derlying cause of sectarianism in medicine, just as theology THE UNITED STATES PHARMACOPEIA. results in sectarianism in religion. It results in making faces one at another, condemning those who differ in opinion and ROBERT A. HATCHER, Ph.G., M.D. Member of those of like notion. It is, therefore, particularly re- Council on Pharmacy and Chemistry of the American praising Medical Association; Assistant Professor in to hear a read that contributes and Pharmacology, freshing paper knowledge Medical fact. It leaves with the individual the exercise of free Cornell University College. thought NEW YORK CITY. and is written in the best manner possible to apply this to pre- senting conditions. Dr. Beates said that when he hears of a It is not my present purpose to add to the many re- person advocating some concoction, when he does not know views or criticisms of the Pharmacopeia, but to call at- what it may represent, and is prompted by the statements of a tention to two conditions, hoping that steps may be representative to employ it, from the point of view of thera- taken by this Section looking to their improvement. he feels that such men are subversive to scientific peusis, prog- The first is the general loss of interest on the part of ress. Exceptional results by no means establish a principle. in the revision of the The A gentleman remarked, he continued, that because an experi- physicians Pharmacopeia. was called into in ment on dogs conducted with a view of proving the antidotal Pharmacopeia being by physicians and in were admitted to power of permanganate of potash proved negative, his belief 1820, 1850 pharmacists the was upset in the efficacy of physiologic investigation; and convention; since then physicians have gradually re- when this same gentleman belittled physiologic research and linquished control to pharmacists, and to-day we are con- vivisection, Dr. Beates could not help but remember that, if fronted with an anomalous condition, in that the com- he is not mistaken, the canine species can without any toxic mittee of revision of 1900, of men, effects in of would kill consisting twenty-five indulge quantities morphia that many numbered nineteen pharmacists or men identified with individuals of the human race, and that, therefore, a statement institutions, and but six whose interests affirmed on such premises is scientifically without any value pharmaceutic were with medicine. For Dr. whatsoever, indeed, positively pernicious, because it to entirely example, Squibb appeals was known as a the sentimental side of those who, in ignorance, do not know almost universally manufacturing phar- members the revision to what degree they are obligated to the wonderful disclosures macist. Only ten of committee of and discoveries of scientific truth, which vivisection alone sup- had the title of M.D. plies. This condition is not creditable to the medical pro- If a body of scientific men will adhere exclusively to pre- fession, for it is obviously not the province of pharma- senting papers that deal with facts and fundamental princi- cists to decide for physicians what remedies they are to ples, intelligently and scientifically demonstrated, and not en- use. deavor claim a to that with dose of castor oil, or what not, I do not think it is realized to how the wonderful ego can do something that Drs. A, B and C can generally great an extent the medical has its mani- not do, and then avoid the Xs and Ys in the profession neglected mistaking propo- in sition, we will progress more rapidly than we otherwise can do. fest obligations connection with the Pharmacopeia, Such a spirit of convention, Dr. Beates said, will avoid the in- leaving the work almost wholly to pharmacists. Less dulgence in invective, invidious distinction and the class of than half the states had medical delegates accredited to mental perturbation, which should be foreign to broad-minded, the Pharmacopeial convention in 1900. Six states named scientific bodies. Physicians will learn to conform with the stern but no Ohio had facts of pharmaceutical, medical, delegates. existence and definitely established laws. They will three medical delegates and New Jersey had one, ac- then that can be in acquire knowledge utilized many pursuits credited, but not one from either state attended the con- in life in which the is an active factor. In Penn- physician vention. Besides these two states and many of less sylvania, this year, opposition to medical great progressive legisla- and North Carolina were tion, having in view the well-recognized corrective necessities importance, Iowa, Virginia without in that conven- on which laws depend, was successfully interposed by effort of wholly medical representation the sectarians and that class who lack in knowledge of funda- tion, and the following states each had but a single med- fifth mental principles and scientific fact, as the weather vane is ical delegate: Missouri and Indiana, the and sixth swayed and points to every