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The 1927 Formulary of Peking's First Western Teaching Hospital

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The 1927 Formulary of Peking's First Western Teaching Hospital college to the China Medical Board (CMB) of the ARTICLE Rockefeller Foundation for the sum of US$ 200,000 in 1915.4, 5 Th e CMB had budgeted US$ 1 million for Th e 1927 Formulary of Peking’s First land, building and equipment in the construction of a Western Teaching Hospital new medical college, to be named the Peking Union Medical College (PUMC), and a 250-bed hospital, to Zhu Zhu and Zhang Bo be named the Peking Union Medical College Hospital (PUMCH) in 1916. Abstract Th e CMB eventually invested a total of US$ 7.6 Th e Peking Union Medical College Hospital (PUMCH) million in the building of the new PUMC and was one of the earliest western medical and teaching PUMCH, with completion after fi ve years in 1921. Th e institutions in China. Th e Hospital Committee was re- overspend of US$ 6.6 million was due to a lack of man- sponsible for compiling the fi ve editions of its Formu- agement control, inadequate construction experience, lary. Physicians, pharmacists and dispensers were re- and high shipping costs during the First World War.6 quired to prescribe, dispense and supply pharmaceutical Since then, the PUMCH has always been at the fore- products and preparations in strict accordance with the front of original research and the development of phar- Formulary. Th e fi rst edition of the Formulary was a 39- macological therapeutics, and the Formulary was one page cloth-bound book published in 1922. Th e edition of several achievements of the time.7 described in this article is the earliest available to the authors – the pocket-sized third edition consisting of Th e PUMCH Formulary 67 pages, published in October 1927. Prior to the release of the Chinese Pharmacopoeia as the offi cial guide to standards set by the Republican gov- ᪈᪈㾱˄ㆰփѝ᮷˅㾱˄ㆰփѝ᮷˅ ernment in 1931, large missionary hospitals developed ेӜॿ઼५ᆖ䲒ᱟѝഭᴰᰙⲴ㾯५५⯇оᮉᆖᵪ their own formularies. Th ese included the Peking Hos- ᶴѻаˈަ५䲒ငઈՊ䍏䍓५⯇㇑⨶о㦟һ㇑⨶ˈ५ pital (1910) and the PUMCH in 1922, and the ‘Hand- 䲒lj༴ᯩ䳶NJㅜа⡸Ҿᒤ䶒цˈӵ亥ˈ䲿ਾ㠣 Book of Prescriptions’ published by the Shangtung ᒤ䰤ޡࠪ⡸⡸DŽ५ᐸ൘༴ᯩᰦ৺㦟ᐸ઼ਨ㦟൘ Christian University Hospital in 1930.8, 9 -䝽ࡦо׋ᓄ㦟૱৺㦟⢙ࡦࡲᰦˈ䜭ᓄѕṬ䚥ᆸlj༴ᯩ Of the fi ve editions of the PUMCH formulary pub 䳶NJ޵䇒・Ⲵḷ߶DŽ lished between 1922 and 1942, copies of only the third ेӜॿ઼५䲒㦟ࡲ、䍏䍓㦟૱৺㦟⭘৏ᯉⲴ䍘 (1927), fourth (1932) and fi fth (1942) editions have been 䟿ǃ䲒޵ࡦࡲ⭏ӗо㦟૱׋ᓄǃ༴ᯩᇑṨо㦟૱䈳䝽 found. Th e other two have yet to be discovered. Th e Ѫ⯵Ӫᨀ׋ᴰާ㓿⍾᭸⳺ⲴĀᴹ⭘㦟 third edition published in 1927 is, therefore, the earliestˈޘ৺⭘㦟ᆹ ⢙āDŽ edition known.10 It is a 67-page, hardcover, pocket-sized ᵜ᮷⹄ウⲴᱟᒤࠪ⡸Ⲵㅜй⡸ˈ亥Ⲵਓ㺻 book, bound in a fabric-lined spine with a cloth border, ҖDŽ measuring 14.5cm by 9.0cm. Th e inside front page con- tains the title and usual details (Figure 1). Introduction September 2021 marks the one-hundredth anniversary of the inauguration of the new Peking Union Medical College Hospital (PUMCH) and its pharmacy depart- ment. Th e origins of PUMCH can be traced back to Dr William Lockhart of the London Medical Missionary Society (LMMS) who founded the Peking Hospital (lo- cally known as the ‘Charity Hospital’) in 1861.1 Th e Peking Hospital and a new medical college, under the name of the Union Medical College, were rebuilt in 1906, with a grant equivalent to £1,400 made to the LMMS by the Empress Dowager Cixi.2 In 1910, the Peking Hospital of the Union Medical College published its fi rst pharmacopoeia; this was a 13-page formulary listing 73 preparations, which was to be used as a reference guide by its physicians.3 LMMS Figure 1. Front cover and title page of 1927 PUMCH subsequently sold both the hospital and the medical Formulary PHARMACEUTICAL HISTORIAN · 2021 · Volume 51/2 33 In 1927 John Cameron, the pharmacy supervisor at Th ere are eight sections in the 1927 Formulary, as PUMCH, shared his views on the Formulary with read- follows: A) Foreword; B) Treatment of Poisoning; C) ers in an article published in the National Medical Jour- Antidotes of Acute Poisoning; D) Narcotics; E) Abbre- nal: viations; F) Formulary; G) Th erapeutic Index; and H) General Index. Th e ‘Committee on the Hospital’ (the In the Peking Union Medical College for many Hospital Committee) expected that the Formulary years, we have had a Formulary of all the drugs and would be used in conjunction with the current edition pharmaceutical chemicals used in the hospital. We of the list of ‘Useful Drugs’ published by the Council have recently published our third edition (October of Pharmacy and Chemistry of the American Medical 1927), and it occurred to the writer that it might Association.15 We now describe each