Prescriptions may be extemporaneous or magistral, so called, because they are constructed by the practitioner ex-tempore and adapted to any case of disease. They may be authenticated, usually the production of medical writers and practitioners that are tendered to the profession on some alleged merit.

A prescription may be simple or compound; simple, when it consists of one drug or of one officinal preparation; compound, when it consists of more than one medical ingredient. A compound prescription has been divided into four parts: the basis, or principal ingredient of the prescription; the adjuvans, or that which is designed to promote the action of the former; the corrigens, or that intended to correct its operation, or obviate any unpleasant symptom which it may be apt to produce; and the constituent, excipient, or vehicle, the substance which gives to the other ingredients consistence of form.*

Respecting the language used in writing prescriptions, the Latin should be employed in designating ingredients to be used, for the reason that the Latin names for medicines and chemicals are the same, or nearly so, both in this country and in Europe; whereas, the vernacular names differ for each nation. Moreover, Latin professional terms are concise and definite. For various and obvious reasons we dissent from the custom of giving in this country the directions to the compounder or druggist in the Latin; as in this there can be no misunderstanding, which cannot always be said on the other side of the question.

The physiological character of a prescription is readily recognized. If of a scientific structure it usually betrays what pathological lesion it is ordained to meet. No prescription from any source should be put to the test, without giving it first the closest examination. We will give the following as an example:

℞ 1 Quiniae Sulphatis......3 ii.

2 Morphinae Sulphatis................. gr. iij.

3 Strychniae.........gr. ij.

4 Acidi Arseniosi......gr. iij.

5 Extracti Aconiti......gr. iij.

e. Make into 6o pills. S. One thrice daily.

Prof. S. D. Gross.

This prescription is somewhat polypharmic, and singularly complex in character; however, the remedies are well put together, and will bear a philosophical examination. The face of it shows that it was intended for an obstinate chronic nervous affection, and from the sedative character of the prescription, evidently of a painful nature. It is an excellent formula for the treatment of neuralgia, and betrays the cause of the disease, as far as symptoms and circumstances could reveal them. Items first, third and fourth are intended as the curative agents of the disease, on the supposition that it was of an asthenic nature. Items second and fifth are intended for immediate relief from suffering. The formula is made up of tonics and sedatives, and it is not clear where its basis is centered. It is evidently consolidated into three synergistics, one depending on the other. Still, the nature of the case, for which the remedy was administered, would fix a basis to any of the three. In malaria it would be quinine, in nervous exhaustion it would be strychnia, under a general cachexy it would be arsenic. With the sedatives the aconite serves as an adjuvant to morphine, and as a constitutional corrective to every other item in the prescription. Aconite occupies a very important position in this formula. It modifies some of the objectionable features of morphine - on the secretions in particular - and as a specific curative agent it stands as an auxiliary to the tonic element in the prescription, and even serves as a prophylactic to a medicinal fever. If there is any weak timber in this prescription, in way of involving its therapeutic diagnosis, it would be the arsenic and the opium; yet these very ingredients stand closely associated in their physiological effects. We are somewhat inclined to think that the distinguished author of this prescription conceded that generally there were malarial influences in the etiology of neuralgia. His places of practice and experience would naturally lead him to that conclusion. So, arsenic is associated with quinine for obvious reasons. It may have been considered necessary to keep the system under an immediate and continuous influence of anti-malarial remedies. Quinine has immediate physiological effects, but as it is rather quickly eliminated, it was here joined to arsenic, which passes through the system by a slow and tedious process. But there was another reason why arsenic was admitted in this prescription and that was to impress the nervous system with a diverting action. A great deal might be said on this point, and in particular on what physiological law a depressed, irritable, nervous system can be relieved by such influences. It is a well tested principle, that all new actions on the human economy, if judiciously managed, have salutary effects on diseased parts and general health. † The arsenic under this alterative principle serves as an excellent nervine in this place, not only on account of its continuous action, but as it has no special election for any organ (except the liver),

† Dr. G. P. Hachenberg, Cincinnati Medical News, 1880, p. 584.

*Dunglison.

it invades all parts of the body, and the systemic distribution is often maintained for many days after it has been discontinued, through the hepatic storage of the remedy. There can be no doubt that the nervous system can be powerfully influenced by such a process of medication.

The relation arsenic has to strychnine is another interesting feature in the prescription. The latter comes in as a nerve tonic of a positive nature, but in its physiological action as such, owing to the time of its elimination, it is but secondary to the former. Here, it appears arsenic serves as a synergistic to strychnine. The sedatives in the formula run a different but an indispensable course of their own; they are to give immediate relief and to facilitate the cure by keeping the nervous erethism in subjection, both pathologically and therapeutically, until the tonics have performed their legitimate work. It might be said that the pathology of neuralgia is not clearly manifested in the prescription, therefore its polypharmic complication. No attempt could be made in that direction in this case, as the treatment indicated in the prescription was strictly symptomatic. As the symptoms of the disease are complicated, there must be a corresponding complication in the prescription indicated. The pain alone in the disease, which so absorbingly occupies the attention of the patient, has nothing to do with its etiology; but may serve as one of the causes to keep up a continuation of the disease; therefore it is of the greatest importance to jugulate the pain by treatment, not only to promote the comfort of the patient, but to destroy the initiatory element of inflammation. When we speak of a complication in the prescription, there is discerned, nevertheless, harmony in the operation of the different ingredients on the system. Quinine stands to give immediate support, strychnine as a powerful auxiliary to it, arsenic to give it durability, and the sedatives to guard against pain, irritability and idiosyncracies. This prescription can likewise be advantageously applied in cases for which it was not originally intended on fixed therapeutic principles.

If a combination of many remedies are at times necessary to subdue a disease, it likewise occurs not infrequently that a train of symptoms can be successfully followed up by a single remedy. For example: administered, would very likely soon effect a cure. Here ipecac alone would meet all these indications, complicated as the case may appear. The face of this shows a very simple treatment. But the science of it lies in a profound therapeutic and pathological knowledge of the remedy and the disease. The physician, who attempts to meet the indications of disease with a polypharmic prescription, when a single remedy will serve a better purpose, will but exhibit confusion and want of judgment.

In the surgical writings of the late Prof. S. D. Gross, single remedies are frequently recommended in the management even of grave and complicated cases. When he says an aperient is the most reliable remedy for incipient hip-disease, and gave his prescription, which called only for a simple domestic remedy, he revealed a lore surpassing that we attempted to trace in his famous prescription above. The manifold physiological effects of a laxative, bearing directly and indirectly on the morbid action, no doubt were all taken into consideration in the case.

If we cannot too far laud the virtue of a well applied simple prescription, neither can we always condemn that of a complex character. Both kinds are to be measured by the nature of the cases for which they are intended. Thus, epilepsy we are apt to treat with a complicated formula, but not so typhoid fever. There is a rule to be observed in writing the two kinds of prescriptions, the one with a symptomatic, and the other a pathological basis. A simple prescription is based on a pathological fact, while the other is more or less based on the symptoms of the case. If we have no pathological data to go upon, such that at least can be successfully combated by medicines, what else have we to be guided by but the symptoms of the disease? Symptomatology alone is apt to lead us into polypharmacy. But even where the nature of the disease is well understood, as in some incurable diseases, as cancer, the last stages of phthisis, etc., and we are obliged to let go our grip on a curative treatment, the treatment then becomes strictly symptomatic, and often complicated to meet a complicated train of symptoms.