Elixirs and Flavoring Plants
One of the popular elixirs of the present day is advertised to have been introduced in the year 1830. Our respected friend Mr. Chas. A. Heinisth writes us as follows:
“I send you a copy of an old label for a ‘Cordial Elixir of Quinine’ my father formerly made. This label I remember appeared old when I first worked in the store in 1838. How long it had been used is more than I can say or remember. This Cordial Elixir of Calisaya was composed of quinine, cloves, cinnamon, bitter orange peel, capsicum, sugar, and dilute alcohol.“
Mr. Heinisth enclosed us a copy of the original label, taken from one of the bottles which was in the cellar of the store in 1838. We take the liberty to reproduce it, and our readers will note that it closely resembles the elixir labels of the present day:
“CORDIAL ELIXIR OF QUININE.
“This excellent preparation is particularly recommended to persons of delicate habit and weak stomach. It increases the appetite, facilitates digestion, and is well adapted to all persons living in low and marshy countries, where ague and fever prevail, and also for those who are exposed to damp and wet weather. It is taken with success by persons weakened by fever and ague, or by a copious perspiration produced by the heat of summer. Persons recovering from bilious fever should use it freely, to prevent a relapse. From half a wineglass to a wineglassful is to be taken once or twice a day, as occasion may require.
“Prepared and sold by John T. Heinisth, Druggist, East King St., Lancaster, Pa.”
The first of these trade preparations which the writer can recall was thrown upon the market in this city (Cincinnati) about 1863, under the name “Sim’s Cordial Elixir of Calisaya.”
The first published formula that I have found for any of this class of preparations, under the name Elixir, is the formula we give for Elixir of Calisaya by Mr. Alfred B. Taylor, from the Journal of Pharmacy, January, 1859.
The Druggists’ Circular of same date states that up to that time no formula for that preparation had been published.
It was of a beautiful red color, nicely flavored, and very pleasant to the taste, and it was the forerunner, or at least among the first, of the line of pharmaceuticals subsequently scattered so abundantly over our country. Afterward the “Elixir of Calisaya and Pyrophosphate of Iron” appeared, and then “Calisaya, Pyrophosphate of Iron, and Strychnine.” Soon traveling agents for pharmaceutical houses began to court physicians and so licit them to specify particular
brands when prescribing, thus necessitating duplicates upon the apothecaries’ shelves of the same preparation, and about the year 1874 the elixir mania was at its height. The burden thus thrown upon our pharmacists was considerable—more in the aggregate than most of us can realize. Elixirs of the same name, and which should have been
identical, were duplicated, or multiplied, in the same store, and each differed in appearance and flavor from all the others. If a prescription was filled with an elixir of calisaya prepared by one maker, it could not be refilled with that of another, since such a course would render it liable to be returned by the purchaser as a different medicine from that
obtained at first. Physician of the highest reputation were accustomed to specify the brand of elixir desired, and the writer can remember that time and again he has hurried to distant portions of the city searching for an elixir of a particular make and which was not in stock, although several substitutes for what should have been the same preparation were on the shelves. In addition to the above-named aggravation, combinations, or rather associations, of substances incompatible under all ordinary conditions were advertised under the name elixir, and substances perfectly insoluble in the menstruum employed were represented as being dissolved; and to add to these questionable features, quinine and combinations of quinine were asserted to be in a soluble form and nearly tasteless. It is needless to consider this phase of the subject longer, for all are familiar with the result. The burden was too great; elixirs as a class were severely criticized, and many pharmacists and physicians included those which were worthy among those which were indifferent and bad. The reaction which followed was disastrous to the interests of the men who unintentionally brought it about (elixir manufacturers), for physicians largely ceased ordering elixirs of special make, and pharmacists threw their influences against the preparations compounded by manufacturers of these specialties.
The writer aims simply to give a brief synopsis of the history of the class of pharmaceuticals under consideration, and does not wish to argue in favor or against them; and the elixir of the present day has been reached.
Throughout this country the preparation of elixirs is gradually passing from a few wholesale manufacturers into the hands of the many pharmacists. Quantities of elixirs are prescribed, but their preparation has extended over the entire country instead of being confined to a few localities. Physicians have their favorite elixirs and prescribe them, but these elixirs must, as a rule, be unquestionable. In many instances, however, incompatibles are undoubtedly brought together at the expense of the final product, drugs insoluble in the menstruum are supposed to be represented by the resultant elixir, and tedious, round about methods are employed where simple, direct processes can be substituted. Before considering elixirs individually, it is but just to review their history during the past twenty years, for many pharmacists have not the necessary works at their command, and reference is constantly made to the action of the societies which
considered them and the men who early made them a study.
