Volume I of the Extra Pharmacopoeia' (" Martin - NCBI [PDF]

metric system, the Imperial equival&nts being added only for those drugs that are often prescribed in this system. .

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SEPT. 6, 1958

PHARMACOPOEIAS AND FORMULARIES

PHARMACOPOEIAS AND FORMULARIES The prescribing doctor of to-day is not short of pharmacopoeias and formularies, to say nothing of the spate of literature from the pharmaceutical houses that he finds in his letter-box every morning. Two new editions of pharmacopoeias have recently appeared, Volume I of the Extra Pharmacopoeia' (" Martindale ") and the British Pharmacopoeia.2 Seventy-five years ago William Martindale in collaboration with Dr. Westcott produced the first edition of " Martindale," a small volume of 313 pages. Martindale was at one time a pharmacist at University College Hospital, London, and later the owner of a retail and manufacturing business in New Cavendish Street. The Extra Pharmacopoeia was an immediate success, and edition followed edition until it was finally produced under the direction of the Pharmaceutical Society with the help of a panel of experts. The latest edition, the 24th, which contains some 1,700 pages, is a very valuable reference book for both doctor and pharmacist. For the first time the titles of the monographs are in English and not pharmaceutical Latin, an innovation introduced by the British Pharmacopoeia Commission five years ago. Doses are expressed for the first time exclusively in the metric system, the Imperial equival&nts being added only for those drugs that are often prescribed in this system. In Martindale one can find the physical and chemical properties, pharmacology, mode of action, dosage, uses, side-effects, antidotes, and literature references for every drug likely to be prescribed. Not only are old remedies described, but also the latest drugs, such as sulphamethoxypyridazine (" midicel," f" lederkyn "). The wide coverage of the book can be judged from the index, which contains 20,000 references. It is remarkable how up to date Martindale is, and Dr. K. Capper, the editor, is to be congratulated for his share in its production. There are references to a large number of foreign pharmacopoeias and to almost every proprietary preparation available in this country. There are special sections on antibiotics, immunological products, and radioactive isotopes. In each successive edition of Martindale the proportion of space allotted to new therapeutic agents has increased, yet with remarkably few deletions of the older and traditional remedies. There are some who deprecate the inclusion of many of the latter, yet they are still prescribed: once a drug becomes established, it takes a long time for it to become obsolete. Undoubtedly Martindale is one of The Extra Pharmacopoeia. vol. I. 1958, the Pharmaceudcal Press, London. Price £3 Ss. net. The Britsh Pharmwopoeia, 1958. Published for the Gen Medical Council by the Pharmaceutical Press. London. Price £3 3s. net.

BUrrmJOURNAL MDICAL

601

the most useful reference books on drugs for both doctor and pharmacist. *The British Pharmacopoeia, which is published under the direction of the General Medical Council at intervals of five years, is more useful to the pharmacist than to the physician. The new edition, which came into force on September 1, is the ninth. The B.P. lays down standards of purity, methods of testing and identification, and the doses of the more important drugs. The doses given are not binding on prescribers, but are intended for general guidance and represent the average range of dosage suitable for adults. B.P. doses are a useful guide for the pharmacist in checking quantities prescribed. As in the new Martindale, doses are now given in the metric system and the titles of the monographs are no longer in pharmaceutical Latin, but in English. The B.P. is drawn up by the British Pharmacopoeia Commission, of which Profess6r Dunlop, of Edinburgh, is chairman. Approved names for new drugs are devised or selected by the Commission from time to time. The permission given in certain monographs for the addition of a suitable colouring agent to the coating of tablets is an innovation. The British Pharmaceutical Codex, familiarly known as the B.P.C., was originally produced in 1903 by the Council of the Pharmaceutical $ociety as a book of reference for those engaged in prescribing or dispensing medicines. The need for a book of standards for drugs and preparations not in the B.P. became increasingly apparent, and the provision of such standards has become an important function of the B.P.C. The inclusion of a drug in the B.P.C. is now regarded as an indication that it is of value, or is an established constituent of a useful preparation. The monographs give a description of the drug, its sources or preparation, physical properties, a critical summary of its pharmacological action and uses, dosage, conditions for storage, and the treatment of poisoning through overdosage. Like Martindale, the B.P.C. continues to be a reference book of the greatest value in the practice of medicine and pharmacy. Its object is to describe all new drugs which clinical evidence and experience have shown to be useful. A new edition is due to appear next year. The many new compounds produced by a very active pharmaceutical manufacturing industry will provide ample material from which to select drugs for the new edition. A valuable part of the B.P.C. is the formulary section, which gives details of the preparation of a number of prescriptions and tablets. The British National Formulary, which is produced by the Joint Formulary Committee of the B.M.A. and

