excessive discharge from the bowels. Subsultus tendinum plete publicity lies with Ayer; whether correctly or not, the in the terminal stage of the disease is usually accompan- quantities are all given. AYER'S rECTORAL. PRUNI-HEEOIN. ied with for which in recent cases I CHERRY great restlessness; Each auid ounce1 represents Each fluid ounce represents have found Hoffman's as recommended Wild cherry .6 grains. Wild cherry bark. anodyne, by White pine .4 White bark. a grains. pine Hare, very useful remedy. Terpin hydrate. .. .4 grains. Terpin hydrate.4 grains. In the later of the feeble heart's Blood root .2 grains. Blood root. stage typhoid fever, Heroin ( !).1/6 grain. Heroin .1/6 grain. action calls for and one must instruct the Grindella rohusta. .4 grains. Ammon muriate. . .16 grains. support; Senega .4 grains. Spikenard. nurse relative to the necessary stimulants to sustain the Rio Ipecac .2 grains. Glycerin. circulation. the urine is loaded Glycerin. Solvents. During convalescence Alcohol .80 m. etc. with the bacillus. in 5- Syrup. typhoid Hexamethylenamin Water. three times a well diluted with grain doses, repeated day, If Ayer's "shotgun" Pectoral ought "to be considered obso- and continued for a week or ten will water, days, destroy lete, what shall we say of Pruni-Heroin? If a pre- the bacillus in urine. physician the scribe Pruni-Heroin and condemn Ayer's to a patient who has taken Ayer's, what will the patient think of the advice if he learns the of composition Pruni-Heroin? _ Expectorants in the Pharmocopeia. THE PHYSICIAN AND THE PHARMACOPEIA. The expectorants official in the United States Pharmacopeia afford a great variety of choice. Innumerable combinations are CHAPTER II. possible, but we shall merely suggest a few of these, in connec- EXPECTORANTS. tion with some of the drugs and preparations available. The prevalence of coughs and "colds" in the winter months It should be remembered that coughing serves to remove is sufficient evidence of the importance of this class of agents. mucus from the respiratory tract and usually requires no treat- ment. If this becomes Their use in domestic practice\p=m-\largelyas "patent medicines," unduly severe, it may require allevia- if secretion is it so called\p=m-\probablyexceeds that directed by the physician as tion; the scanty may be increased or rendered ten to one. more liquid. Acute Physicians are supplied liberally with literature by manu- bronchitis may be divided into two general stages, facturers of proprietary remedies, but the pharmacology of with certain expectorants useful in each stage, but this is not this literature is not always worthy of the faith that some to be taken as a rigid classification. first of physicians place in it. As an example we quote from a The stage—that dryness of the mucous membrane, with circular distributed exclusively to physicians: "In severe considerable cough—calls for sedatives; the second—that of and frequent cough, when little mucus is secreted, as shown free secretion—requires stimulant expectorants. by the scanty viscal sputum, morphin, or, better, its deriva- Sedative Expectorants. tive, ethyl-morphin, is indicated, which increases secretion Among the official sedative expectorants to be used in the and lowers excitability of the respiratory center." For first, or dry, stage of cough we have the following: comparison with this interested statement by the manu- Ipecac. facturers we from the article on in Wood's quote opium Ipecacuanha.—TJ. is the dried root of (11th ed., 716): "Its to check S.