from the symptom complex of each individual case. Foreign bodies arrested in the air tract within the chest walls, offer a more unfavorable prognosis for recovery through external operative interference, than those arrested in the trachea or larynx, and I cannot refrain from relating a most disastrous personal experience in such a case, where it was deemed necessary to employ a general anesthetic preparatory to tracheotomy. The case is the following:

May 14th, 1892, I was asked by Dr. D. A. Cox, of Howell, Ind., to see a three and onehalf-year-old child that had gotten an uncooked butter bean into its wind-pipe. I found the little one on the arm of the mother who was walking the floor to keep down the child's excitement. It would not allow even a superficial examination without screaming and resisting most violently, so after obtaining the history of the case and observing from a distance marked stridor in breathing, preparation was made for a low tracheotomy. The patient was forcibly placed on the operatingtable, all the while screaming and resisting to the utmost, and Dr. Cox began the chloroform administration. Scarcely had half a dozen inhalations occurred when suddenly the child stiffened, became cyanotic and asphyxiated, notwithstanding the anesthetic was at once discontinued and the trachea opened and resuscitation efforts instituted. Evidently the child's struggling had displaced the bean, and from a partial obstruction in the trachea the case was converted into a total in the bronchus, from which we did not succeed in removing it.

As a successful illustration of the expectant plan of treatment, I may relate the following case: Mr. F. J., 42 years of age, while holding a copper cent in his mouth suddenly had it carried into the air tract. Strangling and coughing followed, but subsided in a little while. He consulted me April 9, 1896, and save for dry cough, and a feeling of distress, there were no subjective symptoms. Laryngoscopic examination was negative. Ausculation revealed simply dry rales in the trachea and bronchi. Codeine was prescribed for the cough. Two days later during a paroxysm of coughing, the paroxysm of coughing, the penny was expelled.

The subsequent history of our cases after unsuccessful external operative procedure is still of interest where the patient can be followed through later life, and this is my excuse in referring to the following case:

A boy seven years of age, was brought to me July 10th, 1895, with the statement that while playing among some farming implements on the previous day, he had gotten an iron rivet into the wind-pipe. I performed

an inferior tracheotomy, but failed to recover the rivet. The child was taken home soon thereafter, and I have been able to follow the case through the kindness of the family physician, Dr. J. J. Hassett, of McLeansboro, Ill. For almost one year the boy had purulent bronchitis fever, and attacks of pneu monia, his life being frequently despaired of, until gradually more or less tolerance was established. The boy has now reached young manhood, with the right side of the chest and right lung poorly developed, and incapacitated from carrying his full share of the burden of life. I have always regretted that at the time I made the tracheotomy, the giant magnet had not come into general use, since the metal might have been extracted from the right bronchus in this way. It certainly is worthy of being tried in such cases. Resection of the ribs and bronchotomy has not been extensively advocated for these cases, because of its high mortality.

The

No

WAGGING THE EARS.-An eminent scientist declares that all men may learn to wag their ears if they try long enough. There are few things impossible for man to accomplish if he will only set himself at it seriously enough and keep at it long enough. pity is that so many of us put so much of our enthusiasm and energy into attempts to wag our ears-or many other purposes equally useless-and have so little left for efforts toward useful achievement. Some day, somebody, through marvelous strength, skill and persistence, is going to swim the English channel. And lots of people will think for this reason we are really progressing. doubt attempts will be kept up until, some day, some reckless idiot actually succeeds in going over Niagara Falls in a skiff and coming out alive. What more will be left for brave men to aspire to? A little more time, a few millions of dollars, some scores more of frozen bodies left in the ice heaps-and the north pole will be discovered. Then one of the most picturesque and dramatic series of brave deeds and excruciating_suffering in modern history will end. In what? Some time soon-but let's hope not in our own time-women are going to succeed in turning themselves into wasps at the waist and birds at the top. Wagging the ears is a tame accomplishment beside some others which the human race has been about long and seriously. Whether our aspiration and striving be toward something useful to the world and ennobling to self, or toward some such thing as wagging the ears, we will suc ceed at it, if we only try long enough and hard enough.-St. Louis Star-Chronicle.

