With reference to the case of H. P. Beach, a registered Pharmaceutical chemist, who was brought up at the Prahran. Police Court, on 20th December last, and fined 20s.
with £2 2s. costs, we take the following remarks from theAustralasian Chemist and Druggist. We are pleased to
notice the position taken up by that Journal, which we take to be that of all respectable druggists :
" The case of the Pharmacy Board v. Beach calls for remark,
It1s the first case of the kind, and was taken under Section 25
section (III.)Every registered pharmaceutical chemist,
or personin the employ of quch chemist, who prescribes or Practices medicine or surgery, except in accordance with any rights and privileges hitherto enjoyed by chemists and druggists
1ntheir open shops,' shall be liable to certain pains and penalties.
There can be no doubt that when the Legislature placed this Act
'Vonthe Statute Book it intended—in conformity with public opinion—to protect the ignorant from the dangers of quackery and incompetence—dangers much more real even than imagined.
As the State has, with commendable foresight, provided an elaborate and efficient system at our University for the education of those who are to practise medicine and surgery, it would seem
thatevery well-wisher of the health of the people ought to assist
asmuch as possible in putting down all shams, impostors, and quacks, whether they be registered pharmaceutical chemists or
persons who, with little or no education or scientific medical
knowledge,try to pass off bogus diplomas obtained from obscure,
remote, and unrecognised colleges. It would be of little avail if, while the Medical Board is now determined to sift the claims of every applicant for registration, anyone without any proper medical training, or only a smattering of medical and surgical knowledge, is to be allowed to practise, and so risk the lives—
valuable lives—of men, women, and children. What encourage- ment would there be for our young men to ' shun delights and live laborious days' in diligently and expensively qualifying themselves for the position of the Healing Art—an art which demands the devotion of the highest intellectual powers and moral sensibility' Anyone who has watched the progress of modern medical science must be impressed with the urgent need there is for practitioners who possess, in addition to a sound and liberal education, the most thorough training in therapeutics and pathology. But undoubtedly the Legislature were wise in conceding the right to pharmacists in emergencies to prescribe simple remedies for simple ailments, &c., in their own pharmacies, of course assuming that the borderland between the practice of medicine and surgery is not to be overstepped. People of no medical or pharmaceutical knowledge will, as hitherto, prescribe for themselves or others, but that is a very different thing from a pretence of professional skill and systematic treatment of cases.
As Professor Attfield said in his excellent address last year—' This much would seem certain, however, that if a mother for a child or a friend may prescribe a remedy which has proved servicable under similar circumstances, surely a druggist, who is daily dealing with remedies from year's end to year's end, may prescribe simple remedies too.' If druggists refuse to do so, the patent medicine quack, who is generally without scruples of conscience, will step in. What we contend for is that no registered pharmaceutical chemist has the right to meddle with pathology, attempting to diagnose disease,' when, at the same time, he knows that he knows nothing about the human frame. In this colony, where there is no dearth of medical men of unquestioned ability, there is no excuse for druggists departing from the rule—not too rigid—which we have laid down, and always supported in the columns of this journal. No one attempts to practice the law or at the bar unless qualified, and there is no more necessity for any one to pretend to be a physician or surgeon, than there is for anyone to pretend to be a pharmaceutical chemist who is not duly qualified by law.
" As there has been some confusion in the minds of some of our Pharmaceutical brethren upon this case, it would seem proper that we should give a short summary of the matter. Some months ago the Medical Society drew the attention of the Board of Pharmacy to the advertisements of Beach and another registered pharmaceutical chemist. This was in July, 1882. In the complaint forwarded by the Medical Society it was stated that ' certificates of death have been signed by chemists.' The Medical Practitioners' Statute contains no provision for the prosecution of such offenders ; and as, in the opinion of the Society, they were liable to prosecution under the Pharmacy Act, Section 25, Clause III., after due warning it was deemed by the Board necessary to enforce the law, in order to carry out the obvious intention of the Legislature, and also protect respectable Pharmacists from the imputation of countenancing disreputable practices, and also to establish the rights and privileges of pharmaceutical chemists hitherto enjoyed' in their open shops.