—Ipecac Cephaelis Therapeutics p. tendency ipecacuanha (Brotero), A. Richard (Fam. Rubiacew). It is secretion forbids its use, however, in a very large propor- known as Rio, Brazilian or Para or tion of in those in which there is commercially Ipecac, cases, notably persistent dry- the corresponding portion of C. acuminata, Karsten, known ness of the bronchial mucous membrane." Sollmann, Cushny commercially as Carthagena when and others state that the same Ipecac, yielding, assayed morphin possesses property, by the process given in the Pharmacopeia, not less than to a lesser than opium. though degree 2 per cent, of alkaloids. was first described In such circulars manufacturers advocate the use of ipecac Ipecacuanha usually by Piso and Markgraf, in 1648, in their natural of Bra- some certain for all but we may be history remedy coughs, pardoned zil. The drug appears to have been well known to the natives if we Wood for "It is that the again quote comparison: plain of Brazil and to have been much for a of thera- medical must in each individual case the prized variety practitioner study purposes. It was introduced about relations between tne and the amount of work peutic into Europe, 1675, by cough required." John Helvetius, of Paris. The Carthagena of The of a medicinal is the signal for a host variety Ipecac- discovery agent uanha is a comparatively recent first noted of imitators whose product may differ, if at all, merely in the introduction, being as a distinct variety, about 1870. is official in substitution of an ethyl for a methyl group, or of one harmless Ipecacuanha all pharmacopeias, but up to the present time the Pharmaco- acid radical for another. These are presented in increasing peia of the United States is the one to the Car- numbers to the physician, who can by no possibility remember only recognize thagena as the of the Brazilian. them all. Or some well-known whose of service, variety being equal drug, length Ptjlvis Ipecacuanha.—U. dose: if not merit, entitles it to some respect, is seized on to serve S.—Average Expectorant, 0.050 gm. (1 grain) ; emetic, 1 gm. (15 as a basis for fabulous claims, perhaps long since voiced, dis- grains). proved and forgotten. Fluidextractum Ipecacuanha.—U. S.—Fluid extract of There is still another interesting phase connected with these Ipecac.—Extractum Ipecacuanha? Liquidum Br. should contain 1.75 per cent, of alkaloids. various nostrums. Many of us pride ourselves on the fact Average Dose: 1 c.c. that we use only "ethical" preparations and also that we insist Emetic, (15 minims); expectorant, 0.05 c.c. (1 minim). on knowing just what we are prescribing or using. It must be Pulvis Ipecacuanha et rather embarrassing, therefore, to find that even the public is Opii.—U. S.—Powder of Ipecac and (Dover's This 10 more exacting in this than we are and that the manu- Opium. powder.) contains per cent, of respect 10 cent, facturers of popular medicines, when they do advertise the ipecac, per of powdered opium and 80 per cent, of of milk. composition of their particular mixture, a full and sugar publish Dose: 0.500 complete formula and not an incomplete one such as we fre- Average gm. (7ys grains); used chiefly as a quently find in the advertising pages of medical or in diaphoretic. journals, Syrupus the circulars that come to our desk. Ipecacuanha.—U. S.—Syrup of Ipecac. This con- tains 7 per cent, of Fluidextract of Ayer's Cherry Pectoral Versus Pruni-Heroin. Ipecac and 1 per cent, of Acetic acid in a mixture of glj'cerin, sugar and water. Concrete examples, however, are so much more effective than Average Dose: Expectorant, 1 c.c. (15 15 mere that we select—almost at minims); emetic, generalities random—two ad- c.c. (4 vertisements for no fluidrachms). comparison. Surely physician of our day Vinum Ipecacuanha.—U. S.—Wine of would prescribe "Ayer's Cherry Pectoral." How Ipecac. A mixture many pre- of 10 per cent, of Fluidextract of 10 of alco- scribe the much-vaunted "Pruni-Heroin'!" Let us Ipecac, per cent, compare hol and 80 per cent, of white wine. these formulas, the one from the lay press, the other from Average Dose: 1 c.c. (15 minims). nearly any medical journal. Note that the advantage of com- 1. We give ounces instead of drams to facilitate comparisons.
