from theoretical reasoning and the relations of physiological phenomena as revealed by modern methods of investigation. Were it possible to extend indefinitely the list of remedial agents so as to embrace the entire field of therapeutic knowledge, the empirical method might attain the dignity of an exact science. Such, however, is the complexity arising from the manifold, often contradictory, impressions drawn from human experience that for the evolution of a systematic scheme of therapeutics the empirical system must of necessity prove inadequate.

Rational Therapeutics is based upon the use of medicines in accordance with a scientific knowledge of pathology and the physiological effects of remedial agents. Here nothing is left to chance, and the nostrums of the older system have but little weight compared with the methods of careful and intelligent diagnosis and a skilful administration of remedies suggested by well-known and accepted indications of disease. Every department of medical science has been illumined by the light of modern research, and the chemical and physical properties of Materia Medica submitted to severe and competent analysis, that Rational Therapeutics may establish a system through which the errors and uncertainty of empiricism may be supplanted by a more stable and philosophical method, and the chances of inaccuracy minimized. Through the college curriculum and the medium of professional intercourse, afforded by personal comparison of opinions and by innumerable publications throughout the world, the results of scientific experimentation are becoming widely diffused and the scope of serious investigation constantly enlarged.

In connection with this subject it may be well to call the attention of the student to the technical signification of the following

terms:

Pharmacopeia (pharmakon, drug; poicin, to make), a book compiled by the government, or, as in the United States, a National Committee on Revision, and published by authority, establishing standards for the identification, purity, strength, and quality, and giving directions for the purification, valuation, preparation, compounding, and preservation of drugs, chemicals, and medicinal substances. The United States Pharmacopoeia is revised decennially, the present (11th) edition having been adopted Jan. 1, 1894.

Official-Officinal.-Unnecessary confusion prevails concerning the precise import of these terms. They are readily understood by reference to the Latin originals from which they are derived.

Official drugs are those which bear the stamp of professional— i.e. official-sanction (Lat. officium, authority). They are practically ordered by the Pharmacopoeia to be kept in all druggists' shops, the formulæ being supplied by the work revised in decennial conventions.

Officinal drugs are those prepared or kept by the druggist upon his own responsibility, bearing only the authority of the shop (Lat. officina, a shop). Such preparations are often included in works on Materia Medica, and, together with those emanating from other individual formulæ, are marked "unofficial."

The term "unofficinal," it will be seen, is a solecism; and it follows, moreover, that there are many preparations which are in pharmacy officinal, but not official, and that a pharmacopoeial formula cannot possibly be officinal, although, speaking generally, all official drugs are officinal in that they are kept or prepared in the druggist's shop.

Dispensatory. This is a compilation of and commentary on one or more pharmacopoeias, enlarging the authoritative but restricted pharmacopoeial formulæ by including the medical and physical history of the various substances, with directions regarding dosage, together with observations on their physiological action and therapeutics. It also contains information concerning drugs not accepted by pharmacopoeial authority, yet which are of occasional use or interest. The Dispensatory is in effect a private publication and unofficial, in this respect differing essentially from a pharmacopoeia. There are in the United States various works. of this character, the United States and National Dispensatories being commonly in use.

CLASSIFICATION OF MEDICINES.

THE classification of drugs and remedial agents is a theme regarding which the many writers upon and teachers of medicine have shown a wider diversity of opinion, perhaps, than upon the physiological action and medical uses of individual remedies. The fact that therapeutics is far from being an exact science, and the rapid advance in our knowledge of normal physiological processes, of pathological conditions, and the systematic action of drugs, are sufficient explanation of the ever-changing judgments of our best observers concerning the action of certain medicinal agents under given conditions.

It follows that from time to time, as appears in reviewing the literature of the subject, different writers, in their attempt to keep pace with the advancement of knowledge, have devised various systems of classification.

In earlier days, when the therapeutist culled from the fields his simples for the cure of disease, there was naturally created a strong tendency toward a botanical classification. So far was the system pushed that in certain so-called schools of medicine the authority of Scripture was invoked, it being proclaimed as an axiom that "the leaves of the tree were for the healing of the nations" (Rev. xxii. 2). This eclecticism, strange as it may seem to-day, was the outgrowth of the Thompsonian or Botanical system of therapeutics. On the other hand, as an evolution of the old alchemic school, an attempt was made to found a classification by explaining the remedial action of all medicines upon a purely chemical basis.

With the advent of more modern methods of study, applied to the physiological action of drugs upon the animal economy, came the physiological classification, in which the effects of remedial agents were explained upon rational grounds.

It is hardly necessary to state that coexistent with these various endeavors to attain a philosophical method of classification, complicating them and perplexing their votaries, the dominating principle of empiricism held universal sway, setting at defiance in many instances the cardinal maxims of rational therapeutics, the rational therapeutist even to-day welcoming as a last resort the cruder, though often efficient, empirical method.

