Manual of materia medica therapeutics pharmacology Black Wood

A Manual Of Materia Medica, Therapeutics And Pharmacology With Clinical Index bY Alexander  L  Black Wood

Book review by Dr.Prathibha.K.C  BHMS,MD(Hom)
Medical Officer,Dept. of Homoeopathy, Govt. of Kerala

Author : Professor of clinical medicine and therapeutics in the hahnemann medical college, chicago, attending physician to the south chicago hospital. Consulting physician to the hahnemann hospital. Member of the american institute of homoeopathy. Fellow of the american college of physicians. Author of a treatise on diseases of the lungs, food tract, etc. Published by indian books and periodicals syndicate, New Delhi.

Structure of the book
Preface to the first edition
Preface to the second edition
Blackwood’s Materia Medica

• Homoeopathic pharmaceutics
• Prescription writing
• The management of cases of poisoning
• Medicines
• Clinical index
• General index

Preface to the first edition
Work was undertaken with a desire to place before the medical profession in condensed form a resume of the Materia Medica of all remedies in common use, their pharmacy and therapeutics, together with a chapter on prescription writing, and the management of cases of poisoning.
Under the heading of therapeutics, the cardinal indications for the remedies have been given from a therapeutic standpoint.

Many physicians have not obtained the desired results from their remedies, because the right prescription has not been administered. Under each remedies dosage and preparation have been indicated.
The author’s recommendations for the selection of potency vary, first in accordance with the nature of the remedy employed, second with the clinical history of disease and third with the temperament of the patient.

The repetition of the dose depends up on the stage of the disease. Frequent repetition is required for acute disease. The intervals are lengthened as the symptoms abate. In chronic cases 2 or 3 doses of the remedy are administered within 12 hours. When a placebo is given and the effects of the remedy watched. No more medicine should be administered as long as improvement continues.
When a remedy is indicated, but its administration fails to modify the symptoms, the potency should be changed, not the remedy. When a remedy has ceased to act the case should be carefully reviewed and if it is decided to continue the remedy, it should be administered in another potency.

As the size of dose of potentised drugs is the same in all cases, in giving the “dosage” for different remedies the physiological dose and the maximum dose only are given. The maximum dose being known, it will prevent the giving of overdoses.
The author is indebted to F. A. Boericke, M. D. for the pharmaceutical description of each remedy also to M. R. French, M. D for the article on pharmaceutics and compilation from modern writers on prescription writing.

The preface to the second edition
In the preparation of this edition the author has rewritten and enlarged on parts of the former edition and has revised other portions. In the descriptions of many of the remedies, he has indicated the potency of his preference. His rule is that when he believes the remedy selected is the indicated one and the results obtained are not satisfactory, he changes the potency and not the remedy.
In the first edition space was devoted to a discussion of the therapeutics of a few of the ductless glands. In the present edition, a section has been written on the subject of endocrinology that promises so much for the future of therapeutics. The term “hormopoietic system” has been presented to designate such a system.
The author desires to acknowledge his indebtness to the current medical literature, also to A. L. Tafel, who has prepared the description of the remedies, added and has assisted in the correction of the proof.

Blackwood’s Materia Medica
Homoeopathic Pharmaceutics.
The American Homoeopathic Pharmacopoeia, The British Homeopathic Pharmacopoeia, The Pharmacopoeia Homoeopathica Polyglotta and The American Institute of Homoeopathy Pharmacopoeia are the four principals works on the preparation of homoeopathic medicines.
The American Homoeopathic Pharmacopoeia classifies the various plants, animals etc into nine classes, each substance being prepared according to the rules laid down in its particular class; the drug power of the resulting medicine being the drug power of the particular class under which it is prepared. This classification is also used in the German Pharmacopoeia.
Preliminary to the preparation of various medicines, the following pharmacopoeia rules are to be observed.

The homoeopathic pharmacopoeia of the United States was published in its first edition in 1897; a revised edition was brought out several years later. The object of the work is to provide a plan for the making of homoeopathic tinctures of uniform strength, which strength equals also in medicinal power, triturations of the same potency. In other words all homoeopathic tinctures made according to this pharmacopoeia are 1/10 drug power or first decimal strength.

