SIBLIN

SIBLIN is a pleasant, palatable remedy for the systematic treatment of constipation, either acute or chronic. It is largely made up of highly water-absorbent fiber derived from certain species of plantago. Siblin contains, in each heaping teaspoonful, 50 international units of crystalline vitamin B₁ (Crysto-Vibex), a valuable adjunct to therapy designed to relieve constipation.

Siblin is a granular substance with a pleasant, slightly sweet, salty taste. It may be taken dry and chewed as breakfast cereal often is, or stirred in water or other liquid. Being highly water-absorbent the granules, when saturated, swell greatly, forming a soft, gelatinous mass.

1

The fiber contained in Siblin is not perceptibly affected by digestive ferments, passing through the stomach and bowel unchanged. However, it is nonirritating and its smooth cohesive mass, incorporating all fecal particles, provides salutary bulk, which facilitates movement through the sigmoid colon and rectum.

Siblin may be used generally in the treatment of constipation, and it is a particularly pleasant and convenient means of ensuring, without irritation, ample fecal bulk and optimum consistency.

Whether or not substantial amounts of roughage should be included in the prescribed diet depends on the nature of the case in question. Certain persons are capable of ingesting abundant quantities of roughage without any unfavorable effect; others suffer intestinal irritation with diarrhea and distress if they attempt to follow such a diet. Thus, it is not always feasible to prescribe large amounts

2

of vegetables and fruits for the purpose of ensuring sufficient indigestible residue to provide peristaltic stimulation. Adequate fecal bulk is easily provided by use of Siblin.

Importance of adequate fluid intake in the management of constipation cannot be overemphasized. If the body is forced to economize on water it can do so by cutting down water excretion by kidney and bowel. Withdrawal of water from the bowel reduces fecal bulk and causes formation of inspissated feces, difficult to evacuate.

The lack of fecal bulk can be overcome, and the tendency of small dry masses to remain in the colon and rectum can be corrected by use of Siblin. Regular ingestion of the prescribed amounts will ensure ample fecal bulk, and soft, slippery consistency of the fecal material. Under these conditions restoration and maintenance of normal intestinal elimination usually follow promptly.

3

An important contribution to the management of constipation was the demonstration that vitamin deficiency is often a contributing cause. It has been repeatedly observed, both in man and in experimental animals, that deficiency of vitamin B₁ causes atony of intestinal musculature with resulting constipation. (See page 11). This fact is of special significance, since patients with constipation may be irregular eaters or persons whose dietary is not ideal. Moreover, many patients who need some dietary restriction are likely to develop vitamin B deficiency. The vitamin B₁ supplied by daily use of Siblin augments that obtained from food and serves to facilitate improvement in muscular tone and peristaltic function.

## Dosage

Siblin should be taken once or twice daily; two teaspoonfuls morning and night is usually convenient. This dosage schedule tends to main-

4

tain smooth, bulky, water-absorbent contents of the lower colon at all times. After taking Siblin twice daily until normal intestinal excretion has been restored, many patients will find two teaspoonfuls daily, taken night or morning, sufficient to maintain normal bowel function.

Water should be taken freely, either with the dose of Siblin or at other times during the day. At least one glass should be taken with each dose of Siblin.

In patients known or suspected to be hypersensitive to plantago, or psylla, Siblin should be used cautiously until the patient's tolerance has been observed.

## Packages

Siblin is supplied in friction-top tins, containing four ounces and one pound respectively.

5

SUPPLEMENT

Constipation is singularly an affliction of civilized man, and may be attributed in most cases to diets lacking in residue and in vitamins, also to modern man's sedentary habits. Normally, ingestion of food starts reflex action of the gastrointestinal tract resulting in a progression of the ingested material through the stomach and small intestine in four to six hours. Digestion and a certain amount of absorption occur in the stomach and small intestine, and the absorptive process continues in the colon.

The time required for ingested material to pass through the alimentary tract varies considerably, but in the average healthy person this time is usually between 48 and 72 hours. Thus we see that material ingested normally arrives at the cecum in four to six hours but may not be evacuated until two or three days later.

That portion of the food which is

6

not absorbed in the small intestine reaches the cecum as a gruel-like liquid. In the first part of the colon much water is absorbed, and the colonic contents reach the transverse portion of the colon in a soft, semisolid state. Here, some further absorption of water normally takes place and the fecal material is compressed into a cylindroid. At intervals a strong contraction wave of the colon drives a fecal mass, several inches in length, beyond the splenic flexure of the colon and down the descending colon to the rectosigmoid. Passage of fecal material into the rectum normally starts the "defecation reflex," a reflex which is under voluntary control.

The term "functional" is used to describe that great majority of cases of constipation in which no organic cause can be found. These cases are self-generated, in a sense, since they develop as the result of an improper and unhygienic mode of life. Elimination of waste products from the

7

body is second in importance only
to the ingestion of food, and this
significant fact is frequently over-
looked.

Types of Constipation

Functional constipation may be
classified as atonic or hypertonic
(spastic). The designation "atonic"
refers to the condition of the intes-
tine. Atonic constipation is usually
seen in overweight, flabby persons
whose intestinal musculature is weak.
Such patients show enlarged intes-
tines on roentgenologic examination
and usually complain of distention.
Deficiency of vitamin B may be an
important factor in these cases.

Paradoxically, constipation may
be associated with spasticity of the
colon. Sufferers from spastic consti-
pation are usually nervous and
underweight; they are usually en-
gaged in work which requires a
great deal of nervous energy and
drive. This type of constipation is
common among professional people.

8

Poor selection of food and inade-
quate intake of fluids contribute to
development of constipation. An-
other factor which is difficult to
evaluate but undoubtedly very im-
portant in this connection is the
unnatural expenditure of nervous
energy occasioned by the continual
hurry of modern life. Fatigue of the
nervous system contributes to devel-
opment of constipation and other
functional disturbances of the gastro-
intestinal tract.

Management of Constipation

The term "management" is used
in preference to "treatment" be-
cause the sufferer from chronic con-
stipation must be educated as well
as treated; he may or may not re-
quire medicine; he will almost al-
ways require dietary adjustment.
Since the amount and nature of
ingested food determine to a large
extent the amount and character of
fecal material to be evacuated it is

9

obvious that investigation of the
diet is always indicated.

It goes without saying that the
diet should be adequate, balanced
as to its carbohydrate, fat, and pro-
tein content, and should supply a
sufficient amount of minerals and
vitamins. The gastro-intestinal
equipment of man seems to be about
midway in structure between that
of the carnivores, who have a short
intestinal tract poorly adapted to
handling bulky, fiber-containing
foods, and that of the herbivores,
who have a long intestine of large
lumen, whose diet is entirely re-
stricted to plant life containing a
high percentage of fiber (cellulose).
Thus man is equipped to handle a
mixed diet and there is sound evi-
dence to indicate that he thrives
best on such a diet.

The physiologic stimulus to peri-
staltic contraction of intestinal mus-
culature is distention of a segment
of gut by its contents. Foods con-
taining considerable amounts of

10

fiber or other indigestible material
will, of course, cause increased vol-
ume of intestinal content and stimu-
late peristalsis. Modern diets con-
tain large amounts of highly milled
grains, refined sugars, and pared
and cooked fruits and vegetables.
Too frequently modern methods of
improving the keeping qualities,
appearance, and palatability of food
result in loss of fiber content and
valuable vitamins and minerals.

Vitamins and Constipation

Tokai¹ observed that infants suf-
fering from early beriberi were in-
variably constipated. This associa-
tion between vitamin deficiency and
severe constipation has also been
reported by Chormori. McCarrison
observed that malnutrition and vita-
min deficiency caused “ballooning”
of the colon in monkeys and that
administration of a high vitamin
diet to these animals resulted in a
definite improvement in intestinal
tonus. Plimmer and co-workers

11

found that animals kept on diets
deficient in vitamin B₁ stored large
amounts of fat in abdominal viscera
and not uncommonly had complete
intestinal obstruction from impac-
tion of food in the colon.

Clinical observation on 75 pa-
tients whose diet was judged to be
too low in vitamin B₁, led Fitts² to
conclude that "a continual slight
shortage in the modern day diet of
vitamin B leads to definite changes
in the motor and secretory mechan-
ism of the gastro-intestinal tract."
Study of this clinical group revealed
a syndrome of gastric atony, atonic-
ity or spasticity of the colon, low
values for gastric acidity and evi-
dences of mild hypothyroidism.

By actual measurement Sparks
and Collins³ found that the colons
of rats maintained on a vitamin B₁
deficient diet showed an increase in
average diameter of 42 per cent.
Their studies led them to ascribe
an important place to vitamin B₁ in

12

the maintenance of normal muscu-
lar tone of the colon.

The majority of clinical and expe-
rimental work connecting vitamin
deficiency and constipation refers to
vitamin B, but there is a limited
amount of evidence that other vita-
mins may also be of some impor-
tance in this connection. Yoder⁴
states that deficiency of vitamin B
causes a decrease in the rate of
passage of foods through the gastro-
intestinal tract. Ghinelli⁵ observed
that experimental scurvy also greatly
prolonged the time required for pas-
sage of food through the gastro-
intestinal tract.

From the above clinical and experi-
mental work it seems almost cer-
tain that vitamin deficiency is an
important factor in the development
of constipation and there is little
doubt that a certain portion of our
population gets less than an opti-
mum amount of vitamins in their
daily diet.

13

Spencer⁶ calls our attention to
the dangers of poorly balanced,
vitamin-deficient diets in the man-
agement of chronic constipation.
Speaking of such patients Spencer
says: "If the patient is of the kind
who responds to all digestive dis-
turbances by the elimination from
his diet of first one food and then
another, the problem of lack of food
volume, calories, vitamins, and
roughage may arise. My own expe-
rience has taught me that this occurs
with considerably greater frequency
than I at first supposed. Experience
with severer grades of avitaminosis
has taught me to recognize the
milder forms of vitamin lack. Fre-
quently, such patients resist the
replacement in their diet of the
vitamin-rich foods because of the
distress they arouse. In such circum-
stances the concentrated prepara-
tions of vitamins are of value which
outweighs their cost."

14

Bibliography

1. Tokai, S.: *Tohoku J. Exper. Med.* 27:589, 1935.

2. Fitts, J. B.: *South M. J.* 28:920, 1935.

3. Sparks & Collins: *Am. J. Dig. Dis. & Nutrition* 2:618, 1935-36.

4. Yoder, L.: *Am. J. Digest Dis. & Nutrition* 3:828, 1937.

5. Ghinelli, I.; *Biochem e terap. sper.* 23:65, 1936.

6. Spencer, H. J.: *Am. J. Digest Dis. & Nutrition* 2:7, 1935-36.

R47-3

(52013) 7-38

FROM THE PRESS OF PARKE, DAVIS & CO., DETROIT, U. S. A.

## PACKAGE INFORMATION

Poison Ivy Extract (Rhus Toxicodendron Antigen in Almond Oil) is supplied in packages of six 1-cc. bulbs, (Bio. 397), and six 1-cc. syringes (Bio. 396).

# POISON IVY EXTRACT

## Rhus Toxicodendron Antigen
in Almond Oil

* PROPHYLAXIS and effective treatment of the troublesome dermatitis caused by contact with poison ivy (Rhus toxicodendron) is now possible by use of antigenic extract derived from the leaf of the poison ivy plant. Poison Ivy Extract is the active, alcohol-soluble toxic principle, dissolved in almond oil. The activity of the extract is checked by physiologic test and the final extract is standardized.

## TREATMENT OF IVY POISONING

For treatment of ivy poisoning we recommend the intramuscular injection of 0.5 cc. of Poison Ivy Extract at the earliest possible moment, followed by injection of 1 cc. of the extract every 24 hours thereafter

1

until recovery is well under way.
As a rule two to four injections will
be sufficient but each case must be
treated on its own merits, since the
degree of local and general reaction
in ivy poisoning is extremely vari-
able.

Local treatment applied to the
site of contact with the poison ivy
plant or its irritating principle
should not be neglected. Careful
cleansing and the application of
detergents such as Ethereal Soap
are recommended. Alcohol is useful
for cleansing the skin after probable
or actual exposure.

PROPHYLAXIS

For protection against ivy poisoning we recommend the intramuscular injection of 1 cc. Poison Ivy Extract at the beginning of the spring and summer outdoor season. This single injection will protect the majority of susceptible persons for the season. In case of demonstrated extreme susceptibility it may be desirable to repeated the prophylactic intra-

2

muscular injection of 1 cc. about
one week prior to vacation or any
planned trips into areas where the
poison ivy plant is found.

GENERAL DISCUSSION

Over twenty years ago Duncan¹ advocated employment of the ancient folk remedy of chewing bits of Rhus toxicodendron leaf to develop immunity to ivy poisoning. Strickler² used a tincture of poison ivy leaf administered orally, and Schamberg³ advised hypodermic administration of the tincture for the same purpose. Clock⁴ first advocated the use of almond oil as a solvent for the active, irritative factor. This step was a great improvement since the new extract was not only more potent but was also very bland, and its injection was practically painless, in sharp contrast to alcoholic extracts previously used.

3

CLINICAL REPORTS

Clinical experience has demonstra-
ted that Poison Ivy Extract, ad-
ministered intramuscularly, has
definite prophylactic and therapeu-
tic value. Blank and Coca⁵ con-
ducted a large-scale, controlled
experiment in a Civilian Conserva-
tion Corps camp. Men whose work
was the clearing of ivy-infested
brush lands were divided into two
groups. One group of 40 was given
prophylactic injections of Poison
Ivy Extract. In this group only
three cases of ivy poisoning occurred.
A second group of 45 men doing
the same work was left untreated
and served as controls. In this group
30 cases of ivy poisoning occurred.
Blank and Coca were of the opin-
ion that poison ivy extract must
exert some protective action against
sumac poisoning also, since the inci-
dence of dermatitis attributable to
sumac, to which there was consid-
erable exposure, was far below the
average or expected incidence.

Molitch and Poliakoff⁶ also found,

4

as the result of controlled clinical
investigation, that poison ivy extract
is an effective prophylactic. Their
work was done at the New Jersey
State Home for Boys. Forty boys
who were known to be susceptible
to ivy poisoning were given pro-
phylactic injections of poison ivy
extract. None of this group con-
tracted ivy poisoning although prac-
tically all had had repeated attacks
during previous years. Fourteen
boys, eight of whom had had pre-
vious attacks of ivy poisoning, served
as untreated controls. All boys,
treated and untreated, had repeated
exposure to poison ivy. Nine of the
fourteen controls contracted typical
dermatitis venenata.

Continuing their work at the New
Jersey State Home for Boys, Molitch
and Poliakoff⁷ treated 59 inmates
prophylactically with intramuscular
injections of poison ivy antigen in
an almond oil menstruum. Twenty-
eight boys were given two doses of
1 cubic centimeter each, two weeks
apart; three of these boys developed

5

poison ivy dermatitis during the subsequent summer, twenty-five, or 89.3 per cent did not develop dermatitis. Twenty-two boys were given a single dose of 1 cubic centimeter; four developed dermatitis venenata during the summer, eighteen or 81.3 per cent were free of ivy poisoning during this period.

Combined results for the series showed seven cases of acquired dermatitis; 43 boys, or 86 per cent of those prophylactically immunized by a single or double injection remained free of the disorder. During this same period, thirty-nine children who were not immunized developed poison ivy dermatitis.

6

## PACKAGE INFORMATION

7

Bibliography

1. Duncan, C. H.: *New York M. J.* 104: 901, 1916.

2. Strickler, A.: *J. Cutan. Dis.* 36:327, 1918.

3. Schamberg, J. F.: *J.A.M.A.* 73:1213, 1919.

4. Clock, R. A.: *M. J. & Rec.* 122:93, 1925.

5. Blank & Coca: *J. Allergy* 7:552, 1935-36.

6. Molitch & Poliakoff: *Arch. Dermat. & Syph.* 33:725, 1936.

7. Molitch & Poliakoff: *J. Allergy* 9:270, 1938.

R46-2

(7-38) 51848

RECENT hematologic research indicates the value of Vitamin B complex in the prevention and treatment of anemia. In Kaps seals Ventrex with Iron and Vitamin B we have combined the two antianemic substances, concentrated antianemic extract of stomach tissue and iron, with a highly potent Vitamin B complex (B₁ and B₂).

These ingredients have been prepared in such concentrated form that relatively few tasteless kapseals will furnish the daily curative or prophylactic dose.

KAPSEALS VENTREX
WITH IRON AND
VITAMIN B

VENTREX with Iron and Vitamin B is well suited to the treatment of many forms of anemia. This preparation is offered primarily for treatment of secondary anemia; however, it may also be used advantageously in cases of primary, or pernicious anemia in which iron is indicated.

Recent researches have indicated that vitamin B has hitherto unsuspected importance in blood formation. Experimental and clinical evidence having a bearing on this point is reviewed in the following pages.

It was formerly believed that primary and secondary anemias were entirely different in their therapeutic requirements; that the specific erythropoietic substances, dedicated stomach tissue and liver extract, were of no value in secondary

In secondary anemia of moderate severity we suggest 2 to 4 Kapseals Ventrex with Iron and Vitamin B with each meal (T.I.D.).

Supplied in bottles of 100, 500, and 1000 Kapseals.

anemia, and that iron was never
indicated in primary (pernicious) an-
emia. Recent hematologic research
indicates that these views are not cor-
rect. Starr¹ has shown that during
induced remission in pernicious ane-\mia, delay in hemoglobin regenera-
tion is due to iron deficiency, and
he has advised that iron be given
routinely early in treatment.

In 1929, desiccated stomach tissue
was introduced for the treatment of
pernicious anemia. This substance
was found to be a highly-potent ery-
throgenic stimulant, inducing un-
usually active erythrocytosis and
prompt elevation of the red-blood
cell level.

For several years we have sup-
plied, in addition to desiccated
stomach tissue, a combination of it
with iron. Many cases of *secondary*
anemia recover more rapidly when
given desiccated stomach tissue in
addition to adequate doses of iron.
Many clinicians now use such a
combination routinely in the treat-
ment of various types of anemia.

2

Ventrex is a concentrated product
obtained from desiccated hog stom-
ach by extraction. Concentration is
necessary to reduce the bulk of the
medication so that effective dosage
may be conveniently taken in kap-
seals (sealed gelatin capsules).

Many of the iron preparations used
medicinally are acid and astringent,
and frequently cause gastric and
intestinal disturbances when given
in adequate dosage for any length
of time. Iron and sodium citrate is
practically nonirritating to the
gastro-intestinal tract. In this respect
it has a decided advantage over other
iron preparations. The ready solu-
bility of iron and sodium citrate is
an additional advantage, since hypo-
chlorhydria and anacidity not in-
frequently accompany secondary
anemia, in which case iron salts
soluble only in acid solution are
practically without effect.

3

VITAMIN B AND
HEMATOPOIESIS

It has been repeatedly observed
both clinically and experimentally
that recovery from anemia is more
rapid when certain members of the
vitamin B complex are administered.
Both Eddy and Dalldorf², and
Summerfeldt³ report that the ad-
dition of vitamin B complex to iron
administration in children resulted
in more rapid regeneration of hemo-
globin. It has not been fully estab-
lished whether vitamin B exerts this
beneficial effect on blood regenera-
tion by a direct action on the bone
marrow or by its well-known action
in stimulating appetite and intestinal
absorption.