The Committee on Unofficinal Preparations appointed by the American Pharmaceutical Association in 1870, was Professor J. Faris Moore, M.D., who included in his report to the Society (1871) a series of elixirs, and this was the first general recognition these preparations received from that body. In the year following the appointment of the
committee (1871), Mr. Ottmar Eberbach read a volunteer paper before the Society at its meeting in Cleveland. Ohio, in which he gave the result of his analysis of several commercial elixirs. The paper provoked considerable discussion, and resulted in the following:
“Resolved, That a committee of five be appointed by the President to take into consideration the subject of elixirs and similar unofficinal preparations in all its bearings upon pharmacy, and, if deemed proper, to report suitable formulæ for the guidance of the members of this Association.”
In 1872 Professor C. Lewis Diehl contributed an interesting paper on the elixir subject. It was read before the Louisville College of Pharmacy, and afterward published by the pharmaceutical journals, and by this means several admirable formulæ were introduced. Many of these processes are still used and accepted as standard, being preferred by pharmacists to those afterward offered as improvements.
Next (1873) the committee appointed by the American Pharmaceutical Association made a minority report (including many formulæ), which was that of the chairman of the committee, Mr. J. F. Hancock, and which, after some discussion, was adopted, and the following resolutions were offered by Professor J. M. Maisch:
“Resolved, That the report be adopted, with the recommendation that these formulæ be used by the members of the Association, and that the Secretary be instructed to send a printed copy with the report to the medical societies of the United States, with the suggestion that physicians, if prescribing elixirs at all, prescribe only such formulæ as have been adopted by this Association. The object is to attain, as nearly as possible, a uniformity in the United States.”
“Resolved, That Mr. J. F. Hancock be appointed the
Committee on unofficinal Formulas.”
At the meeting of the Society which followed, in Louisville, Ky.. 1874, the Committee on Unofficinal Formulæ failed to introduce elixirs. However, Mr. Ebert, of Chicago, presented a series of elixir formulæ, based upon those of Professor C. Lewis Diehl, and prepared by a committee under the supervision of the Chicago College of Pharmacy, and suggested that they be revised or adopted by the Society for general use. After an animated discussion, Mr. Peixotto offered a
resolution, which, amended by Mr. Roberts, was adopted, as follows:
“Resolved, That a committee of three be appointed, to whom shall be referred the formulæ of elixirs presented by the Chicago College of Pharmacy, said committee to examine the formulæ and carefully compare them with the formulæ adopted at the last annual meeting, or which may be submitted to them, to modify any or all formulæ if necessary, and to report to the next meeting.”
At the next meeting, 1875, the committee reported a number of formulæ, some differing from those previously adopted by the Society, others new. Since that time many formulæ have been introduced through the “Report on the Progress of Pharmacy,” which is the portion of the Proceedings of the American Pharmaceutical Association devoted to a review of the advance of pharmacy during the year, but there has been no other official consideration of these preparations.
In reviewing the work to which we have referred, we shall simply say that in many instances experience has demonstrated that there are defects in the formulæ which may be overcome. It was not to be expected that the work of these committees could be perfect, and while from necessity we often deviate in manipulation from the formulæ offered by the committees, we feel that, inasmuch as the proportions of the medicinal ingredients are retained by us, our
formulæ may be considered as answering the requirements of the American Pharmaceutical Association. Twenty, nineteen, and sixteen years have passed since these committees successively reported, fully the time required between two revisions of our Pharmacopoeia, and doubtless the members of the committees have individually revised many of their processes, profiting by these years of experience and by the criticisms of others. In connection with the elixir question and the American Pharmaceutical Association, we must not overlook the valuable paper presented by Mr. R. W. Gardner at the meeting in Saratoga, 1880, and which embraces more formulæ than had elsewhere, to our knowledge, been compiled at that time, and to which we often refer in the work which follows. We must not overlook the series of formulæ adopted by the Newark Pharmaceutical Association in 1876, and those adopted by the Associated Committees of the National College of Pharmacy and the Medical Society of the District of Columbia. The formulæ recommended by both of these bodies were published in the various pharmaceutical journals and served a good purpose.