The manner of determining the proper proportion of plant and menstrum (Alcohol) in making tinctures according to this pharmacopoeia are as follows.
A certain amount of the plant or part of it, whichever is used in any particular instance is weighed. The plant is then thoroughly dried, which drying evaporates all moisture. The difference in weight between the dried and fresh plant represents the amount of water in the same. In the making of the tincture, the amount of water is taken in to consideration when proportioning the amount of menstrum and plant, so as to make the resulting tincture 1/10 strength.
Homoeopathic remedies are dispensed very largely in tablet form. Trituration tablets being made by moulding, trituration in to tablet shape, tincture and dilution tablets by saturating sugar of milk with the tincture or dilution and moulding. This is accomplished in several ways.]

One way and a way that is to be heartily condemned by homoeopathic prescribers is to compress the powder in to a tablet form by a tablet machine. In order to accomplish the work by machinery, some saponaceous substance must be added such as Boracic Acid, Talcum powder etc so the trituration will run through the machine. Up to the present time the reliable method of manufacturing tablets is by hand. The given trituration is moulded in to tablets by first saturating the powder with 95% alcohol making it in to paste. This mixing is done on a glass plate, the moulds being made of either glass or highly polished steel. The tablets after the evapouration of the alcohol are easily removed.

The remedies used by homoeopathic physician should invariably be prepared in identically the same manner and under the same conditions as was the remedy at the time of its proving. Tinctures therefore should be made according to the rules laid down in the homoeopathic pharmacopoeias. There are other ways of making them, such as reducing a fluid extract, making them from dried plants, where living plants should be used etc, which methods should not be tolerated.

Four important essentials of prescription writing are

• Legibility
• Accuracy and reliability of the ingredients
• Great care that incompatibles are not used
• That the maximum dose should never be exceeded.

All prescription should be carefully written, the names of ingredients written out in full, so that there can be no possible chance for mistake or substitution. The amounts of each of the component parts, when a compound prescription is made, such that a dose of the finished mixture will represent the amount necessary for each drug to produce the action desired in the organism. The ingredients should be of a reliable make, the writer specifying the particular manufacture.

Many chemicals are incompatible with the other and should never be included in the same prescription, as for instance, mineral acids with the alkalis, metallic salts with the alkalis and tannic acid and caustic alkalis, also all drugs are incompatible with their antidotes.

The following is the maximum dose of some of the more important drugs.
Aconitine, 1200 grain to 160 grain.
Atropine, 1120 to 160 grain.
Arsenic, 1%, 2-10 minims.
Digitalis,12 to 3 grains.
Nux vomica, 1-4 grains.
Santonine, 1-5 grains.

For the purpose of abbreviating, symbols are often used in prescription writing.
Examples
Receipt, Rx Take
Aqua, Aq Water.
Gutta, Gt A drop
Misce, M Mix.
Signa, S Give directions.

It is gradually assumed that there are fifteen teaspoonfuls of liquid medicine in a two-ounce mixture sixty in an eighty-ounce mixture. In cases where poisonous drugs are included in the mixture, more accurate estimation is necessary. In the two ounce mixture therefore, where a teaspoonful is given at a time, each dose will contain 1/15 of the total amount of each drug in the mixture, as for instance, if a drachm of a drug be added to a two ounce mixture, each teaspoonful dose will contain eight grains or minims where the maximum dose of a drug is less than one grain, the two ounce mixture to which one grain of the drug is added will give, in teaspoonful doses of the compound, 1/15 of a grain at a dose, and in the same proportion, if more than one grain is added or if a larger amount of the compound is prepared.

Both the Apothecary’s and Avoirdupois system of weights and measures are used in chemical laboratories.
Apothecary’s table Avoirdupois table
20 grains equal 1 scruple 10 grains equal 1 scruple
3 scruples equal 1 drachm 3 scruple equal 1 drachm
8 drachms equal 1 0unce 16 drachms equal 1 ounce
12 ounces equal 1 pound 16 ounces equal 1 pound

Metric system
The metric system of weights and measures was first adopted in France, but is now used in nearly all countries. The advantage it possesses over other systems is that the several units of length, weight etc have a definite relation to one another and secondly, the different units are multiplied or subdivided according to a uniform decimal scale.
The meter is the unit of the whole system and is the 101000000 part of the length of the fourth part of the distance from equator to the North Pole; its length is 39.37 inches.

The multiples of the different units are indicated by prefixing the Greek names of the numbers to the name of the unit, viz- deca, hecto, & kilo and for decimal subdivisions the prefixes are the Latin names of numbers, viz, deci, centi,& milli.
To illustrate we, have for linear measurements. First the unit, the metre; its multiple being the decametre or 10 meters, hectometre or 100 metres, kilometre or 1,000 metres; its subdivisions being the decimetre or 110 of a metre, and the milli metre or 11000 of a metre.

