and to bring them into notoriety.

One Reason Why Physicians Prescribe Proprietaries.

No man stands higher in pharmaceutical circles than Professor Edward Kremers, Dean of the School of Pharmacy of the University of Wisconsin. He can not be suspected of being unfriendly to pharmacy, and what he may say about conditions in that professions may, we think. be accepted as true. From a recent address delivered by him, which we find in the Southern Druggist, we make the following extract:

"The druggists who organized the Wisconsin Pharmaceutical Association in 1880 lived in the hope that the next generation of pharmacists would be well educated generally, and possess a good tech

nical training.

But what has been the result? The drug store has become less and less efficient as a training school for pharmacists, and yet how few of our apprentices and clerks seek a college education? The cramming schools, which some of them attend preparatory to the State Board examinations, have no educational or technical value whatever. Aside from the personal advantage that the attendants may successfully pass the examination, they are a positive harm to the individual and an increasing menace to the profession.

"Many of the candidates before the State Board can not write ordinary English; fully as many can not do simple problems in applied arithmetic; still smaller is the number capable of logical thinking. They may be excellent salesmen of toilet articles; they may be able to discuss the latest football news while selling cigars; they may be experts in avoiding the payment of a saloon license, as has been the case with hundreds of druggist-saloonkeepers in Massachusetts, Kansas and other States; but they are not pharmacists to whom we should like to entrust the lives of our sick relatives and friends."

All well-informed physicians know that what Professor Kremers says is true. They know, also, that conditions all over the country are as he says they are in Wisconsin. And, having a regard for their patients, and for their own reputations, they hesitate about sending prescriptions to the drug stores, the proper filling of which require the highest pharmaceutical skill. And this is one of the reason why they use so many of the ethical proprietaries. They know that these latter preparations, as a rule, are uniform, and are compounded of the best and purest drugs, and hence can be relied upon.

The Blind Following of Authority. Before the British Medical Association, at its recent annual meeting, Dr. W. Hale White delivered an address in which he severely condemned the tendency towards the "blind following of authority," which, it seems, prevails not only in this country but in England also. According to this learned doctor, this unfortunate ten

dency constitutes the greatest drawback to progress in medical science. He said: "Accept nothing on authority, but look for yourselves, and see if the usual teaching is true; believe nothing you do not see; be skeptical about everything you are told."

While we are not prepared to go quite as far as Dr. White went, yet it remains that he is correct when he says that the blind following of authority is one of the greatest impediments to progress, and that advancement is possible only to the man who thinks for himself. This does not mean that every announcement from a doctor of distinction is to be met in a spirit of antagonism, but it should not be accepted as true simply because some physician of repute enunciates it. It is entitled, probably, to greater consideration when it comes from a recognized authority, but it should, in all cases, be made to stand the test before it is accepted and acted on. The actual, practical experience of the average doctor is worth more to him than the ex cathedra teachings of the physician in authority, however distinguished he may be.

Our minds are given us to think, and unless we exercise our faculties they finally become stunted.

During the past three or four years the physicians of the United States have been treated by a political clique in charge of one of the medical societies as if they were little children. They have been instructed as to how they shall act, and even as to what drugs they shall prescribe, and have been threatened with professional ostracism if they do not comply. Such conduct on the part of a few men in official position has caused a great many physicians to rise in revolt. These physicians realize that the officials referred to are only trying to increase their own power and emoluments, and, like men, they have manifested their resentment at the attempted interference with their liberties as individuals.

The true physician is always looking for light. He is aware that he does not know it all, and, therefore, he is glad to learn from every source. But he refuses to be dictated to by any man or set of

men,

A Reader of the Brief.

Among the large number of subscribers to THE MEDICAL BRIEF there are a few lawyers, clergymen, scholars, etc., who have been on our list for a long time, taking the paper, presumably, on account of its editorials, since they can hardly be interested in purely technical medical literature. One of these is Grover Cleveland, the distinguished and universally esteemed ex-President of the United States.

In Munsey's Magazine for September, in an article on the Distinguished Sons of Clergymen, is a sketch of Mr. Cleveland, together with a photograph showing the great statesman seated at a table in his library. Before him lies a copy of THE MEDICAL BRIEF, which, evidently, he has just finished reading and laid upon the table.

We have reproduced the page from Munsey's herewith, as we thought it might please some of our subscribers to know the distinguished and honorable company they keep. The editor of the BRIEF has always been an admirer of the ex-President, and he only wishes, in these times of unrest, turmoil and agitation, that Mr. Cleveland's conservative and steadying influence could be felt in the counsels of the nation.

[Written for the MEDICAL BRIEF.] Eye Strain.

BY JOHN W. WRIGHT, M. D., Professor of Ophthalmology in the Ohio Medical University. Columbus, Ohio.

Eye strain is at present at high tide. To it are attributed numberless maladies, for not only what is termed the "functional neuroses," but crime, imbecility, incorrigibility and hopeless depravity are often laid at its door. While defective vision may, and doubtless often does, influence the character of the individual, especially in children, eye strain probably does not to a very great extent. ever, there should be made a most searching study of both, especially when regarded in the light of affecting not only the physical but the moral condition of the individual.

