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.