Pernicious anemia is regarded as
a deficiency disease and experi-
mental investigations by Castle ap-
pear to have established a relation-
ship between the vitamin B complex
and the “extrinsic factor” of per-
nicious anemia. One form of mac-
rocytic anemia which is common in

4

the tropics is also not uncommon in
the temperate zone. This anemia,
which is exaggerated by pregnancy,
can be readily produced in experi-
mental animals by deficient diets,
and the human and experimental
forms are cured by vitamin B com-
plex. It is interesting to note that
development of characteristic blood
changes of pernicious anemia is
preceded by a phase of this disease,
which closely resembles vitamin B
deficiency. These initial symptoms—
glossitis, stomatitis, diarrhea, and
occasionally neurologic manifesta-
tions also occur in sprue and pel-
lagra, both of which are recognized
deficiency diseases.

Vaughan and Hunter⁴, Wills⁵,
and Witts⁶ have all reported the
value of vitamin B complex in the
treatment of non-pernicious anemia.
Goodal⁷, Ungley and James⁸, Con-
nery and Goldwater⁹, Russell¹⁰, and
Hitzenberger¹¹ demonstrated the
value of this essential food factor in
pernicious anemia. Hitzenberger
recommends vitamin B₂ preparations

5

in large doses in pernicious anemia.
He says that this therapy is especially
indicated in cases with evidences of
spinal cord degeneration.

6

ANEMIA OF EXPERIMENTAL
VITAMIN B DEFICIENCY

Alvarez et al.¹² have tested the
effects of a diet deficient in vitamin
B on three human subjects. Two of
these persons were maintained for
six weeks on a diet markedly defi-
cient in vitamin B₁, the third re-
mained but two weeks on this diet.
Although the authors failed to sub-
stantiate certain experimental work
showing a fall in gastric acidity due
to vitamin B deficiency, they did
note a very striking fall in hemo-
globin and red cell count. In all
three patients there was a fall in
hemoglobin averaging 11 per cent,
and red cell count was reduced by
7 to 8 per cent. These lost cells and
hemoglobin were rapidly regained
after return to a normal diet. Alva-
rez did not regard these losses in red
cells and hemoglobin as due to
deficiency of iron, inasmuch as the
diet was practically up to normal
requirements.

7

IMPORTANCE OF IRON AND
VITAMINS IN THE DIET
OF CHILDREN

Experiments in nutrition by Pearl Summerfeldt³ indicate the important place of vitamins and iron not only in maintenance of normal blood and hemoglobin but also in promotion of growth. To a group of children kept under standard conditions (in a preventorium) she fed a special diet high in vitamins A, B₁, B₂, and E. This diet also contained considerably more iron than the ordinary house diet of this institution. Controls received the regular house diet, which would be considered adequate by most standards.

Summerfeldt found that children on the special diet gained weight at approximately four times the expected rate, and at the end of ten weeks had, on the average, one gram more hemoglobin per hundred cubic centimeters of blood than the controls. As a further proof, this worker now reversed the groups

8

and put the former controls on the special diet. Again the special diet promoted growth gains and hemoglobin increases of the magnitudes previously noted.

Day, Langston and Shukers¹³ reported a syndrome of leukopenia and anemia in the monkey resulting from vitamin deficiency. They fed monkeys a diet adequate with respect to protein, inorganic elements, fatty acids, vitamins A, B₁, C, and D but deficient in vitamin G (B₂). After a varying period on this diet the animals developed a fatal blood disease characterized by anemia and leukopenia. When this deficiency diet was supplemented by dried brewers' yeast, good growth was supported and anemia did not appear.

The above are but a few of the many reports, based on animal and clinical experiments, which tend to show the very close relationship of vitamin B (complex) to red cell and hemoglobin formation. Until all of the components of vitamin B com-

9

plex are isolated in pure form it will be impossible to determine which of these are most important in this connection.

## VENTREX WITH IRON AND VITAMIN B

In view of these recent hematologic developments a combination of iron, Ventrex, and vitamin B offers obvious advantages. Kapseals Ventrex with Iron and Vitamin B combine proved antianemic substances in a palatable and highly effective form.

Each kapseal represents:
- Ventrex (stomach tissue concentrate) 5 grains
- Iron and Sodium Citrate, Neutral 2 grains
- Vitamin B₁ 20 international units
- Vitamin B₂ (riboflavin) 5 Sherman units

Both the stomach tissue and vitamin B contained in these kapseals are in concentrated form. The concen-

10

tration of antianemic substances to the point where the daily dose may be administered in a few kapseals has definite advantages. Kapseals are attractive in appearance and entirely tasteless. The negligible bulk makes this antianemic preparation acceptable even to the most "finicky" patient, or to patients who manifest marked anorexia. We have included neutral iron and sodium citrate in Kapseals Ventrex with Iron and Vitamin B because of its effectiveness as a hematinic, and because of its lack of gastro-intestinal irritation.

## INDICATIONS FOR VENTREX WITH IRON AND VITAMIN B

Ventrex with Iron and Vitamin B is, by composition, suited to the treatment of many forms of anemia. The value of stomach tissue and iron as hematinics has long been proved, and the indications for these substances well established. The above references and quotations indicate, briefly, the value of

11

vitamin B, directly and indirectly, in the treatment of anemia.

While offered primarily for treatment of secondary anemia, Ventrex with Iron and Vitamin B may advantageously be used in those cases of primary anemia in which the physician decides that iron is indicated.

## DOSAGE

In moderately severe anemia two to four kapseals three times daily will be required. In cases of severe anemia the dosage will have to be adjusted to meet the patient's requirements. Six to ten kapseals daily will be sufficient for maintenance in most cases.

## PACKAGES

Ventrex with Iron and Vitamin B is supplied in bottles of 100, 500, and 1000 kapseals.

12

## BIBLIOGRAPHY

1. Starr, P.: *J. Kansas M. Soc.* 35:121, 1934.

2. Eddy & Dalldorf: *The Avitaminoses*, The Williams & Wilkins Co., Baltimore, Md., 1937.

3. Summerfeldt, Pearl: *Am. J. Dis. Child.* 43:284, 1932.

4. Vaughan, J., & Hunter, D.: *Lancet* 1:829, 1932.

5. Wills, Lucy: *Brit. M. J.* 1:1059, 1931.

6. Witts, L. J., et al.: *Proc. Roy. Soc. Med.* 25:1703, 1932.

7. Goodal, A.: *Lancet* 2:781, 1932.

8. Ungley, C. C., & James, G. V.: *Quart. J. Med.* 27:523, 1934.

9. Connery, J. E., & Goldwater, L. J.: *New England J. Med.* 209:446, 1933.

10. Russell, H. K.: *Ann. Int. Med.* 7:1398, 1934.

11. Hitzenberger, K.: *Wien. klin. Wschnshr.* 49:1235, 1936.

12. Alvarez, W. C., et al.: *Am. J. Digest. Dis. & Nutrition* 3:102, 1936.

13. Day, P. L., Langston, W. C., & Shukers, C. F.: *J. Nutrition* 9:637, 1935.

R 38-6

(7-38) 52071

CLINICAL APPLICATIONS

Crysto-Vibex (Crystalline Vitamin B₁)

Beriberi

Retarded growth

Anorexia

Neuritis

Vomiting of pregnancy

Pregnancy and lactation

Cevitamic Acid

Scurvy

Latent scurvy

Pregnancy and lactation

Purpura

Infectious diseases

Crysto-Vibex with Vitamin C

In addition to serving as a source of vitamins B₁ and C (for indications see above), Crysto-Vibex with Vitamin C is an ideal combination for routine prophylactic administration of these important vitamins. It is especially indicated in growing children, pregnant and lactating women, and for supplementing special diets.

TABLE OF CONTENTS

Crysto-Vibex (Tablets—Crystalline Vitamin B₁)....2

Ampoules Crysto-Vibex..................5

Cevitamic Acid (Crystalline Vitamin C)........8

Crysto-Vibex with Vitamin C (Tablets)........13

Supplement................................16

Vitamin B₁................................16

Physiologic Requirements..................16

Human Requirements......................17

Clinical Reports..........................18

Cevitamic Acid............................25

Chemistry.................................25

Clinical Reports..........................27

Package Information......................15, 36

Bibliography

Vitamin B................................32

Vitamin C................................33

CRYSTO-VIBEX

and

CRYSTO-VIBEX WITH
VITAMIN C

VITAMIN B₁ and vitamin C are now available in pure crystalline form. Both have been isolated and synthesized. These two vitamins, which occur in fruits, glands, tissues and leafy vegetables, may now be conveniently administered for prophylaxis or therapy, the daily dose being measured in milligrams, instead of ounces of fruit juice or grams of vegetable.

Availability of these important vitamins in this form has several definite advantages, as can readily be seen. Persons who are ill, those on special diets, and those in whom vitamin requirements are increased by special conditions, may now be given adequate supplies of these vitamins in bulk so small as to be en-

1

tirely insignificant in so far as gastro-intestinal tolerance is concerned.

Crystalline vitamins B₁ and C are available, singly and in combination, in tablet form. Crysto-Vibex is pure crystalline vitamin B₁. Cevitamic Acid is pure crystalline vitamin C, and in Crysto-Vibex with Vitamin C the two are combined in convenient tablet form.

### CRYSTO-VIBEX

Crysto-Vibex tablets are available in three strengths: 0.5 mg. (150 I. U.); 1.0 mg. (300 I. U.), and 3.3 mg. (1000 I. U.). The tablets are grooved for dividing in half, thus increasing the range of available dosage.

### INDICATIONS FOR CRYSTO-VIBEX

The oral use of Crysto-Vibex is indicated for the prophylaxis of vitamin B₁ deficiency, and for therapy of all except markedly severe cases of B₁ deficiency (in which it is advisable to start treatment with parenteral injections of vitamin B₁). The relation

2

of vitamin B₁ to growth is an important one, and in cases in which there is any doubt as to the sufficiency of this vitamin in the diet of growing children, it is recommended that Crysto-Vibex be given routinely.

Anorexia and disturbances of the gastro-intestinal tract (constipation, gaseous distention, etc.) regularly accompany vitamin B deficiency. While it is obvious that vitamin B deficiency is not the only cause of the above symptoms, it should be kept in mind. If there is any question concerning the adequacy of the vitamin B intake in a given case, we suggest a trial of Crysto-Vibex therapy.

Deficiency of vitamin B₁ is thought to be an etiologic factor in many forms of neuritis (see page 18) and it is advised that Crysto-Vibex be given in these cases.

Vomiting of pregnancy is accompanied by vitamin deficiency and there is evidence to show that deficiency of B₁ tends to aggravate the

3

condition. This is but one more
reason for prescribing tablets of
Crysto-Vibex for the pregnant
woman, since demands for all of the
vitamins, and especially vitamins B
and C, are increased throughout
pregnancy and the lactation period.

## DOSAGE

For routine administration to grow-
ing children—75 to 150 interna-
tional units of Crysto-Vibex per day
is indicated, depending on age.

For prophylactic use in pregnant
and lactating women—300 to 450
international units per day through-
out pregnancy and the period of
lactation.

For all other cases—neuritis, con-
stipation, anemia (both primary and
secondary), and anorexia—it is re-
commended that the diet be sup-
plemented by Crysto-Vibex in
sufficient amount to bring the total
daily intake of vitamin B₁ to above
200 international units per day. If
the diet supplies negligible amounts
of B₁ it will be necessary to give

4

300 international units or more of
Crysto-Vibex per day; if the diet
contains foods which are good
sources of vitamin B₁, 150 interna-
tional units per day maybe sufficient.

Apparently vitamin B₁ is innocu-
ous, and may be taken in several
times the largest recommended daily
dose, without danger of untoward
effects. Up to the present time it has
not been demonstrated that vitamin
B₁, in any dosage, is capable of
causing harmful effects in experi-
mental animals or man.

## AMPOULES CRYSTO-VIBEX

Vitamin B₁ is also available in am-
poule form in two strengths, Am-
poule No. 180 containing 1 mg. (300
international units) and Ampoule
No. 187 containing 6.7 mg. (2000
international units) of the pure
vitamin (600 and 4000 Sherman
units respectively).

A preparation of vitamin B₁ suit-
able for parenteral injection fills a
definite clinical need. Russell² calls
attention to two advantages of

5

parenteral administration of vita-
min B₁: (1) "that it overcomes
possible conditioned deficiency due
to failure in absorption, (2) that it
produces a quick response which is
of value in diagnosis because it
demonstrates that the patient is
really suffering from a lack of the
vitamin. Anorexia of long standing
sometimes responds to a single
dose."

INDICATIONS

Administration of vitamin B₁ by
injection is especially indicated for
quick relief of the more severe mani-
festations of vitamin B₁ deficiency—
beriberi, polyneuritis, and anorexia.
It is also recommended in the
vomiting of pregnancy. Par-
enteral administration of vitamin
B₁ is also indicated in cases of defi-
ciency of this vitamin in which oral
administration is inadvisable or im-
possible. By parenteral injection of
B₁ the physician is able to rule out
uncertainty of dosage due to possible
variability of absorption of vitamins
from the gastro-intestinal tract.

6

DOSAGE

For prophylaxis against vitamin B₁ deficiency, or for the cure of mild deficiency, the average daily dose of vitamin B₁ given by injection is 1.0 or 2.0 mg. Dosage is the same for infants, children, and adults. While it is true that requirements of growing children are much greater, proportionately, than those of adults, the dose suggested above will be found ample for average cases.

For treatment of marked defi-
ciency of vitamin B₁ (beriberi, poly-
neuritis, vomiting of pregnancy)
the contents of one or two 6.7 mg.
ampoules may be given daily for the
first few days of treatment. Vorhaus¹
even recommends an initial dose of
10 milligrams of B₁ intravenously in
cases of beriberi in which the
patient's life is in danger. In these
cases of extreme deficiency of vita-
min B₁, injections may be given
intravenously; in most instances this
will not be necessary, but the purity
of the product makes it entirely suit-

7

able for intravenous as well as subcutaneous and intramuscular injection.

## CEVITAMIC ACID
### CRYSTALLINE VITAMIN C

This vitamin was isolated and identified in pure crystalline form by King and Waugh³⁷ in 1932 and its synthesis was announced byHW worth³⁸ shortly thereafter. Identification of the vitamin in crystalline form was quickly followed by development of tests by means of which the amount of the vitamin in foods, and body tissues and fluids, could be accurately determined. A great deal of work has been done during the past six years to establish therapeutic needs and uses of vitamin C. For a further discussion of the isolation and chemistry of vitamin C, methods for its determination in foods, body tissues, and fluids, and for a continuation of the discussion of clinical uses of this vitamin, the reader is referred to page 25 of this booklet.

8

## INDICATIONS FOR CEVITAMIC ACID

Vitamin C contained in natural materials has long been used to prevent or cure scurvy, but as Szent-Gyorgyi³⁹ has pointed out, scurvy, a premortal condition, is the last manifestation of continued absence of this vitamin. To restrict the therapeutic use of cevitamic acid to treatment of scurvy is to neglect the many ills which are now recognized as attributable to mild deficiency. Twenty years ago Hess⁴⁰ recognized that latent scurvy existed, and he attributed the occurrence of anemia, pallor, anorexia, stationary weight, and weakness in certain cases to deficiency of vitamin C.

Vitamin C plays an important part in man's resistance to infections and toxins. It has been reported that demands for this vitamin are greatly increased in pneumonia, tuberculosis, diphtheria, and rheumatic fever. It should be administered in liberal quantities to patients suffering from these diseases.

9

Vitamin C also is necessary to blood formation and normal blood coagulation. It is recommended that vitamin C be given to all patients showing an abnormally long bleeding time. Lorenz⁴¹ has stated that vitamin C may be regarded as a specific in the treatment of certain types of purpura hemorrhagica. Growing children and experimental animals require vitamin C for normal tooth development. It has recently been shown that vitamin C is necessary for proper union and healing of fractures.

It is well known that the demands of the lactating woman for vitamin C are very high. It has been estimated⁴² the mother requires 80 to 100 milligrams of cevitamic acid per day in order that she may pass on at least 40 to 50 milligrams to her infant. For a more detailed description of the clinical indications for vitamin C, and pertinent references, the reader is referred to the supplement, (pages 27-31) of this booklet.

10

## DOSAGE

The minimum requirements of infants, growing children, and adults for vitamin C are not definitely known. Gothlin⁴³ concluded that the minimum protective dose for an adult lies between 19 and 27 milligrams per day. While infants and growing children would seem to require rather less than adults, rapid growth increases their requirements, so that actually the basic requirements are, perhaps, not greatly different. Kramer⁴⁴ has shown that premature and young infants can safely take 20 to 50 milligrams of cevitamic acid daily.

Since there is apparently no toxic dose of this substance it would seem rational to give a daily dose considerably above minimum requirements. The excess is excreted in the urine.

For infants 12½ to 25 mg. (1/2 to 1 tablet) daily is a suitable prophylactic dose, with dosage up to 100 mg. daily in severe deficiency.

11

For older children and adults: One tablet (25 mg.) or more daily.

In marked vitamin C deficiency and in pneumonia, rheumatic fever, and tuberculosis larger doses (100 to 200 mg. per day) may be given as required for children, or adults.

## ADMINISTRATION

Nearly all patients can take cevitamic acid by mouth. Half or all of the daily dose may be dissolved in an ounce of water or less. Cevitamic acid is odorless and has a slightly acid taste, not unpleasant. Previously dissolved in water (to avoid curdling) it may be added to the infant's bottle, or to milk for older children and adults.

When Cevitamic Acid is administered with the formula it should be added to the bottle immediately preceding each feeding. It should not be added to the day's formula since it will lose some potency on standing. This vitamin is thermolabile and will not stand pasteurization.

12

Cevitamic Acid Tablets may be dissolved in an ounce or so of water, a small amount of sugar added, and given from a bottle in this form.

## CRYSTO-VIBEX WITH VITAMIN C

Due to the fact that the natural sources of vitamins B₁ and C are often identical, it follows that dietary restriction resulting in deficiency of one of these vitamins may frequently cause deficiency of the other. A study of deficiencies of C and B₁ shows that many symptoms are common to both. Thus, retarded growth of the young results when there is deficiency of either B₁ or C. Weakness, nervousness, and digestive disturbances are also common to both. Lactation is seriously impaired by marked deficiency of either B₁ or C. Serious deficiency of vitamin B₁ results in atrophic changes in certain of the endocrine glands. Vitamin C deficiency results in disturbance of glandular function and hypertrophy of the adrenals. Marked deficiency of

13

both vitamins, continued over a long time, results in general atrophy of musculature. Laboratory animals and presumably man, are made more susceptible to intestinal infections by definite deficiency of either vitamin B₁ or C.

The clinical advantages of having a product which supplies substantial amounts of both vitamins B₁ and C are obvious, especially when these vitamins are present in concentrated form, enabling the physician to prescribe the patient's total daily requirement in one or two small tablets. Crysto-Vibex with Vitamin C is such a product. It is supplied in tablet form, each tablet containing 0.5 milligram (150 international units) of B₁, and 12.5 milligrams (250 I. U.) of C. We believe physicians will find that Crysto-Vibex with Vitamin C is ideal for routine prophylactic administration of these important water-soluble vitamins. It will fill the need for a potent source of these vitamins for growing children, pregnant or lacta-

14

ting women, and for supplementing many special diets whose composition is such that danger of deficiency of these vitamins is constantly present.