breeze that wafts across its surface. states in the Union in population and importance (Dr. Dr. George F. Butler, Chicago, has obtained results from hy- Whelpley's interests are mainly pharmaceutical), drastis and considers it a good drug. It may, he said, prove Georgia, Minnesota, Connecticut, Nebraska, Kentucky, of but little value in some men's hands and of great value in Tennessee and Wisconsin. the hands of others. In contrast with this showing it may be mentioned Dr. Robert A. Hatcher, New York City, felt that Dr. Will- that the pharmaceutical organizations of New York iams' paper affords an admirable illustration of the fact that named and those of Ohio named fifteen. there are certain drugs which should be from twenty delegates expunged the From these one may some idea of the pre- Pharmacopeia until we have more knowledge of their value. figures gain ponderance of pharmaceutical over medical influence in that convention. Diagnostic Importance of Cutaneous Reaction to Tuberculin. So far from finding fault with the pharmacists for —Since C. von Pirquet announced last May his Allergie this condition of affairs, I think their is worthy as he spirit test, calls it, numerous communications have been pub- of and I think may with to lished abroad on this of the skin reaction to emulation, they point pride subject tuberculin. their share of the work. It is with the members of our He relates in the Wien. klin. his ex- Wochschr., September 19, own that the blame rests for this condition. perience in 100 cases in which the clinical were profession findings sup- The to I wish to is plemented by autopsy. During the final stage the cutaneous second point which draw attention a in the matter reaction was generally negative, but in the 31 cases of clinical the want of genuinely progressive spirit and in 1 of suspected tuberculosis, the cutaneous reaction was of admissions and dismissals. A very important object positive, while it was constantly negative in the 52 cases in of the Pharmacopeia is to provide an authoritative list which no tuberculous lesions could be discovered at autopsy. of remedial agents. It should represent all that is best In some cases in which the lesion was very small, the cuta- in therapeutics. In order that the Pharmacopeia should neous reaction was not positive until the test was repeated. command the of physicians in the highest de- His cases were all in children from 6 months to 13 years old. respect and secure the earnest of the The test can be made more sensitive by reducing the concen- gree support leading tration of the tuberculin, from 25 to 10 per cent. The former Read in the Section on Pharmacology and Therapeutics of the is liable to rouse even old and inactive strength up foci, while American Medical Association, at the Fifty-eighth Annual Session, a weaker dilution will reveal only recent and active lesions. held at Atlantic City, June, 1907. Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/01/2015 men of the profession it should, so far as possible, em- the wishes and sentiments of many men of a great di- brace every non-secret medicinal agent of unquestioned versity of interests, education and ideas. merit, regardless of its nature, while every article of If we are to strive only for the best we shall be forced doubtful value should be dismissed. to do some violence to the ideas of those who, through It is hardly necessary for me to add in this connec- sloth, incompetence or misfortune, are unable to keep tion that I do not advocate the admission of every as- step with the march of therapeutic progress. tringent, nauseant, diuretic, cathartic and bitter, but It is true that the Pharmacopeia must serve a di- only of those of each type which possess distinct advan- versity of interests, ail of which are represented in the tage over others in some particular condition. direction of its affairs, but with the spread of scientific If we can rid the book of all useless material and fill training we are coming to a better appreciation of the it with all that is best, and only the best, and maintain fact that independence is not incompatible with defer- it at that high standard of excellence, it must inevitably ence to the opinions of those better informed than our- command the admiration and enthusiastic support of selves, and with each revision we should approach nearer the ablest men in the profession. For, while I recognize to the ideal. its imperfections and shortcomings, it seems to me that With the progress of this idea it will be increasingly the greatest need at the present time is a strictly pro- improbable that a substance shall be admitted to the gressive attitude toward the question of admissions. Pharmacopeia before it has been carefully considered I shall not soon forget the fine contempt and scorn by competent pharmacologists and clinicians. with which one of the most respected practitioners of If we accept rational progressive therapeutics as the New York—a firm