This book is a development of Dr Sneader's earlier and invaluable Drug Discovery: the Evolution of Modern Medicines, first published in 1985. The author, who is Senior Lecturer in Pharmaceutical Sciences at Strathclyde University, has identified 240 chemical prototypes and has adopted the novel approach of tracing the development of the final pharmaceutical products through a number of generations. The prototypes, on the basis of their origins, are divided into six main groups: mineral and organic; plants; animal or human body; micro-organisms; synthetic chemicals; and serendipitous discoveries. Typographic devices are employed to indicate degrees of relationship. Prototypes are enclosed in double-line boxes, next-of-kin in single-line boxes, followed by underlining and descending emphasis of type-face, extending in some instances to eight levels of descent. Chapters are introduced by family trees, on which, for example, some 55 derivatives of atropine, 50 of adrenaline or 30 of ephedrine are delineated. Much pharmaceutical fog is dispersed and some unexpected relationships become evident — phenylbutazone to quinine, naloxone to thebaine and fentanyl and its congeners, via haloperidol and pethidine, to atropine, for example. The book is replete with structural formulae, which are invaluable for demonstrating chemical relationships, to which similarities and differences of pharmacokinetic and pharmacodynamic properties can be attached. The book opens with a brief but useful chapter on drug therapy and its origins throughout the ages, starting with the Egyptian medical papyri and proceeding via Greek and Arab medicine and the Renaissance, to the nineteenth century. Comprehensive accounts of the various prototypes and derivatives follow, with brief histories of the compounds, their mode of discovery and development, including the primary references, their uses and, where known, the people involved. Although it covers the whole range of pharmaceutics, the book will be of especial interest to anaesthetists partly because of its comprehensive anaesthetic content and partly because in the nature of things the anaesthetist requires a far wider knowledge of drugs than does any other practitioner. As regards anaesthetics, a number of the inhalational agents, from nitrous oxide to enflurane and several others, including lignocaine and its derivatives, feature as serendipitous discoveries; and the cover is comprehensive. Drugs now obsolete, but which spearheaded the anaesthetic revolution of the late 1940s, are here; penta- and hexamethonium, introduced as antidotes to the muscle relaxant decamethonium and soon found serendipitously and alarmingly to have profound hypotensive effects; and mephenesin, another relaxant, derived from a constituent of an expectorant cough mixture, which itself, by substitution of a chlorine ion for a methane radicle, became an antifungal drug. This comprehensiveness is of great value to the historian and it provides a pleasant stroll down memory lane for those who lived through this period. But as regards anaesthesia there are one or two inaccuracies, or debatable statements. Horace Wells's unfortunate patient, for example, would hardly have ‘struggled in agony under the surgeon's knife’, since he was having a tooth out and Dr Frank Bennetts has shown that the number of barbiturate-attributed deaths at Pearl Harbour was greatly exaggerated. The comprehensive nature of this book makes it of interest and value to clinicians, researchers and pharmacists. It should be in the library of every medical school and postgraduate centre. It is not just another pharmacology textbook; it is like no other. Dr Sneader has produced the Burke's Peerage of pharmaceuticals.
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