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Presbyte- may indeed enter his protest against their sentence, if he think it improper, and appeal to the judgment of the presbytery; but this privilege belongs equally to every elder, as well as to every person who may believe himself aggrieved by the proceedings of the session. The deacons, whose proper office it is to take care of the poor, may be present in every session, and offer their counsel on all questions that come before it; but except in what relates to the distribution of alms, they have no decisive vote with the minister and elders.

13 The presbytery.

14 The provincial sy

Bod.

15 The gene

The next judicatory is the presbytery, which consists of all the pastors within a certain district, and one ruling elder from each parish, commissioned by his brethren to represent, in conjunction with the minister, the session of that parish. The presbytery treats of such matters as concern the particular churches within its limits; as the examination, admission, ordination, and censuring of ministers; the licensing of probationers, rebuking of gross or contumacious sinners, the directing of the sentence of excommunication, the deciding upon references and appeals from kirk-sessions, resolving cases of conscience, explaining difficulties in doctrine or discipline; and censuring, according to the word of God, any heresy or erroneous doctrine which hath either been publicly or privately maintained within the bounds of its jurisdiction. Partial as we may be thought to our own church, we frankly acknowledge that we cannot altogether approve of that part of her constitution which gives an equal vote, in questions of heresy, to an illiterate mechanic and his enlightened pastor. We are persuaded that it has been the source of much trouble to many a pious clergyman; who, from the laudable desire of explaining the scriptures and declaring to his flock all the counsel of God, has employed a variety of expressions of the same import, to illustrate those articles of faith which may be obscurely expressed in the established standards. The fact however is, that, in presbyteries, the only prerogatives which the pastors have over the ruling elders, are the power of ordination by imposition of hands, and the privilege of having the moderator chosen from their body.

From the judgment of the presbytery there lies an appeal to the provincial synod, which ordinarily meets twice in the year, and exercises over the presbyteries within the province a jurisdiction similar to that which is vested in each presbytery over the several kirk-sessions within the bounds. Of these synods there are in the church of Scotland fifteen, which are composed of the members of the several presbyteries within the respective provinces which give names to the synods.

The highest authority in the church of Scotland is ral assem- the general assembly, which consists of a certain number My. of ministers and ruling elders delegated from each presbytery, and of commissioners from the universities and royal boroughs. A presbytery in which there are fewer than twelve parishes, sends to the general assembly two ministers and one ruling elder: if it contain between 12 and 18 ministers, it sends three of these, and one ruling elder if it contains between 18 and 24 ministers, it sends four ministers and two ruling elders: and of 24 ministers, when it contains so many, it sends five with two ruling elders. Every royal borough sends one ruling elder, and Edinburgh two whose election must b attested by the kirk-sessions of their respective bo oughs. Every university sends one commissioner from its own VOL. XVII. Part I.

+

rians

tion.

body. The commissioners are chosen annually six weeks Presbyte before the meeting of the assembly; and the ruling elders are often men of the first eminence in the kingdom for rank and talents. In this assembly, which meets once Prescripa-year, the king presides by his commissioner, who is always a nobleman; but he has no voice in their deliberations. The order of their proceedings is regular, though sometimes the number of members creates a confusion, which the moderator, who is chosen from among the ministers, to be, as it were, the speaker of the house, has not sufficient authority to prevent. Appeals are brought from all the other ecclesiastical courts in Scotland to the general assembly; and in questions purely religious no appeal lies from its determinations.-In the subordination of these assemblies, parochial, presbyterial, provincial, and national, the less unto the greater, consists the external order, strength, and stedfastness of the church of Scotland.

PRESCIENCE, in Theology, prevision or foreknowledge; that knowledge which God has of things to come. The doctrine of predestination is founded on the prescience of God, and on the supposition of all futurity's being present to him. See PREDESTINATION. PRESCRIPTION, in Law, is a title acquired by use and time, and allowed by law; as when a man claims any thing, because he, his ancestors, or they whose estate he hath, have had or used it all the time whereof no memory is to the contrary or it is where for continuance of time, ultra memorium hominis, a particular person bath a particular right against another.

