method, and at the same time the pleasantest manner, of administering active, useful drugs.

WEIGHTS AND MEASURES

It should not be necessary to declare that the metric, decimal, system is the best with which to compute prescriptions. The old apothecaries system is the only attachment modern medicine now has to more or less ancient medicine. Many a physician is technically equipped up-to-date in all branches of medicine except in that of writing prescriptions.

The decimal system of prescription writing is universal except in England and the United States. Our monetary system is the decimal system, and one has only to think of doses in terms of dollars, cents and mills, i.e., in grams, centigrams, and milligrams for solids, and mils (cubic centimeters) and fractions of mils for liquids, to readily understand this method of

meaurement.

Two causes have kept the majority of physicians from adopting the decimal system. First, because most books have taught exact equivalents of doses in the two systems, namely, a grain was .065 grams, and half a grain was .0325 gram, etc., and most doses were translated into impossible figures. If a dose is learned as .05 gram, for instance, but few would try to translate it as 5/6 and a fraction of a grain. When it is recognized that the dose of a drug may vary from one to three grains, it should also be recognized that the dose of that drug is just as accurately expressed as from .05 to .20 gram.

The second reason that the decimal system has not been generally adopted in the United States is because of the inertia of hospitals and dispensaries. They will not change their stock mixtures, and some of the best hospitals in this country have the most ancient formularies. Therefore the young graduate in medicine, though he may have been taught the decimal system, soon forgets it and learns the old weights and measures used in the hospital in which he becomes an interne, and this very hospital will accurately describe how many cubic centimeters of blood were transfused, how many parts to one thousand a given solution of corrosive sublimate contains, and

still have nitrate of silver solutions of "so many grains to the ounce." Let us hope that the hospitals will purge themselves of their ancient formulas and surgically eradicate the old apothecaries system of weights and measures.

The United States Pharmacopoeia gives the average doses in both systems but still insists on the accuracy of a fluid drachm equalling 4 mils (c.c.), which is correct; but the contention seems good that any average dose stated as 4 mils would be equally accurate, on the average, if it was stated as 5 mils. Also the equivalence of one fluid drachm to 4 mils depends upon where the meniscus is read. Such accuracy in doses of drugs and their preparations, the dose of which is as large as one fluid drachm, is refined absurdity. Also, physicians write in the apothecaries system for so many fluid ounces and order the dose as a teaspoonful, and compute the doses of the active ingredients on a basis of 8 fluid drachms to the ounce, i.e., 8 teaspoonfuls. The patient most always gets more than a fluid drachm (4 mils) at a dose, as most teaspoons readily hold 5 mils (5 c.c.). Hence another contention, that most every patient given a liquid preparation written in the old system and prescribed in teaspoonful doses receives more of the active ingredients of the prescription than was intended. The above discussion is really almost superfluous, for the dose of any drug is enough, and too much at any sized dose is too much.

To repeat, fine fractional equivalents of doses, though chemically correct, are therapeutic nonsense. Every student of medicine and every practitioner, who still uses the old system, should learn the doses of drugs in the decimal system and radically dissociate the two systems: namely, a teaspoonful may be considered equal to 5 mils; 1 gram may be considered equal to 15 grains; .05 gram may be considered equal to 1 grain; .01 gram may be considered equal to 1% of a gram; and .001 gram may be considered equal to 60 of a grain.

THE DECIMAL SYSTEM

The United States Pharmacopoeia directs that solid drugs shall be weighed in the decimal system, and that liquid drugs and preparations shall be measured in the decimal system.

The base of this system is the meter, an established length representing one-forty millionth part of the earth's circumference around the poles, and equivalent to 39.370432 inches. The unit of volume is the liter, a cube having the length of its side equal to 10 of a meter, and equivalent to 2.056716 pints. The unit of weight is the gram, the weight of a cube of water at 4°C. having the length of its side equal to 100 of a meter, and equivalent to 15.432 grains. A smaller unit of volume is used, namely, the cubic centimeter (decreed by the last revision of the United States Pharmacopoeia to be termed "mil"). The cubic centimeter, or mil, equals 1000 of a liter, that is a cube having for its side 100 of a meter. A larger unit of weight is used, namely, the kilogram (1000 grams) which equals about 2 pounds.