From the meter, or unit of length are derived the units of capacity and weight, that of capacity being the litre or 1000 cubic centimeters which equals 33.815 fluid ounces.

The unit of weight is the Gram, which equals 15. 45 grains. The grain is the weight of a Cubic centimeter of water at a temperature of 39 degrees Fahrenheit. The three units are therefore, the meter, litre and gram.
A simple rule for computing the dose is, to a person of 20 years an adult dose; 10 years one half of this amount; at five years one fourth this amount; at 2 12 years one eight amount; at one year twelfth the amount.

The management of cases of poisoning
When called to a case of poisoning, the first duty of the physician is to save the life of the patient. To accomplish this-

1. Get rid of the poison by emptying the stomach.
2. Render the toxic agent harmless by administering the proper antidote.
3. Employ such methods as will correct any injury that has taken place, and that will counteract the effects of the poison.

To get rid of the poison an emetic should be employed or the stomach tube used without delay. If vomiting has already taken place they may not be needed.
Of the emetics, Zinc sulphate is one of the best; 20 to 30 grains should be given in water (five grains for children). Two teaspoonfuls of Na Cl (common salt) in a pint of water or two teaspoonfuls of mustard in a cup of warm water are of service and usually are easily obtained. Sodium chloride should not be employed when poisoning is due to corrosive sublimate or tartar emetic.
The following emetics may also be used. Sulphate of Copper in 1-5 grain doses; powdered ipecac in 5-20 grains; Emetine 116 to 13 grains; Tartar emetic 1 12 grains; Apomorphine 116 to 18 grains given hypodermally, as it is thus more certain in its action.

The stomach tube: This is of service in many cases of poisoning before absorption of the poison has taken place. It should be avoided when there is a reason to believe that the mucous membrane of the esophagus has been softened by the corrosive action of the poison, in large quantity this objection should be used with great caution in cases of Aortic aneurysm.

To insert the tube, carry the left arm around the patient’s neck, bringing the left hand, which holds the tube, close to the patient’s mouth. The end of the tube is now taken in the right hand, grasping it much as a pen is held. It is now passed in to the mouth and on in to the pharynx, when the patient is instructed to swallow as it is passed downwards. A mild lubricant may be employed or the tube may be immersed in a solution of Bicarbonate of soda. The end of the tube may be sprayed with Ethyl chloride, which serves to anaesthetize the mucous surface over which it passes.

In cases of delirium or convulsions a mouth gag must be used, and care must be taken to see that the stomach tube is now passed in to the larynx and trachea instead of in to the pharynx and esophagus. When the tube is in place, the solution needed should be passed in to the stomach. To siphon the fluid out, the end of the tube is lowered below the level of the stomach before the tube is empty.
If the poison is known, the proper antidote should be administered. An antidote should posses the following qualities.

The Materia Medica Section begins Abies Cannadensis to Zingiber Officinale in the alphabetical order in the following pattern.

• Description – Natural order
• Common Name
• Habitat
• Preparation
• Dosage
• Physiological Action
• Therapeutics
• Compare

After the drug Elaterium, there is a section about the ‘Endocrane Glands’. This section is to understand something of organo therapy by studying the physiology and pathology of the glands of internal secretion, that it may be ascertained so far as possible the secretion is normal or whether a condition of hyper or hypo secretion exists and if one of these conditions is present, to what extent it is present.
In making such a study, the patient should be considered from foetal life and infancy to old age and senility, when all the organs and their functions should be noted.

A disturbance in one gland will disturb the action of one or more.
The active principle of endocrines, “hormones” is easily disturbed. It may be in excess, diminished or perverted. A loss of this balance plays a large part in pathology and mental symptoms and its restoration has a large part in Modern Therapy.

The description of the following glands is given in the alphabetical order.

• Corpus Lucteum
• Kidneys
• The Mammary Glands
• The Ovaries
• The Pancreas
• The Parathyroid
• Parotid Gland
• The Pineal Gland
• The Pituitary Gland
• The Placenta
• The Prostate Gland
• Secretion
• The Spleen
• The Supra renal Glands
• The Testicles
• The Thymus
• The Thyroid

The description of drugs is followed by clinical index with page number in the following order.
Next is the General Index – Drugs in the alphabetical order.