President, LOUIS H. BEHRENS, 3742 Olive Street Vice-Pres., WALTER C. G. KIRCHNER, City Hospital

Executive. A. Ravold, Century Building Entertainment, Frank Hinchey, 4041 Delmar Ave.

OFFICIAL

Publication, W. E. Sauer, Humboldt Building
Public Health, R. B. H. Gradwohl, 522 Washington Ave

Symposium on the U. S. Pharmacopeia, U.S. and the National Formulary.*

INTRODUCTORY ADDRESS: SOME

FAULTS.

LOUIS H. BEHRENS, M. D.

ST. LOUIS, MO.

Mr. Chairman, Fellow Members, and Friends of the Medical and Pharmaceutical Professions:

On behalf of the Medical Society of City Hospital Alumni, I extend to you, one and all, a hearty welcome to this meeting of physicians and pharmacists.

I trust that the evening spent with us, may be mutually interesting and profitable, and be the means of a better understanding between the two professions, necessarily closely allied, and in the need of each others aid.

Such a meeting as this bodes for much good, and it is unnecessary to state, will be far-reaching in its effect, for, so far as I have information, it is the first of its kind to be held in this United States, whereby a medical society of any consequence has invited its pharmaceutical friends to meet with it and discuss matters of such vital importance, as medical and pharmaceutical faults, and it is to be hoped that no member of either profession will hesitate to air his views, in order that we may arrive at a better understanding and appreciate each others worth.

It is a painful fact that too often both professions take on, to some degree, fads that smack of ignorance and charlatanism, and, if the search-light of Truth be turned. on our work in prescribing and dispensing, but few could hold up their heads and hands and say, "Holier than thou."

At one time it required some knowledge. and moderate skill in dispensing of all prescriptions, today regretfully we say, that such is not the requisite in the majority of prescriptions received by the pharmacist. It is the simple matter of mechanically taking so

Read at the meeting of October 18th, 1906.

much of something, either fluid, powder, salve, etc., and automatically placing just so much from one bottle, box or container into another. The remedy, under a fanciful faddish name has caught on, the physician in too many instances prescribes the stuff, of which he knows but the little, that the suave advance agent has told him, or perchance he has received the glowing literapound or conglomeration, our druggist friend ture, describing the virtues of the new comsits by wondering why he has devoted valuable time and energy to mastering the intricacies of pharmacy, only to be called upon as a simple manual laborer, just having brains enough to pour potions from the containers of the manufacturer, of which compound he knows nothing, and we Medics know less, labeling the vial, jar or box, with voluminous directions, and wonders often of what little use he really is.

My medical friends, this is true of 70% of the prescriptions written and dispensed today, containing fads of the present, that are forgotten tomorrow, and we medical men have the temerity to speak of ourselves as being scientific and giving our work profound thought.

Unfortunately the younger the man in our profession, the more faddish he is, until it seems that the study of remedial agents were relegated to those who are vaunting both foreign and home-made compounds as tutors, instead of that devotion and study, to the various remedies that has made medicine, what it is, both in the past and present; something of our system is radically wrong.

We are truly in a chaotic state, regular medicine seems more at sea than ever before, we are not devoting our time as the disciples of Aesculapius to our materia medica, pharmacopeia and other text books, along this line of thought as becomes us.

May I digress and mention some ridiculous situations, in which we are found and soon find ourselves.

Take acetanilid for instance, it has been slighted by the wise, and not so wise, how hands have been thrown up in holy horror, and medical articles have rebelled against its

use. Yet at the self same breath, the one issuing such warning condemning its use at all, has been the one to prescribe or recommend some one of the various mixtures, so styled synthetic with its many C's, H's and O's, or occasional N, having acetanilid for its principal and active constituent, countless numbers of such compounds have flooded the medical market, one sees them in endless array on every prescription shelf, under fanciful and catchy names, until it seems by now the nomenclature had run the gauntlet, unfortunately for the manufacturer.

