REMARKS ON THE PROPOSED BRITISH PHARMACOPŒIA.

precedence, not only because it has the importance of a physical sign-a morbid change which can be verified during life,-but because its value has not hitherto received a due recognition. For though many are quite acquainted with the exactness of observation attainable by the aid of percussion and palpation in lesions of the belly, these aids to diagnosis are still so far underrated, as that some who apply them sedulously and successfully in thoracic maladies, seem not to derive from them all the scarcely less accurate and useful information they afford in abdominal disease. By careful examination of this kind through the yielding wall of the belly, that abnormal distension of the intestine, which wehavefound to be a condition of faecal vomiting, may be detected in its very origin, and traced in all its successive stages. And, considering that this sign is not only far more conclusive than any mere symptoms, like pain, tenderness, nausea, or even vomiting, hut that it may often be verified before they have become prominent, it is difficult to exaggerate its importance. Experience entitles me to assert, I, that the accumulation of intestinal contents immediately above the obstructed point may sometimes be detected, as a slight fulness to palpation, and a much more definite dullness to percussion, where many of the other indications of obstruction are scarcely perceptible, or even absent. Indeed, I have been thus enabled to decide on the existence, and even the situation, of an obstruction, when there has been no pain or vomiting, no constipation; when the obstruction has occurred suddenly, in the course of a severe diarrhoea; and when the distension of a few loops of small intestine has been obscured by tympanitic dilatation of the neighbouring colon. Four years ago, I was called to see a middle-aged female who had been suffering two or three days from a violent attack of English cholera. The last liquid stool had been passed but six or eight hours before I saw her. But after three hours of comparative quiet, the twisting umbilical pain of the malady had returned, as well as the vomiting which had accompanied it; both, however, with diminished severity. The medical gentleman in attendance thought the patient’s aspect very suspicious; the more so, that she had long suffered from a small femoral hernia. On examining the belly, I found the lower part of the left iliac fossa occupied by what was evidently small intestine, filled with liquid. The hernia (on the same side) was quite painless when handled, and had the doughy feel suggestive of omentum. It was irreducible: a fact upon which the patient laid no stress, as it had often been so before, for many weeks at a time. I could only recommend a careful attempt at the reduction of the hernia, under the influence of a warm bath, aided by opium or chloroform; and, failing immediate success from these, an operation. In accordance with the latter suggestion, she underwent the operation, in little more than fourteen hours from the time of passing the last of a series of choleraic stools, and recovered without a single bad symptom: a recovery which, considering all the circumstances, must be ascribed, I think, to the early date of the operation, scarcely less than to the skill of the operator. (To be concluded.)

REMARKS

England.

ON THE

amounts to

PROPOSED BRITISH PHARMACOPŒIA. BY FREDK. W.

Among

itself, has led

peculiarities, which,

THE unity of the three parts which constitute the kingdom of Great Britain and Ireland has been, until recently, little more than political. The unity of laws, the unity of faith, of scientific institutions, of the learned professions, in these countries, has, with some partial exceptions, never yet been attempted. The word " solidarity," imported from abroad, has no place amongst us-no home in our feelings or in our experience. The all-devouring centralization that is remorselessly carried out in most countries of the continent, is, fortunately for our independence, repugnant to our feelings, and therefore impossible. As regards the medical profession, in which for the present we are most interested, we have to represent us to the rest of the world, no single head, but a sort of manyheaded Gorgon. Each kingdom has its College of Physicians, its College of Surgeons, its Society of Apothecaries, and its

434

But, unfortunately, thip agreement by no means identity. A spirit of provincial rivalry, highly

to the continuance of variations and to say the least, are exceedingly troubleFrance has but one codex, America but one, but we some. have three. An Englishman in Edinburgh must be careful what he orders, as an interpretation to which he is quite unused may be put upon the terms already so familiar to him. The London physician in Dublin may poison his patient if he is not on his guard in prescribing. Dilute hydrocyanic acid of

laudable in

HEADLAND, M.D., L.R.C.P.

half-dozen Universities granting medical degrees.