How

Eye strain does not usually exist in high degrees of refractive error, for in such cases, if correcting lenses are not applied, the patient can not by accommodative effort sufficiently acquire anything like normal vision. He is, therefore, incapacitated to perform a service requiring good vision; when, if an adult, he is compelled to accept menial avocation that does not require acute vision, and thus he is often associated with those whose companionship might deprave his char

acter.

In the child it is unfortunate if the defect is allowed to go uncorrected, for, not being able to see like other children, school and books are neglected, and if unrestrained it seeks amusement, often in environments not conducive to its moral requirements. For this reason a strict examination of the eyes of all children should be made where there is the least misgiving that there is a defect in the vision. School boards in various parts of the country are doing much to augment this matter and should receive the encouragement of the public.

The symptoms usually attributed to eye strain are so numerous, so varied, so complex and so diffused that were I asked which were the most significant, the answer might well be, Which are not?

So far as I know there has been no particular classification of the abnormal concurring conditions which appear with efforts of the accommodation of the eye, that serve definitely to point out their seat. It may be well for us to realize that a great many conditions attributed to eye strain come from other causes, for the functions of the eye may be in a perfectly normal condition, as far as its refraction and accommodation are concerned, yet because of affections of the organs whose nervous connections with the eye are direct or acute, functional efforts of the organ of vision can not be performed without precipitating reflex disturbances of some character or other. In this connection, I would say that I have in my experience often met with cases where no refractive error whatever could be detected, where an effort to read or to perform some work calling for the act of accommodation, would invariably precipitate some annoying neurotic condition. Such cases can

not be corrected with lenses, but require the services, conjointly, of the skilled oculist and physician.

Some of the most prominent recognized symptoms of eye-strain are headache, supraorbital neuralgia, dizziness, chorea, nausea, and insomnia. Sometimes a symptom alights far from the eye.

Some years ago I had under my care a young man who occasionally suffered from lumbago, which was always immediately relieved by the instillation of a mydriatic in each eye. Occasionally we meet with cases of severe pain within the eye, as ophthalmodynia, which, in most cases, is due to cramp or spasm of the ciliary muscle. Relaxation with a mydriatic generally relieves it at once.

Although eye strain from defective refraction of the eye is a frequent cause of this condition, it may be brought about by overwork in the normal eye. Eye strain often is the cause of the symptoms enumerated, and I believe that fully seventy-five per cent of the headaches are due to it.

Fully one-half of the cases of eye strain are due to improperly-fitted glasses. The majority of the people wearing glasses are fitted by so-called refractionists or opticians who know practically nothing of optics or defective eyes. The most severe cases of eye strain are in patients who have little perceptible defect in their refraction, but the constant effort to do near and difficult work causes the obscure nervous conditions. To detect these obscure refractive errors lies within the province of the thoroughly skilled, wellequipped oculists.

American Savings Bank Building.

[Written for the MEDICAL BRIEF.] The Action of Iron.

BY ELI H. LONG, M. D., Professor of Therapeutics, University of Buffalo. Buffalo, N. Y.

While the more recent experiments and observations in the use of iron have enriched our experience, we can not say that much progress has been made in our knowledge of the precise behavior of this metal in the treatment of chlorosis. The

text-book statements of twenty-five years ago regarding the absorption of the inorganic forms of iron, and the therapeutic results of their use, will answer for today with slight modifications. The opinion expressed in 1884 by Bunge to the effect that inorganic iron is not absorbed, but acts simply as a protective to the food iron by uniting with hydrogen sulphide in the intestine, thus saving the food iron from similar combination, leaving it free from absorption, seemed reasonable, and it has had quite an influence in our conception of the action of this metal.

Nevertheless, we can say today that this view has been fully disproved, the proof resting upon two points:

1. The absence of hydrogen sulphide, as a rule, in the small intestine where the absorption of iron is most active, and (2) the experimental work of recent years of Hochhaus, Quincke, Macallum, Honigmann and others, furnishes accumulated evidence that the inorganic forms of iron are freely absorbed from the digestive tract. It seems probable that, whatever form or salt of iron is employed, it is absorbed either as a chloride or an albuminate, chiefly from the duodenum, whence it is deposited in loose combination, chiefly in the liver and spleen, and changed as needed into hematin or hemoglobin or other tissue iron.

Regarding its value in chlorosis there can be no possible question, but it is difficult to understand why the system utilizes the inorganic forms of iron administered, when it seems unable to appropriate the organic forms in which it exists in the food; for chlorotics, as a rule, take foods which are reasonably rich in iron. The question arises whether the inorganic forms are not more easily assimilated. The clinical facts seem to favor this belief. This is not saying that organic forms of iron have no value, because their administration is usually followed by some improvement; but the reported results of several clinicians indicate that the organic forms of iron used today are on the whole inferior to the older inorganic forms, particularly reduced iron, tincture of the chloride and Blaud's pill.

1335 Main Street.