There is a difference between prescription, custom, and usage. Prescription hath respect to a certain person, who by intendment may have continuance for ever; as for instance, he and all they whose estate he hath in such a thing; this is a prescription: but custom is local, and always applied to a certain place; as, time out of mind there has been such a custom in such a place, &c. And prescription belongeth to one or a few only; but custom is common to all. Usage differs from both, for it may be either to persons or places; as to inhabitants of a town to have a way, &c.

A custom and prescription are in the right; usage is in the possession; and a prescription that is good for the matter and substance, may be bad by the manner of setting it forth but where that which is claimed as a custom, in or for many, will be good, that regularly will be so when claimed by prescription for one. Prescription is to be time out of mind; though it is not the length of time that begets the right of prescription, nothing being done by time, although every thing is done in time; but it is a presumption in law, that a thing cannot continue so long quiet, if it was against right, or injurious to another.

PRESCRIPTION, in Scots Law. See Law, p. 675. and 702.

PRESCRIPTION, in Theology, was a kind of argument pleaded by Tertullian and others in the 3d century against erroneous doctors. This mode of arguing has been despised by some, both because it has been used by Papists, and because they think that truth has no need of such a support. But surely in disputed points, if it can be shown that any particular doctrine of Christianity was held in the earliest ages, even approaching the apostolic, it must have very considerable weight; and indeed that it has so, appears from the universal appeals ૨૬

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tion.

tion.

such a man shall find any doctrine or interpretation to Prescrip have been universally believed in the first ages, or as Vincentius Lirinensis words it, semper ubique et ab om nibus, he will unquestionably be disposed to think such early and universal consent, or such prescription, of very considerable weight in determining his opinion.

Prescrip of all parties to those early times in support of their particular opinions. Besides, the thing is in itself natural; for if a man finds a variety of opinions in the world upon important passages in scripture, where shall he be so apt to get the true sense as from cotemporary writers or others who lived very near the apostolic age? and if

Introduction.

I

Nature of

PRESCRIPTIONS, EXTEMPORANEOUS.

A PRESCRIPTION, in a medical sense, signifies much

the same with what in common language is called a receipt, being "a form of direction for the preparation and administration of some compound medicine." These a medical medical receipts are commonly called formula by physiprescrip- cians; and the term prescription is applied to what is written by a physician on seeing his patient, instructing the apothecary what medicines are to be prepared, how they are to be composed, and how administered to the patient. In this sense, a prescription may contain two or more formula.

tion.

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Introduc

will be examined hereafter; and the numbers employed are usually the Roman numerals. After the ingredients tion. have been enumerated, and their quantities specified, there follows the title of the medicine, as Potio in the present instance, signifying potion or purging draught, with M. f. prefixed to it, which stand for misce fiat, or misce ut fiat, mix to make; and lastly the direction how the medicine is to be taken or administered; summo -mane sumenda; to be taken early in the morning. In England, these directions are always written in Latin, but in Scotland it is, we believe, more common to write them in English. We shall consider the propriety of this latter mode in a future part of this article.

The ingredients of which a formula is composed have been, by writers on medical prescriptions, arranged under four heads: 1. The basis of the formula, which in the present instance is the rhubarb, constituting the principal ingredient, on whose action, modified where necessary, the chief success of the medicine, in fulfilling the required indication, is to depend. 2. The adjuvant or auxiliary, added to the basis, for the purpose of increasing its power, expediting its action, or rendering it more easily soluble in the juices of the stomach; in the above formula the tartrate of potash is the principal adjuvant. 3. The corrector, added to the basis, when we wish to moderate or delay its action, to correct some unpleasant or injurious property of it, such as its odour, taste, acrimony, &c. or to prevent it from acting on the body in a different manner from that which the indication requires: thus, in the present formula, the warm tincture of senna is added, rather to correct the griping quality of the rhubarb, than to increase its action, and the syrup of roses to correct the unpleasant taste of the medicine; and the essential oil in the peppermint-water contributes to both these purposes: these, therefore, are to be considered as the correctors. 4. The constituent, or that ingredient which serves to reduce the rest into the form which is considered as most convenient for the exhibition of the medicine; in the present case the peppermint-water is the constituent, serving to reduce the medicine to the form of a potion or draught.