## PACKAGE INFORMATION

### Crysto-Vibex Tablets

CT 758. 0.5 mg. ( 150 I. U.)

CT 767. 1.0 mg. ( 300 I. U.)

CT 768. 3.3 mg. (1000 I. U.)

Bottles of 100 and 500.

### Crysto-Vibex Ampoules, 1 cc.

Amp. 180. 1.0 mg. ( 300 I. U.)

Amp. 187. 6.7 mg. (2000 I. U.)

Boxes of 6 and 25.

### Crysto-Vibex with Vitamin C

CT 759.

Bottles of 100 and 500.

15

## SUPPLEMENT

*A Consideration of the Development of Crystalline Vitamins B₁ and C, and a Resume of Recent Medical Literature on their Clinical Applications*

Williams and associates after many years of effort isolated, in 1935, the crystalline vitamin B₁ as the hydrochloride from rice polishings, and proceeded to identify its chemical structure. Previously the more or less pure crystalline preparations had been separated by Funk, Ohdake, and Jansen and Donath. In 1932, Windaus separated the picrolonate of the vitamin from yeast. In 1936, Williams and co-workers in America, and Windaus in Europe announced independently the synthesis of this vitamin. Williams reported that by biological and chemical tests his synthetic hydrochloride was the same as the natural product. Parke-Davis crystalline, vitamin B₁ in Crysto-Vibex, tablets and ampoules is prepared synthetically by the method of Williams.

### PHYSIOLOGIC PROPERTIES OF VITAMIN B₁ (NERVOUS SYSTEM)

In the absence of vitamin B₁ there is marked functional and organic disturbance of the nervous system. Not only does polyneuritis (beriberi) develop, but in extreme deficiency incoordination and convulsions indicate that the brain and cord as well as the peripheral nerves are involved. There is definite evidence (vide infra) that several forms of neuritis in man have vitamin B deficiency as the main etiologic or an important contributory factor.

It has been demonstrated in experimental animals³ that vitamin B deficiency may cause

16

spinal cord lesions closely resembling those of combined degeneration as seen in pernicious anemia.

### GASTRO-INTESTINAL SYSTEM

It has been repeatedly observed that one of the earliest evidences of vitamin B₁ deficiency is anorexia. Atony of intestinal musculature with resulting constipation is also noted when man or experimental animals are maintained on diets deficient in B₁. Hypochlorhydria is also associated with deficiency of B₁.

### GROWTH

Normal growth in the young is impossible in the presence of vitamin B deficiency. This has been repeatedly observed in experimental animals and is quite constant. Use of this fact has been made in the standardization of vitamin B extracts and concentrates intended for the therapy of vitamin B deficiency. The clinical implications of these facts are clear and authorities agree that infants and growing children require an adequate intake of vitamin B.

### HUMAN REQUIREMENTS OF B₁

Knott⁴ has estimated the optimum daily requirement of vitamin B at 20 international units (about 40 Sherman units) per kilogram of body weight. Other estimates place the infant requirement at approximately 50 international units per day and the adult requirement at 200 international units.

Harris⁵, as a result of studies on excretion of vitamin B₁ in the urine has concluded, “a daily excretion of less than 12 international units raises the presumption that the diet contains less than a normal allowance of vitamin B₁.”

17

While the question of optimum dosage can
not be definitely settled at this time there is
general agreement that 1 mg. of crystalline
vitamin B₁ per day is entirely adequate for the
average needs of both children and adults.
This represents 300 international units.

Peters⁶ has reported that application of
Schopfer's test to human blood indicates that
"normal" vitamin B₁ content is in the neigh-
borhood of 8.5 y ± 1 per 100 cc. of blood;
this is approximately 2.5 international units.
It is advised that during studies of vitamin B₁
utilization, retention, and excretion, the vita-
min be administered by injection so as to rule
out errors due to variable absorption from the
intestine.

CLINICAL REPORTS
VITAMIN B₁ AND NEURITIS

It has been recommended⁷ that in all cases
of polyneuritis parenteral administration of
vitamin B₁ be tried. Vorhaus, Williams and
Waterman⁸ have reported interesting animal
experiments which indicate a relationship
between vitamin B₁ and carbohydrate metab-
olism. They report that six of eleven clinical
cases of diabetes responded favorably to admin-
istration of crystalline vitamin B₁. These work-
ers have called attention to the probability of
frequent deficiency of vitamin B₁ in the hu-
man dietary. Quite favorable results were ob-
tained in treatment of clinical neuritis⁹ in a
series of cases which they classified as: alco-
holic, infectious, toxic, metabolic, anemic,
neuritis of pregnancy, and localized neuritis.
Their conclusion was, to quote: "In a study
of 100 cases of clinical neuritis in which vita-
min B₁ was administered orally, forty-four

18

were rendered symptom free, forty-eight were
improved and eight showed no benefits.”

Both von Lobenstein¹⁰, and Ruschke¹¹ treated cases of neuritis and obtained positive results by the daily intramuscular injection of 1 cc. of a solution containing a crystalline product. Ruschke reported striking relief from pain in cases of intercostal and ulnar neuralgia. He found that long standing cases responded where other forms of treatment had failed. This confirms Neuman's report (1935) where he tried out vitamin B₁ by injection, (intravenous, intramuscular, and subcutaneous) with good results in various conditions of neuritis.

BERIBERI

Hermano and Eubanas¹² treated twelve cases
of beriberi by intramuscular injection of crys-
talline vitamin B₁. They report that the re-
sponse was good with the exception that
numbness of the extremities was not always
entirely relieved.

Bergel¹³ reported a remarkable cure in one
case of funicular myelosis following severe
pernicious anemia. The vitamin was injected
intramuscularly in dosage of five milligrams
daily for a period of ten days. In this same con-
nection Ungley¹⁴ noted rapid recovery of
sensation in a case of polyneuritis complicat-
ing pernicious anemia treated by parenteral
administration of vitamin B₁. In commenting
on Ungley's report, Ritchie stated that he had
found vitamin B₁ of value in the treatment of
certain types of cardiac decompensation.

NEURITIS OF PREGNANCY

Bingham¹⁵ advises the use of vitamin B₁ as a

19

preventive of polyneuritis of pregnancy in
cases of much vomiting or malnutrition.

Successful treatment of neuritis of pregnancy with vitamin B₁ was recently reported by Theobald ¹⁶. Five cases, "suffering from a symptom complex due to nervous lesions and usually described as gestational neuritis were cured by dietetic treatments." In all cases a diet high in vitamin B was prescribed. This was supplemented by oral administration of vitamin B₁. In all of these cases symptoms were so definite and response to therapy so prompt that there could be little doubt that deficiency of vitamin B₁ was the predominant, if not the sole, etiologic factor.

ALCOHOLIC POLYNEURITIS

Alcohol *per se* is not the cause of so-called
alcoholic polyneuritis in the alcohol addict.
Jolliffe *et al*.¹⁷ concluded as a result of their
studies that vitamin B₁ deficiency is the etio-
logic factor in these cases and advised vitamin
B₁ therapy.

Strauss¹⁸ has proved conclusively that so-
called alcoholic polyneuritis is due to defi-
ciency of vitamin B₁ and not directly to alco-
hol. He was able to cure alcoholic polyneuritis
in ten cases while these patients continued to
take large quantities of whisky. He states that
the ingestion of strong alcoholic beverages,
up to a quart a day "has no demonstrable
neurotoxic effect on peripheral nerves in
patients receiving an adequate diet and vita-
min B supplements." Strauss also brings out
clearly the close relationship in the etiology
of beriberi, alcoholic polyneuritis, and the
polyneuritis of pregnancy where "pernicious"

20

vomiting occurs so frequently. Strauss consid-
ers that vitamin B₁ plays just as specific a role
in the latter two conditions as in beriberi
which is a well recognized B₁ deficiency
disease. In these instances we have either an
extremely high carbohydrate and fat intake
or a very low food retention, both of which
according to Cowgill call for an increased
vitamin B₁ demand.

Russell² treated cases of chronic progressive polyneuritis, alcoholic neuritis, and subacute combined degeneration of the spinal cord by parenteral injection of vitamin B₁. He noted that there was a diminution of the skin area of sensory loss within a day or two after institution of treatment. The rapidity with which complete recovery occurs depends upon the degree of nerve damage. In case degeneration has occurred, it is obvious that complete recovery will be considerably delayed.

In some of the cases reported by Russell,
vitamin B₁ had previously been administered
orally without results, and the striking im-
provement which followed parenteral adminis-
tration suggests that in these cases the vitamin
was either destroyed in the gastro-intestinal
tract, or for some reason was not absorbed.

VITAMIN B₁ AND CARBOHYDRATE METABOLISM

Recent studies by Kinnersley¹⁹, Peters and
Thompson²⁰ and others "lead to the hypothe-
sis that vitamin B₁ is indirectly concerned with
the oxidative removal of lactate and pyruvate
in the avian (pigeon) brain . . . These observa-
tions are in harmony with the early suggestions
that disorders observed in polyneuritis may
be due to the accumulation of intermediate

21

substances, arising from carbohydrate break-
down, which cannot be metabolized in the
absence of the vitamin." Further evidence of a
close relationship between vitamin B₁ and
carbohydrate metabolism has been furnished
by the work of Abderhalden and Wer-
theimer²¹, Lajos²², and Lajos and Gerendas²³.

VITAMIN B₁ AND ARTHRITIS

Hall and Myers²⁴ found frank or borderline
vitamin B deficiency in 50 per cent of cases
of infectious arthritis, 42.5 of atrophic arthritis,
and in 26.7 per cent of cases of hypertrophic
arthritis. Steinberg²⁵ in a study of 118 cases of
chronic arthritis found gastro-intestinal dis-
turbances suggestive of vitamin B deficiency
in 99. He believes that vitamin B is of value
in the adjunctive treatment of chronic arthri-
tis. Steinberg noted a marked similarity be-
tween many of the symptoms of vitamin B
deficiency and those of chronic arthritis.

G-I TRACT AND B₁ DEFICIENCY

Dennett²⁶ after giving vitamin B₁ to 150 infants (for prophylactic effect in 129 and for curative effect in 21), found a definite correspondence between vitamin B₁ deficiency and anorexia, listlessness, retarded growth, and general lassitude.

Morgan and Barry²⁷ using wheat germ,
rich in vitamin B₁, as a remedy for under-
weight, nervousness, constipation, and gastro-
intestinal disturbances, found that their
patients gained three times as much in weight
as the controls, and also showed a definite
increase in height.

22

That B₁ is urgently needed by nursing
mothers has been shown by Macy and associ-
ates²⁸, and also by the animal experiments of
Sure, and his co-workers.

Hartsock²⁹ says that the normal modern
diet is so low in vitamin B that deficiency of
the vitamin should be expected when the
diet is limited for any reason. Prominent
among the symptoms of vitamin B₁ deficiency
are anorexia and the symptoms of an insta-
bility and irritability of the gastro-intestinal
tract including evidence of atony of the colon.

Because of the insidious onset of vitamin B₁
deficiency and its slow response to treatment,
Hartsock advises that vitamin B "should be
supplied empirically in large quantities over a
long period of time, even though the clinical
responses do not seem to justify its use. Iron,
calcium and vitamin B should be considered
the more important potential advances in the
diet of the patient with anorexia."

This author also believes that achlorhydria predisposes to deficiency disease, and that patients in whom this condition is found should be given diets which are adequate in all respects with special emphasis on iron and vitamin B.

Sparks and Collins³⁰ found that rats main-
tained on diets deficient in vitamin B₁ had an
average increase of 42 per cent in size of the
colon. They concluded that in this animal
vitamin B₁ was necessary for maintenance of
normal muscular tone of the large intestine.

Clinical studies on a series of 75 patients
caused Fitts³¹ to conclude that "the continual
slight shortage in the modern day diet of
vitamin B leads to definite changes in the

23

motor and secretory mechanism of the gastro-intestinal tract.” The signs and symptoms of avitaminosis in the 75 patients studied by this author led him to call attention to a syndrome of gastric atony, spastic colon, low hydrochloric acid values, and hypothyroidism. When patients having the symptoms enumerated were given vitamin B₁ a decided improvement in their condition followed.

To the above list of signs and symptoms attributed to vitamin B₁ deficiency, Simpson³² adds the following related symptoms: eructations, flatus, headache, visceroptosis, loss of weight, easy fatigue, asthenia, susceptibility to infection, and tardy convalescence.

## VITAMIN B AND HEMATOPOIESIS

Vaughan and Hunter³³, Goodal³⁴, Witts³⁵, Ungley and James³⁶, and others have demonstrated that vitamin B is of definite value in the treatment of anemia. It seems likely that a considerable part of the benefit derived from vitamin B in anemia is due to its tonic effects on the gastro-intestinal tract. In vitamin B deficiency, gastric secretion and function are impaired. In the presence of such impairment it is probable that iron and protein of the diet are not metabolized in a normal way.

The beneficial effects following vitamin B therapy in tropical anemia and certain other macrocytic and microcytic anemias has led to the hypothesis that vitamin B complex probably has a certain amount of specific antianemic action. Crystalline Vitamin B₁ is a component of this complex, and may be found to play a role.

24

## CEVITAMIC ACID

*(Crystalline Vitamin C)*

CEVITAMIC ACID is pure, crystalline vitamin C. Long used to prevent scurvy, vitamin C has been used in many other conditions since its discovery in pure form. Its uses at present, in addition to routine prophylaxis and treatment of scurvy, include administration to persons suffering from certain types of hemorrhage, especially purpura. Acute infections increase the body's need for vitamin C. Rheumatic fever and arthritis may be influenced favorably by vitamin C, and many other uses have been suggested in recent medical literature.

Crystalline cevitamic acid is a fine white powdery substance with a melting point between 190° and 191° C. It is freely soluble in water, and alcohol, but practically insoluble in chloroform, ether, or purified petroleum benzine. Waugh⁴⁵, Birch and Harris⁴⁶ and others have established the formula of cevitamic acid as C₆H₈O₆. In solution it is destroyed by oxidation, hence loses potency if unduly exposed to light and air. In the absence of oxygen cevitamic acid is fairly stable to heat.

25

## CEVITAMIC ACID

Cevitamic acid is a strong reducing agent, reducing Fehling's solution without heating. An alkaline solution of cevitamic acid acquires a dark violet color when allowed to stand with ferrous sulphate. In alcoholic and aqueous solutions cevitamic acid has a characteristic absorption spectrum. Reichstein<sup>47</sup> and co-workers report the synthesis of this substance. Carefully prepared and re-crystallized cevitamic acid exerts all of the physiologic effects of vitamin C and there is no longer room for doubt that it is, in truth, crystalline vitamin C.

A few years ago vitamin C seemed to be the most unstable and elusive of the vitamins. It was predicted that scientists were unlikely to obtain it in pure form for many years to come. Then, in 1932, the complete solution of this problem came with dramatic suddenness, in the announcement by King and Waugh<sup>37</sup> that they had isolated crystalline vitamin C. This announcement was followed a few months later by another one from Haworth's laboratory<sup>38</sup> giving a complete description of the chemical structure of this vitamin. Its synthesis in the laboratory by Ault<sup>48</sup>, Reichstein<sup>47</sup>, and others, was announced the following year.

It was noted at once that crystalline vitamin C, first called ascorbic acid but later renamed cevitamic acid, seemed to be identical with hexuronic acid discovered in 1928 by Szent-Gyorgyi<sup>49</sup>. Shortly after King's announcement of his discovery of crystalline vitamin C, Svirbely and Szent-Gyorgyi<sup>50</sup> confirmed the identity of vitamin C with a hexuronic acid. Thus, while hexuronic acid had been known for four years, its identity as

26

vitamin C did not become known until work begun by King, Svirbely<sup>51</sup> and associates resulted in the isolation of crystalline vitamin C.

## CLINICAL USES

Crystalline vitamin C is still undergoing clinical proving but from the mass of data that is daily accumulating several clear indications are apparent.

## SCURVY

The rapidity with which clinical scurvy responds to administration of cevitamic acid is remarkable. It has been general experience that in infants with frank scurvy (Möeller-Barlow's disease) symptoms such as hyperirritability and tenderness over long bones disappear within 24 to 72 hours after institution of therapy. Wentzler<sup>52</sup>, Kramer<sup>44</sup>, Neumann<sup>53</sup>, Brugsch<sup>54</sup>, and others have reported very satisfactory results in the use of cevitamic acid in scurvy. In Neumann's case—a ten months old infant—there was definite improvement in two days and the case was considered cured in twelve days. Parsons<sup>55</sup>, Harris and Ray<sup>56</sup>, Abt and Epstein<sup>57</sup>, have recently reported successful use of cevitamic acid in treating hypovitaminosis C.

Cevitamic acid is superior to orange juice, lemon juice, etc., for certain types of cases. Frank scurvy is often associated with vomiting and extreme irritability and refusal of food due to tenderness of the swollen, spongy, gums. In these cases cevitamic acid may usually be given orally since the small amount required is well tolerated when bulky foods or fruit juices cannot be given.

27

## LATENT SCURVY

Nearly twenty years ago Hess⁴⁰ described sub-acute or latent scurvy. Today we might prefer to call this condition hypovitaminosis C. Hess found that certain children who showed pallor, anorexia, stationary weight, and weakness, improved remarkably when vitamin C was added to their diet. Certain cases showed mild cardiac enlargement and effort syndrome. These conditions were similarly greatly improved when intake of vitamin C became adequate.

Recognition of latent scurvy has recently been put on a scientific basis by Gothlin⁴³, Harris and Ray⁵⁶, Yavorsky⁵⁸ and others. Gothlin has described the method for estimating the individual vitamin C status by determination of the strength of the skin capillaries.

However, the test described by Gothlin is not as accurate as titration against 2, 6-dichlorphenolindophenol. Also, it has been shown that iodine may be used in titrating the amount of vitamin C in an unknown food, and Becker and diGleria⁵⁹ have recently described a new method whereby the vitamin C content of various foods may be estimated by electrometric titration.

As time passes it seems to be increasingly clear that vitamin C plays an important part in man's resistance to infections and toxins. The basis for this statement is an editorial⁶⁰ (J.A.M.A. 107:1225, 1936) on the increased demands for vitamin C in tuberculosis. Hasselbach⁶¹ concluded, as a result of extensive studies, that vitamin C insufficiency is demonstrable in pulmonary tuberculosis, and

28

that this insufficiency is marked in all febrile and destructive forms of this disease.

Most interesting are the studies of Bullowa et al.⁶² and Gander and Niederberger⁶³ which show that a marked vitamin C deficiency exists in the pneumonia patient. Gander and Niederberger believe that intensive vitamin C therapy should supplement other therapy in every case of pneumonia.

Rinehart⁶⁴ believes that latent or sub-clinical scurvy may be a contributing cause of rheumatic fever and that vitamin C has definite therapeutic and prophylactic value in this disease. This work was recently confirmed by Abbasy and associates⁶⁵ who studied 195 cases of rheumatic fever and demonstrated conclusively that juvenile rheumatism is associated with vitamin C deficiency and that these patients require more vitamin C than other children on a similar diet. Boger and Schroeder⁶⁶ report the successful use of cavitamic acid in capillary hemorrhage and in hemophilia. They also noted an increase in serum albumin in their patient during treatment. Additional evidence of the importance of vitamin C in promoting normal coagulability of the blood is furnished by the work of Lorenz⁴¹ who showed that in purpura hemorrhagica, administration of vitamin C lowered bleeding time to normal. Lorenz says that vitamin C may be considered a specific therapeutic agent in Werlhof's disease (purpura hemorrhagica).