many rival institutions, with their various qualifications, their differences in social status, their separate nationalities, and their conflicting claims, it is to be regarded more as an accident than a natural consequence that any agreement whatever has been arrived at on the subject of medical practice. On the very important ground of the drugs to be employed, the weapons with which we are to be armed in our daily conflict with disease, it was at least desirable that some kinct of agreement should be attained. It has happened, fortunately, that the diversity on this head is not so great as might have been expected. The sect of physicians in each countrythose practitioners who occupy themselves chiefly with the treatment of internal diseases, and with whom it had become a point of etiquette that they should not themselves prepare the medicines which they ordered-felt themselves soon necessitated by this circumstance to prepare some formal code of medicines and preparations which might serve as a guide to those who undertook the task of dispensing for them, and as a, key to their written prescriptions. They having also become affiliated to central colleges in the capital cities of the threekingdoms, it fell naturally to the governing body of each college to draw up this code. Hence the first Pharmacopoeia, of the London College of Physicians, which received immediately the stamp of legal authority, and was recognised in course of time by all practitioners as a concise and satisfactory codex of£ medicines and forms. This example was followed by the Colleges of Edinburgh and Dublin, who, however, thought fit to draw up separate codes of their own, which obtained as a standard of reference in Scotland and Ireland respectively. The pharmacopoeias that sufficed in these old times became quickly out of date as knowledge advanced. Our ancestors fought with bow and arrow: our contemporaries are armed with the Enfield rifle and the Armstrong gun. We possess far more potent means of combating disease than were known in, the dayswhen cinchona, and iodine, and chloroform, and codliver oil were undiscovered and unhoped for. Successive issues of the pharmacopoeias became necessary as science advanced, as chemical and botanical discoveries shed new and wondrous light on our path, and the art of medicine became something more than guess-work. In the Pharmacopoeia of the London College of Physicians, published in 1851, we have an array of potent drugs, a judicious selection of prescribing formulas, to which we may appeal with pride as showing the advance that has been made in modern times-the beautiful simplicity to which practice has been brought by theory, and which may be considered as far more worthy to represent the state of science in our day than the codex of France, of Austria, or of any other country. If the talent and energy of the late Mr Phillips be allowed, as it must be, to have had a large share in the production of this gratifying result, it must also be admitted that our London College of Physicians has deserved. well of the profession at large; and even if all that it had done for medical science were summed up in the issue of this simple, unpretending, but yet most sufficient compilation, its labour has not been in vain. Meanwhile the Colleges of Edinburgh and Dublin have gone on with their Pharmacopoeias, in several editiolis of which they have included to a great extent the same medicaments and the same commonly-used formulas as those which are recognised in.

so

the Dublin Pharmacopoeia is about twice as strong as that of the London Pharmacopoeia. Acetum opii of Edinburgh is three times as strong as the preparation of the same name in the Dublin Pharmacopoeia. Acetum colchici of Dublin is three times the strength of that of London and Edinburgh. Compound iodine solution of the Edinburgh Pharmacopoeia contains sixty timesas much iodide of potassium and thirty times more iodine than. in the London and Dublin Pharmacopoeias. The morphia solutions of the London Pharmacopoeia are twice as strongas those of the other Colleges. The specific gravities of the mineral acids are variously fixed, and there are ten different strengths of acetic acid ! It is, of course, highly desirable that these and other discrepancies should be reconciled. It had been proposed to do this by an agreement between the three Colleges; but the labour is

