The medical student at the end of his third year is many times better prepared to prescribe useful drugs in a useful way than is the student at the end of his fourth year, or is the physician who has spent one or two years in a hospital. The fourth year student receives clinical instruction both in the hospital and in the dispensary, and hears mixtures ordered by number, or by some fancy name, without knowing what the solution, pill, or powder contains. This same indefinite medication goes through his hospital internship, and except in certain particular conditions such as heart failure or when some new drug is studied, he has little idea of the exact dosage that the patient has received of any particular one drug. He therefore begins active practice with little knowledge of scientific or rational medication. It is also regrettable that the hospitals will not adopt the metric system in prescription writing, although they constantly use percentage solutions in the laboratories and in the surgical clinics. Education and scientific knowledge does not save a man or a woman from a belief in the mysterious, and the physician is no exception. While the layman may have faith in talismans and amulets, horse chestnuts, iron rings, and in some particular patented medicine, the physician, unless he is particularly well balanced and particularly prone to self-inspection and to careful study of his patients, will often acquire a belief in some proprietary mixture, or even in some mixture of his own, and will report unusual and continuous favorable results from such medication. If each physician will take a pencil and draw a line through the inactive ingredients of some mixture, he will find that there is probably one single drug that is causing success in his treatment, and the mystery will disappear. Or, he will find that there is nothing in the prescription at all, that it is really his own enthusiasm and his general care of the patient that cause the improvement. No man who has taken a course in a pharmacologic laboratory, or who has carefully watched the action of active drugs on patients who needed such active help, can be an agnostic as to the value of drugs. Besides the drugs that are demonstrated to be active in the pharmacologic laboratories, the practising physician can learn which of the newer drugs and preparations are of value by reference to the annual edition of "New and Non-official Remedies," issued by The American Medical Association. However, it is true that the number of useful drugs is not many, and it may be interesting to note that in 1916 "The Medical Review of Reviews" solicited the opinion of noted therapists as to which were the five most useful drugs. It was understood that the anesthetics and antitoxins were excluded from consideration in this vote. One hundred and seven answers were received by the medical journal, and the five drugs voted (almost unanimously) as most useful were opium, mercury, cinchona, digitalis, and iodine, with arsenic (as arsphenamine) and salicylates as the sixth and seventh choice. A FEW DRUG APHORISMS Alum should not be used as a mouth wash or as a gargle. Bismuth subcarbonate is preferable to bismuth subnitrate, as the latter under certain conditions can cause poisoning. There is no excuse or justification for ever using nitrate of silver, potassium chlorate, or zinc preparations internally. An exception is when zinc sulphate is used as an emetic. If tannic acid is desired for action in the intestines, one of its combinations, that is not irritant to the stomach, should be used. As a bitter tonic, administered in solution before a meal, none is more efficient than the tincture of gentian, or the tincture of cinchona, in teaspoonful doses, or the tincture of nux vomica, in one drop doses. The only preparations of iron needed are the reduced iron, the carbonate of iron pill, and the saccharated oxide of iron. Inorganic irons are of no more physiologic value than are these. Dilute hydrochloric acid is, in the majority of cases, the only digestant a patient requires. Pepsin and diastase are rarely needed, and pancreatin is most valuable as a pre-digester. If lime is needed and milk is not advisable, calcium glycerophosphate is one of the best preparations. One or two salts of quinine are sufficient. Cinchonidia and cinchonina are not needed. The tannate of quinine is of little A large number of the so-called vegetable cathartics are not needed, and the multiple ingredients of the compound cathartic pill should render it only of historical interest. Pre-operative severe purging is now inexcusable. Such treatment causes gas distention, more or less congestion, post-operative pains, and more or less paresis of the bowels and promotes shock. No other drug will inhibit profuse perspiration as efficiently as does atropine. Water, caffeine in some form, and digitalis are efficient diuretics. The many other so-called diuretics are not needed. To render the urine alkaline, no drug is better than potassium or sodium citrate. There is no necessity for, or wonderful