Hanke⁶⁷ showed that in experimental animals profound changes due to vitamin C deficiency can be seen in the teeth. He demonstrated with a large group of children that

29

vitamin C had a definite relation to normal tooth formation. Howe⁶⁸ showed that monkeys on diets low in vitamin C develop dental caries, gingivitis, and dental disease similar to that seen in man.

In a recent editorial in the British Medical Journal⁶⁹ it is stated that vitamin C deficiency is a very important factor in delaying union and healing of fractured bones. Hanke⁷⁰ supports this view and states that vitamin C is indispensable to the repair of fractured bones.

King and Menten⁷¹ found that guinea-pigs given large amounts of vitamin C were able to survive doses of diphtheria toxin which caused death in controls. Torrance⁷² has found that the adrenals of guinea-pigs dying from injection of lethal doses of diphtheria toxin contain only 15 per cent as much vitamin C as the adrenals of controls. Another group of guinea-pigs which had been injected with half lethal doses of toxin eventually reached a level of 85 per cent of the original vitamin C in their adrenals. Immediately after injection, however, the level of vitamin C in the adrenals rose to a level considerably higher than the controls. This interesting point was confirmed by injecting one-third of a lethal dose into another group of guinea-pigs. Here the level of vitamin C rose to nearly three times its original value soon after the injection. These experiments indicate a rapid mobilization of vitamin C in the adrenals following injection of diphtheria toxin.

## VITAMIN C AND LACTATION

According to Baumann and Rappolt⁷³, “the minimum requirement of the nursing mother

30

is 50 mg. of cevitamic acid per day; if human milk contains less than four milligrams of vitamin C per cent, then the maternal organism is being depleted.”

Studies of this same subject by Widenbauer and Kuhner⁴² are reported as follows:

> "In experiments on six nursing mothers investigations were made of the vitamin C balance, of vitamin C saturation, and of the blood content. In all of them vitamin C deficiency, to a greater or lesser extent, was established. The ascorbic acid content of the milk of these women was 0.5 to 2.2 mg. per cent before saturation, indicating a saturation-deficiency of 1500 to 5700 mg. After treatment with high doses of vitamin C its amount in their milk increased to from 3.8 to 7.5 mg. per cent. Urinary excretion did not increase until saturation was reached; the vitamin C content increased more in the milk than in the urine, indicating optimal usage. The vitamin C requirements of the nursing mother are higher than normal. The mother requires 80 to 100 mg. of vitamin C in order to pass on 40 to 50 to her sucklings. Oral administration of ascorbic acid was able to raise lowered erthrocyte, thrombocyte and reticulocyte counts, lowered hemoglobin percentages and lowered blood coagulability, and was also able to a less extent to shift the leukocyte picture towards the normal."

Neuweiler⁷⁴ has shown that “the vitamin C requirements of the suckling are relatively high, six milligrams of ascorbic acid per kilogram per day. Synthesis of vitamin C does not take place in the suckling.

31

Vitamin B

1. Vorhaus, M. G., Am. J. Digest. Dis. & Nutrition 3:915, 1937.

2. Russell, W. R., Edinburgh M. J. 43:315, 1936.

3. Gildea, E. F., et al., New England J. Med. 202:523, 1930.

4. Knott, E. M., J. Nutrition 12:597, 1936.

5. Harris, L. J., Brit. M. J. 1:886, 1936.

6. Peters, R. A., Brit. M. J. 3957:903, 1936.

7. Edit., Brit. M. J. 2:134, 1936.

8. Vorhaus, Williams & Waterman, Am. J. Digest. Dis. & Nutrition 2:541, 1935.

9. Vorhaus, Williams & Waterman, J.A.M.A. 105:1580, 1935.

10. von Lobenstein, Munchen. med. Wchnschr. 83:510, 1936.

11. Ruschke, Deutsche med. Wchnschr. 62:181, 1936.

12. Hermano & Eubanas, Philippine J. Sc. 57:277, 1935.

13. Bergel, A., Deutsche med. Wchnschr. 62:1643, 1936.

14. Ungley, C. C., Quart. J. Med. 29:531, 1936.

15. Bingham, A. W., Am. J. Obst. & Gynec. 32:144, 1936.

16. Theobald, G. W., Lancet 1:834, 1936.

17. Jolliffe et al., Am. J. M. Sc. 191:515, 1936.

18. Strauss, M. B., New England J. Med. 215:1164, 1936.

32

19. Kinnersley & Peters, Biochem. J. 23:1126, 1929.

20. Peters & Thompson, Biochem. J. 28:916, 1934.

21. Abderhalden & Wertheimer, J. Pharm. & Chim. 23:526, 1936.

22. Lajos, S., Biochem. Ztschr. 284:279, 1936.

23. Lajos & Gerendas, Ztschr. f. d. ges. exper. Med. 98:739, 1936.

24. Hall & Myers, Arch. Int. Med. 55:403, 1935.

25. Steinberg, C. L., Am. J. Digest. Dis. & Nutrition 3:765, 1936.

26. Dennett, R. H., J.A.M.A. 92:769, 1929.

27. Morgan & Barry, Am. J. Dis. Child. 39:935, 1930.

28. Macy, et al., J. Biol. Chem. 73:189, 1927.

29. Hartsock, C. L., Cleveland Clin. Quart. 3:164, 1936.

30. Sparks & Collins, Am. J. Digest. Dis. & Nutrition 2:618, 1935.

31. Fitts, J. B., South M. J. 28:920, 1935.

32. Simpson, V. E., ibid. p. 923.

33. Vaughan & Hunter, Lancet 1:829, 1932.

34. Goodal, A., Lancet 2:781, 1932.

35. Witts J. L., Proc. Roy. Soc. Med. 25:1703, 1932.

36. Ungley & James, Quart. J. Med. 27:523, 1934.

Vitamin C

37. King & Waugh, Science 75:357, 1932.

38. Haworth, W. N., Soc. Chem. Ind. 52:482, 1933.

33

39. Szent-Gyorgyi, A., Deutsche med. Wchnschr. 60:566, 1934.

40. Hess, Alfred F., J.A.M.A. 68:235, 1917.

41. Lorenz, E., Wien. klin. Wchnschr. 49:1195, 1936.

42. Widenbauer & Kühner, Ztschr. f. Vitaminforsch. 6:50-75, 1937.

43. Gothlin, G. F., J. Lab. & Clin. Med. 18:484, 1933.

44. Kramar, E., Deutsche med. Wchnschr. 59:1428, 1933.

45. Waugh, W. A., J. Chem. Educ. 11:69, 1934.

46. Birch & Harris, Biochem. J. 27:595, 1933.

47. Reichstein, T., et al., Helvet. chim. acta. 16:1019, 1933.

48. Ault, et al., J. Chem. Soc. p. 1419, 1933.

49. Szent-Gyorgyi, A., Biochem. J. 22:1393, 1928.

50. Svirbely & Szent-Gyorgyi, Biochem. J. 26:865, 1932.

51. Svirbely & King, J. Biol. Chem. 94:483, 1931.

52. Wentzler, E., Monatschr. f. Kinderh. 59:451, 1934.

53. Neumann, U., Deutsche med. Wchnschr. 60:1203, 1934.

54. Brugsch, H., Deutsche med. Wchnschr. 60:1203, 1934.

55. Parsons, L. G., Proc. Roy. Soc. Med. 26:1533, 1933.

56. Harris & Ray, Lancet 1:71, 1935.

34

57. Abt & Epstein, J.A.M.A. 104:635, 1935.

58. Yavorsky, Martin, J. Biol. Chem. 106: 525, 1934.

59. Becker & diGleria, Ztschr. f. Vitaminforsch. 6:86, 1937.

60. Edit., J.A.M.A. 107:1225, 1936.

61. Hasselbach, F., Deutsche med. Wchnschr. 62:924, 1936.

62. Bullowa et al., Proc. Soc. Exper. Biol. & Med. 34:1, 1936.

63. Gander & Niederberger, Munchen. med. Wchnschr. 83:2074, 1936.

64. Rinehart, J. F., Ann. Int. Med. 9:586, 1935.

65. Abbasy, M. A. et al., Lancet 2:1413, 1936.

66. Boger & Schroeder, Munchen. med. Wchnschr. 81:1335, 1934.

67. Hanke, M. T., Diet and Dental Health, University of Chicago Press, 1933.

68. Howe, P. R., J. Am. Dent. A. 43:1607, 1929.

69. Edit., Brit. M. J. 2:980, 1936.

70. Hanke, H., Klin. Wchnschr. 15:1121 1936.

71. King & Menten, J. Nutrition 10:129, 1935.

72. Torrance, C. C., Proc. Soc. Exper. Biol. & Med. 35:654, 1937.

73. Baumann & Rappolt, Ztschr. f. Vitaminforsch. 6:49, 1937.

74. Neuweiler, W., Ztschr. f. Vitaminforsch. 6:75-82, 1937.

(4-38)

R43-3

PACKAGE INFORMATION

Crysto-Vibex Tablets

CT 758. 0.5 mg. ( 150 I. U.)

CT 767. 1.0 mg. ( 300 I. U.)

CT 768. 3.3 mg. (1000 I. U.)

Bottles of 100 and 500.

Crysto-Vibex Ampoules, 1 cc.

Boxes of 6 and 25.

Crysto-Vibex with Vitamin C

CT 759.

Bottles of 100 and 500.

TAR DERMAMENT

Tar Dermament makes coal tar available in a new form. This recently introduced product is made by dissolving washed coal tar in an alcoholic solution of a special type of synthetic resin. It has the therapeutic advantages of an adhesive film with the properties of natural tar. After drying, a resinous layer remains on the skin to hold the tar intimately at the place of application.

Tar Dermament finds wide clinical use in all skin affections in which the stimulant properties of tar, combined with protective action of the synthetic vehicle are indicated. Conditions which fall into this category include eczema, psoriasis, pruritus ani, pruritus vulvae, chronic papular urticaria, epidermophytosis, and bromidrosis.

Tar Dermament may be employed as a protective, water-resist-

1

ant dressing about wounds, boils, carbuncles, and on the hands of industrial workers who are exposed to irritants.

Tar Dermament stays where it is applied. This feature is particularly important in treatment of pruritus ani et vulvae, and in application of the medicament to the inguinal region, the axillae, the under surfaces of the breasts, or to any area in which two cutaneous surfaces are in contact. Ointments and oily medication, when applied to such areas, are rubbed away by the approximating skin surfaces; such preparations are not only objectionable because of their tendency to stain the dressing and the clothing, but also because they frequently have a disagreeable odor.

Animal experiments and tests on the intact human skin indicate that Tar Dermament is no more irritating than most other medicaments containing tar. Of course, this preparation shares with other applications the possibility of idiosyncrasy

2

in the patient, although even the infant skin usually evidences no irritation.

## Packages

For use in the physician's office, or for dispensing by the pharmacist on prescription, Tar Dermament is available in rubber-stoppered, 15-cc. and 50-cc. vials; the 15-cc. vial is equipped with a camel's hair brush to facilitate application to the skin.

Tar Dermament is also supplied in pint bottles for office or hospital treatments.

3

GENERAL DISCUSSION

Nelson and Osterberg¹ noted that crude coal tar, although often bringing "prompt and striking relief," has two important drawbacks: a tendency to cause folliculitis, and undesirable staining-sticking properties. They attempted to overcome this disadvantage by removing fractions of the active substance by steam distillation. In 1935, Obermayer and Becker² stated that "distillates of crude coal tar have a tar-like effect, but to a less marked degree than that produced by the whole tar." They further concluded that sulphonated bibtuminous tars and petroleum tars do not have the therapeutic qualities of crude coal tar.

Tar Dermament is not sticky and does not stain. It dries quickly, and adheres firmly to the place of application, assuring intimate and continuous contact of washed crude coal tar, and affords genuine protection to the skin.

There are four main groups of organic material from which tars can be obtained: coal, wood, bitumen, and petroleum. Chemistry of tars varies with the substance from which they are prepared and with the temperatures to which they are subjected.

Crude coal tar (Pix lithanthracis) has

4

been subjected to numerous attempts to eliminate the most obvious practical obstacle in tar therapy—the black color. The methods to achieve decolorization differ, but all of the more or less colorless substitutes for tar seem to have one property in common—their total pharmacologic effect is less than that of the original crude coal tar. This is not surprising when one realizes the range of possible chemical changes that may occur in manufacturing manipulation.

Complete pharmacologic study of coal tar has not been made but certain properties are known and explain, in part, its action. In addition to its antipruritic property, coal tar has a definite beneficial action on acanthotic processes which occur as part of the histologic change in the prickle cell layer of the skin in various dermatologic lesions. It exerts vasoconstrictive, keratoplastic, and antiparasitic effects.

What substance or group of substances is responsible for the therapeutic effect of coal tar? Phenols, cresols, and naphthalene are undesirable irritants and are, therefore, removed from the tar used in Tar Dermament. Among the heavy oils of tar, "fluorescent green oil" is the most interesting because it contains acridine (di-benzo-pyridine), which has a photodynamic action. The

5

combined effect of ultra-violet irradiation and coal tar in psoriasis may be due to this substance.

Perutz³ states "the analysis of the effect of tar shows that the light and medium oils do not have a specific effect; yet they are important in that they control resorption and thereby prevent an excessive effect. The points of the attack are the basal cell and prickle cell layers. The sphere of action of tar extends to the connective tissue and the vascular system ..."

Much of the success of coal tar in dermatology is due to its vasoconstricting powers. As has been stated by Goodman⁴, an important common property of vasoconstricting agents and of the most effective cutaneous drugs is that they are chemically reducing. Such is true of crude coal tar which contains definite, though not well understood, reducing substances.

Strickler⁵ states "When properly employed the tar preparations are of great value. They exert a local influence upon the epidermis which becomes more intense with their continuation. They promote the involution of lesions by lessening infiltration and scaling. To relieve the itching in the thickened, infiltrated skin, as well as in those instances where itching is present without

6

the evidence of acute inflammation ... use tar in small quantities until the tolerance of the patient is determined."

## Tar Dermament Vehicle

The vehicle for the tar component is distinctive; it is an alcoholic solution containing 25 per cent of a special type of synthetic resin. The solution dries rapidly when brushed on the skin, leaving a thin, elastic, tightly-adherent, resinous film. This film is practically odorless, insoluble in water and soap solutions, and is not sticky or gummy. It holds the tar in intimate, prolonged contact with the skin.

## Clinical Uses

Tar Dermament is suitable in all cases where crude coal tar was formerly used. White⁶ and others have emphasized the value of crude coal tar and recommend it in the following conditions: infantile eczema; moist eczema of adult life; moist eczema seborrheicum of the scalp, especially the frontal type; pruritus ani et vulvae; psoriasis and exfoliative dermatitis; neurodermite, especially of the occipital type; the chronic papular urticarias which border on prurigo, and the moist types of epidermophytosis.

7

Infantile Eczema

Stein⁷ states, in substance, that the vasoconstrictive, keratoplastic and anti-pruritic properties of tar make it an excellent remedy for local treatment of eczema.

Grossman⁸ indicates that crude coal tar in proper dilutions is the most suitable drug for the local treatment of infantile eczema. "If used in proper proportions and used persistently and intelligently, even the very severe eczema cases can be cleared up in 6-14 weeks."

Moist Eczemas of Adult Life

White⁶ mentions two types of adult moist eczema particularly amenable to treatment with crude coal tar. "The first variety is that found just above and just behind the ears. In such instances we suspect the irritating contact of spectacles, or, again, dyed or very seborrheic hair, but we must confess that at times none of these trouble makers is present. This variety of eczema has proved in the past very obstinate to deal with, but under the influence of crude coal tar we are now accustomed to see it dry up and fade away day by day, until within a comparatively short time it has gone for good . . .

"The second example of moist eczema

8

is not so limited in location as the aural one just described. It usually is found in good-sized patches, most frequently on the lower part of the lower legs, next on the lower arms, and finally, in scattered smaller areas on the trunk. In former days we were wont to seek relief from black wash, but now we call on crude coal tar and are seldom disappointed."

Tar Dermament, avoiding as it does the necessity for bandaging, is of particular value in treating eczema of the scalp. Care should be taken to avoid matting of the hair; application is made to the scalp only.

Psoriasis

Goeckerman⁹ reports favorably on treatment of psoriasis with crude coal tar and ultra-violet light. The fact that crude coal tar plus ultra-violet irradiation produces such beneficial effects in psoriasis while either measure, applied alone, has only a mild beneficial action, afforded stimulus to the investigation of Herrick and Sheard¹⁰ on the possible changes in the absorption of crude coal tar when irradiated by air-cooled quartz mercury vapor lamps. They found that thin films of crude coal tar show a marked increase in transmissibility of ultra-violet light after irradiation. These

9

changes in transmissibility, detected by
changes in the absorption spectra, are
regarded as evidences of chemical
changes induced by the quartz mercury
vapor lamp.

Continued observations on the use of
crude coal tar and ultra-violet light in
treatment of 181 psoriatic patients were
reported by Goeckerman¹⁰. Speaking of
crude coal tar he states, "It was appar-
ent almost at once that this substance,
when applied to a patch and exposed to
light, was effective, but whether the
original conception as to the mechanism
of therapeutic action is correct is de-
batable. Herrick and Sheard have shown
that a photochemical change occurs
when crude coal tar is exposed to ultra-
violet light. It is possible, therefore, that
a new chemical is formed which exerts
its beneficial effect by stimulating kera-
tinization or antiseptic action, or by
some other mechanism. Since tar ap-
plied in pure form is effective, it can be
said, without hesitancy, that tar as such
contains the desirable substance. Thus
far, it has been impossible to obtain the
same effect with any other material."

10

OTHER USES

In treating pruritus ani et vulvae one
must be certain that there is no com-
plicating diabetes, pediculosis, or epi-
dermophytosis. Tar Dermament, by
virtue of its cleanliness and firm adher-
ence to the skin, is particularly adapted
to the treatment of anal and vulvar
pruritus.

Neurodermatitis is chronic in ten-
dency and resistant to treatment. How-
ever, the almost intolerable itching is
often so alleviated that relief is almost
immediate after application of crude
coal tar, and with the cessation of
scratching progress toward permanent
relief is effected.

Tar Dermament is often effective in
the treatment of epidermophytosis, al-
though in the presence of deep fissures
or denuded areas the initial application
may cause stinging for a few moments.
It tends to dry up moist lesions and re-
move crusts.

The water-resistant film produced
when Tar Dermament dries suggests its
use as a protective dressing around
wounds in which the discharge is irritat-
ing, on badly infected traumatic areas,
and where gastro-intestinal secretions
drain on the skin. Tar Dermament is a
clean application often useful in local-
ized skin infections; it affords comfort

11

when used to cover fissures and abrasions on the hands of workers exposed to industrial irritants.

Tar Dermament may be painted on the skin two or three times daily with a small brush or cotton applicator. Skin, to which Tar Dermament is applied, should be clean and free from creams and greases.