The Pharmacy Board has nothing to do with the illegal practice of medicine by those who are not registered pharmacists. The powers of the Board are strictly and properly limited to the control of pharmacists, and have to see that unqualified persons do not practice pharmacy and sell poisons, and that pharmaceutical chemists do not practice medicine or surgery. The interests and reputation of our body are deeply involved in this question, and as we enjoy advantages much greater than our brethren in England, it is to be hoped that both now and hereafter nothing shall be done which will endanger our, at present, assured and satisfactory position under the protection of the law. When one who is upon our register advertises himself as ' an un-qualified practitioner upon all diseases, advice gratis,' and another as a ' prescribing chemist who may be consulted without fee,' it is high time for us --if we wish to be considered only respectable,' and worthy of the confidence of the State, the public, and the medical profession
—to do all we can to assist the Board in their honourable task which they have set before them of elevating, educating, and purifying the ranks of pharmacy in Victoria."
FEB. 15, 1884 Australian Medical Journal. 81
DR J MARION SIMS.
Of late years Dr. Sims has been comparatively little before the medical public, but his name is likely to be long remembered. Of the general influence of his teaching, it is not easy to speak. In some respects his work was of the highest value, while in others it is now generally recognised to have been of very doubtful value.
The following letter from Dr. J. C. Nott, of New York, for which we are indebted to Dr. Jakins of Ballarat, is of interest as giving a sketch of some of Dr. Sims' personal characteristics, and we have pleasure in publishing it. It is dated 55th May, 1871.
" Dr. Sims, who has been some years in Europe, is now permanently settled in New York again, and hard at work.
I am with him in cases almost every day, having been friends from boyhood. He is a wonderful man in his way—not of the highest order of mind, not profound in any branch of medical science, but truly wonderful in the mechanical department-4n his adaptation of means to end, his improvements in physical diagnosis, and his tact and delicacy of touch in detecting things that would elude the investigation of any one else. He is altogether a peculiar man, simple as a child, overflowing with kindness and charity, with a mesmeric influence over women, who come around him like children about a mother. He is a handsome, effeminate looking little fellow, with regularly chiselled features, and well formed forehead. He is wanting in manliness and dignity, and is never happy except in the company of women. You cannot know him well without loving him, on account of his generous kind nature.
He is no judge of human nature, and everybody dupes him He has quit writing. His practice is immense, and it is a pity that his experience should be lost to the world. He would rather talk about anything than medical matters, and although I am with him a great deal, and talk about everything else, I find it impossible to pin him down to medical topics."
In the principal foreign cities the rates of mortality per 1000 of the various populations were, according to the latest official returns, as follows :- Bombay 22, Paris 21, Geneva 13, Brussels 20, Amsterdam 24, Rotterdam 20, The Hague 17, Copenhagen 16, Stockholm 17, Christiania 16, St.
Petersburg 25, Berlin 25, Hamburg 22, Dresden 23, Breslau 29, Munich 27, Vienna 23, Prague 29, Buda-Pesth 24, Rome 21, Turin 19, Venice 19, Lisbon 31, New York 22, Brooklyn 18, Philadelphia 19, and Baltimore 19.
FEB. 15, 1884 Australian Medical Journal. 83
Extracts front tke alebiral lournals.
Treatment of Locomotor Ataxy.