Although the United States Pharmacopoeia recognizes decimils and decigrams, for dosage and prescription writing the following fractional terms are sufficient, more simple, and accurately agree with the pharmacists' metric weights and

It should be remembered that I mil is the same as I c.c, and 1000 mils as

0.010 or 0.01 = 10 milligrams, or I centigram

0.100 or 0.10 = 100 milligrams, or 10 centigrams (or 1 decigram).

I.

1000.

= 1000 milligrams, or 100 centigrams, or 1 gram.

= 1000 grams, or 1 kilogram (1 kilo), 2% pounds.

OLD SYSTEM

For ready reference the tables of the old system are given; the complicated and easily mistaken symbols should be compared with the clear figures of the decimal system.

TROY, OR APOTHECARIES, TABLE

60 grains (Gr. lx) = 1 drachm (3i). 8 drachms (3 viii) = 1 ounce (3i). 12 ounces (3xii) = 1 pound (1 lb.)

WINE, OR APOTHECARIES, MEASURE

60 minims (M lx) = I fluid drachm (fl. 3i).

8 fluid drachms (fl. 3 viii) = 1 fluid ounce (fl. Zi).

16 fluid ounces (fl. 3xvi) = 1 pint (0 i).

For ready reference the following table of approximate equivalents of the two systems will be found useful:

Even if surgical, special and specific treatments are the only correct methods of effecting a cure of disease, and even if most acute diseases tend to recovery, and even if correction of the diet, hygiene, etc., tends to eradicate abnormal conditions of the body, the patient will still require more or less medicinal treatment to stop pain, to promote nutrition, to increase general elimination, to decrease any abnormally profuse eliminative activity, to produce sleep, to supply or aid the activity of some internal secreting gland, and to soothe, stimulate, or otherwise treat the external surface of the body. Hence, however much the surgeon may state that he does not need drugs, and however much the consultant may deplore the use of drugs, they must be, and are, used legitimately for the vast majority of all patients.

Nothing in the above statements is intended to declare that many chronic conditions, especially of the nervous system, are not better treated by physical methods than by drugs, or that it is not a fact that too much medicine is often given to acutely sick patients. However, the absolutely drugless treatment of acute and really tangible chronic illness is a myth. If there is nothing the matter with an individual, of course he can be cured of what he did not have by what he does not get.

That there are useful drugs and that such drugs have a known and demonstrable activity is doubted by no one of sane mind. That these drugs can produce the symptoms and signs of their action in patients is known by everyone who has had laboratory and subsequent clinical experience. These facts should compel two restrictions in the use of drugs: (1) a drug should not be used that is not known to have some definite, safe activity; (2) only one who has the knowledge of the action of a drug on the human being in health and in disease should prescribe that drug for a patient.

A self-evident corollary of the above is that a mixture of drugs cannot be prepared or "kept in stock" to fit a patient who may need treatment some time in the future. Each patient should be individualized and should receive the drug needed, in the amount necessary to cause the effect desired, and he should not receive a mixture of drugs that was made to fit a series of patients who will vary in age, size, nutrition, strength, and in the severity and complications of their disease, even if they have the same disease. Hence proprietary, drug-store, hospital, dispensary and office mixtures are unscientific, and at times may even be dangerous treatment.

Many official (U. S. P.) preparations of useful drugs represent good methods of administering such drugs, and these should be more frequently ordered rather than to have recourse to proprietary preparations of no more value, efficiency, or elegance. Some of these preparations are kept ready prepared in the drug shops, and some are compounded by the pharmacist at the time of receiving prescriptions calling for them. In either case, the physician expects the preparation to be standard and always the same. Some ready-made preparations, and especially if in unsealed packages, may deteriorate, and hence freshly prepared preparations are, and should be, demanded. In spite of the pharmacal elegance and perfection of the preparations of the United States Pharmacopoeia and National Formulary, generally a prescription should be written especially individualized for the particular patient. This does not mean that a drug must necessarily be combined with something else, or that some mixture be ordered by the physician when there