Lastly (1884), the “New York and Brooklyn Formulary” appeared and presented an excellent (though limited in number) line of elixir formulæ, which work being adopted by the American Pharmaceutical Association, Pittsburgh, l885, and enlarged under the title “National Formulary " (1888), is now the most complete authoritative treatise on elixirs. In this edition of our work we have made the proportions of the drug ingredients conform to those of that publication for such elixirs as are common to both. We will add that the “National Formulary” should be in the hands of every pharmacist.
Compound elixirs have now multiplied until their number is such as to be burdensome. The problem regarding proportion of ingredients was one that early commanded our attention, and which we endeavored to systematize, in the absence of authority, so as to conform, if possible, to some general rule. The necessity for some such action may be illustrated as follows:
Elixir of phosphate of quinine contains one grain of quinine
in each fluidrachm.
Elixir of pyrophosphate of iron contains two grains of pyrophosphate of iron in each fluidrachm.
What shall be the proportion of phosphate of quinine and of pyrophosphate of iron in each fluidrachm of elixir of phosphate of quinine and pyrophosphate of iron? Again,
Elixir of phosphate of quinine contains one grain of quinine in each fluidrachm.
Elixir of phosphate of cinchonidine contains one grain of cinchonidine in each fluidrachm.
Elixir of phosphate of cinchonine contains two grains of cinchonine in each fluidrachm.
What shall be the proportion of the several ingredients in the elixir of phosphate of quinine, cinchonidine, and cinchonine ?
If each fluidrachm of this last elixir contains the amount of each ingredient which is present in the same amount of the simple elixir of that substance, we will have four grains of the combined alkaloids, an unreasonable quantity for a preparation of the character of an elixir.
In consequence of examples similar to those above named, and which demanded some regular plan of procedure, if such could be devised, we have for many years attempted to systematize the matter, and our efforts have met with some success. In making compound elixirs, where it was possible, we have represented in each fluidrachm the aggregate amount of alkaloids which would be present were the several elixirs mixed together in equal quantities. We believe that, as a rule, under the conditions which confront us in the problem of compound elixirs, physicians desire the associated action of smaller amounts of the several ingredients rather than the full dose of each. It is true that, for obvious reasons, this rule cannot always be upheld, but where it has been practicable we have endeavored to carry it out.
The proportion of strychnine in the elixirs of commerce has never been uniform, and even the men who seem to have made elixir formulæ a special consideration vary one from another. Some use one grain of strychnine to sixteen fluidounces of the finished elixir, which is the one-hundred and-twenty-eighth part of a grain to each fluidrachm, while others use severally one-hundredth, one-sixtieth, and one-fifty-first of a grain. Strychnine is far too violent and poisonous a substance for such a range of proportions, and in our opinion it is to be regretted that, even though ignoring elixirs as a class, our Committee upon Revision of the Pharmacopoeia did not authorize some proportion which pharmacists could adopt in order to further a uniformity in these preparations.
Since the foregoing was written the National Formulary has authorized the making of elixirs containing strychnine compounds in which one and one-quarter grains of strychnine or of the strychnine salt are used in preparing sixteen fluidounces of the elixir. Thus the authoritative proportion of strychnine has been accepted approximately as the one-hundredth part of a grain to each fluidrachm.
In accordance therewith, in the body of the present edition of our work on elixirs, the strychnine proportions in these elixirs are made to conform to that strength.
In making solutions of strychnine we usually convert it into a soluble salt by means of acetic acid. This forms a combination which in our experience is best for associating strychnine with the entire list of substances which are used to form the compound elixirs containing that alkaloid. In some instances the elixir in which the strychnine is to be placed has an alkaline reaction and may decompose the salt; yet as the elixir contains some alcohol, and besides has as a menstruum a solvent action different from that of water, it does not necessarily follow that precipitation of the alkaloid will result. However, it is well to be cautious, and should a white, flocculent precipitate occur in elixirs containing strychnine and which are alkaline in reaction, this precipitate should be considered as dangerous and care exercised in
dispensing the elixir.