Professor A. Eulenburg reports that of 300 cases he has seen a cure effected in three, that cure being established by its Continuance for several years after treatment was stopped. In one of them nitrate of silver was administered in small doses, (3 to 5 mgrm. a day), the quantity taken amounting to 2/ grammes bi months. The second case was subjected to galvanic treat- ment for four months, and then sent for two and a-half months to a hydropathic establishment. In the third case the treatment consisted of galvanization daily, together with the use of Chapman's spine bags and lukewarm baths. Eulenburg thinks that nitrate of silver often fails to do good on account of difficulty attending its absorption, and he recommends a solution of the hypo-sulphite as the best form of administration. Sometimes the derangements of motion and sensibility may be benefited by the subcutaneous injection of strychnine, but he seems to hold that the continuous wearing of Chapman's bags is most likely to be useful, the temperature depending on the conditions of the ease.—Berlin Klin. Wochenschrift, Nos. 1 and 2, 1883.
Pathology of Pneumonia.
As a supplement to a previous note on this subject (Aust. Med.
Journal, Oct. 1883) it may be added that, at a meeting of the Berlin Physiological Society on Nov. 9th, Dr. Friedlander read a Paper, in which he stated that, since his previous communication two years before, he had examined over fifty cases of true croupous pneumonia. In nearly all he had found the micrococci then described, and the cases in which they were absent were those in which death resulted after the eighth day, when the disease had gone through its typical course. As they were absent in all other forms of pneumonia he held that the cocci were
characteristic of true croupous inflammation of the lungs. As a anal test of their nature and relation to the disease, Friedlander took some of the cocci from the lungs of persons who had died of genuine pneumonia, and cultivated them on stiffened gelatine according to Koch's method. He obtained in that way organisms
perfectly characteristic, and distinguished by their nail shape.
Inoculations were made with these pure cultures in mice, guinea pigs, rabbits, and dogs. No effect was taken on rabbits, and little on guinea pigs, but, in one of five dogs, violent dyspncea came on, and post mortem examination revealed the existence of pneumonia with the cocci in the blood and lungs. The most obvious effects were got with mice. Nearly all of them died in twenty to twenty- eight hours with violent symptoms of dyspncea, and extensive pleurisy and pneumonia were found in each case, cocci being present in great abundance in the lungs, pleura, and blood.
These, when cultivated as before, again gave the characteristic organisms which, when injected into other mice, produced similar effects, death resulting from pneumonia on the second day.—
Berlin Klin. Wochenschrift,
48, 1883, andNature,
Dec. 6th, 1883.
Professor Bergmann (Langenbeck's successor) has recently pub-
lished a lecture on the conclusions arrived at on the subject of
transfusion during the last decennium. On all questions that
concern the chemistry of the blood and its life changes, Bergmann
is a recognised authority. The special interest of the lecture is
contained in the definite rejection of transfusion ofblood,
which a dissolution of both red and white blood corpuscles is
effected, as well as more or less coagulation in the vessels of the
recipient, by the action of the fibrin ferment first discovered by
A. Schmidt. The essential benefit accomplished by transfusion
consists in the restoration of tone to the relaxed walls of blood-
vessels, by the mechanical support of the fluid transfused. It does
not result from the restoration of new oxygen-carrying elements,
to take the place of those which had been lost. Bergmann
therefore definitely declares, that the benefit, in the way of saving
life, which has followed transfusion has been in spite of, rather
than because of the use of blood. Equal advantage, without the
risks, is to be got from the introduction of dilute solution of
common salt. He says, " We must confess that, in this operation,
we have over estimated our ability in the very worst fashion. By
this more than doubtful, even dangerous measure, we accomplish
nothing more than this, that in cases of acute anaemia, we restore
the activity of the heart by filling the elastic tube of the blood-
vessels." Only direct transfusion from artery to vein might
perhaps be justified, but that, independently of the great sacrifice
FRB. 15, 1884 Australian Medical Journal. 85 of blood by the giver, the danger of coagulation in the course of the operation is as little excluded as formerly, and we know that any blood contains, in its fibrin ferment, a principle which is poisonous to any other blood, and may cause solution of the blood discs and acute hmmoglobineeraia, with all its deleterious consequences, viz.
