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H. EDWIN LEWIS, M. D., Managing Editor.

PUBLISHED MONTHLY BY THE AMERICAN-MEDICAL PUBLISHING COMPANY. Copyrighted by the American Medical Publishing Co., 1910.

Complete Series, Vol. XVI, No. 1. New Series, Vol. V, No. 1.

JANUARY, 1910.

The Pharmacopeia is certainly receiving its full share of criticism these days and nearly every writer seems obsessed with the desire to "knock"-if we may be pardoned the expression. While granting freely that the last revision was open to certain criticisms, we feel that it was a vast improvement over its predecessors, and all in all a credit to those intrusted with the enormous amount of detail incident to its compilation. A work of such character, representing data from so many sources, presents difficulties that the casual critic can at best only partly comprehend. Deficiencies and weaknesses not evident in the making, become all too apparent in the work viewed and examined as a whole. Perfection might have been hoped for, but should hardly have been expected, especially when it is admitted, as it certainly must be, that practically no general interest was shown in the work of the last Convention. Its duties were done, however, and the committee charged with the completion and culmination of the concrete result brought forth a volume that was far superior in every way to those preceding it.

When, in all fairness, we consider the difficulties that were encountered, the labor involved, the burden imposed on a comparatively few men without hope of fee or reward, the indifference shown generally, and realize, as every intelligent person must that neither pharmacology nor therapeutics had advanced sufficiently to permit the most

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desirable results, we can only commend the volume that was produced. The U. S. Pharmacopeia as it stands may be a long way from perfection, but it far surpasses any former revision. as a fairly accurate and reliable index of the pharmacological and chemical knowledge up to the time of its production. That very great progress has since been made, may give more promise for our next Pharmacopeia, but in no wise reflects on the work that gave us the present one.

The charges of graft, incompetency and ignorance that have been hurled at the last Revision Committee are as false as they are unworthy of notice. They are amply refuted in the volume produced, and in the lives and everyday work of the men who formed the Committee. We are extending no compliments, simply giving just due to men who were big enough, brave enough and earnest enough to carry through an undertaking that meant infinite labor, no gain or fame, and-alas, unlimited criticisms and accusations. In truth, the price of duty sometimes seems high!

The next Revision of the Pharmacopeia will be accomplished under much more favorable conditions. During the past decade pharmacology has made more substantial progress than ever before. Chemistry has gone rapidly forward and therapeutic knowledge has been placed on a scientific foundation only recently possible.

A live interest in the Pharmacopeia has developed, due somewhat to its adoption as a standard in the Food and Drug Law, and a better realization of the place it should fill has gradually extended throughout medical, chemical and pharmaceutical circles. All this augurs well and enthusiasm is indeed warranted.

But a warning should be sounded. Under the most favorable conditions the Pharmacopeia must have its limitations. It has been heralded far and wide as the ultimate cure of every therapeutic as well as pharmacologic ill. But to those who will calmly and sensibly consider the proposition all this is ridiculous. The Pharmacopeia has a definite place, a most important place in medicine and all the collateral sciences. That place is to stand as the national official standard of the quality, nomenclature, preparations, sources, composition, solubility, assay and established dosage of the drugs of the period. It can never be complete enough to serve as a working manual of pharmacology or therapeutics. As a work of reference, however, giving established data concerning the principal drugs of the period, selected for their generally accepted utility by a representative body of pharmacologists, chemists, teachers and clinicians, the forthcoming revision of the Pharmacopeia, like its predecessors, will fill its place to the credit of the earnest, honorable men who compile it and the benefit of those who have occasion to use it.

Governmental assumption of the Pharmacopeia would be a disaster, and yet this is undoubtedly the intent of the bill recently introduced into Congress by the Hon. H. M. Coudrey. Many of our contemporaries have referred to the frightful language of this bill, which is indeed fearfully and

wonderfully constructed with an affront to good English in almost every line. These are remediable, however, and only call for passing reference. The avowed purpose of the bill stamps it as both impractical and ridiculous. To call for the standardization of every remedy used for man or animal is not only beyond all possibility of chemistry, since the science has only progressed to a point where a small proportion of drugs can be standardized, but would mean a work of years and results so voluminous that they would be practically useless. As far as Government control of the Pharmacopeia is concerned that it would prove dangerous from every standpoint. Once let political machination became a factor in Pharmacopeial revision and the work will be destroyed forever. Under present conditions there is a scientific esprit du corps operative among the gentlemen intrusted with the enterprise, that in our mind constitutes one of its most valuable assets.

we believe

It is extremely doubtful if the Coudrey. Bill will receive any serious consideration. for it is so patently weak and untimely that few Congressmen will care to support itat least in its present form.

Pure drugs are absolutely essential and every effort should be utilized to secure them. Our Boards of Health-city and state

are doing a splendid work to this end, and we do not hesitate to venture the belief that our drugs are of a higher quality and freer from adulteration today, as a result of these activities and the execution of the Food and Drug Law, than ever before. The Custom authorities carefully scrutinize and test all imported drugs and therefore do much to assure their purity and quality, while commercial competition is another

, 1910

, Vol. V.,

factor constantly tending to raise and maintain proper domestic standards.