Today we prescribe it under the name of some name, which is forgotten tomorrow, and so on until the Omega has been reached in acetanilid mixtures, but thank goodness, we are getting back to acetanilid again, in its plain, twelve cents a pound variety, which we were duped into using in the many mixtures at $1.00 per ounce with a penny's worth cf acetanilid activity, and then wondering why our prescriptions cost our patient so much.

Seems we are made poorer in knowledge, our patient more so in pocket, through such careless exercise of our therapeutic thoughts, and the manufacturer has been reaping the golden harvest of coin, until we must feel that it is profitable to be the physiological ignorant maker of such stuff; that had our testimonials and hearty encouragement.

Some time ago during the kola craze, a certain maker's kola-wine was prescribed fiercely by men of medicine and surgery, we were kola mad; in time, however, the profession, tired of it, and its popularity was in the wane. What was the result? This remedy to be dispensed on physicians' prescriptions only was placed on sale in the druggist's windows, with the large placard, "Endorsed by Eminent Physicians' as a catch advertisement for the gullible public. It is a fact that it had It is a fact that it had the endorsement of some of our eminent members, their testimonials so freely given; as a matter of fact the preparation contained, but little kola and a poor Maderia wine, it presumably did but little harm.

And in this connection I wish to mention a celebrated acetanilid compound. under a catchy name, that is working its "Endorsed by Physicians" and seeking profane patronage, by sampling the various stage celebrities and folk each week, with each small box of free tablets is given, a small booklet on disease and the tablet, and that same may be had at so much per dozen, in various combinations at the druggist, warn them to look for the trade mark on each tablet, and yet the condemner of the patent medicine is the prescriber of this nostrum.

The good old tincture ferri murias, Basham's mixture, and the other old time tried

iron compounds, once so useful, have been relegated to the rear, and the fanciful, expensive peptonates, albumoids, etc., of iron with their omnipresent blood count increase charts, hemaglobin estimations, have unseated them, and today it is common to find such compounds, we are asked to prescribe, on the pharmacists' shelf with directions that the laity understand, the same as any other patent medicine.

Perhaps many of my professional friends here assembled, recall the obliging gentleman, that called upon the medical profession, some months ago, presenting a bold front and a bottle of salts, which superiority he dilated on at length, claiming many virtues for it, which was also told on the label in true patent medicine style. To those who treated him courteously he showed his appreciation by then and there trying to have you take a dose of said salts, as he felt that to take it was to prescribe it. I judge that many of my confreres must have taken some. After extoling the virtues of this salts of a supposedly noted spring in Germany, he condescended to present us with two asthmatic cigarettes, and furthermore, the formula of the latter, nicely type written, and requested as you will recall, that his confidence be not betrayed, by handing the formula to others. It is needless to say, that no danger of that formula being filled by any one, was imminent, it smacked somewhat of those advertisements one sees in the daily papers, send $1.00 for recipe that cured me of lost manhood. The patient gets the formula, but while it contained some familiar drugs, several very foreign names were seen among the ingredients, and one is advised to send recipe to sender, if his druggist has not the drugs. The druggist or no one else has the drugs, it's sad that we should be so duped and be mistaken for members of that finny tribe, known as suckers.

So it is with foreign specialties that have flooded our shores, passed to us first, for our use and endorsements, which seem very easy to get, then later advertised in the daily papers. One has but to peruse the newspapers of every type and be convinced, santal capsules, salicylate globlues, etc., galore, always with the "Endorsed or recommended by Physicians," they catch the unwary as they caught us.

It would not be difficult to spend several hours in citing instances of such imposition, we must admit, however, that many manufacturers and agents do remain in ethical lines; of this it is needless to speak.

What has in part been a factor in bringing about this condition of affairs? Some may say lethargy on the part of the pharmacist, besides the carelessness on the physician's

part. Both share to a considerable degree the fault.