now transferred by the new Act to the Central Medical Council, in which all corporate bodies are represented. I have thought it not out of place to direct the attention of the profession to a which all practitioners of medicine must feel to be of matter vital importance, and which is already engaging the anxious deliberations of many scientific bodies throughout the kingdom. The experience of many amongst us may be brought to bear most advantageously upon some of the points in question; and those which are likely to give cause for debate, and to elicit varieties of opinion should be mooted early, in order that they may be fully discussed. Having thus touched lightly on the general bearings of the subject, I proceed to more precise observations on the matter in hand. I have said that 1. A National Pharmacopoeia is desirable. 2. It must consist of a judicious amalgamation of those at present in existence. The London Pharmacopoeia, as confessedly the best, and of most authority, should be taken as the basis of the new compilation. It may receive improvement from a careful addition of the best points in the other two, especially that of the Dublin College, which has been more recently issued than the last Edinburgh Pharmacopoeia, (1850.) A pharmacopoeia, must consist of a materia medica, or list of drugs which may be prescribed, singly or together, and a formulary, or code of combinations, fitted for administration, as mixtures, tinctures, ointments, &c., and the precise methods of preparing these. In all pharmacopoeias that have yet appeared, a number of chemical compounds and metallic salts have been included in this latter department. It would be much better for the future to transfer these to the materia medica. It will be sufficient to indicate the tests by which their identity may be established and their purity ascertained, and to leave to the operative chemist to choose for himself the best method of preparing them. Thus tartarized antimony, nitrate of bismuth, the sulphates of iron, copper, and zinc, the chlorides of mercury, and so forth, are precise chemical compounds, which are the same by whatever mode prepared. It is needless to prescribe a formula, except in such cases as pulv. antim. comp., hyd. c. cretâ, liq. plumb, diacet., which are distinctly pharmaceutical compounds, of arbitrary strength and composition, and which need to be determined by authority. This transfer, which has already been commenced in the l.tte London Pharmacopoeia, will very much simplify the Pharmacopoeia, and will lighten the labours of its compilers, who will be left to their own duties, instead of usurping the functions of the manufacturing chemist, whose science changes and developes from day to day. The insertion in the materia medica of the salts of quina and morphia, and all the acids, has shown how impossible it is now found to determine chemical processes by authority, or to lay down one inflexible rule in the case of any formula of the kind. The materia medica of the three Pharmacopoeias must thus be amalgamated and reinforced. Many vegetable substances may, in my opinion, be safely expunged, as I shall presently point out. The forms in the second part must be rendered uniform, and the system of weights, which has been complicated by the introduction by the Dublin College of a modified avoirdupois weight, must be fixed to one standard. 3.I contend, in the next place, that the Latin language should be adopted, as in the present London Pharmacopoeia. An English translation might be published to satisfy those who prefer it, but the authoritative text must be in Latin; and this for the same reasons that induce us to continue the old custom of Latin prescriptions. Any arguments brought against the one system, must tell with equal force against the other. The arguments in favour of the Latin language are distinct and decisive. It is the language of science. Chemical terms are given more simply and unmistakably, botanical names are only recognised in Latin. It is a language understood by the learned throughout the world-the universal tongue. Its adoption has given to the London Pharmacopoeia an advantage above all other European codes, which it might not else have obtained. Its abbreviations are precise, and are well understood by dispensers, which is found a great convenience in prescribing. And lastly, it is not understood by the common people, nor by the majority of patients. With the English tongue the contrary is the case. There is no preciseness about it. Many of our medicaments have several names, and one appellation may indicate any out of several distinct substances. It may suffice to instance copperas, orange, vinegar, vitriol, bark, almond, verdigris, camomile, nightshade, hellebore, poppy, turpentine,-names which I have taken indiscriminately. The English language is little understood abroad, but Latin formulas are read and understood all over the world. The former is not capable of being much abbreviated, because these abbreviations

only

not recognised, and would be unintelligible. If written in full, it is no clearer than Latin to the properly-trained dispenser ; whereas its being understood by the patient would be a great source of embarrassment, inasmuch as our endeavours to administer opium, colchicum, arsenic, mercury, &c., to nervous patients who understand their own cases, and "know that their constitutions will not bear them," would often be ineffecare

tual 4. There should be no change in the present system of chemical nomenclature and The introduction of the system of atomic weights, recommended first by Gerhardt, and adopted by Brodie, Williamson, and some others in England, would utterly revolutionize our formulæ from beginning to end. Fortunately for us, the habit of doubling the elementary equivalents of oxygen, sulphur, carbon, &c., is by no means generally adopted, and, with other equally daring innovations, is likely to die out before long. It is hardly necessary to point out the danger of tampering with the accepted names of the chlorides of mercury, the compounds of arsenic, and other powerful medicines. We prefer to leave things as they are, and decline to sit down and commence de novo our study of chemical names, at the bidding of every rash speculator who may choose to propose an alteration. 5. In the next place, we cannot at present see our way to the substitution of any new system of weights and measures. The adoption of the avoirdupois instead of the troy weight in the late pharmacopœia of the Dublin College has caused great consternation and confusion amongst the pharmaceutists of the sister isle. The object was to assimilate pharmaceutical weights to those employed in trade. But that object has only partially been attained, inasmuch as the lb avoirdupois is subdivided by the Dublin College into ounces, drachms, and scruples, after the manner of troy weight. The necessity of decimal numbers in these subdivisions is almost fatal to their practical adoption. Nor is it possible for us to adopt the French decimal system, admirably simple though it is, inasmuch as the kilogramme of 15,434 grs. troy is a weight which has no analogue whatever in our commercial system. There can be no doubt that a decimal system of our own might be adopted with very great practical advantage. We must wait for its legal adoption in commerce before we introduce it in pharmacy. On the other hand, it would be idle to take up the present avoirdupois weight, when it may any day be subverted by an improved decimal system in the world without. The first step to such an arrangement has just been made in the legal adoption of the cental of 100 lb avoirdupois. By this, the rule is established that the Th avoirdupois shall be our English standard. I may suggest, as a matter worth consideration, that this lb might very conveniently be subdivided in the decimal manner. 1 Th 7000 grs. Let the new decimal grain be instituted of 7-lOths of the present grain. Then, 1 lb 10,000 grs., which being divided successively by 10, we have 1000, 100, 10, 1.

equivalents.