12

Bibliography

1. Nelson, M. O., & Osterberg, A. E.: *Arch. Dermat. & Syph.* 15:669, 1927.

2. Obermayer, M. & Becker, S.: *Arch. Dermat. & Syph.* 31:796, 1935.

3. Perutz, A., & Siebert, C.: *Handbuch der Haut- und Geschlechtskrankheiten*, Julius Springer, Berlin, 1930.

4. Goodman, H.: Rational Pharmaceutical Treatment of Common Skin Diseases, Medical Lay Press, New York City, 1932.

5. Strickler, A.: Diseases Of The Skin and Syphilis, F.A. Davis & Co., Philadelphia, 1927.

6. White, C. J.: *Arch. Dermat. & Syph.* 4:796, 1921, *Ibid* 7:50, 1923.

7. Stein, R.: *Ars Med.*, Vienna, 9:51, 1931.

8. Grossman, H. D.: *Arch. Pediat.* 47:533, 1930.

9. Goeckerman, W.: *Northwest Med.* 24:229, 1925, *Idem, Arch. Dermat. & Syph.* 24:446, 1931.

10. Herrick, J., & Sheard, C.: *Proc. Soc. Exper. Biol. & Med.* 26:33, 1928.

R36-3

(6-38) 51833

'Delsterol' is a vitamin-D product obtained by irradiation of a sterol fraction of animal origin with ultra-violet light. It consists of a number of sterols, including pro-vitamin D which is converted into vitamin D by irradiation. The irradiated pro-vitamin content of the mixed sterols is believed to be identical with, or similar to, that of 7-dehydrocholesterol.

Because of the association of the pro-vitamin with cholesterol, it has sometimes been incorrectly referred to as irradiated or activated cholesterol, a name which appears frequently in the literature.

'Delsterol' in Oil is supplied in 5-cc. bottles with dropper.

For Dosage Information
See Page 5

# DELSTEROL IN OIL

ACTIVATED ANIMAL
PRO-VITAMIN D*

DELSTEROL in Oil is a highly potent vitamin-D product, biologically standardized to a potency of 10,000 U.S.P. units per gram. 'Delsterol' in Oil is prepared by activating (by ultraviolet irradiation) the pro-vitamin D occurring with cholesterol. Extensive laboratory and clinical studies have shown that an activated animal pro-vitamin D is a potent antirachitic agent. Unit for unit, the Vitamin D in 'Delsterol' in Oil is fully as effective as that in cod liver oil in all species of animals tested.

*The designation "activated animal pro-vitamin D" is used to indicate that the vitamin content of Delsterol in Oil is derived from animal sources, and to distinguish it from Viosterol, which contains activated pro-vitamin D (ergosterol) of plant origin.

1

Clinical Studies

Over ten years ago Hess¹ showed that irradiation of cholesterol or some substance associated with it and irradiated dried brain tissue (high cholesterol content) would cure rickets in infants.

In 1935 Tisdall, Drake, and Brown² reported healing of rickets in two infants (prematures) by administration of activated animal pro-vitamin D (750 U.S.P. units daily). They also showed³ in a preventive study conducted on 77 white infants that administration of 150 units of vitamin D in this form afforded absolute protection to over 80 per cent of the group; eight per cent of the infants showed extremely slight rachitic changes and ten per cent only developed mild rickets at this extremely low dosage level.

These results compared favorably with a control group of 74 infants who were given a comparable daily dose of cod liver oil. These workers also demonstrated that 300 units of activated animal pro-vitamin D

2

given daily was sufficient to cause healing of several cases showing moderate rickets.

Lewis⁴ also showed that activated animal pro-vitamin D is a very effective antirachitic. He treated three rachitic infants by daily administration of 435 units daily and observed moderate to marked healing in four weeks.

Hood and Ravitch⁵ made an outpatient preventive study on one hundred and seventy-seven non-rachitic infants varying in age from one to five months. The infants were divided into three groups and activated animal pro-vitamin D ('Delsterol') was administered at varying dosage levels from 350 to 1200 U. S. P. units. Two curative studies were conducted in forty-one infants who had incipient rickets or deviations from normal roentgenologic appearance which led the authors to classify them as doubtful. Thirty-seven of the forty-one cases were promptly restored to normal (roentgenologically) and the re-

3

maining four (one mild rickets and
three doubtful bony changes)
showed regression of abnormal bone
changes.

Space prevents a detailed account
of the report of Hood and Ravitch.
Their conclusions may be sum-
marized as follows:

In the matter of protection
against rickets, activated animal
pro-vitamin D was found to be quite
effective when administered at a
dosage level of 400 to 775 units per
day. Although the number of cases
included in the curative test was
too limited to permit final conclu-
sions, this form of vitamin D seemed
to be a potent antirachitic substance
for both prophylaxis and treatment.

4

Dosage

For routine prophylaxis against
rickets in infants, a dosage of 5
drops of 'Delsterol' in Oil daily is
suggested. The studies previously
mentioned indicate that this amount
should provide adequate protection.

For the treatment of incipient or
active rickets, administration of 15
to 20 drops daily is recommended.

For pregnant and lactating
women, ten drops of 'Delsterol' in
Oil daily is suggested.

NOTE:

Ten drops of 'Delsterol' in Oil, delivered from the
dropper supplied with the bottle, furnishes
approximately 1700 international (U.S.P.) units
of vitamin D of animal origin.

5

SUPPLEMENT

It was observed by Huldschinsky nearly
twenty years ago that ultraviolet ir-
radiation (of the skin) would prevent or
cure rickets in man or experimental
animals. It was postulated that the
substance in the skin which was
“activated” by irradiation was choles-
terol and this substance was, therefore,
the first pro-vitamin D to be identified.
However, when it was demonstrated by
Windaus, Hess and Steenbock, and
others, that irradiation of ergosterol
produced a substance with high vitamin
D potency, studies of cholesterol as a
source of vitamin D were, for the most
part, dropped.

Recently it has become clearly evi-
dent that vitamin D containing sub-
stances from different sources are not
identical. Vitamin D derived from plant
sources is different (in effect upon fowls
at least) from vitamin D of animal
origin. Vitamin D from plant sources

6

is represented by irradiated ergosterol
(Viosterol) and irradiated yeast.

Fish liver oils and activated animal
pro-vitamin D ('Delsterol') contain vita-
min D from animal sources. It seems
highly probable that a substance derived
from or associated with cholesterol in
the skin and other tissues of animals
becomes an active antirachitic on
ultraviolet irradiation.

Koch and co-workers⁶ showed that
heated, purified cholesterol could be
activated by ultraviolet irradiation and
that the resulting substance behaved
very much as did the vitamin D of cod
liver oil.

In 1934, Waddell⁷ reported studies
which proved that the pro-vitamin D
of cholesterol is not ergosterol (as had
been previously supposed) and that
the activated material derived from
cholesterol behaved much like the vita-
min D of cod liver oil. Waddell's work
did much to clarify certain controversial
points concerning the differences be-
tween vitamin D from plant and that
from animal sources.

7

Bethke *et al.*,⁸ corroborated the views of Waddell and offered further proof that the pro-vitamins D of animal and plant sources are not identical. They also present evidence suggesting that there is no taxonomic difference between the antirachitic efficiency of irradiated products from higher plants (cottonseed oil, wheat middlings, and alfalfa leaf meal) and irradiated plants (yeast and fungus mycelium) of lower botanical order.

There is good reason to believe that the vitamin D which is formed by activation of the pro-vitamin associated with cholesterol is the same as the natural vitamin D of cod liver oil⁸, tuna liver oil and halibut liver oil⁹. It is this vitamin D ($D_3$) which is present in 'Delsterol' in oil, biologically standardized to contain 10,000 units (international or U.S.P.) per gram.

8

Bibliography

1. Hess, A. F.: *J.A.M.A.* 89:337, 1927.

2. Tisdall, Drake & Brown: *Canad. M. A. J.* 32:490, 1935.

3. Drake, Tisdall & Brown: *J. Pediat.* 9:421, 1936.

4. Lewis, J. M.: *J. Pediat.* 10:155, 1937.

5. Hood & Ravitch: *J. Pediat.* 11:521, 1937.

6. Koch, *et. al.*: *J. Biol. Chem. Soc.* 85:141, 1929-1930.

7. Waddell, J.: *J. Biol. Chem.* 105:711, 1934.

8. Bethke, *et. al.*: *J. Biol. Chem.* 112:231, 1935-36.

9. Hume, E. M.: *Nutrition Abstr. & Rev.*, 6:891, 1937.

10. Brockmann, H.: *Ztschr. f. physiol. chem.* 245:96, 1937.

R48-2 (10-38)

51542

KAPSEALS COMBEX

COMBEX IS A COMBINATION of crystalline vitamin B₁ (thiamin chloride) with other members of the vitamin B complex obtained from liver, in convenient kapseal (sealed gelatin capsule) form. Each kapseal contains 300 international units of vitamin B₁ and 40 units (Sherman) of vitamin B₂; also present are the following recognized components of the B complex—B₃, B₄, B₅, B₆, and nicotinic acid (the P-P factor). Combex is an excellent source of vitamins B₁ and B₂, and contains in addition all the known members of the vitamin B complex. The comprehensive nature of this product makes it especially well adapted for prophylaxis against general vitamin B deficiency.

INDICATIONS FOR COMBEX

Kapseals Combex are indicated for the prophylaxis or treatment of deficiencies of vitamins B₁ and B₂,

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and may be used to supplement diets lacking in these particular vitamins. Among the indications for Kapseals Combex are the correction and prevention of beriberi, the treatment of neuritis, polyneuritis, and anorexia of dietary origin. They are also of value in securing optimal growth of infants and children. They are of special value in all cases involving difficulty in utilizing ordinary foods in the usual way.

Patients who may be benefited by administration of Kapseals Combex include those whose diet is inadequate due to idiosyncrasy, allergy, gastro-intestinal lesions, or faulty eating habits. Also, Combex is indicated for persons whose need for the vitamin B complex is increased—growing children, pregnant and lactating women, persons whose metabolism is increased due to infection, hyperthyroidism, or whose caloric intake is especially high. Certain other conditions constitute indications for administration of the vitamin B complex. These include

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degenerative cardiovascular disease, all forms of neuritis, malnutrition, arrested growth in children, atonic constipation and anorexia of dietary origin.

## DOSAGE

As a supplement to an unbalanced or inadequate dietary, we recommend one to three Kapseals Combex daily administered with the meals. This includes therapeutic diets such as diabetic, ulcer, and reduction diets.

For pregnant and lactating women, two to six kapseals should be given daily.

For malnourished children, and especially those who show underweight and retarded growth, two to six kapseals daily.

For treatment of beriberi, polyneuritis or other evidence of severe vitamin B₁ deficiency, six to ten kapseals should be given daily for ten days to two weeks, following which the dosage may be reduced to two to six kapseals per day.

For cases of atonic constipation

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and anorexia of dietary origin, degenerative cardiovascular disease, and general debility and asthenia, we suggest the administration of two to six Kapseals Combex daily.

It is well-known that fever increases metabolism and markedly increases the body's need for certain vitamins. We suggest, therefore, that Kapseals Combex be administered routinely to patients who are febrile, the dosage ranging from two to six kapseals per day depending upon the height of the fever and the amount of protective foods which the patient is able to take. Marked diuresis or diarrhea involves loss of unusual amounts of vitamin B complex from the body and constitutes an indication for administration of the important vitamin B complex.

## PACKAGE INFORMATION

Kapseals Combex are supplied in bottles of 100.

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# GENERAL DISCUSSION

## Vitamin B₁—Thiamin Chloride

Deficiency of vitamin B₁ prevents normal growth of the young and causes characteristic symptoms preferable to the nervous system and gastro-intestinal system. Although beriberi, the end result of prolonged, severe deficiency, is rarely encountered in the United States or Canada, there is abundant evidence that definite deficiency is by no means rare, and there is reason to believe that mild deficiency is fairly widespread.

## NEURITIS

Alcoholic polyneuritis and the neuritis of pregnancy are now thought to be evidences of vitamin B₁ deficiency. Other types of neuritis and polyneuritis (specific and nonspecific) are doubtless aggravated by deficiency of this factor, and helped by its administration. It is recommended that all cases of polyneuritis have a trial course of vitamin B₁ administration in ade-

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quate dosage—1000 to 2000 international units (3.3 to 6.6 mg.) per day for several weeks. Many reports of the successful use of vitamin B₁ in the treatment of neuritis and polyneuritis have appeared in medical literature. Among these are the reports of von Lobenstein¹, Ruschke², Neuman and Vorhaus *et al*.³ The latter report cites quite favorable results in a series of cases of neuritis which the authors classify as "alcoholic, infectious, toxic, metabolic, neuritis of pregnancy, and localized neuritis."

It is interesting to note that vitamin B₁ deficiency in experimental animals has apparently been the cause of spinal cord lesions closely resembling those of combined degeneration as seen in pernicious anemia. Clinical reports in this connection include that of Bergel⁴ who reported that crystalline vitamin B₁ brought about a remarkable cure in a case of funicular myelosis which had followed severe pernicious anemia. The vitamin was injected intra-

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muscularly in a dosage of 5 mg. daily for ten days. Pfaffenberg and Mielke⁵ advise that vitamin therapy (B₁) of funicular spinal diseases should be started early, and large doses of the vitamin should be given. Injections should be continued for some time after cure is obtained. Molnar⁶ considers vitamin B₁ therapy superior to any other form of treatment in various types of neuritis. He reports that cases of herpes zoster, sclerosis lateralis amyotrophica, funicular myelosis and trigeminal neuralgia were treated with success.

## GASTRO-INTESTINAL DYSFUNCTION

The most constant and important symptom of vitamin B₁ deficiency referable to the gastro-intestinal tract is anorexia. This symptom alone, if long continued, brings on a state of undernutrition and leads to many secondary changes. Cowgill⁷ believes that many of the gastro-

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intestinal dysfunctions previously considered attributable to vitamin deficiency are only secondarily so, since they are also encountered in malnourished subjects not deficient in this factor. Vitamin B₁ deficiency causes decrease of gastric secretion (including acid secretion) and a decrease of pancreatic lipase secretion.

Intestinal atony and atonic constipation are symptoms associated with deficiency of B₁, and constitute indications for a therapeutic trial with vitamin B₁. This vitamin probably also exerts a synergistic action with specific medication (iron, liver extract, and ventriculin) in the treatment of the anemias. Vaughan and Hunter<sup>8</sup>, Goodall<sup>9</sup>, Witts<sup>10</sup>, Ungley and James<sup>11</sup>, and others have demonstrated that vitamin B is of definite value in the treatment of anemia. It seems likely that a considerable part of the benefit derived from vitamin B in anemia is due to its tonic effects on the gastro-intestinal tract.

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## VITAMIN B₁ AND THE HEART

Vitamin B₁ probably has no specific influence on the normal heart, but there is no doubt that vitamin deficiency definitely handicaps this organ. Weiss and Wilkins<sup>12</sup> are of the opinion that "dysfunction of the cardiovascular system resulting from unbalanced food intake is a disease of regular occurrence in the United States." They report their studies on 120 such cases, and present evidence to indicate that vitamin B₁ deficiency plays a primary role in precipitation of the disease. It is believed that the cardiovascular changes are dependent on changes in the nervous system, in the vascular system and in the myocardium. The clinical signs and symptoms observed included "tachycardia followed by bradycardia, gallop rhythm, vagal reflex irritability, dilatation of the heart, dyspnea, orthopnea and pulmonary congestion, associated with bounding arterial pulsation, arterial 'pistol-shot' sounds, engorged veins, warm

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skin and edema." Other reports connecting vitamin deficiency with cardiac dysfunction are those of Porter<sup>13</sup>, Jones and Sure<sup>14</sup>, Strauss<sup>15</sup>, and Waring<sup>16</sup>. Of interest also is the paper of Crowell<sup>17</sup>, who advocates use of vitamin B<sub>1</sub> with digitalis and reports "I have used this combination in a number of cases with strikingly beneficial results including some cases which previously had not responded to digitalis."

## VITAMIN B<sub>2</sub> (RIBOFLAVIN)

That part of the vitamin B complex known as vitamin B<sub>2</sub> (synonyms—lactoflavin, vitamin G) has been officially designated riboflavin. It is a yellow-green fluorescent water-soluble pigment widely distributed through both plant and animal kingdoms. This vitamin is presumably present in every living cell of the higher animals, where in combination with phosphoric acid ester and protein it is intimately connected with the chemical reactions involved in cell respiration.

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The most important result of vitamin B<sub>2</sub> (riboflavin) deficiency in experimental animals is arrest of growth and cataract formation. Several workers offer convincing evidence that deficiency of this vitamin causes production of cataract in rats, mice, monkeys, and chickens. It was formerly believed that vitamin B<sub>2</sub> was the anti-pellagra factor in man and the anti-blacktongue factor for dogs. These views have been definitely disproved and it is now believed that nicotinic acid, and not riboflavin, is most likely the important factor in these deficiency diseases.

Although riboflavin occurs in substantial amounts in liver extract, it is not the extrinsic factor nor is it the anti-pernicious anemia principle<sup>18,19</sup>.

## VITAMIN B<sub>2</sub> AND CELLULAR METABOLISM

Dietrich and Pendl<sup>20</sup> report heart perfusion experiments which demonstrate the importance of vitamin B<sub>2</sub> (riboflavin) to tissue respiration.

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They found that the muscular contractions of the heart were weakened when the oxygen pressure of the perfusing solution was lowered. The contractions could be restored to normal either by increasing the oxygen pressure in the perfusion fluid or by adding minute amounts of riboflavin to it.

The important place occupied by vitamin B₂ (riboflavin) in nutrition (human and animal) has been summarized by Sherman and Lanford²¹ as follows: "Shortage of riboflavin stunts growth of the young and at any age causes a lowering of general tone and a condition of premature aging or unwholesomeness of the skin, with loss of hair. The skin condition has sometimes been called a 'nonspecific' dermatitis or dermatosis as distinguished from the 'florid' dermatitis of vitamin B₆ deficiency."

## VITAMIN B₂ IN HUMAN NUTRITION

### Sources and Requirements

Vitamin B₂ (riboflavin) is found in widely separated biological

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sources—milk, muscle, liver, eggs, malt, grasses, fresh water algae and fish eyes. In spite of its wide distribution in nature this vitamin may not be present in optimum amounts in the average diet. As Eusterman and Wilbur²² suggest "certain individuals, the poor in particular, do not consume enough foods that contain (significant amounts of) vitamin A and vitamin G (B₂) to insure a state of nutrition essential to the greatest physical stamina, efficiency and ability to resist infectious diseases."

Excellent food sources of vitamin B₂ (riboflavin) are relatively few in number—lean beef, cottonseed flour and meal, eggs, kale, liver, spinach, wheat germ, and dry yeast. Other than these, relatively few foods contain as much as one unit (Sherman) per gram. Since human requirements for B₂ have been placed at from 400 to 600 units (figures arrived at independently by Rose and Stiebeling) it is conceivable that many diets do not contain an optimum amount of this essential food factor.

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BIBLIOGRAPHY

1. von Lobenstein, H.: Munchen. med. Wchnschr. 83:510, 1936.