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/13/2015 When the bronchi are inflamed and the secretion is scanty or Antimony. thick and tenacious, nauseants, such as lead to increased ipecac, Antimony and potassium tartrate is a more depressing nau- secretion which secures its removal The choice by coughing. seant than the above mentioned. It be used on of nauseants is the condition of the drugs may guided by general patient, robust but not with or the infirm. to Potassium Tartrate persons, safety on children ipecac being preferred Antimony and Its mode of action is similar to that of and here, too, in those cases (children and in which ipecac, weakly persons) great we have a of official would be The active of variety preparations. depression dangerous. principle ipe- Antimonii et Potassii Tartras.—U. and cac is not in the state as an S.—Antimony usually employed pure expector- Potassium Tartrate; Antimonium Tartaratum Br., Tartarus ant, the of as tannin syrup ipecac being preferred, the present Stibiatus Ger., Tartar Emetic. Colorless, retards absorption and prolongs the action. transparent crys- tals or a white granular powder, soluble in 15.5 parts of water, The dose of the nauseants is very much expectorant always insoluble in alcohol. It was discovered in 1631 by Mynsicht, less than the one-tenth in the case of emetic—approximately whose of was The doses and process manufacture subsequently improved by ipecac. average given are approximate the ex- Glauber. It has long been the most popular and widely used dose is to be two or three the pectorant repeated every hours; of the medicinal of and is now official in emetic dose is to be until effective. compounds antimony, repeated half-hourly all recent the official nomenclature For in small children few remedies a pharmacopeias, differing croup enjoy greater widely, however. reputation than sjrrup of ipecac, which is given alone in doses Average Dose: Expectorant, 0.005 gm. (1/10 grain) ; emetic, of from ten to thirty drops, repeated at intervals of thirty 0.03 gm. minutes until occurs. (yz grain). vomiting Vinum Antimonii.—U. S.—Wine of Antimony. This con- A Typical Ipecac Prescription. tains 0.4 per cent, of Antimony and Potassium Tartrate in so- lution in 1 of alcohol and 5 of white wine, and enters The of are seldom used alone as part parts preparations ipecac expec- the well-known mixture of deservedly torants, but are added to mixtures of allied use. compound glycyrrhiza—a usually popular expectorant. The following may be considered a typical prescription for Dose: 1 c.c. of the wine (15 ipecac to be used in teaspoonful doses every two hours; for the Average minims). Mistura Glycyrrhiza Composita.—U. S.—See Glycyrrhiza. syrup of ipecac a corresponding amount of fluidextract or Tartar Emetic is an (0.2 cent.) in the Com- wine may be substituted. When an opiate is de- ingredient per imperatively of which see below. manded 15 c.c. of of pound Syrup Squill, (4 drachms) camphorated tincture opium and Potassium be added without other For the administration of Antimony Tar- may change: the official Mixture of R. Syrupi ipecacuanha? .3vi 251 trate, Compound Glycyrrhiza (6 per Ammonii chlorid .Jiss cent. Wine of Antimony, —0.024 per cent. Antimony and Po- 61 is used alone with Syrupi tolutani, q. s. ad.3iii 100| tassium Tartrate) or 4 gms. (60 grains) Ammonium Chlorid to 60 c.c. (2 ounces). A typical pre- Senega. scription follows: Senega.—U. S.—Root of Polygala senega—Radix Senega— R. Vini antimonii .3iv 151 is one of the few drugs of American origin that has found a Aqua? ehloroformi, q. s. ad.5iii 100 place in every recent pharmacopeia. It contains a saponin A teaspoonful every two hours. which is locally irritant, but which is not absorbed; hence, the drug is not depressing. It is almost invariably used in Apomorphin. small amount as an addition to other expectorants. It has the Apomorphina Hydrochloridum.—U. S.—Apomorphin hy- disadvantage of an unpleasant acrid taste. The official'prepa- drochlorid.—The hydrochlorid of an alkaloid prepared from rations are: morphin by the abstraction of one molecule of water. Soluble of in the Fluidextractum Senega.—U. S.—Average dose, 1 c.c. (15 in 40 parts water, same proportion of alcohol, prac- minims), and tically insoluble in all other solvents. Syrupus Senega.—U. S.—This contains 20 c.c. Fluid- Apomorphin is much less useful as an expectorant than as extract of Senega in 100 c.c. an emetic, its action being brief. Average Dose; 4 c.c. (1 fluidrachm). Average Dose: Expectorant, 0.002 gm. (2 mg. or 1/30 See also Syrupus Scillce Compositus. grain); emetic, 0.005 gm. (5 mg. or 1/12 grain). Sanguinaria. Ammonia. Another irritant nauseant more notable for its abuse than Ammonii Chloridum. U. S. Ammonium Chlorid Br.