=

=

We should then have a ponderary system of perfect simplicity and neatness. The decimal pound would be identical with the standard avoir-

dupois as

pound.

Some such system as this must, sooner or later, be introduced the world advances. It might easily be applied to fluid

weights

and

measures.

The

70,000 grs. of imperial gallon, It might be divided into =

water, would become 100,000 grs.

10 pints of 10,000 grs. each, and a pint be then subdivided as the Tb. 6. With regard to the important question of what remedies and what formulas are to be excluded from the Pharmacopoeia, while I state my own feeling, I beg respectfully to invite the opinion of those members of the profession who may have given attention (and who has not?) to this important matter. The lists of the three Pharmacopeias, if added together, would burden us with a number of old-fashioned names with which we would readily dispense. Some sacrifice must be made by each, and a spirit of friendly accommodation shown by their supporters. As the Roman triumvirs brought each a list of proscribed friends whose lives they offered up on the shrine of

435

The number of alkaloids and other active principles of plants should be increased. Aconitia, of which a certain mode of Thus, as a melancholy indispensable in our new pharmaceutical preparation has been published, should not have been omitted reform bill, I beg to present a list of rotten boroughs for dis- from the last London Pharmacopoeia. The principles of conium, franchisement-a catalogue of drugs drawn from the materia hyoscyamus, tobacco, lobelia, and other activedrugs, might be medica of the three Pharmacopoeias whose constituencies, or retained in greater safety if combined with an acid, such as the doctors who prescribe them, have become so extremely sulphuric, which renders them very soluble in water. For limited that it seems scarcely necessary to retain them any convenience of prescribing, and the avoidance of mistakes in dispensing such powerful poisons, I would recommend that longer. standard solutions of one certain strength of dose should be My Index Expurgatorius would run much as follows :Absinthium, acetum, acidum aceticum (omit eight of these, ordered in the British Pharmacopoeia. Such solutions would and leave only a strong acid of 85 per cent., and a dilute acid be uniform in strength, and more to be depended on for cerof 5 per cent.), allium, althsea, anethum, angelica, anthemidis tainty and safety of effect than any tincture, juice, infusion, or oleum, aurantii fructus, balsamum Canadense, barytas carb. et extract of the plant, the amount of whose active principle of sulph., calamina (replace by pure carb. zinc), calamus aroma- course varies much. Mistakes would be next to impossible if ticus, canna, cannabis, carota, cassiae cortex et oleum, casto- all the solutions of the Pharmacopoeia were so diluted that the reum, centaurium, chiretta, cinchona cinerea, cocculus, cornu ordinary dose for an adult man should be just one drachm, and et c. ustum (replace by pure phosph. lime), cyminum, dul- in no case more or less. This is already the case with the liquor camara, euphorbium, gossypium, hemidesmus, inula, lactuca, hydrargyri, bichloridi, and solutions of morphias hydrochloras lactucarium, lauro-cerasus, lauri baccse, linum cath., lixivus and acetas. The liquor ammoniac must be diluted, liquor cinis, lupulina, malva, marmor, matico, melissa, menyanthes, ammonias acetatis concentrated, arsenical solution made ten mori succus, mucuna, origanum, ossa, petroleum, plumbi carb., times weaker, liquor potassa? and liquor potassa3 carbonatis plumb, ox. rubrum, potassse bichromas, potass. carb. impura, diluted with one measure of water; the diluted acids mixed rhamni succus, saccharum commune, sacch. lactis, sagapenum, with three parts of water. This would very much simplify salicis cortex, sassafras, simaruba, spigelia, spiritus pyroxilicus, prescribing, and make dispensing safer. Graduated solutions spongia, stannum, tapioca, terebinthina veneta, ulmus, viola. In of drachm strength may be made of the active principles of the following vegetables :-hyoscyamus, conium, aconite, hemall seventy-four. This would make a great clearance, after which we should lock, tobacco, lobelia; also of quina and cinchona. Resinous be able to see our way better. Half of the list are superfluous medicines, as guaiacum, jalap, scammony, perhaps rhubarb, -i.e., rendered unnecessary by the existence of better drugs may be exhibited in solution by means of alkali, as I have elseof the same kind. The others are useless, or nearly so. I where recommended. These alkaline drachm solutions would shall be glad, if called upon, to give my especial reasons for be far more easy of absorption than the undissolved resin, wishing to expunge any particular member of the foregoing which must undergo the action of an alkali before it can pass into the blood. list. With regard to the formulae, an amalgamation must of Along with this plan of drachm solutions, it would be highly As far as desirable that tinctures for internal use should be brought to a course be made, and all discrepancies must cease. possible, the present London formu]ae may be retained, because