A Guide to Therapeutics
334 KEVIEWS.
- Author:
Robert Farquharson, M.D.
Edin., F.R.C.P. Lond., Lecturer on Materia Medica at St. Mary’s Hospital Medical School, &c. London: Smith, Elder, & Co., 15 Waterloo Place. 1877.
At the commencement of his undertaking the author furnishes us with a highly interesting treatise upon the course and pro- gress of therapeutics during a considerable number of past years.
bome brief rules for prescribing are laid down, and the combination of drugs is ably dilated upon. In the case of diuretics three or four members of this group will often act when one produces little effect. In rheumatic fever several alkaline remedies appear to act better together than when one member of the group is only administered. The unpleasant symptoms of lodism are often mitigated by spiritus amnionic aromaticus, and the chances of discomfort attendant upon the subcutaneous injection of morphia are often diminished bY the exhibition ot atropia. Speaking of the mode of administra- tion, we learn that the metals are best given in the form of pill or in a small quantity of fluid, whilst the purgative salts are best employed in large quantities of fluid. In reference to period of administration, drugs of a lowering effect are best given with or after meals, in order to counteract such a result and cod-liver oil is most conveniently taken after food since’ oily matters are best absorbed when the lacteals are in full working order; again, it is a well-established fact that anthel- mintics are always most efficacious after a long fast. As regards large and small doses, purgatives and emetics are best employed in one considerable dose, whilst tonics, astringents, diuretics, require steady repetition at certain short and regular inter- vals. In the treatment of acute tonsillitis or catarrhal febrile disturbance the most reliable administration of aconite is in drop 01 half-drop doses every hour, half-hour, or every ten minutes; ipecacuanha in minim doses will often check obstinate vomiting. Certain medicines must be given in very large quantities; thus, to tranquillise irregular muscular movements we must prescribe succus conii in at least Jj doses, and even more is frequently required; in nocturnal incontinence of urine belladonna must be pushed up to 5j or 5jss of the tincture. Idiosyncrasy is a matter of great moment in the exhibition of certain lemedies, since purgatives act very differently on different^ persons, and others require immense quantities of anaesthetic vapour for the induction of complete insensibility. Ihe influence of habit calls for every consideration, since medi- cines often lose their effect when continued for lengthened periods. It is well known that the habitual arsenic-eaters of Styria are enabled to consume quantities of that substance which would prove inevitably fatal to the novice.
The accumulative property of certain drugs is a noteworthy fact. How often do we observe the twitchings from strychnia, the cardiac depression of digitalis, the paralysis from alcohol. Incompatibility may be of two kinds, viz. chemical and physiological. The chemical variety consists in the reaction of one drug upon another. Add decoction of cinchona to iron, and an unsightly black mixture, consisting of tannate of iron, is produced; strychnia and corrosive sublimate will not go with gelatine. As regards physiological incompatibility, the rationale is that one drug is so far antagonistic to another that the mixture of the two is inert. Thus belladonna and opium, atropine and prussic acid, aconite and digitalis, strychnia and calabar bean, and, in a marked degree, caustic alkalies with belladonna, hyoscyamus, stramonium, or tobacco, are opposed to one another in combination.
In prescribing for children Dr Farquharson impresses upon us the important fact that these little ones can often take with impunity, and even with decided benefit, quantities of active remedies which will correspond to a full adult dose. He attributes this to the much greater destruction and construc- tion of tissue in early life, whereby the organs of elimination are in unusual activity, and hence disposed to excrete medicinal substances with special promptitude.
Arsenic may be freely given to children, and at the age of five or six the author would unhesitatingly commence with v and push this even up to i^x if necessary : prussic acid may be given in -ny to r?|_iij at the same age. Strychnia is well borne, tinc- tura ferri may be taken in large quantities, and excellent results have followed the administration of 3j ?f the latter three times daily in a child of six. Children are strangely capricious, for whilst they strongly object to bitter or acid substances, they readily take oils, and appear to derive satisfaction from sucking in cod-liver oil.
We heartily agree with Dr Farquharson’s views with regard to writing prescriptions in our native tongue, since by this means the chance of mistake is limited, and that mystery is done away with which, beyond anything else, has tended to keep back the progress of our art.
