Pharmacopoeia

“ The rapid increase in medical and pharmaceutical knowledge renders necessary frequent new editions of the national pharmacopoeias, the office of which is to furnish definite formulae for reparations that have already come into extensive use in medical practice, so as to ensure uniformity of strength, and to give the characters and tests by which their purity and potency may be determined. But each new edition requires several years to carry out numerous experiments for devising suitable formulae, so that the current Pharmacopoeia can never be quite up to date. ”

“ A common, fallacious belief is that Pharmacopœial recognition means that the drug recognized is of value; the fact is that the United States and other Pharmacopoeias have in them numerous drugs of very little use. The nature or motif, so to speak, of a pharmacopœia is not to distinguish between worthy and worthless drugs, but to see that a drug which is asked for is as sold by the apothecary pure, and that proper preparations of uniform strength are made by the apothecary. ”

“ The enactment of the 1938 Federal Food, Drug, and Cosmetic Act illustrates the expansion of the definition of drug. One of the changes contemplated in S. 2800, an early version of the Act, [7] defined 'drug' to include
' (1) all substances and preparations recognized in the United States Pharmacopoeia, Homoeopathic Pharmacopoeia of the United States, or National Formulary or supplements thereto; and (2) all substances, preparations, and devices intended for use in the cure, mitigation, treatment, or prevention of disease in man or other animals ”

“ But, from the very nature and object of a Pharmacopœia, it cannot be supposed to proceed pari passu with the march of chemical science, indeed it would be dangerous that it should, for a chemical theory must receive the seal and stamp of experience before it can become current: a Pharmacopœia however is always an object of abuse, because it is a national work of authority, which is quite a sufficient reason why the ignorant and conceited should question its title to respect, and its claim to utility. ”

“ The pharmacopœia exists for the purpose of requiring the apothecary to give in the first place pure brick-dust or pure witch-hazel when asked for; and in the second place uniform preparations of these remedies.
Every European country has its own pharmacopœia, prepared by governmental officials; or, in the case of England, by a board especially authorized by the government. One of the peculiarities of Anglo-Saxon civilization is the performance by volunteer bodies under sanction of law of functions which are really governmental. ”

“ Modern medical prescriptions may be classed as lineal descendants of the healing-spells of former ages. In the most ancient known pharmacopœia, a papyrus discovered [158] about the year 1858 in the Necropolis at Thebes, and believed to date from the sixteenth century b. c., no invocations or symbols are found, nor were the latter generally employed as prefixes to medical formulas prior to the first century a. ”

“ There is another word, “antidote,” which has very materially changed its significance during the lapse of centuries. Galen, for example, employed this word as a synonym of pharmakon—a simple remedial agent, and medical writers continued using the term in this sense during the following thirteen or fourteen centuries. The word commonly employed, by mediaeval physicians, to signify “pharmacopoeia,” was “antidotarium.” In modern times the word “antidote” signifies only an agent which neutralizes a poison. ”

“ It appears probable, however, that the growth of pharmaceutical chemistry will indicate, in time, which of those in use form the most active and trustworthy preparations, while the general adoption of the metric system will lead to clearer approximation of strength than hitherto. The method adopted by the Portuguese Pharmacopoeia comes nearest to that uniformity which is so desirable in such preparations, as the tinctures of the fresh plants are all prepared with equal parts of the drug and alcoholic menstruum ”

“ It was the Arabs who invented the apothecary, and their pharmacopoeia, issued from the hospital at Gondisapor, and elaborated from time to time, formed the basis for Western pharmacopoeias. Just how many drugs originated with them, and how many were borrowed from the Hindoos, Jews, Syrians, and Persians, cannot be determined. It is certain, however, that through them various new and useful drugs, such as senna, aconite, rhubarb, camphor, and mercury, were handed down through the Middle Ages, and that they are responsible for the introduction of alcohol in the field of therapeutics. ”

“ For many drugs and chemicals not in the Pharmacopoeia there is no standard of purity that can be used under the Adulteration of Food and Drugs Act, and for these, as well as for the commercial quality of those drugs and essential oils which are also in the Pharmacopoeia, a legal standard of commercial purity is much needed. ”

“ But there are many substances in the Pharmacopoeia which are not only employed in medicine, but have other uses, such as sulphur, benzoin, tragacanth, gum arabic, ammonium carbonate, beeswax, oil of turpentine, linseed oil, and for these a commercial standard of purity as distinct from a medicinal one is needed, since the preparations used in medicine should be of the highest possible degree of purity obtainable, and this standard would be too high and too expensive for ordinary purposes. ”

“ Probably four doctors out of five have no clear, correct conception of the Pharmacopoeia, its intent and scope; whilst the ordinary citizen does not know of its existence. I have thought perhaps a short article concerning it might not be uninteresting to the readers of the The Popular Science Monthly, and the concurrence of the editor in this belief has led to the present dictation. ”

“ The majority omit chemical formulae. An alphabetical arrangement is followed in all. The maximum doses of preparations are given in several pharmacopoeias and the physician must indicate on his prescription, if he exceeds this limit, by using a note of exclamation after each article, that he purposely intends such a dose to be employed. ”

“ Fatal Period.—From a few seconds to as many minutes. Under active treatment, if a patient survive forty minutes, he will generally recover.
Fatal Dose.—Thirty minims of the dilute acid of the Pharmacopœia. This contains six-tenths of a grain of the anhydrous acid. Recovery has, however, taken place even after comparatively large doses. The strength and age of the individual, and also the emptiness or fulness of the stomach at the time the poison is swallowed, will materially affect the issue. ”