Medical formula are either officinal, or extemporane- Division of ous; the former being such as are directed by authority formuke. of some public medical college to be kept in the shops of apothecaries, and the preparation of which is described in their pharmacopoeias or dispensatories; the latter such as are prescribed by the physician or surgeon as occasion may require.

6

Having explained the nature of a prescription, and Division of enumerated the several circumstances which are usually the subject. comprised in it, we propose, in the present article, to consider the importance of acquiring the habit of writing prescriptions with ease, elegance, and scientific accura

Importance cy; the previous information required by a physician, of the to enable him to prescribe properly in the several cases Subject. which come under his care; the general rules which we deem it necessary to lay down for attaining the art of prescribing with neatness and accuracy; and lastly, we propose to give a brief historical view of the progress of pharmacy from the revival of literature to the present time, with a critical examination of some of the best writings on this subject.

7 Advanta

I. Before considering the importance of learning the ges of com- art of prescribing, it may be proper to explain why such position. an art is required, or to point out the advantages to be expected from the composition of several simples in the same medicine. There are indeed a few drugs, which cannot be more efficacious in the generality of cases than when in their most simple state. Thus, crude opium in a pill, cinchona bark or ipecacuan in powder, mixed with some ordinary liquid, afford the most effectual, as well as the most simple remedies. The same may be remarked of mustard seeds, white pepper, and garlic swallowed whole, and so of a few others. In general, however, it is much more convenient, and in many cases it is absolutely necessary, to have recourse to composition. Many remedies cannot be taken or applied in their simple state, especially such as are used externally; while others are rendered more certain, safe, or expeditious, by being combined with others. Thus opium and tartrate of antimony and potash are both diaphoretics, or sweating medicines; but when combined, their effect in this way, is considerably increased. (See Kirby's Tables, formula 27. and 28.). So of jalap and calomel as purgatives (Ibid. form. 49). Opium with many patients produces headach; but if citric acid (lemon juice) be added, this unpleasant symptom seldom takes place. (Tables, formula 137.). Chemical medicines are for the most part compound from their very nature; but even such of these as are contained in the catalogues of the materia medica can seldom be employed except in composition. Mercury in its native state is nearly inert, and yet how many valuable and powerful remedies are formed by its union with other bodies. Sulphuric acid and alcohol form æther, but æther cannot be swallowed except in combination. Thus we see, that independently of neatness and convenience, which, though they ought to have their weight, are secondary considerations, there are many positive arguments to prove the utility of composition: and if composition be of use, it must surely be of some consequence to know the scientific principles on which this is to be founded.

Importance The importance of acquiring a readiness at writing a of the sub- neat and scientific prescription, seems not to be generally ject. understood. Indeed few parts of a medical education have been more neglected than this department of pharmacy, especially in Britain. In many of the continental medical schools, there is a professor appointed to give lectures on the art of writing prescriptions, while in our colleges this subject is at most confined to a single lecture from the professor of materia medica, and the student is left to learn the art as he can, by copying the courses of prescriptions of the physicians whose clinical practice he has an opportunity of witnessing, or by attendance in insufficient an apothecary's shop. for prac

General

medicine

tice.