In constructing a general plan of arrangement for the doses of drugs, a few rules are laid down. Thus, in general, tinctures may be prescribed in doses of from 5SS 3j? infusions and decoctions from sss to sij, powders from two to ten grains, pills four to ten grains.
In stating what we know concerning the properties of each drug, we? ” Take first its local or external action ; then its influence on the brain and on the spinal and sympathetic system of nerves.
? This will lead us up gradually to the effect on the heart and blood-vessels, whose functions are presided over and ruled by nervous influence. The effects of the drug on respiration and temperature will next be considered; and we then proceed to the alterations of secretion in the following order : Urinary intes- tinal, salivary, cutaneous, etc. ‘
“Then other actions which come under no heading, and which may be called specific.
” Finally, we must consider the various modes of elimination from the body, the antidotes, contra-indications, and best modes of prescribing; winding up, in most cases, with a prescription which will, as far as possible, combine efficiency and elegance with palatability.
The grouping of drugs is beset with no inconsiderable diffi- culties,for whilst opium is an astringent, it lays claim under some circumstances to be called a purgative; it is diaphoretic, sedative, and antiphlogistic, and the confusion inseparable from hunting it about among its various headings must of necessitv perplex the mmd of the student and occasion great loss of time.
In the work before us the arrangement of Garrod and other popular text-hooks has been adopted, with one modification, that the general principles of Therapeutics are removed from their usual position at the end of the book, and a systematic elassifi- cation is scattered through its pao-es.
In order to explain the general aspect of the book, it may not be out of place to quote the following passages. It will be seen that Physiological and Therapeutical properties are placed in parallel lines, and this scheme is preserved through almost all its pages.
CHLOEAL. Local Actions. Physiological Therapeutical. Applied externally chloral has It has been recommended as an been by some authorities supposed external application in neuralgia, to have sedative properties, and it rheumatic and other painful affed is also an undoubted antiseptic. tions; used as a dressing to ulcerated surfaces, it seems to act well by removing the foetor of discharges and lessening pain; and it has been successfully em- ployed in solution for the pre- servation of anatomical prepara- tions.
Constitutional Actions. Physiological. Therapeutical. 1. Nervous System.?1. Brain. 1.?Chloral is an excellent ?Chloral produces an antemic hypnotic, causing sound and re- condition of the brain, and thus freshing sleep without the diges- causes sleep by imitating the tive disturbance which usually natural anatomical arrangement of follows the use of opium. that process.
(1) The alkali of the blood is too feeble to liberate the chloroform, and the albumen is considered an- tagonistic to such a process. (2) No smell of chloroform can be observed in the breath and no ana;sthetic effect is produced on the sleeper in moderate doses.
2. Spinal Cord. ? The reflex 2.? Chloral is of service in some irritability of the spinal cord is spasmodic diseases, as chorea, very decidedly lessened, and the re- whooping cough, asthma, incon- spiratory centre becomes weakened tinence of urine, labour, after- and eventually paralysed. pains, etc.
3. Sympathetic and General 3.?Chloral, having no influence Nervous System.?The vaso-motor over sensory nerves, has no power, system is enfeebled ; but no special per se, of allaying pain, and is effect seems to be produced on therefore useless in that class of other nervous structures, unless we cases where opium is of such believe any part of the loss of signal service.
muscular power sometimes ob- served in those who have taken chloral for some time to be due to an action on the motor nerves. II. Circulatory System Chloral II.?Chloral, weakening cardiac has a powerful action on the heart, action, must not be given Avhere lowering and weakening its action we have any reason to suspect an by paralysing its contained sympa- enfeebled state of the heart thetic ganglia. muscle.
We must sincerely congratulate the author upon his handy and admirable volume. We have followed its pages with the highest interest and gratification. To the student in Materia Medica it cannot fail to be of the utmost service, whilst the more experienced reader may derive from it much profitable information. Both in style of composition and clearness of arrangement Dr Farquharson’s ” Guide to Therapeutics ” may well merit a position amongst the best known and accepted works upon the subject in our language.
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