supporter of the Pharmacopeia and touchstone by which we are to decide all questions con- one but little given to prescribing unofficial remedies— cerning admissions to the Pharmacopeia, it will be com- spoke of the admission of an "imitation of antikamnia." paratively easy to eliminate most of the dead matter, Is there any one in this audience who will maintain that and it will aid in the selection of all that represents antikamnia represented a distinct advance in therapeu- actual progress in therapeutics. tics? If it did not, the best excuse for its imitation by It is imperative that effective provisions, not mere the Pharmacopeia is still only a very poor excuse. authorization, be made for additions as fast as new Is there a physician worthy of his degree who is un- remedies are proved beyond reasonable doubt to possess able to write a prescription for acetanilid and caffein ? actual merit, for more progress is now possible in one antikamnia Doubtless the inclusion of this imitation year than was made in the ten years from 1820 to 1830. aroused the enthusiasm of many whose therapeutics are It is of almost equal importance that an official ar- taken from the wrappers of nostrums or some manu- ticle which has been superseded by a manifestly better facturer's pocket therapeutics, but for each friend so one should be dismissed. This would serve notice to the gained it lost the respect, to that extent, of such a man practitioner that the article in question had failed to as the one to whom I have referred, and the good opin- measure up to the standard of the best then in vogue. man for cause of ion of one such is better the perma- There are not many who would prefer to employ a rem- nent progress than is the enthusiasm of a host of the edy so discredited if the merits of the Pharmacopeia other kind. were more generally esteemed. While this compound acetanilid powder represents the Physicians will employ whatever appears useful to most objectionable of the admissions to the Pharmaco- them, but at present we have no legally authorized guide peia, there is another type, the elimination of which wifl in the matter of very many agents, and amid all the cause much greater opposition—I refer to the many misrepresentations there is little cause for wonder that hoary representatives of obsolete or useless substances the physician should be duped occasionally, but it is which have been retained wholly out of deference to the remarkable' how systematically, persistently and amaz- sentiments of a goodly number of very respectable, but ingly he allows himself to be cheated, humbugged and not progressive, practitioners who use the remedies even disgraced by the wily swindlers. used with- which their honored preceptors before them If such a thoroughly progressive policy should be out any definite idea of just what they expect to accom- adopted it would place a greater burden of responsibility plish thereby. on the committee of revision, for on the wisdom which The representatives of this class of substances are so that committee displayed would depend the use of Phar- numerous that I fear to mention one member lest every macopeial substances instead of the most skilfully one present should name a better (or worse), but sar- vaunted nostrums. saparilla, syrup of lactucarium, cannabis Indica and its Should that committee not be progressive it would preparations, lappa and calendula, may be cited as exam- leave the door wide open in the future, as it has been ples. There are numerous official substances which are in the past, for the introduction of a host of compounds not even mentioned by the standard text-books on thera- for each new substance which might come into deserved peutics and pharmacology. I should be glad to have a notice. Thus the early admission of urotropin would clear and concise exposition of the pharmacology of the have done much to prevent the flooding of the market compound syrup of hypophosphites. with the same product under a variety of names which It has been argued with much reason that it was added much to the confusion of the nostrum-guided necessary to have aif* authoritative standard for many practitioner. articles in domestic use; this argument has lost much If, on the other hand, there is not painstaking care of its force, so far as it applies to the Pharmacopeia, and wisdom displayed in the selection of substances to since the National Formulary has been clothed with be admitted, the good opinion of the ablest men in med- legal authority, and that work should relieve the Phar- icine will be forfeited. macopeia of this hindrance to its upward progress. This is exemplified by what has been said with re- Another strong argument used in support of the re- gard to compound acetanilid powder. This also illus- tention of many substances which the committee of re- trates the type which has served its doubtful purpose vision would hardly commend individually is based on and should now be promptly dismissed.