— use is: Ammonium chloratum Ger. A white— crystalline powder, with- Sanguinaria.—U. S.—Rhizome of Sanguinaria canadensis out odor, having a cooling saline taste, permanent in air, solu- (bloodroot). This drug, usually omitted by modern thera- ble in 2 parts of water and in 50 parts of alcohol. peutists or dismissed with a line, contains sanguinarin, belong- As sal ammoniac, this substance has been known from a very ing to the morphin group, and causing depression of the respir- early time. It is popularly supposed to have been first ob- atory center. It is mentioned here more particularly because of tained from the neighborhood of the Temple of Jupiter Ammon, its widespread use by the nostrum makers. The common name in Northern Africa. —bloodroot—appears to possess considerable psychical effect. Ammonium Chlorid was known to the Arabian physicians The Indians, perhaps, displayed more wisdom in its use than and was described by Geber. It is now official in all recent we do; they only applied it externally, as war paint. The pharmacopeias. Wood recommends this salt in the stage just only official preparation is: before secretion becomes free; for this purpose the following Fluidextractum Sanguinaria.—U. S. may be used: Average Dose: 0.1 c.c. (1% minims). Trochisci Ammonii Chloridi.—U. S.—Each troche contains The "Compound Syrup of White Pine" of the national for- 0.1 gm. (1% grains) Ammonium Chlorid and 0.2 gm. (3 mulary represents the "popular" expectorants. It is not rec- grains) Extract of Glycyrrhiza. ommended, however, as it is too complicated.1 Ammonium chlorid is much used as an addition to Com- pound Mixture of Glycyrrhiza in the proportion of 4 gms. (60 1. The following is the formula for the Compound Syrup of grains) to 60 c.c. (2 ounces), and it may be added to nearly White Pine: any expectorant mixture which is not strongly alcoholic. White pine bark (pinus strobus)Siiss 75 Wild cherry bark .Siiss 75 Spikenard root.3iiss 10 Stimulating Expectorants. Balm of Gilead buds .3iiss 10 Sanguinaria root .311 8 Tolu. Sassafras bark .grs. cv 7 Morphin sulphate .grs. viiss 5 Balsamum Tolutanum.—U. S.—Br.-Ger.—Balsam of Tolu, Chloroform .3iss 6 Sugar' .Jxxvss 750 a balsam obtained from Toluifera balsamum, a yellowish- Alcohol brown, solid that has a aromatic odor and a Water plastic pleasant Syrup (U. S.), of each, to make.Oil 1000| mild aromatic taste. It is readily soluble in alcohol, nearly
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/13/2015 insoluble in water. Balsam of Tolu was first described by It has been suggested as a remedy in a variety of ailments, Monardes, a Spanish physician, about 1574. The drug, it is but it appears to be useful mainly as an expectorant, enjoying said, was collected in a district near Carthagena, called Tolu, a reputation particularly among the nostrum vendors. It i», and appears to have been well known to and used by the na- in reality, useful in aiding to get rid of secretion from the tives of Northern South America. Balsam of Tolu, at the bronchial mucous membrane. present time, is a widely used and popular drug and is official Terebene. in all of the leading pharmacopeias. Terebenum.—U. S.—Terebene.—This is a Average Dose: 1 gm. (15 grains). polymerization Syrupus Tolutanus.—U. S.—Syrup of Tolu, containing the product derived from turpentine which it closely resembles. It is colorless a rather odor and water-soluble principles of 5 per cent, of Tincture of Tolu in a liquid, having agreeable Syrup. an aromatic, somewhat terebinthinate taste, readily soluble in 3 times its volume of but soluble in Average Dose: 15 c.c. (4 fluidrachms). alcohol, only slightly Tinctura Tolutana.—U. S.—Tincture of Tolu, a 20 per water. cent, solution of Tolu in alcohol. First obtained by Soubeiran and Capitaine about 1841, it was into medicine Dr. William Murrell about Average Dose: 2 c.c. (30 minims). introduced by The mildest of the stimulant expectorants is Syrup of Tolu, 1885; it was made official in 1890 and in the British Pharma- 1898. if, indeed, this can be considered as anything more than a copeia of much the conditions as flavorod syrup. The balsam is not infrequently used in medi- It is used in same Terpin Hydrate; its with the mixtures as ex- cine, but may be given in the form of an emulsion made with immiscibility usually employed no small with its acacia and water and sweetened with sugar. pectorants has interfered in way employ- The benzoic acid and volatile oil in the balsam give it the ment. It may be prescribed in alcoholic solution, in capsules advantage of being mildly antiseptic, the syrup, however, be- or in the form of an emulsion. ing too weak to be effective in the dose usually employed. Average Dose: 0.5 c.c. (8 minims). Balsamum Peruvianum.