Some authors, perceiving the inutility of the older systems, have contented themselves with a mere alphabetical arrangement of medicinal agents, regardless of their origin, natural affinities, mode of preparation, and physiological action.

With due respect for the many able and worthy efforts at classification recorded in the history of modern therapeutics, the author believes that the main object of classifying medicinal remedies-viz. to facilitate the retention of a vast number of valuable yet isolated facts-is best accomplished by grouping them along the lines of greatest practical utility.

Remembering that the medical student of to-day is animated by an earnest effort to fit himself for the noblest sphere of usefulness -knowledge applied to the relief of human suffering-the author holds that the most philosophical, as well as practical, synthesis and comparison of remedial agents, based upon manifest physical

and physiological relationships, will afford to the pupil the widest grasp, from a therapeutical standpoint.

With the object of aiding the student, in accordance with this conviction the author has endeavored in this work to give emphasis to a therapeutical classification, claiming for it no especial originality,' but assured that the method he has selected is alike the most judicious and the one best calculated to respond to the demands of daily, practical utility.

The thoughtful and logical student of medicine must realize that there are two great classes of remedial agents:

I. Those used in cases which cannot be relieved by a single dose of any remedy, but require repeated and prolonged administration. 2. Those employed in cases which are susceptible of immediate relief by the exhibition of a single dose.

The remedies employed for the cure of the first class of cases have been appropriately styled Disease- or Organic-Medicines—an unscientific term, perhaps, yet useful to convey the intended idea, since they remove the cause of the departure from normal physiological action in the living organism-i. e. perversion of functional integrity, or morbid conditions.

Upon reflection it will be seen that remedial agents in the second class are, by the nature of the case, designed for the relief of some manifestation or change in the system or in its functions indicating the character, locality, severity, etc. of a morbid process-a symptom of disease. The remedies in this class, therefore, are termed Symptom- or Functional-Medicines, partly because of their specific virtue in relieving symptoms, partly from the fact that they produce certain manifestations characteristic of themselves.

Disease-Medicines are usually administered for the relief or cure of chronic diseases. Symptom-Medicines are employed to relieve symptoms of, or prevent complications in, acute diseases-not for the cure of the disease itself.

The classes named might be subdivided ad infinitum, yet it has seemed advisable to the author, for the sake of simplicity, to divide only the first class, Disease-Medicines, including the remedial agents. employed therein, under three general heads, Restoratives, Alteratives, and Antiseptics.

It is obvious to every reflecting physician that a class of remedies act as such by supplying some deficiency in the animal organism, the agent in such cases being either itself the substance

1 This classification is adapted from one formerly used by Prof. William N. Thompson of New York.

lacking, or its analogue, or by its presence restoring the deficient element or secretion. Iron or fats, for instance, act in certain forms of anemia in which these ingredients are wanting in the red bloodcorpuscles; phosphorus or the earthy salts behave similarly in conditions where the tissues are deficient in these necessary constituents; and bitters, though not natural ingredients of the system, act upon the gastro-intestinal mucous membrane, stimulating the glands to secrete a larger quantity of normal digestive fluid.

In view of the physiological action of the remedies pertaining to this division, the term Restoratives so aptly expresses their general character that no apology is needed for its adoption.

The second division, Alteratives, can be administered without injurious results only in diseased conditions, in which the particular remedy combats in a specific and occult manner the prime etiological factor of the pathological derangement. These medicines act properly only upon diseased organisms, their peculiar effect never being obtained by the exhibition of a single dose, but only after prolonged administration. They are unnatural to the system, and are more or less poisonous. Functional medicines are also unnatural to the system, but they are given only to relieve symptoms of disease, not for the disease itself; whereas Alteratives relieve the symptoms by removing the cause of the disease. The latter normally produce no symptoms, the patient being unaware of their action save by a recognition of his gradually improved condition. Should, in fact, symptoms occur, they should serve as a warning that the remedy is not indicated or that the dose is unsuitable.

To elucidate this principle, the use of morphine to allay the pain of gout may be cited. A single dose is usually sufficient, yet it is not curative; while colchicum acts as an alterative through its well-known specific and eliminative properties, and by continued treatment cures the disease. Again, caffeine may be employed to relieve anemic neuralgia, yet it may require hemic restoratives to alleviate the morbid condition producing the symptoms.

A genuine alterative seems to have the property of antagonizing some disease. For instance, A and B are put under a prolonged course of mercury: A is salivated beyond recognition, while B's health improves-simply for the reason that B had syphilis, which A had not. At present the number of remedies which we are compelled to relegate to this class, Alteratives, for want of accurate knowledge regarding their modus operandi, is quite limited. The second great class of agents to which the name Symptom