Years ago the pharmacy was the work-shop that required skill in the detection of spurious drugs, and pharmacists were noted for care in such selection and compounding. It was the pharmacist's pride to have such a reputation, and this in some instances holds good this day, in many of our drug stores.

Stores no doubt present a better aspect now than they previously did, more pleasing and more beautiful perhaps. One observes the elegant fountain and cigar cases, necessities we must admit. The patent medicine side seems the same as ever, only larger. Its array of vari-colored cartoons, bottles, etc., is pleasing to all, no matter how objectionable. On the opposite side is the usual line of tinctures and salt mouths full of drugs, in many instances seldom used, with the sundry soap, toilet article and toilet paper everywere, all of which goes to make a pleasing, clean picture, and all of which is admittedly necessary, to help meet those daily expendi. ture that enable the pharmacist to live.

But let us go back, away back, in the drug store to that part from which the name phar. macy is derived, that place that should interest us as physicians, and is, or should be of such vital import to the pharmacist; "The Prescription and Compounding department, must be admitted that this part of the majority of drug stores is the darkest, most uncleanly portion thereof, and entirely at variance with the other parts, or front. Here one observes a total lack of pride in its keeping, and in common phraseology, the old skill and knowlegde "seems on the bum." usual diploma is out of place.

The

The kitchen of the apothecary is not, as we understand, a kitchen should be at best. And, under most cleanly circumstnaces, drugs are bad enough to take by the enfeebled patient, but when wantonness and carelessness are so evident, pride no longer exists, and no an unkempt prescription counter, I take it, as a rule means inferior knowledge and drugsand no scruples exist when it comes to substitution.

It is proper to expect no results from medicine sent out from such a place, as a rule; it is here that recklessness is manifest and potent medicines become inert under improper care. Inert medicine is dangerous medicine, we give medicine to get some result if not a cure, some of the medical profession still believe that many symptoms or diseases are amenable to proper remedies, and the scalpel does not represent the only remedial agent, nor can any physician go forth, thoroughly equipped with the knowledge of four or five

remedies, and be successful from a scientific or even ordinary standpoint.

Take digitalis. What a satisfactory agent it is when indicated, its activity depends on agencies combined in the leaf, whose fragility bespeaks a warning of care in its growth, selection, and above all preservation. The slightest infraction of the above means a leaf of little or no value as a therapeutic agent.

Just think how carelessly ofttimes this and other allied active drugs are handled, too cften given only a consideration due Fuller's earth.

I have known digitalis to be used, that has laid in some herb drawers or can for years, worm eaten and inert the commonest tea of the grocer shop would receive more consideration than this valuable leaf.

And then the observant physician wonders why he does not get results with its tincture or infusion when prepared at certain stores; valuable time is lost, in treating a patient with such stuff, in fact a life is often jeopardized, and such a druggist is guilty of criminal negligence in so dispensing such.

Then the pharmacist wonders why the doctor specifies. I have known of the infusion digitalis being prepared from an old fluid extract (I say old fluid extract because of this leaf the fluid extract, is so little used, that it is invariably old) the druggist in order to hoodwink physician and patient has heated the water to which the fluid ext. digitalis was added, so as to have some semblance in warmth at least to the properly made infusion.

The fluid extract is as reliable as a rule as the old worm eaten leaf, both are a curse, not remedial agents.

I shall not go further, but what I've said of digitalis holds good of many other preparations and such has been in part the cause and furnished often the argument for proprietary preference.

The well kept and clean prescription department like a neat kitchhen means "bonum" for everything that comes out of same. 5 So. Broadway.

THE UNITED STATES PHARMACOPEIA.

HENRY M. WHELPLEY, M. D.

ST. LOUIS.

Secretary United States Pharmacopeial Convention.