2. Ruschke: Deutsche med. Wchnschr. 62:181, 1936.

3. Vorhaus, M. G., et al.: Am. J. Digest. Dis. & Nutrition 2:541, 1935; J.A.M.A. 105:1580, 1935.

4. Bergel, A.: Deutsche med. Wchnschr. 62:1643, 1936.

5. Pfaffenberg, R., & Mielke, H.: Klin. Wchnschr. 16:919, 1937.

6. Molnar, I.: Klin. Wchnschr. 16:1022, 1937.

7. Cowgill, G. R.: J.A.M.A. 110:805, 1938.

8. Vaughan, J. M., & Hunter, D.: Lancet 1:829, 1932.

9. Goodall, A.: Lancet 2:781, 1932.

10. Witts, L. J.: Proc. Roy. Soc. Med. 25:1703, 1932.

11. Ungley, G. C., & James, G. V.: Quart. J. Med 27:523, 1934.

12. Weiss, S., & Wilkins, R. W.: Ann. Int. Med 11:104, 1937.

13. Porter, W. B.: Virginia M. Monthly 65:459, 1938.

14. Jones, W. A., & Sure, B.: J. Lab. Clin. Med. 22:991, 1937.

15. Strauss, M. B.: J.A.M.A. 110:953, 1938.

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16. Waring, J. I.: South. Med. & Surg. 100:119, 1938.

17. Crowell, L. A.: South. Med. & Surg. 99:585, 1937.

18. Salah, M.: Tr. Roy. Soc. Trop. Med. & Hyg. 29:299, 1935.

19. Stare, F. J., & Thompson, L. D.: Proc. Soc. Exper. Biol. & Med. 33:64, 1935.

20. Dietrich, S., & Pendl, E.: Klin. Wchnschr. 16:13, 1937.

21. Sherman, H. C., & Lanford, C. S.: J.A.M.A. 110:1278, 1938.

22. Eusterman, G. B., & Wilbur, D. L.: J.A.M.A. 98:2054, 1932.

R53-1 (10-38)

52710

Kapseals Dilantin represent a new product which is not yet widely distributed. Although your pharmacist may not have this product in stock, he can readily obtain it from the nearest Parke-Davis Branch or Depot.

Kapseals Dilantin, each containing 0.1 Gm. (1 ½ gr.), are supplied in bottles of 100, 500, and 1000.

## KAPSEALS DILANTIN

Dilantin, (sodium 5,5-diphenyl hydantoinate) an anticonvulsant with relatively little hypnotic effect, is supplied particularly for the treatment of epileptics not responsive to other medication. Dilantin gives promise of definite value in epilepsy, but it should not be prescribed without a full appreciation of the various secondary effects that are common, particularly during the first few weeks of treatment.

Dilantin was first subjected to experimental study and clinical evaluation by Drs. H. Houston Merritt and Tracy J. Putnam¹ of the Harvard Medical School and Boston City Hospital, Neurological Unit. A review of their clinical experience in the use of this compound for the treatment of convulsive disorders was presented at the annual meeting of the American Medical Associa-

1

tion at San Francisco, June, 1938.

## Clinical Use of Dilantin

Dilantin seems to be more effective in controlling grand mal seizures than those of petit mal type. Dilantin is not a cure for epilepsy and will not correct congenital mental defects or the mental deterioration frequently encountered in the epileptic. However, published reports indicate that it will prevent, or greatly decrease incidence and severity of, convulsive seizures in a substantial percentage of epileptics—without the hypnotic and narcotizing effects of many anticonvulsant drugs.

In order to determine the relative effectiveness of Dilantin, Merritt and Putnam selected a group of patients who had been having frequent seizures for many years and who “had obtained little or no benefit from the usually accepted treatment, i.e. bromides, phenobarbital, ketogenic diet, restricted fluid intake, and the like.” In all, 200 patients were studied. At the time their

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report was drafted 142 patients had been under treatment for from two months to one year.

## Grand Mal Epilepsy

Sodium diphenyl hydantoinate was found to be very effective in controlling grand mal seizures. Of 118 patients having this type of seizure, 58 per cent were completely relieved, in 27 per cent the attacks were markedly reduced in number, and in the remaining 15 per cent little or no improvement was noted over the previous status under treatment with bromides or phenobarbital. The remarkable results noted (complete cessation of epileptic seizures in 58 per cent of a group of hitherto uncontrolled epileptics) were most encouraging. At the time of reporting many patients who had suffered from attacks ranging in frequency from one attack in several weeks to several attacks per day had remained free from attacks for several months.

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## Petit Mal Epilepsy

Results obtained in the treatment of petit mal epilepsy were decidedly encouraging though not as striking as those obtained in the grand mal type of seizures. Seventy-four patients with frequent petit mal seizures were treated. Of these, 35 per cent obtained complete relief, and an additional 49 per cent experienced a marked reduction in the number of attacks. The remaining patients showed slight or no improvement beyond that previously effected with other treatment.

## "Psychomotor Equivalent" Attacks

Included among the patients studied were six who suffered from "psychomotor equivalent" type of epilepsy. Under Dilantin therapy four of these were completely relieved and the remaining two experienced a marked reduction in the frequency of attacks.

## Dosage of Dilantin

Dosage of sodium diphenyl hydantoinate which effectively con-

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trolled epileptic seizures varied in adult patients, between 0.2 and 0.6 Gm. daily. The procedure evolved by Merritt and Putnam was to start adult patients on 0.1-Gm. doses three times daily. Dosage was increased gradually to 0.2 Gm. three times daily if necessary.

Dilantin is more rapidly effective when given before meals, and it is advisable to give at least the first of the daily doses immediately on arising.

Dilantin is strongly alkaline and should be taken with at least half a glassful of water to minimize gastric discomfort complained of by certain patients. In cases showing a tendency to gastric intolerance to the medication, it may be given with or immediately following meals.

Merritt and Putnam advised starting children on 0.1 Gm. sodium diphenyl hydantoinate twice daily and adjusting subsequent dosage in accord with therapeutic response. For very young children (under 4 years of age) dosage can be con-

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veniently started at low levels by
giving 0.05 Gm. (one-half the con-
tents of a Dilantin Kapseal). The
bitter taste of the medication can
be partially covered by mixing it
with cream.

In all cases the optimum dosage
of Dilantin must be determined by
trial. Merritt and Putnam advised
that children above the age of six,
and adults, be started on 0.1 Gm.
three times daily. In case this dose
proves ineffective after one week's
trial, a fourth dose of the same size
(0.1 Gm.) should be given at bed-
time, making the total daily dose
0.4 Gm. Further increase up to a
total daily dosage of 0.6 Gm. may
be made if necessary.

It is advised that increase in dos-
age be made, where necessary, at
intervals of approximately one week.

In practically every case, Dilan-
tin will be given to patients who
have previously been receiving bro-
mides, phenobarbital, or some other
drug. Merritt and Putnam advised
that the administration of sodium

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diphenyl hydantoinate be started
by overlapping with previous medi-
cation or regimen, to avoid any sud-
den changes which might bring
about unfavorable results. If, for
example, the patient is receiving
phenobarbital, the dosage of this
drug may be gradually decreased
following the institution of Dilantin
therapy. Sudden withdrawal of phe-
nobarbital in such a case might
precipitate a series of attacks before
Dilantin is present in sufficient
amount to exercise control.

In the absence of untoward re-
actions the minimum effective daily
dose of Dilantin is to be continued.
Dosage in excess of that which will
just prevent convulsions is not rec-
ommended.

Tolerance and Toxicity

It is to be expected that a certain
number of toxic manifestations may
be associated with the use of Dilantin
as an anticonvulsant. Merritt and
Putnam have reported that symp-
toms such as dizziness, ataxia,

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tremors, blurring of vision, diplopia and slight nausea occurred in approximately 15 per cent of patients.

Probably the outstanding complaints are dizziness and "unsteadiness"—evidence of disorders in neuromuscular control. These discomforts are common in the earlier weeks of treatment, but fortunately tend to subside in the course of time.

Cutaneous reactions, mostly morbilliform or scarlatiniform in nature and tending to disappear when the drug was temporarily discontinued, have been reported. Present experience indicates that as Dilantin therapy is continued these discomforting side manifestations tend to be minimized or to disappear entirely, the anticonvulsant efficiency of the drug remaining apparently unchanged.

To date clinical observation of this drug has not revealed any serious toxic effects on the blood, kidneys or liver. No fatalities have occurred in the work so far reported.

Since the significance of observed reactions to Dilantin is not fully

8

established, patients receiving Dilantin should be closely observed. Many of the discomforts reported during the first or second week of treatment can be relieved by reducing the dosage. In the majority of cases the dosage may later be gradually raised to effective levels without recurrence of toxic symptoms.

Reactions which were classed by Merritt and Putnam as more serious occurred in five per cent of patients treated. These reactions consisted in practically all cases of a dermatitis or purpura. In only two instances was the reaction regarded as dangerous. One patient developed an exfoliative dermatitis, another non-thrombo-cytopenic purpura; both cleared up following withdrawal of the drug.

Several patients developed a skin eruption which was scarlatiniform or morbilliform in nature. In nearly every case the rash was accompanied by fever, and both tended to disappear in three or four days, after which medication could be

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resumed without reappearance of
these signs and symptoms. A tem-
porary eosinophilia has been noted
concurrently with the skin eruption.

It has been noted in some patients
that Dilantin causes the gums to be-
come swollen and tender—occasion-
ally quite markedly. This reaction
is apparently not related to the
amount of drug being taken or the
duration of treatment, and has been
observed to occur in both children
and adults. The exact nature, and
the mechanism involved in these
reactions is not understood, but is
being studied.

On the appearance of symptoms
of toxicity, we advise that dosage
of Dilantin be reduced. If eviden-
ces of serious reactions are noted,
the drug should be discontinued
altogether. In many cases where
dosage is reduced, it will be found
that convulsive seizures are not con-
trolled and it will be necessary, fol-
lowing disappearance of toxic symp-
toms, to bring Dilantin dosage back
to the former effective level.

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It is suggested that purpura or
exfoliative dermatitis be a signal for
immediate and permanent discon-
tinuance of the drug. Mild toxic
reactions do not necessarily contra-
indicate further administration of
the drug, but in case they tend to
recur after temporary decrease of
dosage or resumption of therapy fol-
lowing discontinuance of the drug,
any further administration of Dilan-
tin is not recommended.

Clinical experience to date has
revealed little tendency on the part
of patients to become resistant to the
drug's effects. It has seldom been
necessary to increase dosage beyond
that which on initial trial proved ef-
fective.

Packages
---

Dilantin is supplied as 0.1-Gm.
(1½-gr.) kapseals in bottles of 100,
500, and 1000.

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SUPPLEMENT

Chemically, Dilantin is the sodium salt of 5,5-diphenyl hydantoin; it has the following structural formula:

It is an odorless, white, or cream colored powder, with a bitter taste; it is soluble in water, slightly soluble in alcohol, but practically insoluble in ether or benzene. An aqueous solution is alkaline to litmus and possesses a shiny, silky precipitate characteristic of diphenyl hydantoin, which dissolves completely when the alkalinity is adjusted to pH 11.7.

Putnam and Merritt² developed a standardized method of causing convulsions in experimental animals, the significant feature of the method being that it permitted quantitative determination of the “convulsion threshold.” Using this method these

12.

workers³ studied the anticonvulsant properties of a large number of drugs including “phenyl, cresyl, and tolyl sulfonates, benzoates, ketones and esters of such radicals as carbamic, malic, and barbituric acids, and hydantoin.” Among the compounds possessing greatest anticonvulsant activity and least hypnotic effect, diphenyl hydantoin stood out prominently. It was found that this drug was as effective as phenobarbital in raising the threshold to experimentally produced convulsions in cats, and that it (diphenyl hydantoin) produced considerably less narcosis.

Further Laboratory Data

Large single doses and frequently repeated small doses were well tolerated by laboratory animals. The solid sodium salt of diphenyl hydantoin (Dilantin) was found more practical for clinical use than the insoluble diphenyl hydantoin itself.

Dogs receiving two kapseals to eight kapseals of Dilantin daily for periods up to six months continue in

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normal weight and health. One animal receiving six kapseals daily developed a mild anemia during the first two months of administration but the hemoglobin returned to its original level during the subsequent four months without interruption of the drug. On no occasion did animals receiving Dilantin orally exhibit a sedative effect nor did any abnormalities occur in urine or blood except as related.

Animal experiments to date have not disclosed how Dilantin is disposed of in the body—apparently that portion of the drug not absorbed from the gastrointestinal tract passes in the feces unchanged. Two and one-half to 10 per cent of the administered Dilantin (two kapseals to eight kapseals daily to dogs orally) has been recovered from the feces and less than 0.1 per cent on any occasion appeared in the urine.

The minimum lethal dose (M. L. D.) and the maximum tolerated dose (M. T. D.) of Dilantin in laboratory animals by oral and intravenous

administration, respectively, are compared in the following table:

### Oral Administration

M.L.D. M.T.D.
Rats 1600 mg./Kg. 1500 mg./Kg.
Rabbits 1400 mg./Kg. 1200 mg./Kg.

### Intravenous Administration

M.L.D. M.T.D.
Rats 115 mg./Kg. 100 mg./Kg.
Dogs 70 mg./Kg. 60 mg./Kg.

## BIBLIOGRAPHY

1. Merritt, H. H., & Putnam, T. J.: J. A. M. A. 111:1068, 1938

2. Putnam, T. J., & Merritt, H. H.: Science 85: 525, 1937

3. Merritt, H. H., Putnam, T. J. & Schwab, D. H.: Arch. Neurol. & Psychiat. 39:1003, 1938

R49-5 (12-38)

53598

14

SULFANILAMIDE

(PARA AMINO-BENZENE SULFONAMIDE)

SULFANILAMIDE has been shown by animal experiments and clinical testing to have a definitely beneficial effect in streptococcic infections. The greatest number of reports of treatment with this drug and related compounds concern erysipelas and puerperal infections, although it has now been used in a wide variety of streptococcic infections, including purulent pleurisy, purulent otogenic meningitis, septicemia, chronic pemphigus, endemic lymphangitis, and pyuria (in children). It is indicated in streptococcic peritonitis which may develop following rupture of inflamed appendix or ulcer. Particularly striking results have been noted in conditions known to be due to beta-hemolytic streptococci.

Parke-Davis Sulfanilamide is administered orally, two or three 5-

1

grain tablets being the common in-
dividual dose, to be repeated at four
hour intervals (30 to 75 grains
daily). In beginning treatment,
especially if the infection is severe,
20-grain doses may be repeated at
four-hour intervals for four or five
doses. After two or three days of
treatment, dosage can usually be
reduced, giving one or two 5-grain
tablets, three or four times daily. In
treatment of children, dosage must
be proportionately reduced, largely
according to weight.

DEVELOPMENT OF
SULFANILAMIDE

It has seemed hitherto, as is ob-
served in a *Lancet*¹ editorial that
some radical differences between
protozoal and bacterial infections
offered an insuperable bar to treat-
ment of the latter by chemical
means. The disappearance of mala-
ria parasites or trypanosomes under
the influence of appropriate drugs
was regularly seen and confidently

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expected. On the other hand chem-
otherapy in bacterial diseases had
been uniformly disappointing.

Recent revival of interest in chem-
otherapy in streptococcic infections
dates from the work of Domagk².
This investigator found that a new
dye synthesized by Mietzch and
Klarer (the hydrochloride of 4-
sulphamido-2:4-diaminobenzene),
exerted distinct protection against
streptococci introduced by intra-
peritoneal injections in mice, the
dye being given by stomach tube.
His work was partially corrobo-
rated by Levaditi and Vaisman³.

This new drug was the subject of
reports which appeared in Germany
in 1935; it is one of a long series of
dye compounds which had been
synthesized in the hope of finding
something of therapeutic utility, and
the original evidence in its favor con-
sisted of experiments in which the
development of streptococcic infec-
tion in mice was prevented by its
administration, and a number of
clinical reports of its effect in acute

3

streptococcic infections in man. These reports and their confirmation on the experimental side by Levaditi and Vaisman were commented on in the *Lancet*.

Heidelberger and Jacobs⁴ in 1919 called attention to the bactericidal action of 4-sulfonamido-phenylazo-hydrocupreine. Trefouel and his co-workers⁵, of the Pasteur Institute (France) recognizing the similar therapeutic action of 4-sulfonamido phenylazohydrocupreine and 4-sul-phamido-2:4-diaminobenzene in-vestigated the hypothesis that both substances act by a similar series of changes within the organism, of which the first would be rupture of the azo linkage to form sulfanila-mide. Their study of a long series of compounds showed that sulfanila-mide, a relatively simple white crys-talline organic compound, was fully as effective in the treatment of beta-hemolytic streptococcus infections as the red dye and was almost devoid of toxic action. Furthermore, they found that it was this portion of the

4

dye molecule which was responsible for its effectiveness, thus substantiat-ing their original hypothesis. These observations were confirmed by Goissedet *et al*⁶.

Buttle and co-workers⁷ succeeded not only in confirming Domagk's original reports on the action of the dye in mice, but were also able to demonstrate that sulfanilamide was superior to it in effectiveness. Cole-brook and Kenny⁸ furnished further evidence of the curative action of sulfanilamide.

Buttle's work and that reported by Colebrook and Kenny are of great significance. It had been shown re-peatedly, years ago, that streptococ-cic infection in mice could be pre-vented if within an hour or two of infection the inoculated area was infiltrated with acriflavine or other substances of similar composition. Experiments with these new dyes might appear to be of the same na-ture, especially so since they are some times referred to as protection ex-periments. The difference is that the

5

action of acriflavine is directly bactericidal and purely local, whereas the action of these new dyes is not due to direct bactericidal action, and is attained by introducing the drug not locally but by the alimentary tract, or by subcutaneous injection remote from the site of infection. Not only do these drugs work at a point distant to the point of introduction but they work when administered some days before or at least some hours after infection. Commenting on these recent developments the *Lancet*¹ said "This is the first time that any drug has been shown to have a specific and regular effect on an acute bacterial infection when administered by mouth."

Buttle *et al*⁷ reported that sulfanilamide (para-amino-benzene sulfonamide) will protect mice against streptococcic infection and that it has the same therapeutic activity as 4-sulfamido-2:4 diaminobenzene but is less toxic when given by mouth, so that it is possible to obtain better protection by giving larger doses.

6

They also reported that protection can be obtained against streptococci belonging to different serologic types.

It was noted by Colebrook and Kenny, and later confirmed by Long and Bliss⁹, that the dye solution (4-sulfamido-2:4 diaminobenzene) had little if any effect on hemolytic streptococci in vitro. Long and Bliss observed that sulfanilamide in concentration of 1:10,000 had a marked bacteriostatic action on beta-hemolytic streptococci when tested in vitro in the presence of beef infusion broth or 50 per cent normal horse serum broth; the same observation was made independently by Colebrook and co-workers.

It has been shown by Domagk, and Colebrook and Kenny and others, that while the dye solution (4-sulphamido-2:4-diaminobenzene) was inactive in vitro it had a very active chemotherapeutic effect in vivo. In an early report, Long and Bliss postulated that a reduction of the chemical substance in solution

7

occurred in vivo in the presence of
infection and that the reduced form
represented sulfanilamide. They
have been able to repeat this obser-
vation in vitro by demonstrating the
bacteriostatic action of dye solution
that has been reduced to the active
form by cysteine hydrochloride¹⁰.

From the foregoing data it may
be seen that sulfanilamide appears
to constitute the active principle of
various related compounds. The
clinical experience with sulfanila-
mide already reported and being
steadily increased indicates that sul-
fanilamide is the most useful drug so
far developed for specific chemo-
therapy in most cases of strepto-
coccic infection.

Long and Bliss were among the
early workers to report experiments
with sulfanilamide. They conclude
"In view of the experimental evi-
dence presented, we believe that
careful clinical use of para-amino-
benzene-sulphonamide and its deriv-
atives in the treatment of human
beings ill with infections due to

8

beta-hemolytic streptococci is war-
ranted.”