-602 SEPT. 6, 1958

PHARMACOPOEIAS AND FORMULARIES

the Pharmaceutical Society, is a small pocket-size handbook, now in its fifth edition, giving a comprehensive range of preparations and formulae sufficient to meet the needs of the prescriber in hospital and general practice. Some of these formulae correspond to proprietary preparations. In the main edition the formulae are listed under descriptive headings such as mixtures and tablets, whereas in the alternative edition, first published last year, the drugs and preparations are arranged according to their predominant action on the bodily systems-that is, pharmacologically-and each group is preceded by a short account of the actions and uses of the preparations that follow. The alternative edition of the British National Formulary is certainly the best therapeutic seven-and-sixpence-worth that can be bought between two covers to-day.

PSYCHOLOGICAL MEDICINE AND UNDERGRADUATE EDUCATION The teaching of general practice and that of psychological medicine are two subjects which have been coming more prominently into ihe arena of debate about medical education. Elsewhere in this issue Dr. Richard Scott writes on "Undergraduate Education and the General Practitioner" and a working party of the College of General Practitioners reports on " Psychological Medicine in General Practice." It may well be that these, from the educational point of view, are but two facets of a single problem. The working party of the College of General Practitioners recognizes how great to-day is the unmet need. Such studies on the prevalence of psychological illness in general practice as have been published, allowing for observers' predilections and inevitable differences in criteria, leave little doubt that general practice in the future will concern itself increasingly with such matters. As J. R. Ellis' has pointed out, there is no great virtue in teaching medical students simply what is done currently in general practice. Rather educators must aim to teach what they believe should be done by the future generation they are training. Improved teaching in general practice and improved teaching in psychological medicine (meaning by psychological medicine the management of neurotic and psychosomatic difficulties, rather than the formal disease entities of psychdsis and dementia) may therefore be a part and parcel of each other, separate only for descriptive and administrative convenience. Improved teaching in psychological medicine will come gradually, for there is still much disagreement I 2 3

Ellis, J. R., Lancet, 1956, 1, 813. O'Neill, D., et al., ibid., 1958, 2, 34.

Malleson, N., The Matrix of Medicine, 1958. London. D., Universities Quarterly, 1955, 9, No. 3. 5Times Educatfonal Supplement, 1958, p. 1309.

4 Thodlay,

about it, and no prospect of any large part of the syllabus soon being given to the psychiatrists. The amount of time a student gives to psychological medicine is more or less voluntary; it will probably remain so. Many psychiatrists, as the working party points out, feel that their subject will only get its rightful weight if there are compulsory questions in the final examinations. But for a time yet psychiatrists must depend on taking up their option on the students' interest. This should not be too hard; properly presented the subject is as interesting as any in medicine. D. O'Neill and two of his students2 have described a method whereby students do practical case-work. Here may well be an opportunity worth further investigation. Medicine and surgery are now so highly developed that students can hardly be more than passive onlookers, having no essential role in the therapeutic machinery of the teaching hospital. Psychiatry, however, is still a developing art: the novice may make a useful contribution as well as the expert. In the casework that O'Neill describes, the student does something of real value for the patient; this may appeal increasingly to the keener but frustrated embryo doctor. Development of student health services, too, may have repercussions on the teaching of psychological medicine. Teaching which helps the student himself clinically with his own difficulties can be most effective. N. Malleson3 has shown how some 25% of ordinary undergraduates, at some time in their course, will go with personal and minor psychiatric problems to their student health doctor-provided that he has established a reputation for friendliness and helpfulness. As high, or higher, a proportion of medical-students might learn by example some of the general principles of good medicine, good psychiatry, and good general practice from a physician to whom they go when in difficulties themselves. As to the teaching of general practice, Dr. Richard Scott describes the view of the College of General Practitioners in these words: "Our College," he writes, "does not advocate vocational training for general practice during the undergraduate years, but recommends that the field of general practice should be exploited in order to widen the professional horizons of the next and succeeding generations of medical graduates." New buildings and departments are not likely to come easily, and for better or worse most teaching is likely still to be given in the surgery of the ordinary working practitioner. It is here a little surprising that the arrangements for such apprenticeship, already running for some years at a number of medical schools, have not prospered more. Is it the students themselves who are not too keen ? If it is realism to appreciate that the whip of an examination question is in practice a principal spur to study, it is realism to acknowledge that students are almost invariably fighting keen to fix themselves remunerative vacation employment.4 5 Could not this keenness be harnessed ? Are there not large busy practices where, either in vacation or in the evening during term, a medical student, game for all jobs, would not prove worthy of some modest hire?

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