—~r 1—1 ec •»— TRITURATION of ALKALOIDS A. Paper Read, by Edwin Pynchon, M.D., BEFORE THE CHICAGO MEDICAL SOCIETY, At its meeting, April 16,1888. CHICAGO : Reprint from Western Medical Reporter, May, 1888, Press of Geo. T. Halla, 51. 53, 55 Dearborn St., CHICAGO, ILL. TRITURATION OF ALKALOIDS. In its progress the science of medicine receives much assistance from the collateral professions among which Pharmacy and Chemistry have been most lib- eral contributors. Of the products of chemistry the alkaloids merit consideration as being among the first in importance. In the alkaloid of a plant we have in a concentrated and invariable form the value—the med- icinal worth of the plant. I say invariable, as a given alkaloid has ever the same chemical formula. In sev- eral cases a drug has been found to contain two or more alkaloids, though in such cases one of the same possesses pre-eminently, as compared with the others, those powers or properties which have been attrib- uted to the crude drug. I believe where but one alka- loid is found it possesses therapeutically the proper- ties of the mother remedy. Two specimens of the 'same plant may differ as to the per cent, of alkaloid which they will yield. In other words, pound for pound, they differ in richness as to the quantity each may respectively contain of their active principle. In such case should a fluid extract be made from each specimen in accordance with the directions of the Pharmacopcea how could it be expected that the two extracts would be of uniform strength? This condition of variance has been taken note of by some of our leading manufacturing Phar- macists, who, in case of a few of the more active rem- edies have attached to the container a note giving the per cent, of alkaloid which analysis has proven the preparation to contain. One manufacturer goes fur- ther by giving with each of the fluid preparations which he prepares, representing pound for pound, a printed formula for a test to prove that the prep- 4 aration contains a required per cent, of the active principle. By a judicious mixing of the products of different percolations or distillations, as well as by dilution, a standard, which though arbitrary, can be retained. In this way an uniformity of preparation is secured which cannot be had by following the Phar- macopcea and is undoubtedly a step in the right di- rection. If then, for example, the physician prescribes a fluid extract in order to obtain the effects of the alkaloid which it contains, why not prescribe the alkaloid itself and omit the starchy, coloring and other inert matter of which the extract is composed ? This query is equally applicable in case of the solid extract, tincture, etc. The more general employment of alkaloids has been subject to several objections. In but compara- tively few drug stores can a full line of alkaloids be found. Again, as compared with more crude prepara- tions, they are expensive, the greater number of them being imported and principally of German manufac- ture. Other objections to their employment are the minuteness of the dose, requiring more delicate pre- scription scales than the average drug store is pro- vided with, and particularly the difficulty in always remembering the exact dose, the importance of which, owing to the activity of the remedy, will suggest itself. The object of this paper is to show a means whereby these latter objections can be overcome. In city practice, where drug stores are accessible, it is customary to write prescriptions, but in many places, and cases, were it neeessary to await the arri- val from the drug store of the remedies prescribed, the case would either have recovered or have termi- nated fatally. I favor the use of the pocket medicine case containing a reasonable number of appropriate remedies with which to meet the most common indi- cations found in acute diseases and emergency cases. By the use of the medicine case and through the pal- 5 atableness of the remedies therein contained, the Ho- meopathists have been enabled to secure much prac- tice which would otherwise have fallen into the hands of regular practitioners. The employment of the pocket medicine case, will, to a certain extent, do away with the annoyance and danger of the substitu- tion and adulteration which are occasionally practiced by disreputable pharmacists in the compounding of prescriptions, for no physician for his own use would buy other than the best and purest which can be ob- tained, and as the profit on compounding prescriptions is generally large, the physician can frequently furnish one or more of the needed remedies at one tenth of the cost which the patient would entail at the corner drug store. This financial side of the question has often been the cause of the patient employing one of that school of medicine the practitioners of which fur- nish their remedies without charge. And again, when prescriptions are invariably written it often occurs that the druggist gets all the money which the patient can spare and the poor medicus waits, and continues waiting for his pay until the patient’s gratitude has been effaced by time, and while thus waiting not in- frequently learns that death has come to cancel the obligation ; whereas had he furnished a portion of the medicine required he might have received at least a portion of his fees. When in addition to the foregoing we take into con- sideration the promptness with which a remedy can be prescribed and the avoidance of the otherwise neces- sary trouble of the patient being obliged to send out to the pharmacy, and when after closing hour being subjected to extra delay as well as to extra expense, it is not difficult to see why the physician should pro- vide himself with a case of