In all the formulæ where it is practicable we have introduced fluid extracts instead of crude drugs. This we consider advantageous for several reasons, and fluid extracts may now be readily obtained to represent nearly every plant used in medicine. In many instances we object to certain drugs under any consideration as the foundation of an elixir, and we have not hesitated to criticize freely where the medicinal principles of the drug cannot in our opinion be extracted or held in solution by the elixir. However, if the menstruum precipitates these principles from the fluid extract, it will probably refuse to extract them from the crude drug, so that little if any advantage will accrue in this direction from the use of the crude material. We vary from the methods employed by the committee appointed by the American
Pharmaceutical Association regarding the manner of mixing a tincture or fluid extract with the menstruum. If they are mixed directly together, precipitation results immediately of much of such substances as are insoluble in the resultant menstruum. This produces a preparation which pharmacists and physicians refuse to accept as an elixir. True it is that these substances may be inert and that filtration will separate them; yet the nature of the case is such that filtration is
only of temporary benefit, and even after several filtrations the precipitation continues. This trouble may be overcome to a great extent by following the old process for making medicated waters, that is, by triturating the fluid extract or tincture with magnesium carbonate, or with some other inert powder if this substance is inadmissible, after which the simple elixir is added and the mixture filtered. By this process the insoluble materials are separated at once, which is preferable to having the precipitation extend over days and weeks. Besides, the surface exposure caused by the trituration of the fluid extract with the magnesium carbonate may favor the saturation of the menstruum in the manner it does with essential oils under the same conditions.
We have adopted a simple elixir which practically agrees with that of our Pharmacopoeia (1883), although the method of
manipulation differs somewhat. We object to elixirs which contain cinnamon, caraway, coriander, cardamom, or cloves (unless used as aromatic elixirs), for many persons are prejudiced against certain of these substances, and it is not unusual to meet persons with whom the flavor of one of the foregoing is unbearable. The simple elixir should, in our opinion, be as nearly as possible pleasant to the majority of persons, and we have no record of an objection to the flavor of lemon or of orange, separate or combined. Our formula for simple elixir, therefore, associates these substances in such proportion as to produce a very acceptable and grateful combination, the orange preponderating.
When we consider that in the pages which follow we find processes for making 271 different elixirs, we are confronted with the fact that these elixirs alone would fill the shelves of an ordinary storeroom. The problem to be considered by pharmacists is that of finding the most convenient method which will enable them to dispense these combinations in a creditable manner without overstocking their shelves. This has been and is a consideration of pressing importance to the writer, and the trouble has been overcome, to a very great extent, by adopting a system which would permit the
preparation of compound elixirs from those more simple, and in studying how to make the different elixirs from compatible ingredients. In many instances this is impossible without injury to the product, and yet, in the large majority of cases, pharmacists are able to extemporize and supply most demands from their stock of standard elixirs, which are those in most common use.
Some elixirs may be called permanent, but this term cannot be applied to the larger number. Associations of the alkaloids in acid solution only, or elixir of pyrophosphate of iron in alkaline solution, or others under certain conditions, might possibly be claimed as fairly permanent. However, the elixir of pyrophosphate of iron will decompose if exposed to the sunlight or even strongly diffused daylight, and it may gelatinize after a time if of acid reaction, while alterations will follow with the solutions of the alkaloids. Few organic bodies are permanent in solutions containing far more alcohol than is permissible with the modern elixir, and in consequence many elixirs will alter in appearance, or even precipitate, if they contain the substances which are supposed to be present.
In reviewing the formulæ which follow, the reader may criticize the number of different elixirs presented. This, we admit, is a fault, but one beyond our control, and some of the elixirs are seldom used, some are simply curiosities. This country is large, however, and if the reader will regard a certain preparation as one which should have been omitted, he may be surprised to learn that in other localities it is very much in demand. Time and again we have been surprised on
learning of the local consumption of substances we scarcely thought commanded a sale, and, upon the other hand, we have excited comment over certain preparations scarcely known to others and yet made by us in quantities. In connection with this phase of the subject, we feel that our position is not that of a judge—a position occupied by certain committees—but that, as our subject is “elixirs,” it is our duty to consider them as a body.
We desire to call attention to the fact that it was our first intention to give the several processes and criticisms which have been made regarding each elixir introduced during the past twenty years.
This proved to be impracticable, and we were forced to draw the line sharply. If the reader will select as an example any one of the prominent elixirs, and hunt up the reviews, different formulæ, etc., regarding it which have appeared in the various pharmaceutical journals and the Proceedings of the American Pharmaceutical Association during that period, he will doubtless be astonished at the magnitude of the matter; and when it is remembered that recent years have given us several new and worthy pharmaceutical journals, and that elixirs are more or less considered by all of them, it will be seen that to give an intelligent and faithful resume in a work like ours would be impracticable.
Our aim has been to credit those who introduced special combinations and the journals whose pages we consulted to find their records, and yet it is likely that unintentional oversights and errors have been made.
In conclusion, we may say that we trust pharmacists will find our formulæ to present some advantages over a line of compilations, for they are not simply abstracts from the work that others have done.