“ Another legal difficulty connected with modern pharmacopoeias is the inclusion in some of them of synthetic chemical remedies, the processes for preparing which have been patented, whilst the substances are sold under trade mark names such as veronal. The scientific chemical name is often long and unwieldy, and the physician prefers when writing a prescription to use the shorter name under which it is sold by the patentees. ”

“ The numerous preparations used by druggists are mostly prepared in factories under competent and careful supervision, and the standards laid down in the British Pharmacopoeia are, broadly speaking, carefully adhered to. ”

“ So it comes to this, that during three thousand years remedies have been accumulating until between two and three thousand drugs are recorded in the archives of the medical profession, and yet we have the admission of some of the highest authorities on the subject that the nature of disease is still a mystery, that the "modus operandi" of drugs is equally obscure, and that in consequence there is profound uncertainty as to the relation of drugs to the diseases for which they are prescribed.
Can one cause cure another. Can a poison expel a poison? ”

“ Alonzo Clark, who for years stood at the head of his profession as a consulting physician in New York City, is quoted as saying, “All curative agents, so called, are poisons, and, as a consequence, every dose diminishes the patient’s vitality.” I doubt whether this view of drugs would be seriously contested by any of his professional brethren of good standing.
The venerable Professor Joseph M. Smith, M.D., said: “All medicines which enter the circulation poison the blood in the same manner as do the poisons that produce the disease. Drugs do not cure disease.” ”

“ His difficulties are only increased when diagnosis is complete and he turns to the labors of treatment. For with the advance of modern medical science there are left now but few physicians who believe that disease can often be cured by a drug. It is recognized by the better element of the medical profession all over the world that only in seven or eight out of about one hundred and fifty diseases clearly distinguished in our textbooks of medicine, have we a drug with any genuine pretensions to cure. What is to take the place of drugs in dispensary treatment? ”

“ There is one great advantage in specifying U. S. P. drugs and preparations: Physicians who do so invoke legal standards of purity and identity. The only way to be sure of obtaining substances of therapeutic efficiency, however, is to exercise discrimination. The Pharmacopeia is no guide. Being prepared mainly by pharmacists to meet the needs of pharmacists, the Pharmacopeia of course contains much matter of little interest to physicians and entirely foreign to scientific medicine.— (Editorial from The Journal A. M. A., Sept. 2, 1916.) ”

“ King's New Discovery for Consumption, Shiloh's Consumptive Cure, Piso's Consumptive Cure, Peruna, Duffy's Malt Whisky, Warner's Safe Cure, and Paine's Celery Compound are all by analysis said to contain large amounts of morphine, chloroform, or alcohol.
Consumptives cannot be cured by any drug now known, and any person who believes it is mistaken. Cancer still baffles the skill of the most clever and the best-trained [Pg 277] scientists. It is perfect folly to believe that any drug or man can cure either disease by a few pills or by a few bottles of medicine. ”

“ It goes without saying that in this system the old, pernicious drug method of filling the body with various poisons to counteract the effects or symptoms of disease, has no place whatever. Certain poisonous drugs may prove effective to suppress certain symptoms by benumbing the nerves and preventing pain; they may, and do counteract the natural process by which nature exercises her power in various ways in the spontaneous effort to throw off disease, in the form of inflammations, fevers or pains; but they can never heal, or eradicate disease. ”

“ If his diagnostic spectacles enable him so distinctly to discern the "poison of disease," he ought to know better than to aggravate it by an additional poison. And if the doctor believes that the tenuous prescriptions of the homœopaths can not be considered as medicines, their success proves the very point I am contending for, namely, that in an infinite plurality of cases diseases can be better cured without any drugs at all. ”

“ Imperative drugging—the ordering of medicine in any and every malady—is no longer regarded as the chief function of the doctor. Naturally, when the entire conception of the disease was changed, there came a corresponding change in our therapeutics. In no respect is this more strikingly shown than in our present treatment of fever—say, of the common typhoid fever. During the first quarter of the century the patients were bled, blistered, purged and vomited, and dosed with mercury, antimony, and other compounds to meet special symptoms. ”

“ The writer has seen violent catharsis produced by bread pills, after podophyllin, castor-oil, and phosphate of soda in the most generous doses—administered as one would drop a letter in a mail-box—had completely failed; it is all in the manner and way we give a medicine or treat a disease. Certain narcotic and irritant poisons or powerful sedative agents have a physical action uninfluenced by the mind, but an intelligent physician is hardly supposed to drive at the small tack of disease with such powerful sledge-hammers. ”

“ By means of this alternate exhibition of two drugs, we not only prevent every aggravating primary effect, but we at the same time act in accordance with the important law, that, in order to secure the effective and undisturbed repetition of a drug, we have first to interrupt its action by some appropriate intermediate remedy. All repetitions should cease as soon as a [12] general improvement sets in; if the medicine is continued beyond the point where the organism is saturated with the drug, it acts as a hostile agent, not as a curative remedy. ”

“ His view is that the pharmacopaeal doses are in nearly every instance much too low. Excessive timidity has cut down the dose until it has ceased to produce a real effect upon the disease.
Medical men, according to his view, have been afraid of producing a poisonous effect with their drugs. ”

“ Some, like salts, operate to thin the blood, and reduce the system; others are stimulating; and others have a peculiar operation on certain organs. Of course, great discrimination and knowledge is needed, in order to select the kind, which is suitable to the particular disease, or to the particular constitution of the invalid. This shows the folly of using the many kinds of pills, and other quack medicines, where no knowledge can be had of their composition. Pills which are good for one kind of disease, might operate as poison in another state of the system. ”

“ They all believe in the principle of "curing one disease by producing another." In other words, their practice is, to induce a drug disease to cure a primary one, for this is exactly what is done when drugs are administered, in pathological conditions as we shall prove later on by testimony from authorities on medical practice. ”