Careless Doctors Criminally Serious Slips Made In Writing Prescriptions Physicians, And Not Druggists, Generally To Blame For Accidents In Putting Up Medicines--how Mistakes Frequently Occur--another Evil
How of ten do we hear of a fatal error made by some sleepy or negligent druggist's clerk, compounding morphine for quinine, laudanum for paregoric or oxalic acid for Epsom salts. How seldom do we hear of the criminal carelessness or murderous errors made by physicians themselves in writing their prescriptions. I am satisfled, after careful examinaron, that the latter exceed the former ten to One, and that the services of the coroner are not of tener required is due alone to a fact notorious in the profession, that a competent druggist carefully studies every prescription calling for powerful drugs, and himself corrects the doctor's mistakes. One serious error by a druggist winds up his business in rapid order. There is no one to stand between the incompetent druggist and his victim, but the careless doctor can depend with reasonable assurance upon the strong probability that if his figures are wrong and the dose of the drug is doublé what it should be, the pharmacist's trained eye will detect the slip or the ignorance and put in the right quantity. I asked a prominent druggist the othsr day if he often had to correct prescriptions. He smiled. "I never correct a physician's prescription," he replied. "My business is pharmacy, not medicine." "But in case you got an order calling for ten grains of strychnine, to be taken at once!" "I would not fill it. I would send it back to the physician with a polite note of inquiry. That would be the retort courteous." "Do you examine all prescriptions you compound with a view to possible errors?" "Certainly. Every druggist is compelled to do that in self protection. For exarnple, here is a prescription sent here a few weeks ago. "Now this, as you see, called for twenty pills of sulphate of morphine, gelatine coated, each to contain two grains." "Did you refuse it?" "No, I filled it- and there was no funeral followed. I gave ten two-grain pills of sulphate of quinine, gelatine coated, for I knew that to be what the physician intended to prescribe. He is getting a little okl now and sometimes makes a slip of that kind, but we always manage to set it right. About four months ago one of my clerks brought me a prescription calling for one gramme of bichloride of mercury, or corrosive sublímate, in eight pills. A gramme is sixteen grains, which would have made the dose two grains in each piü - enough to kill an elephant. I sent the preseription to the physician. He erased gramme and wrote gram, even then prescribing the maximum dose of the drug - one-eighth of agrain." "Could not gramme be easily mistaken for gram?" "Most easily. Gramme is usually abbreviated thus, 'gm. ,' while grain is 'gr. ' Many physicians use the metric system, and specify the weight in grammes. Now, if only one drug is ordered the sign 'gm.' may easily be read 'gr.,' and the patiënt will get only onesixteenth of the amount intended, or, vice versa, he may get sixteen times too much. The latter case is not so probable, for the druggist's knowledge of doses would interfere. But such a prescription falling into the hands of an ignorant clerk could easily furnish business for the undertaker and no one be the wiser." "How often is the judgment of the druggist called into play over sueh questions?" "With us it is a matter of almost daily occurrence, but of course we handle a large number of prescriptions. Most of the puzzles are due to the wretched handwriting affected by some doctors." I asked another leading uptown druggist concerning his experience with errors in prescriptions. "They have numbered hundreds," he said, "but as we invariably refer them back when illegible or calling for more than the maximum dose giveu in the dispensatory the eonsequence does not f all upon the patiënt." "How do the doctors behave when advised of their mistakes?" "Sometakeit kindly; others try to bluff the case through by saying that heroic doses were required ; others get angry. I sent one prescription back to an eminent professor in this city. It called for half grain of strychnine to the dose. He tore it up, withdrew his patronage and wrote us an indignant letter, claiming that the prescription called for only 1-35 of a grain. He had destroyed our evidence and there the matter ended. One night I got a prescription calling for 120 grains of iodide of potassium in three powders, one to be taken every four hours. The regular dose of iodide is from five to ten grains. I sent a messenger to inquire, and the reply was the erasure of 'iodide' and the substitution of 'bromide.' The least consequence of the iodido would have been a f urious eruption all over the patiënt, to which certainly his malady would not justly have entitled him, as he was suiïering from delirium tremens." "Do you have much trouble with quacks?" "No. Quacks usually give very simple and harmless remedies. They know their incompetence and constantly fear arrest for malpractice should an accident occur. The quack, as a rule, confines himself to light cathartics, tonica and lotions, giving a child's doïe to an adult and trusting to luck and nature to effect a cure. Most of them compound their own nostrums and thus make doublé profit, besides avoiding the placing of their errors on record. It is the regular physician and the pbysician of high standing who is most apt to be careless." Another evil to which my attention was called is the habit of some physicians instead of specifying the dose and the time for its repetition, to give simpiy this general order: "To be used as direeted." Perhaps several medicines have been ordered. The invalid may be in charge of an ignorant or forgetf ui nurse to whom this gives discretionary powers which may easily become fatal. I saw myself a prescription calling for Majendie's solutiou of morphia and marked in this way. Was not this criminal carelessness? Medicines are often kept in the household after the illness for which they were prescribed has terminated. The direction of the physician has loag since been fprgotten. Another member of the family, perhaps a child, is taken down with some petty complaint, and the quondam patiënt prescribes a dose of the remedy used in his own case. How much shall he give? He looks at the bottle: "Use as direeted." He thinks he remembers having taken a tablespoonftil, so he administers that quantity. The sulïerer grows rapidly worse. The doctor is sent for and finds a case of morphine poisoning. The bottle is produced. The doctor sees "Use as direeted," and discreetly holds his peace. Perhaps death follows, and no one is the wiser. - New York World.
Ann Arbor Register