remedies for bedside pre- scribing. For this purpose it is desirable to select remedies of the greatest efficiency and concentration. As to 6 form, the employment of liquids is not so convenient and cleanly as is the employment of granules &nd pow- ders. There is now being introduced the dosometric granules of the Metric Granule Company, which prep- arations are all that could be asked for in the way of granules. What is next needed is to provide a system of pre- paring remedies in the form of powder which shall be practical and comprehensive and be a companion to the dosometric granule. In the system of decimal triturations oh the home- opathic school we have an indication of what is de- sired. In triturating the remedial agent with an inert powder, preferably sugar of milk, it is an undoubted fact, and most generally admitted by observing prac- titioners that the action of the remedy is increased by such process of subdivision—oftimes developing prop- erties which the crude remedy does not possess—and that it is thereby better absorbed and assimilated, and gives better and more prompt results. Now, while the iX and 2X and in some cases the 3X triturations of the decimal system, which when given in the usual dose of three grains means a dose of either 1-3, 1-33 or I_333 part of a grain, are allowable and are sensi- ble preparations; it stops at that point, for 4X means a dose of only the 1-3333 part of a grain, which is an amount too minute to warrant further consideration, unless prescribed as a placebo. The centesimal sys- tem of trituration, one of the wild vagaries of Hahne- mann, does not merit attention. It will be observed that the principal defect of the decimal system is that the arithmetical progression employed is too rapid. What can be done with the many agents the medicinal dose of which is between the 1-3 and the 1-33 or between the 1-33 and the 1-333 part of a grain? A system of trituration and nomen- clature is desired by which this objection will be removed. 7 I employ a numeral which I have called the medi- cal denominator, hence triturations prepared in accor- dance with this system can be known as “denominator triturations.” In this system, as with the decimal, the medium or general adult dose is uniform—to wit: three grains, which by the way, can always be accu- rately measured by means of the three-grain spoon, which at the opposite end is provided with a smaller concavity which when even full contains two grains. I have triturated one grain of a given alkaloid with a sufficient number of grains of sugar of milk so that three grains shall contain the usual adult dose. As a title after the name I affix a number which is the num- ber of grains containing one grain of the remedy. For example, taking sulphate of morphine, the average dose of which is 1-8 of a grain, I triturate one grain thereof with twenty-three grains of sugar of milk and mark it “ Morphiae Sulphas 24 ; ” of this preparation the number of grains given at a dose is always the nu- merator over the denominator 24. Thus three grains is 3-24 or 1-8; two grains is 2-24 or 1-12; six grains is 6-24 or 1-4, etc. The remedy is thus sufficiently triturated for accurate dosage and so plainly marked, that, while unintelligible to the layman, it reads in the clearest possible manner to the initiated. The nu- meral is written or printed in as large type as is the name of the remedy and is on a line therewith, so there is no second line with a large fraction in very small figures to decipher. One soon learns to associate the numeral with the name as a part thereof, and further to classify together those remedies which require the same denominator. The denominators which I find are the best to em- ploy are 3, 6, 9, 12, 18, 24, 30, 36, 48, 60, 75, 90, 120, 150, 180, 240, 300, 360, 450, 600, 750, and 900. 10 and 100 may also be employed, they being the equivalents respectively of iX and 2X of the decimal system, and may be substituted one for the other as desired. I do 8 not think that the benefits of trituration are secured when less than two parts of the inert powder are com- bined with one part of the remedial agent. This sys- tem of trituration need not be limited to the alkaloids, but may be employed with the resinoids, glucocides, oleo-resins or with other agents, as arsenious acid or any other remedy which is employed in small doses. In like manner those popular preparations the tablet triturates, can be marked with the denominator num- ber and divided in three-grain tablets. If desired, they can be reduced to powder and the required dose measured with reasonable precision, which would also permit of the employment of tablets which have been accidentally broken. This system of trituration and marking remedies will be found to be both convenient and practical by physicians who care to do any office dispensing. And the specialist may also find it of value in the preparation of powders for topical appli- cation, in which case such other inert powder as de- sired can be substituted for the sugar of milk. There has within the past year been put upon the market a class of remedies advertised as “ alkatrites,” which are similar to the preparations which I sug- gest, inasmuch as they are triturations which it is in- tended shall be given in three-grain doses, and in each case there is marked on the vial, in small figures, the quantity of the alkaloid which each three grains con- tains. It can easily be seen that it would prove at least annoying when the dose is increased or dimin- ished to tell easily and quickly the exact amount being given. These remedies are triturated with an inert coloring matter, which is not a bad idea, as it is a proof of thorough trituration. 703 Chicago Opera House.