When a gentleman has passed through the usual course of education at a medical school, and has received a di

of the

ploma, it is supposed that he is fully qualified to enter Importance on his career with confidence, and proceed with success. Let us for a moment consider what are his usual qualifi- Subject. cations. He has, we shall suppose, acquired a tolerably acurate knowledge of the structure and functions of the human body; he has been made acquainted with the nature, properties, and, so far as known, the mode of action of the various simple and compound bodies, which, as medicines, food, and poisons, exert an influence on the animal economy; he has been instructed in the general nature of disease, the various symptoms or appearances by which its presence is indicated, and the general means to be employed for their removal. He has more particularly taken a view of many of the maladies to which the human frame is subject; has seen them exerting their influence on patients, and has frequently witnessed the effects of remedies in expelling them from the system, or in alleviating the distress which they occasioned. Here, it will be said, is a complete physician, and such, to a superficial observer, he may appear. With all this knowledge, however, (and without all this no man is qualified for the active duties of the profession) many gentlemen are still deficient in a most important point, the capacity of applying this knowledge to actual practice. A physician may be able to distinguish a disease at a glance; he may be prompt and accurate in forming his indications of cure, and may be well acquainted with the general nature of the remedies by which these indications are to be fulfilled, and still, if he be not master of the form and method in which these are to be exhibited; if he be not familiar with the practice of writing prescriptions, he will often be placed in a most unpleasant predicament, and will not unfrequently expose himself to the ridicule of those who are far his inferiors in knowledge and abilities, by writing prescriptions which, though they contain the essential means of cure, yet wanting the mode and fashion of the day, will be read with a smile, or perhaps be imperfectly understood, by the apothecary or the druggist to whom they are presented.

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This, however, is an inconvenience which, as it may Necessity not be attended with serious effects, is trifling in com- of acquiring parison of some which he will encounter. a habit of writing

II

From a want of habit in prescribing, or from a want prescripof some medical or chemical information, which we shall tions. presently explain, he will be often liable to jumble together substances which, though when single, they are possessed of similar medical properties, may, when combined, exert an action greater or less than he had intended to produce, or even altogether of an opposite nature. By way of illustration let us suppose a young practi- Illustration. tioner, at his first outset, called to a patient labouring under tetanus, or that disease of which a locked jaw is one of the most obvious symptoms. The patient is in the most distressing situation, and it is expected that every renewal of the spasm will end in those convulsions which most frequently bring on the fatal termination of this formidable disease. How is he to act? The remedies to be employed are evidently antispasmodics, and of these he has heard opium and mercury highly recommended in this disease. Which of these is he to employ, or is he to make a trial of both? He determines to give opium: in what form is he to order its administration? That of pill is the most obvious; but perhaps the patient cannot, in the ordinary state of his health, swallow pills, and every effort of the muscles of deglutition, increases ૨ ૧૩ the

of the

Importance the disease. He must then prescribe it in a liquid form. Shall he order it in the form of laudanum to be given by Subject. the attendants, or shall be prescribe draughts or a mixture, with a certain proportion of tinctura opii? What is the dose of the opium? He knows that a person affected with this disease can bear a large dose. Is he to give this large dose at once, or is he gradually to increase it? In a short time the patient can perhaps no longer swallow even liquids. Can be administer opium in any other form? He has heard of opiate clysters. What is the best formula for them? Is the same quantity of opium as when taken by the mouth, sufficient for a clyster? Again, if the patient cannot swallow, how is he to be supported? By nutritive injections. How is the physician to prescribe a nutritive injection? Should it be large or small in quantity? and is there any mode of making the bowels retain it for a sufficient time, to draw from it the proper nourishment? We might carry this illustration, simple as it is, to a much greater length; but we forbear, that we may not be thought tedious. We need say little to persuade those who are at all acquainted with the practice of physic, that it is the duty of every physician who values the comfort and safety of his patient, or who has any regard for his own reputation and respectability, to spare no pains in enabling himself to write a prescription with facility, perspicuity, and neatness.

12

Attendance

necessary,

but not alone suffi

eient.