The Bureau of Chemistry at Washington has shown its possibilities in this direction, and if the much talked of plan of placing all of the public health agencies under one organized bureau materializes, as it bids fair to, there will be still further opportunity for investigating drugs.

When all is considered, therefore, it would seem that a more systematic supervision, inspection and study of drugs should be provided for by national law, and a bureau established solely for this work. A weekly or monthly bulletin should be issued giving the results of the investigations. Such a bureau would supply the present great need for systematic chemical and pharmacological research, and its regular publications would. fill in the time between Pharmacopeial Revisions with needed data. The resources of such a bureau should be at the service of the Revision Committee of the Pharmacopeia and its chief and other officers should be permanent members of the Revision Committee.

It is recognized that these suggestions are rather indefinite, but it must be evident to all interested that a decennial revision of the Pharmacopeia leaves a barren period between each issue. It has been suggested that the Revision Committee publish an annual supplement or addendum. Under present conditions the work required to properly prepare and issue such a supplement would be prohibitive, to say nothing of the cost. The plan to have a government bureau constantly carrying on a constructive work in the investigation of drugs meets every demand of current needs, and at the same time provides for the building up of an enormous amount of material subject to final disposition by each Decennial

Convention. The publication of such material in serial bulletins would allow general scrutiny and testing before consideration by the Convention or Revision Committee. Some such plan would seem to be needed if we are to progress in our knowledge of drugs. The Pharmacopeia can serve us within circumscribed limits, but we should not make it a fetish to blindly worship, and in our devotion and enthusiasm lose our sense of proportion. Valuable as it is, and as it especially will be after the next revision, it does not seem that anyone can deny the supplemental value of contemporary drug investigations by a properly organized government bureau.

In the interests of true progress in pharmacology and therapeutics, we earnestly hope to see some such plan soon materialize.

Attacks upon the fomites theory of contagion are becoming more and more frequent of recent years. Indeed every new discovery in etiology generally shatters some old hypothesis which was long supposed to account for the facts. Every theory does account for all known factsit is only the unknown which are not included, and it is expected that as soon as discovered they are bound to change prior generalizations. Until within a decade or so, the evidence indicated that contagion adhered to clothing and merchandise and was thus carried from the sick to the well, SO we naturally disinfected everything which had come in contact with diseased persons and more or less neglected the real carriers. In the case of yellow fever we even destroyed millions of dollars' worth of inert property and let the infected mosquito go free. When Chapin of Rhode Island stated that diphtheria was transmitted directly from patients or convales

cents and not things, he was viciously attacked in the Section of Hygiene of the American Medical Association, but he showed that the bacilli could not live very long on dried surfaces, and that the walls of the sick room were sterile by the time we got around to disinfect them. So he kept the sick from spreading the disease and stopped the waste of disinfectants and had better results than when he attacked the dead germs. Similarly until we learned that the flea transmitted plague bacilli which could not live long outside of a host, we wasted millions of dollars in disinfecting and destroying the supposed carriers of the fomites. Now the contagiousness of typhoid is taking our minds from the fomites theory, although we know that water and milk and nutrient stuffs generally can keep the bacilli alive and multiply them. Drying is so quickly fatal to many organisms that we have long ceased to consider dry stuffs as carriers and the causes of cholera, glanders, gonnorrhea, syphilis and many other diseases.

The commercial side of marine quarantine is thus vastly changed, for we can now admit harmless goods and keep out the living organisms in the bodies of the sick, and trade may be little affected or not at all. This has been the policy of Great Britain for a long time, because interference with trade means prompt starvation. The shotgun quarantine of self-supporting communities would be suicidal. We in America are quickly approaching the condition of England. It will soon be disastrous to interfere with commerce, so that it behooves us to look into the quarantine methods, with a view of passing in everything harmless and only detaining the living organisms. To this end, all the old evidence must be

reconsidered. In small-pox, for instance, though it is well established that the germs may live some little while on the clothing of a patient, yet they die in time and there is a suspicion now that many of the cases formerly believed to have been contracted from such articles a long time after convalescence, were really caught from a newly imported fresh case. imported fresh case. As far as known, it

is impossible or rather very difficult, for a doctor to carry the germs from merely being in the vicinity of the sick, so there is a tendency to consider contacts harmless if they are vaccinated. The greatest shock is the increasing doubt that scarlet fever organisms are as long lived and resistant as we believed five years ago. There is much evidence that they are pure parasites and like the protozoa in general, are eventually killed by drying, even if skin scales can transport them through the air for a short distance, and that the old stories of garments having retained the virulence for several years are mere coincidences in

which the real source of infection was an unrecognized infected person. The case for the fomites must then be reopened for reconsideration, though it is a matter of common sense to go slow. Nevertheless, the theory is on the defensive and must show cause why it should not be abandoned. Its advocates must prove that in the alleged cases, no other sources of infection were possible.

Accuracy of disinfection is the modern. necessity, for the public will not tolerate needless expenses. Efficiency also is impossible unless we shoot straight. We cannot kill the enemy unless we know where he is, and it is foolish to shoot dead soldiers. For these reasons there is a world wide movement to simplify all methods of quar

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