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NATIONAL WAR FORMULARYTHERE was a time when a doctor could achieve a

fair reputation as a prescriber by the liberal use ofpharmaceutical cocktails such as the compoundtincture of cardamon, and by avoiding the morespectacular catastrophes of incompatibility repre-sented by explosive mixtures. The advent ofnational health insurance, by curbing extravagantprescribing, showed many practitioners the error oftheir ways, and not a few physicians were content tohang the blunderbuss in the hall and practise poly-pharmacy no more. Modern war, which is fought assavagely in the realm of economics as on the battle-field, has now forced all doctors to exercise morediscrimination when prescribing. The therapeutic

- requirements committee of the Medical ResearchCouncil stated the position succinctly in their memor-andum 1: " Economy in the use of a drug may benecessary in war-time because the drug is importedor because its manufacture at home diverts materialsand skill from other essential services." The com-mittee classified drugs into those which we can or mustuse freely (A), those with which we must be careful(B), and those which we must give up altogether (C).Based mainly on this classification a National WarFormulary 2 will shortly be issued by the Ministry ofHealth, and its importance can hardly be overstated.The general practitioner is specially concerned, for theN.W.F. will replace the National Formulary forN.H.I. purposes on Dec. 1, before which date allinsurance practitioners and pharmacists will receivea copy. But the new formulary is not intended ex-clusively for N.H.I. patients, as its children’s sectionbears witness ; it is hoped that all practitioners willfamiliarise themselves with the N.W.F. and use itwhen prescribing for their private and hospitalpatients as well.

, Comparatively few doctors are sufficiently wellinformed on the dry bones of materia medica toappreciate the more subtle reasons for avoiding this orthat drug as a contribution to the war effort. Theywill therefore be glad to have the guidance of thesection on war-time prescribing. The reasons forsome of the " Don’ts " are at once apparent, par-ticularly those referring to confections, glycerin andalcohol. On the other hand, it will come as a surpriseto many that they must’go carefully with such com-monplace substances as linseed, starch and soap lini-ment (high alcohol content). We referred last week

(p. 489) to the urgent need for economy in aspirin,and this is mentioned in the formulary, though itincludes mixtures and tablets containing aspirin. Ifthe results of recent research 3 are accepted, it followsthat five grains of aspirin have as powerful an anal-gesic action as ten. There seems therefore to be no

pharmacological justification for the practice (ascommon among doctors as laymen) of taking " acouple of aspirins " ; the essential thing is that the1. Economy in the Use of Drugs in War-time. M.R.C. War

Memorandum No. 3, 1941, p. 3.2. H.M. Stationery Office. Pp. 70. 6d.3. See Lancet, 1941, 1, 483.

dose should be absorbed, by grinding it up, chewing itor taking it in suspension. There are some helpfulremarks on proprietary preparations, the abuse ofwhich has become the blight of modern therapy. Toquote the formulary: " Before prescribing anyproprietary preparation the medical practitionershould consider carefully whether the needs of thepatient would not adequately be met by the use of adrug or preparation which is identical or of reputedanalogous therapeutic effect. Particularly should herefrain from prescribing proprietary preparations offoreign origin." Because of skilful publicity andtheir convenience these preparations tend to accumu-late in the doctor’s therapeutic armamentarium, andthe prescriber is likely to continue to use the originaltrade-name long after the identical substance hasbecome official=usually under a name which has somebearing on its composition but not necessarily easierto remember on that account. There can now be noexcuse for such extravagance.In this country we are well supplied with works

of reference on materia medica, but our B.P., ourB.P.C. and our Martindale tell us little about therelative effectiveness, availability and cost of the

preparations they describe! Sweet indeed are theuses of adversity which has compelled a committee ofdistinguished medical men and pharmacists to cometo grips with these aspects of prescribing. The advicewhich the N.W.F. offers has been made necessary bythe difficulties of supply, but there has clearly been ja careful search among pharmacological title-deeds in

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deciding the claims of each drug. -Exception can betaken to few of the successful candidates, though it isdifficult to justify the inclusion of opium in a lotion ;the addition of sodium bromide to the sleepingdraught containing chloral hydrate merely spoils theend-point of the latter drug ; and mist. brom. etarsen. is based on the long-exploded belief that a smalldose of Fowler’s solution prevents bromism. Thereis a welcome departure from the so-called classicalprescription, with its tiresome insistence on basis,adjuvant, corrective and vehicle ; and there isevidence of a determined effort to eliminate super-fluities and go straight to the point. A diagnosishaving been made and drug treatment decided on, thisbooklet shows how simple it is to prescribe for thepatient. The legacy of, elaborate polypharmacybequeathed to us has hero been decisively repudiated ;let us hope that this wholesome decision, forced on usby the war, will remain ours by choice with the returnof peace.

INSUFFLATION OF THE FALLOPIAN TUBESSiNOB the procedure was first described by RuBrrr

in 1920 insufflation of the fallopian tubes has beenlargely practised by gynaecologists in this country,and various modifications of RUBIN’s originalapparatus have been made, notably those of BONNEYand PRO vis. This minor operation, however, largelybecause of its simplicity, is sometimes misapplied.KING,’ who surveys his results in 635 insufflations,sets up six indications for insufflation-as part of aroutine investigation in cases of primary and secondarysterility ; as a help in the differential diagnosis inobscure pelvic conditions ; to determine the state ofthe residual tube after salpingectomy for any.reason ;

1. King, G. Caduceus, 1930, 19, 161.