—U. S.—Balsam of Peru may be Squill. used in the same dose and for the same purpose as Balsam of Tolu. Scilla.—U. S.—Squill. The bulb of Vrginea maritrima. irritant Attention is called to the fact that the urine of persons containing several potent principles, it is exceedingly taking such amounts of these balsams gives a precipitate with and in large doses toxic. nitric acid which may be mistaken for albumin, but the precip- Average Dose: 0.1 gm. (2 grains). itated resins dissolve in alcohol, while albumin does not. Of all the official drugs used in the treatment of cough, few are better known than the the most Benzoin. squill, syrup being popular of its preparations. BENZ03N.—U. S.—This balsamic resin is also a harmless This drug is both stimulant and nauseant; hence, it is used stimulant, useful in bronchial irritation. in both stages of bronchitis. Tinctura Benzoini.—U. S.—A 20 per cent, solution of Syrupus Scilla.—U. S.—Syrup of Squill. This represents 5 Benzoin in alcohol, or: per cent, of Squill; made from Vinegar of Squill and, therefore, Tinctura Benzoini Composita.—U. S.—"Turlington's Bal- containing dilute Acetic Acid; it is, of course, incompatible sam," commonly called "Friar's Balsam" (also containing with ammonium and other carbonates—a fact not infrequently Benzoin, Aloes, Storax and Tolu), also may be given. lost sight of by the prescriber. Average Dose: 1 c.c. (15 minims) every two hours. Acet
Downloaded From: http://jama.jamanetwork.com/ by a Florida International University Medical Library User on 06/13/2015 Anodynes. The following demulcents may be used as vehicles: Syrupus Acacia.—U. S. the throat When irritability of the causes excessive cough- Mucilago Acacia.-—U.S. indicated. must be ing anodynes are Morphin, however, only Licorice. used with the greatest caution owing to its tendency to check secretion, "free circular therapy" to the contrary notwith- Glycyrrhiza.—U. S.—Licorice root is so well known as to standing. require but little comment. Its preparations afford a variety Codein. of forms for administering it. Fluidextractum Glycyrrhiza.—U. S.—This is the fluid- Codeina.—U. S.—Codein. Very soluble in alcohol, much extract of licorice root, from which a satisfactory syrup may less so'uble in water. be prepared by mixing 25 c.c. of the fluidextract with enough Codeina Phosphas.—U. S. syrup to make 100 c.c. Codeina Sulphas.—U. S.—Both are quite soluble in water, Average Dose: 2 c.c. (30 minims). but not in alcohol. Extractum Glycyrrhiza Purum.—U. S.—This is a semi- Average Dose: 0.003 gm. (3 mg. 1/20 grain). solid extract prepared from the root and is well adapted as an Codein, rather than its salts, is suited for combination with addition to extemporaneous mixtures. since both as Terpin Hydrate, require" alcohol its solvent. Average Dose: 1 gm. (15 grains). use mix- Codein has come very largely into in expectorant Trochisci Glycyrrhiza et Opii.—U. S.—This contains 0.005 tures in recent because its action resembles that years, partly gm. (5 mg. or 1/12 grain) of opium. of morphin without disturbing digestion or causing constipa- Glycyrrhizinum Ammoniatum.—U. S.—Ammoniated Gly- tion in moderate no because manufac- doses, partly, doubt, is an excellent demulcent; it is readily soluble in it in order avoid the cyrrhizin turers have popularized to stigma attach- water, but is incompatible with acids. to the of and ing general use morphin opium. Dose: About 0.25 gm. (4 Codein lessens Average grains). undoubtedly cough, but, as already stated, Pclvis Glycyrrhiza Composita.—U. S.—Brust Pulver Gr. this is not desirable. Codein or always phosphate sulphate, Compound Powder of Glycyrrhiza, a laxative, containing Senna, being soluble in water, may be added to almost any cough Washed Glycyrrhiza, Sugar and Oil of Fennel, and is mixture which is not alkaline.3 Sulphur, popularly believed to be a desirable adjuvant to expectorant Ammonium Chlorid is not well suited for combination with medicines. since the latter a Terpin Hydrate, requires strongly alcoholic Average Dose: 4 gm. (60 grains). menstruum which precipitates ammonium chlorid. Mistura Glycyrrhiza Composita.—U. S.