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/01/2015 So great would be the responsibilities of the therapeu- presented to this Section a year ago, and I can do no tic committee charged with this duty that it would be better than to reiterate what he said then. necessary to have a number of men of great ability, It must come to be considered a distinction, a priv- breadth of view and undoubted integrity who could give ilege and a duty on the part of delegates to be present much time to the subject, for it must be conceded that and to participate actively in the deliberations of the in the effort to keep the Pharmacopeia in the van of Pharmaeopeial convention. therapeutic progress the way would be left open for That this has not been true in the past is shown by great scandal if the men charged with this duty were what has- already been said and by the fact that of the not above the least suspicion either as to personal integ- physicians actually named as delegates to the convention rity or the faithful and painstaking performance of ex- in 1900 more than fifty failed to attend. Indeed, it may acting obligations. be safely stated that less than one-tenth as many medical Medical education is making such rapid strides that delegates participated in the deliberations as would have we have every reason to demand a higher standard of been eligible had a proper interest been aroused. usefulness for the articles to be admitted to the next This Section and its officers can not escape just cen- Pharmacopeia. sure if no steps are taken to prevent such a wholesale on of at There are at present several well known pharmacologic neglect of duty the part pharmacologists, least laboratories in operation in charge of such men as Abel at the time of the next convention. and Sollmann, and there is no excuse for the clinical Despite all of this indifference on the part of physi- know of the use of new agents before they have been thoroughly cians, many of whom practically nothing its its tested on animals, and the evidence is not lacking that Pharmacopeia, origin and many excellent features, this branch of medical research will make considerable we constantly hear them sneer at its imperfections. progress in the near future. The American Medical Association can use its vast The great medical with their ample hospital influence to no better purpose than in getting the best colleges, heed claims the facilities, are making strenuous efforts to secure capable men in medical circles to give to the of clinicians—men trained to accurate observation—and Pharmacopeia on their interest and their efforts. Then, their that of can and only then, will it cease to be the fashion to sneer work, supplementing pharmacologists, in not fail, in the vast majority of cases, to possess advan- at the defects of the work—but rather will it be held as best in tages over that of the man in private practice not nearly the highest esteem representing the medical, even as it now in so well situated for controlling his patients and not usu- does pharmaceutical, circles. ally so well trained in accurate observation. 414 East Twenty-sixth Street. look to men with such We should advantages—clin- DISCUSSION.* icians and pharmacologists—for guidance in the choice of the official materia medica, rather than to the pre- Dr. J. P. Remington, Philadelphia, thinks that every one numbers entitled to in the will admit that the medical profession has been grossly negli- ponderating representation of its duties in the although the physicians who were we are to the Phar- gent past, Pharmacopeial convention, if place members of the Committee of Revision of the Pharmacopeia in forefront of macopeia the therapeutics. did their duty. He said that it is a common thing nowadays The committee of revision was empowered to secure to "take it out of the Pharmacopeia." If any man wants a expert advice in matters pertaining to chemistry, and subject for discussion, and one which he can hit with safety, there is every reason why this policy should be so ex- there is always the Pharmacopeia. The authors of the papers, he to were con- tended as to embrace the results of pharmacologic and said, failed make any definite charges; they in a "The names are too clinical research, for many clinicians and laboratory demnatory only general way: long; the average doses are good for nothing; the work is ancient are deterred from workers investigating proprietary and antiquated, and it pleases but a very few physicians; the are so com- remedies by the fact that notorious methods compound syrup of hypophosphites is an abomination; phy- in use so monly pursued by nostrum makers securing phar- sicians do not buy or it," and on. Dr. Remington quoted macologic and clinical reports. I may recall to your one of the speakers as having said that there were nineteen minds the exposure1 in The Journal of the American pharmacists