action from, the "A B C mixture." As genitourinary antiseptics hexamethylenamine, phenyl salicylate (salol) and other salicylic acid preparations are efficient. As a stimulant to the genitourinary tract, and also as a mild antiseptic, nothing is better than the oil of santal. As emmenagogues, iron, thyroid extract, and at times corpus luteum are the most efficient. The many mixtures lauded for dysmenorrhea and disturbances of the menstrual function are of value only on account of their alcohol content. If alcohol is advisable, it should be ordered wittingly, and not in some proprietary mixture. As expectorants nothing has been shown to be better than ammonium chloride, ipecac, and iodides. To diminish the secretion of the air passages, no drugs are more valuable than atropine, terpin hydrate, and, if needed, codeine. All of the other so-called expectorants are unnecessary and are often harmful to the stomach. Every treatment of asthma which is efficient contains an atropine in some form, an alkaloid or preparation of opium, or a nitrite. Bromides and chloral may at times be of value, and caffeine and suprarenal are often efficient, but all of the many preparations of belladonna, stramonium, and hyoscyamus are superfluous. All of the proprietary and mysterious preparations for asthma contain more or less of these drugs. The newer coal-tar products or synthetics of the antipyretic and analgesic class have not been shown to be improvements on the original acetanilid, antipyrine and acetphenetidin. Chloral is still the most efficient hypnotic, and barbitalsodium (veronal-sodium) is thus far the best synthetic drug for this purpose. Sodium bromide and potassium bromide are the only bromide salts that are needed. All others are absolutely superfluous. In most instances sodium iodide is better than potassium iodide, and other iodide preparations are not improvements on these two drugs. A very small dose of sodium iodide is as efficient as a larger dose of some preparation which contains but little iodine, and generally an iodide "without its sting" is a preparation that contains but little iodine. Salicylic acid preparations that cause no disturbance of the patient act thus pleasantly because they do not offer much salicylic acid. If the action of salicylic acid is needed, it must be pushed to mild salicylism. Acetyl salicylic acid (aspirin) will reduce temperature and stop pain, and may relieve some symptoms of rheumatism, but the drug is too depressant to use in acute inflammatory rheumatism. DRUG FALLACIES Sweet spirits of niter as a diuretic is a joke. A solvent action of lithium is unproved, and any benefit from waters containing lithium is due to the amount of water drunk. Hypophosphites as such are worthless, and practically no hypophosphite solution is offered by any proprietary firm unless it contains such drugs as quinine, iron, strychnine, etc. There is no use for hypophosphites. There is no tonic, so-called alterative, or any other kind of action from sarsaparilla. Valerian is of no benefit in hysteria except by its smell, unless it is put up in an alcoholic preparation and the patient is alcoholized. The old lead and opium wash is no longer a muddy necessity. It is too bad to so misuse opium! The "rhinitis" tablet to stop colds, if analyzed as to its ingredients, resolves itself into nothing but the action of its atropine, and a tablet representing 1500 of a grain of atropine sulphate will act as satisfactorily as any rhinitis tablet. Basham's mixture (Liquor Ferri et Ammonii Acetalis) which contains very many ingredients, with aromatics, supposed by all hospitals and a large number of physicians to be of great value in Bright's disease, is an old combination that has no special value except in the mind of the one prescribing it. There is no question that many patients who have Bright's disease need iron in some simple form, but there is no physiologic or therapeutic necessity for administering the mixture named after Doctor Basham. Many of the mixtures still retained in the Pharmacopoeia, notably the compound cathartic pill which contains eight ingredients, the compound mixture of glycyrrhiza (Brown Mixture) which contains six ingredients, the syrup of hypophosphites which contains three hypophosphites and hypophosphorous acid, the compound syrup of sarsaparilla which contains seven ingredients, the compound syrup of squill (Hives' Syrup) which contains three ingredients, are all more or less respectable antiques. The compound tincture of lavender containing five or six spices is a pleasant alcoholic preparation that may be used judiciously in the present dearth of cocktails. THERMOMETRIC EQUIVALENTS To convert degrees Centigrade to degrees Fahrenheit, multiply by 9, divide by 5, and add 32 to the quotient. To convert degrees Fahrenheit to degrees Centigrade, subtract 32, multiply by 5, and divide by 9. A few commonly used equivalents are as follows: C. F. +32 + 68 Freezing point of water. +98.6 About normal body temperature. +140 Pasteurizing temperature. Boiling point of water. |