To those who, previous to their attending medical in a shop lectures, have been for some time in an apothecary's shop, instructions for the writing of prescriptions may be thought useless or impertinent. In the daily habit of perusing and copying formulæ from the hands of various physicians, it may be thought "custom hath made it in them a property of easiness." Certainly, with respect to form and method, doses and proportions, they can require but little information. But after all, this knowledge is merely imitative; they have learned to write prescriptions as a parrot learns to speak, and unless they have added considerable chemical knowledge to their practical information, they can only copy what they have seen, and will often find themselves very much at a loss. This is considering the matter in the fairest point of view, taking it for granted that they have been under a master who had abilities, leisure, and inclination to give them all the necessary information; to point out to them how' particular formulæ were suited to particular indications; to shew them why one is preferable to another, and how they should distinguish a scientific from an empirical prescription.

How seldom this is the case, and how easy it is for a young man to be several years in an apothecary's shop, and learn but little, we leave to the judgment of others to decide. We trust it would not be difficult to show, that many of the formulæ which they have witnessed, may be simplified or improved; that many of them are unscientific, and not a few absurd.

We would, however, by no means be understood to consider attendance on a shop as an unnecessary part of a medical education; far from it. We are of opinion that every one who intends to practise medicine, whether it be as surgeon, apothecary, or physician, should for some time accustom himself to the preparing of medicines, and the keeping of an apothecary's day-book: and we conceive that a young practitioner without this experience, will commence practice under considerable

I

disadvantages. By perusing, copying, and preparing Previous the formula of various practitioners, the student cer- Requisites tainly acquires a readiness at prescription, which he cannot so easily and imperceptibly attain in any other way. To those who have had little opportunity of profiting in this way, and their number is by no means small, the instruction intended to be conveyed in the following observations will be peculiarly adapted; and probably such as have passed some time behind a compter, will learn something which had before escaped their notice, or will at least be convinced that the subject admits of considerable improvement by the ap plication of recent chemical discoveries.

routine in

It may be thought, that such as have, during their Hospital residence at college, given diligent attention to hospi-sufficient tal practice, will there have received all the informa- for private tion on the subject of prescription which is necessary practice. to qualify them for private practice. But those who are familiar with both will readily agree, that what is sufficient for the one, is by no means calculated for the other. The unexperienced physician, accustomed to the hospital routine, thinks it sufficient if he prescribe the proper quantities of the proper medicines in the most simple form. Is an emetic required? He will order gr. xv. ori of powdered ipecacuanha. Is a gentle diaphoretic indicated? He would prescribe 3ij of mistura salina to be taken every four hours. Were his future practice to be confined to any infirmary, to the negroes of a West India plantation, or the crew of a man of war, this might be sufficient; but if he aim at extensive or genteel practice, he will find it necessary to take a much wider range.

II. The subject of extemporaneous prescription may be considered as constituting the finishing part of a physician's education; so far, at least, as we can say, that the study of a profession, for the perfect attainment of which the father of medicine has declared life too short, may admit of a completion. This is truly the practi cal part of a physician's duty; it is this for which all his previous studies are intended to prepare him. Having acquired a knowledge of diseases and their remedies, he is, when entering on the active duties of his profession, to apply that knowledge to the best advantage, so as to cure or relieve his patient in the easiest, safest, and most expeditious manner. It is not merely the mechanical business of penning a medical receipt, which he might copy from his memory or his vade mecum, that we are here considering as the practical duty of a physician. It is the adapting of the means which he possesses to the peculiar case that is under his care; the modifying his prescription according to the circumstances of the pa tient the age, sex, temperament, peculiarity of constitution, season, climate, and many other circumstances; the choice of remedies, and the necessary variation of them; it is these which constitute the duty of a practical physician, so far as relates to the business of prescription.

15

14

Before a physician can attempt to prescribe for his Previous ftpatient, it is requisite that he possess much previous quisites.

information.

16

In the first place, he must be well acquainted with the Knowledge nature and seat of the disease, the cure or alleviation of of diseases which he is about to attempt; with the symptoms which usually appear in similar cases, and the variations which are likely to take place, with the causes, so far as

known,

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Previous known, which predispose to the disease, or which remoteRequisites. ly or immediately have a tendency to produce it; with the probable termination of such a case, and the general indications of cure. This knowledge presupposes an acquaintance with anatomy, physiology, and pathology, without a competent share of which a physician can no more effect a cure of a disease, than an algebraist can accomplish the solution of an equation, while he is ignorant of its terms.