and six physicians on the committee. As a matter Medical Association of recent date of the clin- of fact, some of the men on the committee were pharmacists pretended who were also in medicine so that the number of ical of Gude's in anemia Mateo graduates study pepto-mangan by physicians and pharmacists was almost the same. Dr. Rem- on Island. M. Guillen at the City Hospital Randall's ington also emphasized the fact that the United States Phar- Fortunately for all interests concerned (except those macopeia is made for the United States of North America. of the nostrum maker) the reaction against the truly It is more important that the Pharmacopeia be recognized as condition which has prevailed in therapeu- an authority and used by the country doctor who is not a pro- disgraceful in a medical a in a and which had and worse, fessor college, than by professor college, tics, grown steadily rapidly because the knows more of the of in of to the im- professor study pharmacology has resulted the awakening physicians than the doctor. he want a and it is much country Physicians, said, prepara- portance of the Pharmacopeia, becoming tion on which they can depend, and of which they know the better known to the medical profession. Owing to this ingredients. They want something which is non-secret. By increasing interest in, and popularity of, the Pharmaco- placing tables of incompatibles after each article the Pharma- peia there should be a large sum available for research copeia, he asserted, would be larger than the dispensatory. in the preparation of the next revision, and it may be Dr. Warren B. Hill, Milwaukee, Wis., a member of the considered as certain that any expenditure in that direc- 1900 Committee of Revision of the Pharmacopeia, said that tion will yield a return many times greater than the some doctors on the committee were eloquent, but the pharma- incurred. cists would not heed them because they were doctors. The expense medical men are so outnumbered that anything they had to If the reaction is to we must arouse in gain impetus say was absolutely useless. Dr. Hill said that he himself had a livelier sense of in the matter physicians responsibility the temerity to say that he wanted to show the committee what of revision. This was argued by Mr. Wilbert in a paper2 This discussion, which took place after the article by Dr. 1. The Journal, April 6, 1907, p. 1197. Hatcher, has more or less reference also to the four papers read 2. The Journal, Dec. 15, 1906, p. 1989. previously (by Drs. Wood, Remington, Hallberg and Osborne).

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/01/2015 the doctors needed, and he was told: "We don't care what the Dr. H. G. Piffard, New York City, one of the members of doctors need. This is a book made by the druggists for the the Committee of Revision of 1880, said that the discussion druggists and we don't care what the doctors need." This alter- so far is almost a repetition of the discussion which occurred cation was expunged from the records. Dr. Hill urged that at the meeting of the Committee of Revision for 1880. He physicians be stimulated to greater interest in the Pharma- was chairman of the subcommittee on titles. After a year's copeia. Medical societies do not know the importance of rep- labor a report was agreed on. More than two-thirds of the resentation. By sending good delegates from each state and report was cut out by the action of the pharmacists led by Dr. society to the next convention, it may be possible to influence Squibb. Dr. Charles Rice, he thought, stated the matter clearly the druggists. A matter to be considered, however, is whether when he said that the doctors should say what kind of drugs the Pharmacopeia should be a little book—a text-book, as it they want and the pharmacists should decide the best means were—for the use of the doctor and the medical student, or a of preparing them. larger book, one to be used only as a reference book. Dr. Hill Dr. J. J. Taylor, Philadelphia, called attention to the three believes that it should be a large book, a reference book, one drugs which Dr. Hatcher would exclude from the Pharma- that could be used anywhere. That would be the kind of copeia. One of them was cannabis indica. He felt that the Pharmacopeia best adapted to the needs of the country, and, practicing physician would be willing to drop everything offi- then, by making a syllabus or brief of it, the other purpose cial, if he could but have cannabis indica. Cannabis indica is might be carried out also. probably dearer to the heart of the doctor than to that of the Dr. William J. Robinson, New York City, said that he pharmacist, because of the extreme pharmaceutical difficulties long ago concluded that 99 per cent, of all quarrels and dis- in its manipulation. The crux of the matter is, he continued, agreements originate in misunderstandings. And this, he that the physician