Development of the Genital System and Male Pseudohermaphroditism

Most seriously ill patients receive many drugs intravenously. Mr. Fowler has written this pamphlet to prevent doctors and nurses from putting incompatible drugs or infusion solutions in the same bottle. Although the commonness of in-line small resevoir systems for giving intermittent doses of drugs make in-the-bottle mixing unlikely now, some of his points still stand as legitimate warnings. Others have deeper implications which he does not discuss. Important in-the-bottle chemical incompatibilities are correctly noted. Many agents form visible or invisible precipitates and highly basic diphenylhydantoin and aminophylline are model offenders. The incompatibility of phenothiazines with many catecholamines is another matter. This deals with pharmacology rather than simple chemistry. The beta-adrener-gic stimulus from catecholamines can lower blood pressure further when pheno-thiazines cause hypotension by alpha-adrenergic blockage. Such an untoward response occurs in the patient, not in the bottle, and raises questions about in vivo incompatibilities of drugs regardless of the administration route used. Coumadin remains the only drug about which such incompatibilities are generally understood. What effects other drugs have on each other in patients remains uncertain and probably more important than in vitro problems. Mr. Fowler's pamphlet is incomplete but at least makes it clear that pharmacists, nurses and doctors must work together to avoid neutralizing their drug combinations before or after they go into patients. The safest rule seems to be to assume that all iv medications are incompatible. Whatever must be given should be given by in-line reservoir systems intermittently with saline solutions. NVe should borrow Oslerian parsimony from its traditional diagnostic role and apply it to therapy. This book is an excellent anatomic atlas illustrating the development of the genital system plus various disorders of sexual development. The photographs and schematic diagrams are superb and quite illustrative. The author's anatomic de