Definition of Pharmacopeia.-A lexicographer would define the word according to its Greek derivation as meaning a work devoted to the formulas and directions for preparing medicines. Times, however, have changed since the word was coined and today a pharmacopeia is a book issued by some

recognized authority for the purpose of furn. ishing physicians and pharmacists with a list of medicines, accompanied by descriptions, tests and formulas. A pharmacopeia differs from other similar text and reference books, such as dispensotaries, works on the practice of pharmacy, materia inedicas and formularies (with the exception of the National Formulary) on account of its being issued and revised by an authority legally empowered to define the character, establish the purity and regulate the strength of medicines for the country in which the pharmacopeia is issued.

The first pharmacopeia was, no doubt, a practitioner's book of prescriptions stamped only with the approval of personal authority and intended for his individual use. Next in the order of development came the hospital book of prescriptions, from which we can easily imagine the growth of a local medical association pharmacopeia. Thus came into existence the London pharmacopeia of 1618 and the Paris authority of 1639. The city of Edinburgh followed with a pharmacopeia in 1699. While London is credited with a pharmacopeia in 1618, no work of a national character appeared until 1818, when France, full of political turmoil, calmly gave her physicians and pharmacists a pharmacopeia which was truly national in character. This was the first pharmacopeia fulfilling the meaning of the word as understood at present. The United States followed the example of her European friend, and in 1820 published the second pharmacoeia of a national type.

The First Pharmacopeia in the United States was not national in character, but the expedient of Wm. Brown, M. D., for the use of a military hospital at Lititz, Lancaster County, Pa. It contains eighty-four formulas for internal and sixteen for external remedies. The author explains that the number of preparations is small, owing to the insufficient supply of phials for the use of the hospital. This condition is emphasized in the title page, which reads as follows:

REPERTORY

of

Simple and Efficacious Prescriptions,
For The Use of the
MILITARY HOSPITAL,
Belonging To The Army
Of The

UNITED STATES OF AMERICA. Adapted especially to our present state of need and poverty, which we owe to the ferocious cruelty of the enemy, and to the cruel war brought unexpectedly upon our Fatherland.

The Pharmacopeias of the World.-Man stands alone in the animal kingdom as a constant consumer of medicines. All civilized nations soon followed France and the United States in adopting definite standards of an authoritative source for the purpose of secuaing uniformity in nature and strength for the medicines most generally prescribed or administered. As a result, we find at the present time twentyy-three pharmacopeias in use which are national in character. With few exceptions, those countries not having a pharmacopeia of their own recognize the standard of some other government. The United States Pharmacopeia is either the chief or one of several pharmacopeias recognized in the Central American States, Liberia, Peru, Uruguay and Venezuela. Our pharmacopeia is also gaining favor in Cuba, Hawaiian Islands, Porto Rico and the Phillipines since our colser commercial and political relations with these countries. Costa Rica has gone so far as to make the United States Pharmacopeia the official standard for that country, although but few of the physicians and pharmacists practicing there can read English.

No International Pharmacopeia. -For a generation past pharmacists and physicians have endeavored to agree upon a standard to become a pharmacopeia in common for all of the countries now having national authorities. The seventh and last international congress for this purpose was held in Chicago during the Columbian Exposition. The tenacity with which physicians cling to inheritance from the materia medica of their forefathers and the number of medicines peculiar to each country are conditions which render it impossible to agree upon a common standard. All creation, both animate and inanimate, contributes to materia medica, and each country is dogmatic in selecting the medicines to be recognized in a pharmacopeia and uncompromising in determining how they shall be prepared.

An international pharmacopeia is an ideal not to be realized, but the International Conference for the Unification of Potent Remedies which met in Brussels in 1902, accomplished the most important consideration in favor of an international standard. The conference decided upon the strength of those potent preparations which are prescribed in a number of countries. As an example, the potent tinctures are to represent ten per cent of the drug and the arsenic solutions to be one per cent in strentgh. Our country was the first to revise its pharmacopeia after the Brussels conference, and the first to put into practice the principles and rules adopted by the conference. This explains why the re