of the eight sec- serve a very useful purpose in China if this publica- tions. tion were printed in Chinese. We have suggested to the Committee on the Hospital (PUMCH) that Th e Foreword such a publication would be great in many of the Th e Formulary was published by the Hospital Commit- smaller hospitals in China. Th eir decision in the tee, and the four executives in the 1927 Hospital Com- matter will be awaited with interest.11, 12 mittee were:16 • J. Heng Liu, MD., medical superintendent, (Chair- Th e fi rst edition of the Formulary was published man); one year after the opening of the new PUMCH phar- • F.R. Dieuaide, MD., professor of medicine and act- macy in 1921, and from that date until the implemen- ing head of the department; tation of the offi cial Chinese Pharmacopoeia in 1931, the • J. Preston Maxwell, MD., BS., LRCP., FRCS., pro- Formulary – along with western pharmacopoeias – fessor of obstetrics and gynaecology and head of the were relied upon as the offi cial standard for materia department; and medica and imported drugs used at the hospital. Th e • Adrian S. Taylor, MD., FACS., professor of surgery Formulary was developed in response to a number of and head of that department. needs, as articulated by John Cameron: Although John Cameron, the hospital pharmacy su- pervisor, was not part of the Hospital Committee, he For the most part, the Formulary consisted of drugs and Moody Meng, assistant pharmacist, were involved and preparations which were offi cial in the British in the consolidation of drug monographs and formula- Pharmacopoeia or United States Pharmacopoeia or tions, and in the dispensing of prescriptions according were included in ‘New and Non-offi cial Remedies’. to the dosages laid out in the British Pharmacopoeia. Prescriptions of preparations peculiar to PUMCH Th e objectives of the Formulary, since the publication were given in detail in the text.13 of the fi rst edition, were stated in the Foreword: Adulterated and counterfeit medicines were fre- First, to promote the teaching of rational drug ther- quently supplied by unscrupulous pharmaceutical apy within the institution; and Second, to secure the wholesalers, and routine quality checks were required greatest degree of economy compatible with the wel- to ensure that the quality of the chemicals and drugs fare of patients of the hospital. Th e Hospital Com- delivered were up to the standards specifi ed. mittee also agreed to a special list of drugs in the ex- From our own experience, we have found that it is perimental stage which might at some future date be sometimes necessary to submit drugs to careful analysis included in the Formulary. Additions and deletions before issuing them to the wards of our hospital or as from this list were to be made from time to time by prescriptions to our outpatient department. We have the Hospital Committee, on the recommendation published elsewhere some of the results of our analyses, of the head of a clinical department.17 and these prove that it would be a mistake to accept chemical and drug stocks without verifying the con- In this edition of the Formulary, minimum and tents of the bottles. Unless some pharmacopoeia stand- maximum dosages are given, which as a rule comply ard is referred to in the order, wholesale dealers in Chi- with those of the British Pharmacopoeia. In cases na are able to supply chemicals and drugs of any grade. where the maximum dosage is exceeded, the pre- If no standard of purity or strength per cent is men- scriber is required to initial the amount; otherwise, tioned in the order, there is little point in analysing the the pharmacist was not authorised to dispense the item concerned and complaining that it diff ers from prescription without verifi cation by telephone or in- what was required.14 person. Th e hospital pharmacy could only dispense 34 PHARMACEUTICAL HISTORIAN · 2021 · Volume 51/2 Table 1. Poisoning cases at PUMCH, 1926 Type of poisoning Poison Inpatient cases Outpatient cases Deaths Animal poisons: Miscellaneous 1 1 Drugs, habit: Alcohol 0 3 Morphine 18 3 Opium 7 23 Drugs, acute poisoning by: Arsphenamine 7 0 2 Mercury 3 0 Opium531 Drugs, miscellaneous: 15 6 2 Poisoning by gases and vapours: Carbon monoxide 5 0 2 Coal gas201 Miscellaneous121 Total: 64 41 9 drugs which were included either in the Formulary B) Treatment of poisoning or in the special list. Requests for the purchase by Th e treatment of poisoning guidelines contained in the the pharmacy of drugs not included in the Formu- 1927 Formulary addressed three basic principles: lary were to be referred to the Chairman of the Hos- prompt relief, the maintenance of normal body tem- pital Committee.18 perature, and the removal or dilution of the ingested poison using emetics or lavage.
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