TROCHES 
BY 
v'' 
WILLIAM T. CATHELL, M. D 
BALTIMORE. 
Compliments of 
J. F. HANCOCK, 
Manufacturing Pharmacist, 
BALTIMORE, MD. 
REPRINTED FROM 
The Maryland Medical Journal, 
August 18, 1894 3 / TROCHES. 
By William T. Cathell, M. D. 
BALTIMORE. 
Reprinted from the Maryland Medical Journal, 
August 18, 18^4. 
As a large number of patients suffer- 
ing with throat affections have more or 
less pain and difficulty in swallowing, it 
is of considerable importance, in treat- 
ing them, that a suitable method of 
administering the proper remedies to 
meet these, be at the command of the 
practitioner. Such a need is more or 
less filled by the various medicated 
troches that are made by manufacturing 
chemists, and it has been a matter of 
great surprise to me that their use is so 
limited among American physicians, 
while in Great Britain and on the Conti- 
nent, they are largely prescribed, and 
with the most satisfactory results. 
3 In laryngeal disease the efficacy of 
troches may be at times somewhat doubt- 
ful, still they have a long-standing repu- 
tation for usefulness in all voice affec- 
tions, due probably, aside from their 
direct local action, to their exciting a 
reflex curative influence upon the larynx, 
through the path of the laryngeal plexus 
of nerves. Their usefulness has now 
been too thoroughly demonstrated to 
require any extended explanation as to 
their efficacy. 
Their great advantage consists in our 
being able by their use to keep the 
selected drugs continuously in contact 
with the irritated and diseased mucous 
membranes of the fauces and throat, by 
which we obtain more prolonged topical 
action than would otherwise be possible 
with even a greater quantity of the drug. 
In reliability troches are necessarily 
superior to gargles, which all fall short 
of what is required of them. Especially 
is this true when we have a lesion pos- 
terior to the faucial pillars, owing to the 
fact that the ingredients are gradually 
dissolved in the saliva, and thus brought 
in immediate and prolonged contact 
with the affected parts, whereas in a 
4 gargle the drug is greatly diluted, and 
never reaches beyond the palato-pharyn- 
geal fold. It can not therefore be other- 
wise than logical for us to conclude that 
better results will be obtained from 
slowly-dissolving troches than the non- 
permanent contact of gargles. Besides, 
gargling, to say the least, is disagree- 
able to a great many patients and to 
some, is wholly impossible. 
Confectioner’s troches do not answer 
our purpose, being uncertain in the 
dosage, and so easily breaking and chip- 
ping as to make them unreliable. Be- 
sides, they fall to pieces too quickly in 
the mouth; and are also affected too 
easily by the weather, and usually result 
in giving dissatisfaction to the patient, 
and injuring the prescriber’s reputation. 
I have found troches of service in vari- 
ous acute inflammatory diseases of the 
throat; and also in most chronic affec- 
tions of that organ, combining absolute 
accuracy of dose, convenience in admin- 
istration, speedy disintegration, and con- 
sequently rapid absorption, thereby ob- 
taining the most effective results. And 
with me they have met the demands of 
a large class of out-door patients. 
5 Of course a thousand and one combi- 
nations could be made, but as we must 
necessarily have stock troches at our 
command for prescription, in every-day 
cases, I have devised the following three 
varieties, and for memory’s sake have 
given each the prefix “ Muco,” and find 
the three to admirably cover the ground 
in ordinary practice. 
Apomorphinae 
Hydrochloras, £r* i2® 
Ext. Eucalypti 
Glob., Sr- * 
Muco-Stimulant 
S. Use one every two or three hours. 
Ext. Pulsatillae, gr. 
Ergotin, gr. TV 
Codeina, gr. ■£? 
Ext. Belladonnae, gr. A 
Muco-Sedative 
S. Use one every two or three hours. 
Kali Chloras, gr. j 
Oleoresin. Cubebae, 
Pulv. Ipecac., 
“ Catechu, 
aa gr. i 
Muco-Tonic 
“ Capsici, gr. 
Balsam. Tolutan., gr. § 
S. Use one every two or three hours. 
The respective terminations of name 
serve to indicate their therapeutic uses, 
and save the necessity of memorizing 
endless varieties of formulae and indica- 
tions. 