—Compound Mix- Numerous substitutes have been introduced for morphin ture of Glycyrrhiza, Brown Mixture, containing Purified Ex- and codein, but it has not been demonstrated that they possess tract of Glycyrrhiza and Acacia, each 3 per cent., syrup 5 per all the advantages and none of the disadvantages of the offi- cent., with Camphorated Tincture of Opium 12 per cent., Wine cials. It must not be that forgotten habit may be formed of Antimony 6 per cent, and Spirit of Nitrous Ether 3 per cent. with of any the morphin derivatives, including codein. Average Dose: 8 c.c. (2 fluidrachms). Attention has previously been called to the extreme similar- This is a deservedly popular expectorant. It is very often ity between Ayer's Cherry Pectoral and Pruni-Heroin, and the prescribed alone, but is also much used as a vehicle for other reader is invited to compare the extravagant claims made for expectorants, particularly ammonium chlorid. with the action of heroin as stated Glyco-Heroin (Smith) by Ammonia. Sollmann and other accepted authorities. Still another of the host of expectorant nostrums is "Syrup Ammonium Carbonate.—U. S.—Ammonium Carbonate Br., Codeia Compound—Bell," said to contain codein phosphate, Ammonium carbonicum Ger. terpin hydrate, eucalyptus and ipecac (compare with formula White, hard, translucent, striated masses of a strong odor of of Ayer's Cherry Pectoral). ammonia without empyreuma, and a sharp, saline taste, slowly The manufacturers of the "Syrup Codeia Co.—Bell" but completely soluble in about 4 parts of water and decom- lay hot water. particular stress on the purity of their codein. The United posed by mention is that in which the States a very test for the of A condition deserving especial Pharmacopeia gives simple purity thick codein, which We invite mucus is particularly and tenacious, requiring liquefac- any physician may apply. again this ammonium a careful comparison of the testimony of accepted authori- tion; for purpose, carbonate is frequently other it of an un- ties concerning the constituents of this nostrum with claims added to expectorants; has the disadvantage which can not with diluted acids made the manufacturers. pleasant taste, be disguised by because these the carbonates. The bromids of ammonium, potassium and sodium are safer decompose The of chronic bronchitis requires the use of one of than morphin, and are frequently beneficial when are cough anodynes the stimulant such as Terebene or indicated. Their doses be more expectorants, Terpin Hy- should, however, than propor1 the of tionately reduced for children. drate, bearing in mind avoidance those which will prove objectionable with continued use. Hydrocyanic Acid. While urging the advantage of using the pharmacopeia I agents, we particularly suggest that the physician consider Hydrocyanic Acid may be added to expectorant mixtures, the several ingredients of any nostrum instead of accepting the but its action is fleeting and it must be frequently repeated. absurd and often grotesque claims of the manufacturers.* Acidum Hydrocyanicum Dilutum.—U. S.—Contains 2 per cent, absolute HCN. 4. Compare the following, purporting to have been written by a physician, with any text-book of the of which The average dose is 0.1 c.c. (li^minims). treating ingredients Respiton is alleged to be composed\p=m-\5grains, each. Asclepias Demulcent Expectorants. (species ?) berberis and aromatics to the teaspoonful: "I have used Respiton in cases of La Grippe and on a Demulcents are frequently to the irritation a baby, 9 months old, for severe cough, with excellent employed allay results. H. E. M.D." of the mucous membrane, and they possess the great advantage Williams, of being harmless. They may be administered in the form of in Anemic and lozenges or troches. Constipation Chlorotic Subjects.—Sir Andrew Clarke recommended one-half grain each of aloin, ferri sulphas ext. belladonnae, ext. nucis 3. The following is suggested as a simple prescription contain- exsic., vomica?, pulv. ipecac, pulv. ing codein: myrrha? and soap: One pill one hour before last meal, should the uses a confection [unk] Codein\l=ae\sulph.....grs. viii 5 bowels not act during day. Osier sulphur Ammonii chloridi ....[unk]iss 6 in the morning and a pill of iron, rhubarb and aloes throughout Syrupi pruni. virg. q. s. ad. 100 ... [unk]iii Shoemaker Aloes massae M. Sig.: A teaspoonful every two or three hours. day. prescribes: R. purif. gr. iii; ferri carb. aromat. One or at Compound Mixture of Glycyrrhiza, Syrup of Tar, Syrup of Squill gr. ii; pulv. gr. i: two pills the or Syrup of Tolu may be substituted, wholly or in part, for the bed hour. Exercise in the fresh air is, of course, a valuable syrup of Wild Cherry. adjunct.—Denver Medical Times.
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