This preliminary report was sup-
plemented by a subsequent report
by the same authors<sup>9</sup>, in which they
stated that they were able to confirm
in part the reports of European in-
vestigators regarding the efficacy of
sulfanilamide and its chemical deriv-
atives in treatment of beta-hem-
olytic infections in mice. They
found, however, that mice thus
treated have died of streptococcic in-
fection as late as 74 days after the
infection, or 60 days after discon-
tinuance of treatment. The explana-
tion for this occurrence is not clear,
but since the dye probably acts by
inhibition of bacterial growth dis-
continuance of chemotherapy might
allow organisms to resume multipli-
cation.

REPORT OF SEVENTY
TREATED CASES

In reporting results of treatment of
seventy persons ill with infections
due to beta-hemolytic streptococci,

9

Long and Bliss⁹ stated there were only four deaths and only one of these was considered to represent failure of the specific therapy. The types of infections treated with sulfanilamide or its derivatives covered by this report are shown in the accompanying table.

## TYPES OF INFECTIONS PRODUCED BY BETA-HEMOLYTIC STREPTOCOCCI TREATED WITH PARA-AMINOBENZENESULFONAMIDE AND ITS DERIVATIVES

<table><thead><tr><th>Type of Infection</th><th>No. of Patients</th><th>Recovered</th><th>Died</th></tr></thead><tbody><tr><td>Erysipelas and cellulitis</td><td>19</td><td>19</td><td>0</td></tr><tr><td>Septicemia</td><td>3</td><td>2</td><td>1</td></tr><tr><td>Puerperal Sepsis</td><td>2</td><td>2</td><td>0</td></tr><tr><td>Traumatic orbital cellulitis</td><td>3</td><td>3</td><td>0</td></tr><tr><td>Osteomyelitis</td><td>2</td><td>2</td><td>0</td></tr><tr><td>Cystitis</td><td>3</td><td>3</td><td>0</td></tr><tr><td>Peritonitis</td><td>1</td><td>0</td><td>1</td></tr><tr><td>Tonsillitis</td><td>14</td><td>14</td><td>0</td></tr><tr><td>Peritonsillar infections</td><td>5</td><td>5</td><td>0</td></tr><tr><td>Scarlet Fever</td><td>8</td><td>8</td><td>0</td></tr><tr><td>Ludwig's angina</td><td>2</td><td>0</td><td>2</td></tr><tr><td>Otitis media</td><td>9</td><td>9</td><td>0</td></tr></tbody></table>

Long and Bliss say the clinical reports obtained in treatment of these patients were striking. Although the series was not large enough for accurate statistical analysis based on

10

mortality figures, in practically every instance marked clinical improvement in the patient's condition occurred promptly after administration of sulfanilamide or its derivatives. The observations, both experimental and clinical, made by these authors in the treatment of streptococcic infections lead them to believe that about 48 hours is required before maximum therapeutic effects can be obtained with these drugs. Because of this time factor they feel that if an infection is considered to be due to hemolytic streptococci, treatment should be instituted immediately. Striking results are not to be expected in patients with far advanced infections or those who are moribund when treated.

Long and Bliss estimate the total dose for the first 24 hours on the basis of three tablets (1 Gm.) for each 20 pounds of body weight up to 100 pounds. In the treatment of acute infections they believe 5 grams (15 tablets) of this substance represents the maximum daily dose in

11

adults which may be used with
safety. This total amount is divided
into four doses given at intervals of
six hours. Thus for a patient weigh-
ing 100 pounds these authors con-
sider sixteen tablets the total dose
for the first day and have it admin-
istered in doses of four tablets every
6 hours.

In severe infections in which the
immediate prognosis is grave Long
and Bliss prefer parenteral treat-
ment. Mild or relatively chronic
streptococci infections can be con-
trolled, they say, by oral treatment
alone and as a rule in infections of
little immediate severity from one-
half to two-thirds of the estimated
dose will be effective. The amount
of treatment to be given after the
first day is sometimes difficult to
determine and should depend on the
clinical condition.

In severe streptococcic disease it
has been the practice of Long and
Bliss to continue treatment with the
dosage used on the first day until a
definite improvement has been

12

noted. In streptococcic septicemia
they feel that at least two blood
cultures should be negative before
the total daily dose is decreased. In
moderately severe streptococcic in-
fection, especially if a visible lesion
is present, such as erysipelas, peri-
tonsillar abscess, or scarlet fever,
the course of further treatment must
be determined by appearance of the
lesions and the general clinical con-
dition of the patient. These authors
found that it is rarely necessary to
continue full doses after the second
24 hours of treatment. They point
out, however, that if the drug is dis-
continued too soon a recurrence of
the streptococcic lesion may occur.

In dealing with mild acute strep-
tococcic infections, recovery after ad-
ministration of sulfanilamide is gen-
erally so prompt that it seems safe
to decrease rapidly the amount
being administered. In mild chronic
infections, such as chronic impetigo,
and chronic otitis media, it is often
necessary to administer the drug
over a rather long period, or until a

13

definite clinical and bacteriologic
cure is effected.

Long and Bliss believe it is logical
to expect that the prompt recogni-
tion of hemolytic streptococcic in-ection plus the adequate adminis-
tration of specific chemotherapeutic
agents will greatly lessen mortality
and duration of illness.

GASTRO-INTESTINAL
ABSORPTION

Marshall, Emerson and Cutting¹¹ have recently reported a method of analysis of blood and urine, as well as certain other body fluids, for determination of sulfanilamide in free and combined form. Experiments on dogs, analysis of blood and urine made after administering sulfanilamide by mouth, subcutaneously, or intravenously indicated that this substance is apparently absorbed and excreted rapidly, and in most instances can be almost completely accounted for by direct determination on the urine. No evidence

14

of its being changed in passing
through the dog's organism has been
obtained. The unchanged material
has been isolated from the urine and
identified. It was found that subcu-
taneous administration does not lead
to a higher blood concentration
than oral administration; in fact the
curve of blood concentration (after
subcutaneous injection) is some-
what lower, whereas excretion is
slightly more rapid.

Examination of the curves of
blood concentration after intraven-
ous injection shows that shortly
after injection only a small part of
the injected sulfanilamide remains
in the blood stream. Only a small
fraction is accounted for by urinary
excretion following injections. Ob-
viously sulfanilamide passes readily
from the blood into the tissues.

A comparison of the blood con-
centration and urinary excretion
after oral administration with those
resulting after intravenous injection
suggests nearly complete absorption
from the intestinal tract within three

15

to five hours. The rapidity of absorption was checked by actual determination of the amount of drug remaining in the intestinal tract some hours after oral administration.

## URINARY EXCRETION

The human subject excreted sulfanilamide partly unchanged and partly in conjugated form. Differences in the rate of absorption occur in different persons. It is possible that this drug may be a more delicate test of kidney function than substances now in use.

In certain patients undergoing prolonged treatment with sulfanilamide administered in divided doses throughout the day, Marshall *et al*¹¹ followed urinary excretion and blood level for several days. It was found that it takes from two to three days to establish equilibrium between the amount ingested and the amount excreted. After equilibrium is established it takes about the same time to free the organism of the drug.

16

When the body is in equilibrium with respect to the drug one can frequently account for almost 100 per cent of the daily dose by the daily excretion in free and conjugated form. Blood concentration can be maintained fairly constant for a long time. In one experiment the daily excretion amounted to 0.07 to 0.13 grams per kilogram. To excrete this amount blood concentration of from 11 to 16 milligrams per 100 cubic centimeters are required.

Since sulfanilamide is so rapidly excreted by the kidney it might be expected that with impaired renal function smaller doses would suffice to raise the blood concentration to any given level, and that after suitable administration a much longer time would be required to clear the body of the substance. In two cases studied by Marshall *et al* this was found to be the case. These authors remark that different types of renal insufficiency must be investigated before final conclusions are drawn.

Preliminary determinations indi-

17

cated that sulfanilamide is present in plasma in slightly (about 10 per cent) higher concentration than in whole blood. Experiments on anesthetized dogs show that it is present in saliva and pancreatic juices in slightly lower concentration than in the blood.

## CONCENTRATION IN THE BLOOD

Experimental determination of the concentration of sulfanilamide present in blood of patients undergoing treatment is important from many aspects. It is shown that concentrations between 1:5000 and 1:10,000 can be attained and maintained in blood.

Experiments on mice infected with beta-hemolytic streptococci demonstrate that the maximum curative effect of sulfanilamide is exerted by maintaining a high concentration of this substance in blood and tissues for several days. The two factors which appear most important in determining the concentration

18

in the blood are: (1) the dose per unit of body weight, and (2) the efficiency of the kidney in excreting the drug.

## TOXICITY

The question of how long sulfanilamide can be administered to a patient without any danger can only be finally answered after prolonged clinical experience with the drug. Long and Bliss have observed patients who have been given rather large amounts of this drug (3 to 5 grams per day) over a period of several weeks without any ill effects.

There is little evidence that this compound is appreciably toxic for the human subject. Long and Bliss report the following evidences of toxicity which they have observed: A few patients complain of nausea, ringing in the ears, or slight dizziness shortly after ingestion of the first oral dose. As a rule these symptoms pass off rapidly and so far have not contraindicated use of the compound. Subcutaneous injection may

19

produce fever; oral administration
has been noted to produce fever in
animals but not in human subjects.
This possibility, however, should be
considered in the prolonged treat-
ment of febrile patients. Few patients
have exhibited slight cyanosis
coupled with rapid breathing. These
symptoms are said to be the result
of acidosis. Jaundice developed in
one patient while under treatment
but recovery occurred promptly
after discontinuing treatment.

Subsequently this patient was
given larger doses of sulfanilamide
without recurrence of jaundice.

Colebrook and Kenny report that
sulfhemoglobinemia developed in
three patients while under treat-
ment. The concurrent use of saline
laxatives may be of importance in
production of this condition, al-
though Long and Bliss have noted
development of sulfhemoglobinemia
in three patients who did not receive
saline cathartics. None of the toxic
manifestations observed by Long
and Bliss has been severe.

20

ADMINISTRATION AND
DOSAGE

Since the blood concentration curves
in the human subject following a
single dose by mouth usually resem-
ble those obtained with dogs, Mar-
shall *et al* conclude that absorption
is in most instances complete or
nearly complete in man in about
four hours. For this reason if the
daily dose (30 to 75 gr.) is to be
divided in order to attempt to main-
tain a nearly uniform concentra-
tion in blood and tissues a four-hour
interval between doses appears to
be indicated. These authors say
that if it is desired to reach quickly
a high blood concentration and
maintain it, a large single dose (e.g.
0.05 grams per kilogram—1/3 grain
per pound of body weight) could be
given and followed after six or eight
hours by the usual dose every four
hours. From their studies these
authors feel that no advantage is
gained by injection in attaining the
desired concentration in the blood.

21

They say "When possible, oral administration would appear to be indicated."

When considering massive dosage, as suggested by Marshall *et al*, it should be noted that Long and Bliss⁹ regard 75 grains (5 Gm.) as the largest daily dose that can be given with safety, and this only in adults.

## PACKAGE

Parke-Davis Sulfanilamide is available in 5-grain tablets, bottles of 25.

22

## BIBLIOGRAPHY

1. Editorial, *Lancet* 1:1303, 1936.

2. Domagk, G., *Deutsche med. Wchnschr.* 61:250, 1935.

3. Levaditi & Vaisman, *Presse med.*, December 25, 1935, p. 2096.

4. Heidelberger & Jacobs, *J. A. M. A.* 41:2185, 1919.

5. Trefouel *et al.*, *Compt. rend. Soc. de biol.* 120:736, 1935.

6. Goisseder *et al.*, *Compt. rend. Soc. de biol.* 120:1082, 1935.

7. Buttle, Grey *et al.*, *Lancet* 1:1286, 1936.

8. Colebrook & Kenny, *Lancet* 2:1319, 1936.

9. Long & Bliss, *Archives of Surgery* 34:351, 1937.

10. Long & Bliss, *Bull. Johns Hopkins Hosp.* 40:149, 1937.

11. Marshall, Emerson & Cutting, *J. A. M. A.* 108:953, 1937.

12. Levaditi & Vaisman, *Compt. rend. Soc. de biol.* 121:803, 1936.

13. Levaditi & Vaisman, *Presse med.* 43:2097, 1935.

14. Kramer, W., *Munchen med. Wchnschr.* 83:808, 1936.

15. Colebrook, Kenny *et al.*, *Lancet* 1:1297, 1936.

16. Anghelescu, V., *et al.*, *Deutsche med. Wchnschr.* 62:1639, 1936.

17. Bloch, Michel *et al.*, *Presse med.* 44:1583, 1936.

18. Frankl, J., *Klin. Wchnschr.* 15:1563, 1936.

19. Domagk, G., *Klin. Wchnschr.* 15:1585, 1936.

20. Editorial, *J. A. M. A.* 108:32, 1937.

21. Long & Bliss, *J. A. M. A.* 108:32, 1937.

22. Colebrook, Buttle & O'Meara, *Lancet* 2:1323, 1936.

23

23. Nitti, Bovet & Depierre, *Compt. rend. Soc. de biol.* 124:16, 1937.

24. Proom, H., *Lancet* 1:16, 1937.

25. Rosenthal, S. M., *Pub. Health Rep.* 52:49, 1937.

26. Refouel, Nitti & Bovet, *Ann. de l'Inst. Pasteur* 58:30, 1937.

27. Fuller, A. T., *Lancet* 1:194, 1937.

28. Marshall, Cutting & Emerson, *Science* 85: 202, 1937.

29. Southworth, H., *Proc. Soc. Exper. Biol. & Med.* 36:58, 1937.

30. Unshelm, E., *Arch f. Kinderh.* 110:76, 1937.

31. Foulis, M. A., *Brit. M. J.* 1:445, 1937.

32. Frost, L. D. B., *Lancet* 1:510, 1937.

33. Current Comment, *J. A. M. A.* 108:976, 1937.

R44-1

(4-37) 46546

SYRUP of MANDELIC ACID
(AMMONIUM MANDELATE)

MANDELIC ACID is an organic acid which, when given by mouth, is excreted unchanged in the urine. In an acid urine (pH 5.0) a concentration of 0.25 to 0.5 per cent of this acid is reported to be bactericidal for most organisms.¹

Ammonium mandelate, the ammonium salt of mandelic acid, will supply an effective concentration of this organic acid when given in a daily dose of 12 to 14 grams. Moreover, this dose of ammonium mandelate will usually render the urine sufficiently acid to furnish optimum conditions for the action of mandelic acid.

Both mandelic acid and ammonium mandelate have an unpleasant taste. After careful investigation and testing we have developed a vehicle which renders ammonium mandelate acceptable to the patient and less irritating to the gastro-intestinal

1

tract. Syrup of Mandelic Acid, P. D. & Co. makes it possible to obtain the full benefit of this new treatment of urinary infections without necessity for rigorous (ketogenic) diets.

## CLINICAL USE OF MANDELIC ACID

Dolan² has recently described his successful use of ammonium mandelate in urinary infections. His directions as to dosage are quoted:

> "In using this treatment the patients are given 2 drachms of the 40 per cent elixir of ammonium mandelate, which amounts to 3 gm. of mandelic acid, four times daily in a small quantity of water. The total fluid intake in twenty-four hours should not exceed 1 liter of fluid, actually measured at the beginning of each twenty-four hours and evenly distributed to maintain a balanced concentration. The patient, if not hospitalized, is cautioned against the use of all other drugs, also foods and fruit juices, which might readily produce an alkaline

2

urine. No other restrictions seem necessary. If the patient is not physically incapacitated he may carry on his usual occupation. We have maintained, however, a close check on each patient with a daily cell count of the urine and a pH determination. This observation is obviously necessary for proper control of the case."

The success of this treatment depends on two factors: maintenance of an effective concentration of mandelic acid in the urine, and maintenance of an acidity of the urine of approximately pH 5.0. It has been established that administration of 12 gm. of mandelic acid as ammonium mandelate (one ounce of Syrup Mandelic Acid, P. D. & Co.) per day will provide a sufficient urinary concentration of the acid and will in addition cause a reduction of urinary pH to effective levels. Rigid dietary restriction is not necessary while the patient is receiving ammonium mandelate, but it is essential that alkalinizing drugs and drinks, citrus

3

fruits and fruit juices be entirely
avoided. Alkaline-ash foods such as
leafy vegetables, apricots, dates, lima
beans (canned and fresh), carrots,
beets, and parsnips should be omitted
also.

In all cases it is necessary to check
urinary acidity to insure that opti-
mum conditions are present for man-
delic acid to be effective—namely
pH value of from 5.0 to 5.5. Simply
testing the urine each day will often
forestall failure of the treatment. It
should be impressed on the patient
that milk of magnesia, baking soda,
mineral waters, etc., are alkalinizing
and must not be taken during this
treatment.

CHECKING URINARY ACIDITY

We strongly advise that urinary
acidity be checked daily during ad-
ministration of mandelic acid. This
relatively simple laboratory proce-
dure will greatly aid the physician
in determining whether or not the
patient is taking the medication as
prescribed, and whether or not he is

4

following instructions with regard to
diet and avoidance of alkaline drinks
and medication; daily urinalysis has
the further value of checking thera-
peutic effectiveness of the treatment.

Approximate urinary pH may be
determined quickly and easily by use
of an appropriate indicator. There
are two indicators, either of which
can be used. Chlorphenol red is
yellow in solutions whose pH is 5.0
or less. It changes to red at pH 6.6.

If the urine is concentrated and
highly colored it should first be di-
luted with an equal volume of dis-
tilled water. Place 10 cc. of the urine
(diluted if necessary) in a test tube.
Add 0.5 cc. (ten drops) of a 0.04 per
cent solution of chlorphenol red and
shake. A yellow color indicates that
the urine is sufficiently acid. Red
color shows the urine is not suffi-
ciently acid.

A second indicator which may be
used exactly as above and in the
same strength (a 0.04 per cent solu-
tion) is bromcresol purple. This dye-
indicator is yellow in solutions of pH

5

5.4 or less; therefore, the development of a yellow color following its addition to the urine (diluted if necessary) indicates a satisfactory acidity. In a neutral or alkaline urine bromcresol is, as its name suggests, purple in color.

## DURATION OF TREATMENT

Since the mandelic acid treatment of urinary infections is not as rigorous as the ketogenic diet regime it may be continued somewhat longer than is ordinarily feasible with the latter. However, it is believed that treatment should not be prolonged beyond twelve to fifteen days in most cases. If the urine still contains viable organisms at the end of this period it is advisable to discontinue the treatment for at least a month when another two-week course may be given.

There have been occasional reports of hematuria following this treatment. While it seems that mandelic acid is relatively harmless in the majority of patients, it is advised

6

that daily urinalysis be made. This should include microscopic examination of urinary sediment for red blood cells and casts, test for albumin, and estimation of the pus and bacteria present. In addition daily determination of urinary acidity should be made as described above. Appearance of urinary albumin and a considerable number of red blood cells and casts during course of treatment should cause its immediate discontinuance.

## CONTRAINDICATIONS

It is too early to state definitely the contraindications to mandelic acid therapy. Certain urologists believe that this treatment is contraindicated in acute pyelitis. It would also seem to be contraindicated in cases of acute nephritis and in certain cases of chronic kidney disease. Concerning the latter group of patients each case must be judged on its own merits—since in many cases the kidney damage is due to urinary infection.