uniform standard of two drachms for a dose, and all infusions, liable to very little exception. But their number, as I have decoctions, and mixtures, to a dose of one ounce. The tinctures said, may be materially curtailed by the removal to the materia of cantharides, aconite, opium, conium, stramonium, &c., being medica list of those pure chemicals of which it is unnecessary thus diluted, would be no longer sources of danger. The soluto prescribe the mode of preparation. Most of the additions tions not intended for internal use should be kept in a separate to the last London Pharmacopoeia were wisely made. But the part of the druggist’s shop, and labelled Poison. This seems strained preparations of the gums are objectionable, as in the to me to form a simple solution of a pregnant question that has process the essential oil is partly lost. Linimentum saponis is been much agitated of late. 8. The object of the changes which I have recommended may solid at ordinary temperature, and requires to be altered. I may mention some drugs and forms at present peculiar to be stated in one word as simplification. Out of manifold reeither the London, Edinburgh, or Dublin Pharmacopoeias, but forms on a subject which has much engaged my attention, I which should by all means be introduced into the new one. have culled a few of the more prominent, in order to present In the London Pharmacopoeia : atropia, its sulphate; phos- them to the notice of the profession. The British Pharma. phorus ; granati rad. cort.; sulphur precipitatum; the distinct copceia must soon be taken seriously in hand; but ample time oils of vegetables; the concentrated infusions (cinchona); tinct. must first be given to elicit all discussion that may pave the quins co.; the ammoniated tinct. colch. co. In the Edinburgh way for the compilation of a volume that, whatever its faults Pharmacopoeia we find filix mas. In the Dublin Pharmacopoeia, or its excellencies, must serve as our prescribing manual forglycerina. I would exclude the valerianates of the Dublin many years to come. Let us hope that the result of these dePharmacopoeia, which are not to be relied upon; also the liberations, in the hands of a body of men who have been pulvis ferri of Quevenne, preferring much the saccharine carbo- selected as most worthy to represent all grades of the profession in the three kingdoms, will be worthy of them and of us. nate of the London Pharmacopoeia. 7. What remedies and forms may most advantageously be ’, introduced in addition to those now remaining? On this point i very great caution must be observed. Two rules may be safely CASTRATION AND MUTILATION. laid down for our guidance. 1st. Remedies and forms extenshould used in not where obviously irrational, CASES SHOWING THE IMMUNITY OF INSANE PERSONS FROM sively practice, be introduced. 2nd. Remedies and forms which may safely be INFLAMMATION AFTER INJURIES. recommended on sure theoretical grounds, or which chemical BY WM. C. HILLS, ESQ., M.R.C.S., Maidstone. knowledge enables us to substitute for substances already in use, may be included, but with greater caution. To the lists of preparations of the alkalies, the sulphurets ofi CASE l.-J. B-, a homicidal and suicidal maniac, had for potassium and sodium, which are an admirable means of ad- a long period occasioned much anxiety in consequence of the ministering sulphur internally or externally, may be added; also the phosphate and benzoate of ammonia, both advisable as severity of his symptoms. On the 29th of April, 1856, during having the power of keeping uric acid in solution in the urine. the temporary absence of his attendant, he castrated himself in To the preparations of iron the lactate may be added, and a the watercloset; using a little piece of pointed lath to make tincture of the potassio-tartrate substituted for vinum ferri, an in the scrotum, which he enlarged by tearing with opening uncertain of is For antimonial which very powder, ’, his strength. so fingers as to lay open each tunica vaginalis. The wound the preparation of which is most unscientific, and which in the ’i last London Pharmacopoeia is reduced to the verge of absolute bore the shape of a Y inverted. The exact way in which the inertness, a mixture of a small proportion of teroxide of anti- spermatic cords had been severed could not be ascertained; it mony with phosphate of lime may be adopted. In the prepa- seemed probable, however, that they had been jerked asunder, ration of mercurial pill and ointment the use of some old mass reto oxidize the quick metal should be prohibited, and about 1 per the naked testis being firmly grasped in the hand. The of was one he had down moval both testes thrown cent. of protoxide of mercury, the chief active element of these ’, complete: compounds, may be incorporated instead. A tincture of chloro- I the pan, the other in a corner. The man was faint from the form, of about 10 per cent. strength, may be used instead of the shock, but no haemorrhage occurred, and no vessels required variable mixture prescribed so widely as " chloric ether." tying. Sutures were used to hold together the torn scrotum

their union, so must the united of self-abnegation.

Pharmacopaeias

set

an

example

,

’

I

I

436