who has been in practice a number of years, thinks, is well illustrated by what Professor Remington said, when he takes up the Pnarmacopeia and finds that the ma- because if he had listened carefully to the report of the com- jority of his favorite drugs are out of it, has but little, if any, mittee, he would not have made the statements he did. Dr. further use for the book. So that, in his opinion, the drugs Robinson said that there is no desire to make a smaller Phar- we have been accustomed to using with good results should macopeia for the pharmacist. So far as the pharmacist is con- with great hesitation be eliminated from the list. cerned, the Pharmacopeia may be as big as the dispensatory; ^R. M. Clayton Thrush, Philadelphia, said that it must be but it should more more be made attractive to the physician, remembered that the Pharmacopeia was never intended to be available for his is uses. The physician not interested in the a text-book. It is simply a standard for the identification and process for making spirit of nitrous ether; he does not care purity of certain medicinal products. It is the Pharmacopeia know for to the assayed process determining the amount of of the whole United States, and no matter how many prepara- -Mid of vomica nor strychnin extract mix in the crude drug, tions are added, it will not please everyone. It is impossible does he care to know how to in various chem- detect impurities to satisfy all, for what is popular in one section of the country ical salts. All this is entirely out of his sphere. What he does is practically obsolete in another. The committee is trying to care know is the or to general appearance of the drug chemical, adopt preparations that will satisfy the majority of the pro- its solubility, its average dose, its antitdotes. and its most com- fession. Dr. Thrush commended Dr. Osborne's suggestion, that mon And this is what the incompatibilities. Pharmacopeia when the next committee meets, there should be on it an equal should give to the physician. If one book will not do for both number of physicians and druggists. It is the physician's duty, pharmacist and physician, then a special abstract should be he said, to select the preparation he prescribes, and it is the made for the physician's use. pharmacist's duty to prepare it. Dk. Oliver T. Osborne, New Haven, Conn., thought the Mr. M. I. Wilbert, Philadelphia, asked why, if the Phar- points made by Dr. Robinson were well taken. As to members macopeia is the Pharmacopeia of the United States, should it on the Committee of Revision, he said that the mere title of not be restricted to drugs that are used in the United State?. to do with it. It is M.D. Jjas nothing practicing physicians and why should it include drugs used only in one particular that are wanted. The question is, What is the man doing with section of the United States? If drugs that are not widely his If he is with a M.D.? connected pharmaceutical concern used can be demonstrated to have advantages, they will soon he is not in practice. Dr. Osborne commended the report re- be more widely used and will then be eligible for inclusion in ceived from Professor Remington from the Pharmaceutical the Pharmacopeia. Mr. Wilbert claimed that if the Pharma- Association. copeia can be brought to the attention of every practicing phy- Dr. Henry R. Slack, La Grange, 6a., feared that Dr. Hill sician in this country, it will prove to be the greatest educator created a wrong impression by not qualifying his statment. that they have ever had, and that, after all, appears to be the The discussion, he said, was on the question of doses and greatest use for or the most important function of the Phar- whether medicinal properties should be mentioned in the Phar- macopeia. macopeia. A professor of chemistry in one of the colleges Dr. J. P. Remington decla^d that the physicians of this stated that the object of the Pharmacopeia was to furnish the country do not quite grasp the fact that the U. S. Pharma- pharmacist with a book by which he coulfT make his drugs and copeia is the law of the land, and that its first valuation and test them, and that i+ was not intended to teach therapeutics its greatest function is to provide a standard for purity and medica the was and materia to medical profession. It not in- for strength, and that while it is of use to the physician in tended to be a treatise on therapeutics. To say that the phy- the matter of providing a standard for the Food and Drugs sicians had no voice in this, Dr. Slack said, is not exactly cor- Act, there is no other book that the U. S. Government relies rect, because no man wielded a greater influence in that con- on to provide a standard of purity for drugs but the Phar- vention than Dr. H. C. Wood of Philadelphia. macopeia. If average doses can be provided, the physician Dr. George F. Butler, Chicago, said that the Pharmacopeia