hmmoglobinuria, plugging of the urinary canals with clots. and uraemia. The hiemoglobin of animals, even of closely allied species,
i8 very different in its chemical properties, and therefore the use of the blood of some animal (ail that of the lamb) for transfusion is utterly improper. This condemnation of blood for transfusion purposes applies not only to cases of anaemia from loss of blood, but also to cases of blood poisoning, as by carbonic oxide, in which it has frequently been carried out. It is not only attended with the dangers above mentioned, but it is unnecessary, in so far as, according to the investigations of Zuntz, the combination of haemoglobin with CO is a loose one, and with a sufficient supply of oxygen is with comparative ease again converted into oxyhmmoglobin.—Berlin Klin. Wochenschrift,45, 1883. J. J.
On the A ntiphlogistic action of local Blood-letting.
In the inflamed web of the frog's foot, Genzmer has observed the effects of blood-letting on the stasis, emigration of white cor- puscles, &c., occasioned by the previous application of a hot needle or lunar caustic. When a leech was applied to the leg of such a frog, the inflamed capillaries were in a few minutes completely cleared by the suction, and the circulation in some cases remained to the end of the experiment perfectly normal, or even quickened.
Scarification was also tried, as well as general blood-letting by opening an abdominal vein, with the same result, but not nearly
80 effective as in the case of the leech. The blood-letting induces not only local anaemia, but even a transient arterial hyperaemia — that is, an increased flow of arterial blood to the inflamed spot ; and this, it can be imagined, will tend to the better nutrition of the tissues, and therefore favour their resistance to the inflammation.
The antiphlogistic effect depends also on the amount of blood withdrawn ; it should if possible be taken from a spot between the inflamed part and the right heart, and not far from the former, in order to obtain the desired effect.
Genzmer concludes that the antiphlogistic effect of local blood- is purely mechanical. Centralbl. f. d. M ed. Wissensch., 1882, No. 13, p. 225.
On the Influence of Blood-letting on the Circulation.
Prof. Arloing has studied the effects of bleeding in the case of the ass, and records his conclusions according to the effects produced (1) on the blood-pressure. Hales showed that the blood-pressure diminished in proportion to the quantity of blood lost ; but Arloing finds that to get an appreciable fall, say one-sixth to one fifth, nearly a third of the mass of the blood must be withdrawn.
(2.) The pulse increases in frequency as long as the pressure does not exceed one-third of the normal, with lower pressure returning almost to the original rate, and falling when the pressure sinks below one-fifth. (3.) The force or amplitude of the pulse diminishes if the heart quickens, as in small and medium bleedings ; it increases if the heart slows, but this was exceptional and transient in Arloing's experiments. In pathological conditions we can imagine a case, in which blood-letting would increase the force of the pulse, namely, great acceleration of heart's action combined with very high arterial tension. (4.) As regards form of pulse-tracing, there is a great tendency to the formation of flat summits, such as are characteristic of insufficiency and stenosis of the aortic valves, showing the sudden impact of blood into the arterial system and its slow circulation between the two systoles. (5.) Variations in
rate of flow : On withdrawal of first third of blood, there is augmentation of diastolic rate, and diminution of the systolic, During the loss of the second third of the blood, with slowing of the pulse, the diastolic rate returns to its original condition.
but the systolic rate increases. In this period the capillaries undergo a succession of contractions and dilatations, and the heart is affected in a corresponding manner. While the remainder of the blood escapes, the diastolic rate falls to zero, but the systolic remains considerable, though short, up to a few moments before death. In this stage the blood circulates in the arteries only during the systole, irrigating the tissues in a sort of intermittent fashion.
These results teach us that small and medium bleedings increase the irrigation of the tissues, and favour the processes of ssimilation and excretion, because they are accompanied by dilate ion of the capillary network. But if the loss of blood exceeds about the third of its total quantity, the irrigation of the tissues is seriously disturbed, since the capillaries, by contracting and relaxing in an irregular manner, interfere with the regular action of the heart.
Rev. de Med. No. 2., p. 97, 1882.