17 Materia Medica.

The prescriber must also be familiar with the Materia Medica and pharmacy, from which he learns the natural history, the chemical and medical properties of the various simple substances employed in medicine; their usual doses and their officinal compounds, as contained in the pharmacopoeia of the country in which he resides; as it is these articles that are to form the ingredients of which the medicines he prescribes are to be composed. As without considerable practical experience few men are able to retain all the requisite information respecting each article of the Materia Medica, it would be of great advantage to the young prescriber to have by him a tabular sketch, which might, within a small compass, contain the information more immediately necessary for writing a prescription. Nothing is found to assist the memory, or to facilitate the attainment of knowledge, more than these tabular views; and so much is the learned world convinced of this, that such

15

views are daily becoming more fashionable, and are now Previous applied to almost every branch of science. It was with Requisites. the intention of assisting the young practitioner in writing prescriptions, that Dr Kirby, a few years ago, published Utility of his tables of the Materia Medica, containing a concise tabular view of the most material circumstances respecting the view. various simple and compound medicines admitted into the catalogues of the London, Edinburgh, and Dublin Pharmacopoeias. In this volume the articles are arranged under 18 classes; the titles and order of which are much the same with those given in our article MATERIA MEDICA; and of each article are given the systematic name, the synonymous pharmaceutical name, the country in which it is produced, or from which it is brought; the part employed in medicine; the form in which it is commonly administered, and the usual doses of the simple, and of the several officinal compounds. In the original draught of these tables, the circumstances above mentioned were arranged in columns; but it was found, that the difficulty and consequent expence of printing the work in that form would be so great, as nearly to counterbalance the advantage which might be derived from it. We are, however, of opinion that the arrangement in columns is better adapted to strike the eye, and we shall here give a specimen of such an arrangement, taken from one of the shortest classes in the above work (A).

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13. ALLIUM SATIVUM. Ed. Do. Aldium. Lond. Dub.

14. AMMONIACUM. Ed. Lond. India. Dub.

15. ARUM MACULATUM. Ed. Britain. Arum. Lond.

OFFICINAL PREPARATIONS.

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Powder. gr.j.every Vinum Ipecacuanha. Ed. Lond. Dr. 1. or 2. Peripneumo-
3 or 4
Dub.
nia and asth-
hours.

Smoke and extract.

Root fresh Conserve, Grs. I
or dried.
powder, to 2.
pill, &c.

Fresh root. Substance. Dr. I to 2.
Gumresin. Pill, mix- Grs. 10 to

Freshroot.

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a. Acetum Scilla Maritimæ. D. 2 to 4. Ed.

Acetum Scilla. Lond. Dub. In comp ob. Syrupus Scilla Maritimæ. sition. Ed.

Gts. 10 to dr.

c. Oxymel Scillæ. Lond. Dub. Gts. 30 to 40. d. Conserva Scilla. Lond. e. Tinctura Scillæ. Lond. f. Pilulæ Scilliticæ. Ed. Pilula Scilla. Lond. Dub. Syrupus Allii. Dub.

Lac Ammoniaci. Lond.

Conserva Ari. Lond.

I.

Gr. 10 to 15.
About a table
spoonful.
Oz. I to 2.

Dr to I.

a. Syrupus Colchici autumnalis. Dr 2 to 1 oz. Ed.

b. Oxymel Colchici. Lond. Do. Dub.

ma.

Consumption.

(A) The simples in the first columns of the above table have numbers prefixed to them. To explain why these do not follow each other in a regular series, it is necessary to mention, that the articles marked 5, 6, 8, 11, and 12, are, in the tables of Materia Medica from which this specimen is altered, inserted in a former class, viz. emetics.

Peripneumonia, asthma.

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