should say what the average dose is. Dr. Remington hopes is not intended for any other purpose than to furnish a re- that the American Medical Association and the Section on liable authority for the purity of drugs and the proper prep- Pharmacology and Therapeutics will have a splendid record, aration of pharmaceuticals. It is not so much a book for doc- and that it will be the report that will go into the next con- tors as for druggists. When a certain remedy is prescribed it vention and that medicine will be well represented. After the must be pure and properly prepared. The Pharmacopeia is Food and Drugs Act passed and was signed by the President, chiefly a receipe book for the druggist, and never can be any- Dr. Remington received many letters from manufacturing thing else. Dr. Butler agreed with Dr. Hatcher that all drugs chemists offering criticism, because for the first time in 100 should he tested pharmacologically on animals, but the results years the Pharmacopeia touched their pocketbooks. Dr. Rem- » should be corroborated on sick human beings. The mere fact ington asked them to get together and give the Committee on that a drug produces a certain action on a dog is no reason Revision a report of what they wanted. They did so, and the why it should produce such an effect on a sick person. It is, work of correction and addition has been easy. With the ap- after ail, the remedies doctors have used clinically, and from proval of the Bureau of Agriculture in Washington, the Sec- which they have derived good results that should find a place retary of the Treasury and the Secretary of Commerce and in the Pharmacopeia. Labor, the committee had to make some corrections in the

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/01/2015 Pharmacopeia in order to make a book on which prosecutions list of drugs that are really being prescribed by physicians in can be based. Dr. Remington pointed out that the very fact this country. The pharmacists can secure statistical reports that one can get from any drug store in the United States an between now and the Decennial Convention of perhaps a unadulterated potassium iodid or bromid, or anything in the million prescriptions distributed throughout various parts of Pharmacopeia, is a tremendous advantage to the medical the United States. The convention on assembling would know profession. The medical men in the last Committee on Re- what articles are used sufficiently to warrant their retention vision were given entire charge. Dr. Squibb, Dr. Hare and in the Pharmacopeia. Dr. H. C. Wood were on that committee, and while Dr. Lyon of Dr. Robert A. Hatcher, New York City, stated that his plea Detroit is an a analytical chemist, he is also physician. A report was that more interest in the Pharmacopeia be manifested on from the American Medical Association, he said, would cer- the part of the physician, not because six instructed men are tainly receive respectful consideration, and will stand a very not sufficient—one instructed medical man, if he had the in- good chance of being adopted because it comes from the struction after thorough discussion by the medical bodies of American Medical Association. the United States, would be sufficient. It seems incredible, Prof. Henry Kraemer, Philadelphia, said that he was he said, that in the entire state of Ohio there was not one pleased to witness this awakening on the part of the med- physician to make a plea for the profession; not one was ical profession. He agreed to the fundamental principle instructed to make it. If, he said, the country doctor is as enunciated by Dr. Charles Rice, that the members of the benighted as some of the representatives of two cities iii the medical profession should select the substances which enter eastern part of the United States, which he could mention, into the Pharmacopeia, and that the pharmaceutical profession God help the country. He believes in making clinical tests of should provide the descriptions of these substances, necessary drugs, and, if possible, pharmacologic tests. He teaches his tests, and methods for making preparations. With the work students that they must under no circumstances accept a thus apportioned, there is not the necessity for an equal nu- pharmacologic test as final, as in the use of quinin, for ex- merical representation of the two professions on the Commit- ample, but that the final test is the clinical result. tee on Revision. He feels that five or six medical men on the committee would be sufficient to represent the interests of medicine. This number would constitute a large subcommitW. Dr. Frank M. Reade, Richmond, Va., believes that the work EVACUATION AND DEPLETION OF THE TYM- of revision of the Pharmacopeia has been most excellently PANIC CAVITY AS AIDS TO DRAINAGE and the bad done by the pharmacists and chemists; that work, IN ACUTE MIDDLE-EAR SUPPU- if there is any, has been