6 I may here remark, that the manufac- 
turer has combined in each of these for- 
mulae, an unobjectionable excipient se- 
lected for its elegance and palatability. 
When either of them is used in the 
treatment of oral, faucial or pharyngeal 
affections, chiefly for its local effect; it 
not unfrequently plays an exceedingly 
useful role, either alone or as an adju- 
vant to other treatment. 
Recognizing the usefulness of these 
combinations in daily practice, and the 
advisability of having them properly 
and pharmaceutically prepared, I gave 
the formulae to Mr. John F. Hancock, a 
well known manufacturing pharmacist 
of Baltimore, who has devoted many 
years of his professional attention to the 
manufacture of troches, knowing that, 
with his experience in this line and his 
facilities for their manufacture, they 
would be made as perfect as present art 
will allow. As made by him, they are 
especially adapted and intended for pre- 
scription use, being dispensed in tube 
vials of 36 troches each, in which form 
they are not only convenient for carry- 
ing in the pocket, but are also thor- 
7 oughly protected from the influence of 
the atmosphere. 
I would here add a brief word about 
the action of each of the three varieties 
mentioned : 
Muco-Stimulant.—The action of these 
is astringent, stimulant and antiseptic, 
and very marked upon the mucous sur- 
face, preventing the formation of thick 
tenacious mucus. I have, moreover, 
found them of special advantage in 
obstinate coughs by promoting freer ex- 
pectoration, and mollifying many bron- 
chial and laryngeal troubles. Again, 
while they possess valuable stimulating 
properties, they are free from the ex- 
tremely bitter taste that characterizes 
many of the other troches j in this res- 
pect they contrast strongly with catechu, 
kino, etc., which greatly favors their 
administration to children and fastidi- 
ous patients. 
Muco-Sedative.—These troches sheathe 
the mucosa, lessen the tendency to 
cough, and produce a very soothing 
and calmative effect on throat soreness. 
I have found them of marked benefit 
where the throat and tonsils are acutely 
inflamed and much swollen. They 
8 quickly mitigate irritation, liquefy tena- 
cious mucus and lessen expectoration, 
and do not constipate. If a patient’s 
cough is severe and irritating two or 
three may be allowed in rapid succes- 
sion. They have also been used in the 
early stages of mercurial salivation with 
wonderful benefit. 
Muco- Tonic.—In regard to this troche 
I can say, with emphasis, that I know of 
no other combination that has so many 
points of merit, and is so effective in its 
action. 
I some time ago added to the original 
formula the small quantity of capsicum 
and find that the slight glow it produces 
increases their usefulness. And now 
after an extended use of this improved 
combination, I find their value both in- 
creased and confirmed. They are 
admirably adapted for allaying slight 
irritation of the throat and giving tone 
and flexibility to the vocal organs. 
In many cases, and especially those 
of a more chronic character, the best 
effect can only be secured by their pro- 
longed and systematic administration. 
Probably the most frequent and 
troublesome form of throat affection 
9 that is encountered by the general practi- 
tioner is that condition where the throat 
is a little weak, with insufficient tone of 
voice, caused ofttimes by over-exertion 
in speaking or singing, and confined 
mostly to those who depend largely for 
a livelihood upon the voice ; so that per- 
fect resonance and timbre are all the 
more imperative ; and in such cases as 
these I can with confidence aver that 
this troche is perfect; they are, in fact, 
one of its chief sources of reputation. 
Further : for dry cough, hacking throat 
with slight expectoration, or weak voice, 
they can be relied upon, and will be 
found of signal service. 
By relieving many cases of fetid 
breath due to disordered secretions, they 
have also proved efficient correctives. 
A troche should be dissolved upon the 
middle of the tongue, not too near the 
tip, so as to fully impregnate the saliva 
and bathe the membranes before being 
swallowed. A valuable property which 
the ideal troche possesses is the persist- 
ence with which it adheres to the 
mucous surface, and it is on this account 
that some varieties are more effectual 
locally than others. 
10 Finally, if this little trio of troches 
answers in other hands as well as they 
have in mine therapeutically, and at the 
same time assist legitimate physicians 
in supplanting the various quack lozen- 
ges now so largely and indiscriminately 
used among the laity, my sole object 
will be fulfilled. 
11