done by physicians. They have failed to show what physicians want. The pharmacists have RATION. their work well. have tests for done They provided purity, M.D. and have standards which have been adopted PERCY FRIDENBERG, they provided Assistant Mt. Sinai Hospital; Junior Surgeon, New York the U. S. Government. have that Adjunct, by They given physicians Eye and Ear Infirmary. which enables them to medicines from store get any drug NEW YORK CITY. where medicines are dispensed. Dr. Reade• suggested that the Section on Pharmacology should appoint men on the next Notwithstanding the numerous advances in pathology Committee on Revision of the Pharmacopeia who will indicate and surgical technic which have, as it were, crystallized what physicians want. The other men have shown that they into a definite form represented by the modern simple will do their part as it should be done. mastoid and radical operations, the question of the Dr. C. S. N. Hallberg, Chicago, said that the Pharmacopeia minor in acute otitis, and the detail has assumed the to the medical and surgical procedures always position pharma- of their is still as now as was a few ceutical profession that the statutes do to the profession of application, open the whether or not should be law. Since it has become a legal standard, it has assumed years ago question they As a acute otitis media that position fully because it is now a law, and being legal it applied at all. matter of fact, must be simply a code and statute. Nothing extraneous is to this day considered a self-limited disease with should be added because it may not be desirable. Dr. Hallberg typical, cyclical course and critical defervescences like defined the Pharmacopeia as being a book which provides pneumonia, by no less an authority than Zaufal. His standards for the identity, purity, quality and strength of school, in common with other German otologists, has chemicals and medicinal substances, and directions drugs, gives statistics to show or, more properly, to make it appear, for the preparation and valuation, compounding and preserva- that is to that made tion of these substances. The Pharmacopeia can not go into spontaneous perforation preferable the that is unnecessary, all the details that every on* wants. With regard to the by knife, paracentesis generally doses, comparing these doses with those given in the works and that the results of expectant treatment are at least on materia medica, Dr. Hallberg said that quite a discrepancy equal to those obtained by early surgical interference. will be found. The doses in the Pharmacopeia, of the phar- The fallacy and the folly of these views need not be maceutical preparations, that is, the preparations from drugs, pointed out to American otologists, nor need they be approach mathematical correctness. Thus, for example, if the reminded that the conscientious surgeon will not be dose of the dose the of opium powder is 1 grain, of tincture consoled by any percentages for the loss of a single life opium containing 10 per cent, of opium is 10 minims; but it through needless waiting when a simple, safe and rapid is put at 8 minims as equivalent to 0.5 c.c. The doses of the would have averted the of death. extracts and tinctures in the dispensatories and in similar procedure danger Any- one has seen acute mastoid in works often have been designed without reference to their who otitis involve the a virulent over to drug-strength. In some instances the dose of the drug and of process night and lead death in less the extract is the same, though the extract is from four to five than twenty-four hours, in spite of operation, or who times the strength of the drug. These discrepancies pharmacists has seen meningitis develop in a child in less than a endeavored to correct in the last revision of the Pharmacopeia. day after the initial symptoms of pus retention in the The Pharmacopeia of the United States assumes more nearly tympanum, will take with a more than usually large the character of an international pharmacopeia than any other. of salt for the treatment of acute of school in the world here. Their grain any suggestion Physicians every practice otitis media fails to take into considera- wants have to be The of the purulent which regarded. pharmacists Philippines tion the vital and essential facts that this is have the right to demand that some of the medicines they use process shall be incorporated in the Pharmacopeia of their country. one fraught with the most ominous potentialities for Porto Rico is also entitled to consideration in the Pharma- mastoid bone disease, cerebral or meningeal infection, copeia of the United States. Dr. Hallberg believes the plan general sepsis and death. Delav is more dangerous in proposed by Dr. Remington a good one. There ought to be a this particular disease and in this region than in any

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