7

## DOSAGE

For adults—one ounce of syrup of mandelic acid per day; given in divided doses of 2 drachms each after meals and at bedtime.

For children under two years of age—one to three teaspoonfuls daily; from 2 to 5 years—three to four teaspoonfuls; from 5 to 12 years—four to six teaspoonfuls. In all cases the medication is to be given in divided doses—four or more per day —and is best tolerated when given after meals or a feeding.

The above recommendations are to be used as guides but should be supplemented by daily urinalysis and determination of urinary acidity.

## PACKAGE INFORMATION

Syrup of Mandelic Acid P. D. & Co. contains 185 grains of Mandelic acid as ammonium mandelate per ounce. It is supplied in pint bottles.

8

## MANDELIC ACID AND URINARY INFECTION

The mandelic acid therapy of urinary infections is a direct outgrowth of the observations of Clark and Helmholz that beta-hydroxybutyric acid is a bacteriostatic and bactericidal agent in acid urine. Growth of colon bacilli is inhibited when the pH of the medium falls below 5 (acid) or rises above 9.2 (alk.)³. This fact has long been utilized in treating bacillary infections of the urinary tract. In 1931 Clark⁴ and Helmholz⁵ showed that certain ketone bodies exerted a bacteriostatic or bactericidal effect in the urine beyond that attributable to acidity alone. Fuller⁶ showed that the substance responsible for these effects was the levorotatory form of beta-hydroxybutyric acid.

Helmholz and Osterberg⁷ showed clearly that two factors, acting synergistically, are responsible for the observed bacteriostasis or bacteriolysis. One is the concentration of the organic acid (beta-hydroxybutyric or mandelic), the other the acidity of the urine. Their "in vitro" experiments revealed that "a concentration of beta-hydroxybutyric acid of 0.5 per cent at a pH below 5.5 is usually bacteriostatic and frequently is bactericidal for organisms found in urinary infections. A normal urine of pH 5.0 or above does not inhibit the growth of Escherichia coli or other organisms in vitro. At pH 5.0 a 0.4 per cent solution of beta-hydroxybutyric acid is bacteriostatic." This work included studies on Escherichia coli, Proteus vulgaris, Aerobacter aerogenes,

9

Staphylococcus and Streptococcus fecalis. Although it is generally agreed that staphylococcic and streptococcic infections of the urinary tract are considerably less amenable to the type of therapy under consideration, Helmholz and Osterberg showed that staphylococci (two types) were killed, or had their growth inhibited when a concentration of beta-hydroxybutyric acid of 0.5 per cent and a hydrogen ion concetration (pH) of 5.0 or 5.2 were established. There have also been a few reports of spectacular results in chronic staphylococcic urinary infections following mandelic acid therapy.

Since beta-hydroxybutyric acid is readily
metabolized in the body its oral administra-
tion does not obtain effective concentration in
the urine. The only practical way of procuring
significant concentration of beta-hydroxy-
butyric acid in the urine is to place the subject
on a so-called ketogenic diet. These diets are
constructed so as to limit carbohydrates and
alkaline-ash foods, and to feed so much pro-
tein and fat that the organism cannot com-
pletely metabolize all of the latter. The result
is accumulation in the blood and subsequent
excretion in the urine of considerable amounts
of ketone bodies. Ketogenic diets consist for
the most part of cream, eggs, milk, butter and
bacon. Such a diet becomes very unpalatable
after a few days and its use for prolonged
periods is attended by considerable difficulty
and some danger.

Rosenheim⁸ investigated several organic
acids and was successful in finding one—
mandelic acid—which, when fed by mouth,
was excreted in the urine unchanged. Clinical

10

trials of mandelic acid indicate that it is very
effective in combating urinary infection when
properly used.

AMMONIUM MANDELATE

Ammonium mandelate was introduced by Holling and Platt⁹ as a refinement of mandelic acid therapy. Prior to their work it was customary to administer the acid in the form of its sodium salt so as to avoid gastric irritation, but that required the additional administration of ammonium chloride in order to acidify the urine. Ammonium mandelate, however, has an advantage in that the ammonia is metabolized to urea, leaving free (mandelic) acid radicals to acidify the urine.

CLINICAL REPORTS

Helmholz and Osterberg¹ showed that by oral administration of mandelic acid in the form of one of its salts a urinary concentration of the acid varying from 0.25 to 1.0 per cent could be readily obtained; and, further, that "In this range of concentration the acid will act bactericidally on most organisms at a pH ranging from 5.0 to 5.7."

Carroll et al.,¹⁰ reported their results of the mandelic acid treatment in 50 cases of urinary infection. Thirty-seven of these cases were B. coli infections and in this group all but two were cleared of infection—a very gratifying percentage. The average days of treatment required to produce negative urine was 7.1. In six cases of B. proteus infection there was complete clearing in one case, improvement in another and failure in the remaining four. In seven cases of this series the infecting or-

11

organisms were staphylococci. In four of these
there was improvement but in none was there
complete clearing.

Cook and Buchtel¹¹ used mandelic acid
with ammonium chloride or ammonium
nitrate in seventy-five patients with com-
pletely successful results in sixty-one. More
recently these same workers used ammonium
mandelate in twelve patients with bacillary
infections of the urinary tract; in eleven of
these the urine was sterilized.

12

BIBLIOGRAPHY

1. Helmholz & Osterberg, Rate of excretion and bactericidal power of mandelic acid in the urine. *J. A. M. A.* 107:1794, 1936.

2. Dolan, L. P., Experiences with ammonium mandelate in urinary infections. *J. A. M. A.* 107:1800, 1936.

3. Shohl & Janney, The growth of bacillus coli in urine at varying hydrogen ion concentration. *J. Urol.* 1:211, 1917.

4. Clark, A. L., Escherichia coli bacilluria under ketogenic treatment. *Proc. Staff Meet.*, Mayo Clin. 6:605, 1931.

5. Helmholz, H. F., The ketogenic diet in the treatment of urinary infections of childhood. *J. A. M. A.* 99:1305, 1932.

6. Fuller, A. T., The ketogenic diet: nature of bactericidal agent. *Lancet* 1:855, 1933.

7. Helmholz & Osterberg, The bactericidal effect of levorotatory and racemic beta-oxybutyric acid in urine. *J. Urol.* 35:86, 1936.

8. Rosenheim, M. L., Mandelic acid in the treatment of urinary infections. *Lancet* 1:1032, 1935.

9. Holling & Platt, Mandelic acid and ammonium mandelate in the treatment of urinary infections. *Lancet* 1:769, 1936.

10. Carroll et al., Mandelic acid as a urinary antiseptic. *J. A. M. A.* 107:1796, 1936.

11. Cook & Butchtel, Mandelic acid in the

13

treatment of infections of the urinary tract. J. A. M. A. 107:1799, 1936.

12. Rosenheim, M. L., Mandelic acid in the treatment of urinary infections. *Lancet* 2:1083, 1936.

13. Newns & Wilson, Mandelic acid in the treatment of pyelitis in childhood. *Lancet* 2:1087, 1936.

14. Bramwell, R. R., Mandelic acid in the treatment of twenty-three cases of urinary infection. *Quart. J. Med.* 29:534, 1936.

R 39-2 (2-37)

45611

Adhesions are the bane of abdominal surgery and in many cases detract greatly from what would otherwise be brilliant surgical results. The prevention of intra-abdominal adhesions is a matter of very great practical importance.

PAPAIN
IN ABDOMINAL
SURGERY

USE of purified papain for prevention of intra-abdominal adhesions is based on the work of Walton, Ochsner & Garside, and others. Study of this preparation has been carried on intensively during the past nine years.

Ochsner and his associates, Department of Surgery, Tulane University Medical School, instituted in 1928 an experimental study of measures designed to accomplish the following effects: (1) To prevent the initial formation of adhesions following abdominal surgery and (2) to prevent the reformation of adhesions eliminated by surgical methods during operations.

After four or five years study on animals and human subjects Ochsner and Garside³ published a pre-

5

liminary report on the prevention
of peritoneal adhesions by the use
of digestive ferments. They re-
ferred to the beneficial effects of
dilute solutions of papain and
trypsin, when placed in the ab-
dominal cavity at the time of
operation, in preventing the for-
mation and reformation of
peritoneal adhesions. The labora-
tory of Parke, Davis & Company
was cooperating with Dr. Ochs-
ner throughout this initial period
of investigation and at his sug-
gestion, began to distribute ster-
ile, standardized, and purified
papain for experimental purposes.
Papain was selected since it
remains active in the peritoneal
cavity for long periods of time in
contrast to other enzymes, such as
trypsin, which rapidly lose their
activity when brought into con-
tact with serum.

Clinical studies were pursued
for another period of four years in
conjunction with forty or fifty
well known surgeons. The result

6

of this study has been summarized
recently by Ochsner and Storck<sup>4</sup>,
under the title of "Papain Preven-
tion of Peritoneal Adhesions."

The salient features of this
report are:

1. Purified Papain (P. D. & Co.) in dilutions of 1 to 20,000 in physiologic Hartmann's solution is effective in preventing the formation and reformation of peritoneal adhesions in 199 or 88.8 per cent of 224 cases.

2. Many of the cases had "adhesion diathesis" (tendency) or "keloid tendency" (excessive scar formation) because 122 of 231 cases studied had had previous operations and in 46.9 per cent of instances the previous operation had been for adhesions.

3. Thirty-seven cases were op-
erated on after the use of papain
intra-abdominally. In 22, or 59.4
per cent, of the cases there were
no adhesions found although many
and massive adhesions had been
found at the initial operation.

7

4. There were four deaths (1.8 per cent) in the series of 231 cases, none of which was attributed to the use of papain solution.

5. Ochsner's method of using papain solution in this procedure required from 250 to 1500 cc. of the 1 to 20,000 solution, the average amount per patient being 1095 cc. An average quantity of a liter would, therefore, require the use of one ampoule of Purified Papain (P. D. & Co.).

The solution is best prepared by emptying the contents of one ampoule (approximately 50 milligrams) of papain into a sterile mortar and adding a small amount of sterile Ringer's or Hartmann's solution. By using mortar and pestle, dissolving the papain is greatly expedited. A small amount of Ringer's or Hartmann's solution may be used to rinse out both the ampoule and the mortar. As soon as the papain is dissolved in the smaller amount of solution, this is then made up

8

to one liter by addition of more of the same solution.

After the division of all the peritoneal adhesions and just prior to putting in the last serosal suture, a catheter to which a funnel is attached is introduced into the peritoneal cavity. As much papain solution (at body temperature) is introduced into the peritoneal cavity as is possible.

The purified enzyme is stable in dry form but loses activity rapidly in solution. Each ampoule will contain a sufficient quantity of standard, purified, sterile papain powder to prepare 1000 cc. of a 1 to 20,000 solution.

Solutions should be made up as needed, with careful attention to asepsis. Solutions are not stable to heat and therefore cannot be heat sterilized.

Each lot of purified papain is standardized for enzymatic activity by a special "fibrin digestion method" developed by R. P. Walton, of Tulane University.

9

PACKAGE INFORMATION

Ampoule 186, contains Papain
Purified, in dry powder form.
Each ampoule contains approxi-
mately 50 milligrams, and is
supplied in boxes of 6 ampoules.

10

Bibliography

1. Fausel, E. G., Experimental Postoperative Intra-abdominal Adhesions, with special reference to the Use of Papain Solution. *M. Times and Long Island M. J.*, 62:1, 1934.

2. Grieco, F., Prevention of Postoperative Peritoneal Adhesions; Experimental Research. *Ann. ital. di chir.*, 13:269, 1934.

3. Ochsner, A., and Garside, E.: Peritoneal adhesions: Their Prevention by the Use of Digestive Ferments. *Surg., Gynec. Obst.*, 54:338, 1932.

4. Ochsner, A., and Storck, A.: The Prevention of Peritoneal Adhesions by Papain. *Ann. Surg.*, 104:736, 1936.

5. Walton, R. P.: Behavior of Papain in the Peritoneal Cavity. *J. Pharmacol. and Exper. Therap.*, 43:487, 1931.

6. Walton, R. P.: Sterilization and Standardization of Preparations Intended for Surgical Use. *J. Lab. & Clin. Med.*, 17:459, 1932.

R 41-1

(6-37) 46842

FROM THE PRESS OF PARKE. DAVIS & CO., DETROIT, U. S. A.

# Physicians' Reference List of Biological Products

INCLUDING SERUMS, BACTERINS AND TUBERCULINS
FROM THE LABORATORIES OF PARKE, DAVIS & CO.

## ANTIDIPHTHERIC SERUM AND GLOBULINS.

An antidiphtheric unit is the amount of antitoxin required to protect the life of a 250-gramme guinea pig for four days against the L+ dose of diphtheria toxin. The L+ dose of toxin is the amount of toxin which will kill a 250-gramme pig in the presence of an immunity unit of antitoxin as supplied by the U. S. Government.

### Antidiphtheric Serum (in syringe containers).

<table><tr><td>FYLAW</td><td>Bio. 1. 500 units.</td><td>per pkg. $1 10</td></tr><tr><td>FYLBO</td><td>Bio. 2. 1000 units.</td><td>per pkg. 2 00</td></tr><tr><td>FYLCA</td><td>Bio. 3. 2000 units.</td><td>per pkg. 3 50</td></tr><tr><td>FYLDE</td><td>*Bio. 4. 3000 units.</td><td>per pkg. 5 00</td></tr><tr><td>FYLEZ</td><td>Bio. 5. 4000 units.</td><td>per pkg. 6 50</td></tr><tr><td>FYLFE</td><td>Bio. 6. 5000 units.</td><td>per pkg. 7 50</td></tr></table>

### Concentrated Antidiphtheric Serum (Globulin) (in syringe containers).

<table><tr><td>FYLHU</td><td>Bio. 15. 500 units.</td><td>per pkg. 1 10</td></tr><tr><td>FYLIB</td><td>Bio. 16. 1000 units.</td><td>per pkg. 2 00</td></tr><tr><td>FYLJY</td><td>Bio. 17. 2000 units.</td><td>per pkg. 3 50</td></tr><tr><td>FYLKA</td><td>*Bio. 18. 3000 units.</td><td>per pkg. 5 00</td></tr><tr><td>FYLLO</td><td>Bio. 19. 4000 units.</td><td>per pkg. 6 50</td></tr><tr><td>FYLME</td><td>Bio. 20. 5000 units.</td><td>per pkg. 7 50</td></tr><tr><td>FYTOK</td><td>Bio. 21. 7500 units.</td><td>per pkg. 10 00</td></tr><tr><td>FYTPY</td><td>Bio. 22. 10,000 units.</td><td>per pkg. 12 00</td></tr></table>

### Antidiphtheric Globulins (Dry).

<table><tr><td>FYLNI</td><td>Bio. 81. In bulbs of 3000 units.</td><td>per bulb. 5 00</td></tr></table>

*Administration.*—The average dose is 3000 to 5000 units in mild cases. In laryngeal diphtheria an initial dose of 5000 units is advisable. Children require as large doses as adults, because they are more susceptible to the disease and have less power of resistance. In very severe cases and when the disease is well advanced, use from 5000 to 10,000 units as the initial dose. The dose should be repeated every six hours if improvement is not observed.

The Concentrated Antidiphtheric Serum (Globulin) enables the physician to use large doses in small bulk. The dry "Globulins" is a concentrated and practically permanent antitoxin, always ready for use. Send for descriptive circulars.

*Supplied on unspecified orders.

In ordering by telegraph, the code word, representing the product and package opposite which it stands, may be used.

2

ANTIGONOCOCCIC SERUM.

FYLOC Bio. 95. In boxes containing three sealed glass bulbs of 2 Cc. each...................per box. $5 00

Used in the treatment of the complications and sequelæ of gonorrhea.

Dose: Two Cc. hypodermatically into loose subdermal tissue. Repeat the dose at intervals of two to four days, as indicated. Send for literature.

ANTIMENINGITIC SERUM.

FYTSE Bio. 170. In 15-Cc. syringe containers, 2 in a package, with long needle and stylet.......per pkg. $5 00

Used in the treatment of epidemic cerebrospinal meningitis. A special needle and stylet for lumbar puncture are provided in each package, together with full directions for use.

ANTISTREPTOCOCCIC SERUM.

FYLRO *Bio. 110. 10 Cc. in syringe container.........per pkg. $1 50

FYMKE Bio. 111. 10 Cc. in glass bulb, 3 bulbs in box...per box. 4 50

FYLPY Bio. 112. 20 Cc. in syringe container.........per pkg. 3 00

Used in the treatment of erysipelas, pneumonia, pyemia, scarlatina, tuberculosis with secondary infection, puerperal sepsis, streptococcus infections following injuries, etc.

Dose: In mild cases 10 Cc. may be injected every eight to twelve hours. In severe infections 20 to 40 Cc. will be required at the same intervals until a decline of temperature occurs. Write for literature.

ANTITETANIC DUSTING POWDER.

FYLWO Bio. 125. In 1-Gm. vials...................per vial. $1 00

Used in the local treatment of wounds suspected of being infected. Apply immediately after the injury, or within six hours.

ANTITETANIC GLOBULINS (DRY).

FYLSU Bio. 130. In sealed glass bulbs containing 1500 anti-tetanic units...................per pkg. $2 50

Antitetanic Globulins is a potent and practically permanent preparation for emergency use. It keeps for years in the unbroken package.

ANTITETANIC SERUM.

FYMFI Bio. 140. 1500 units in plain bulb, boxes of 3...per box. $4 75

FYLXU *Bio. 141. 1500 units in syringe container.......per pkg. 2 50

FYLTA Bio. 142. 3000 units in syringe container.......per pkg. 4 25

FYLGO Bio. 143. 5000 units in syringe container.......per pkg. 6 00

Most valuable as a prophylactic in cases in which tetanus infection is suspected. Prophylactic dose: 1500 units as soon as possible after the receipt of the injury, and repeated in ten days.

3

As a therapeutic agent after the development of the characteristic symptoms large and frequently repeated doses are imperatively indicated —3000 to 5000 units every hour until the symptoms decline.

An antitetanic unit is the amount of antitoxin required to protect a 350-gramme guinea-pig against ten times the standard dose of tetanus toxin furnished by the U. S. Government.

ANTITUBERCLE SERUM.

FYMAX Bio. 160. In 1-Cc. bulbs...................per case of 10. $1 50

FYMBU *Bio. 161. In 2-Cc. bulbs...................per case of 10. 3 00

FYMCO Bio. 162. In 4-Cc. bulbs...................per case of 10. 6 00

PASTEUR ANTIRABIC VACCINE (Cumming).

FYJVA Bio. 440. In graded and numbered doses, each dose in a 2-Cc. syringe equipped with needle, etc.—7 syringes in a case...................3 cases.$50 00

For the prevention of rabies after exposure.

Full treatment with the Pasteur Antirabic Vaccine (Cumming) consists of 21 doses of 2 Cc. each, or the contents of three cases. Orders will be filled from the laboratory direct, in installments of seven doses.

BACTERIAL VACCINES (BACTERINS).

Parke, Davis & Co.'s Bacterial Vaccines or Bacterins are supplied in rubber-stoppered glass bulbs and in glass syringe-containers holding 1 Cc. The latter afford a most convenient means of administering the vaccines. The dose may be accurately measured by the aid of a graduated scale on the barrel of the syringe. For complete information on the vaccine therapy, please write for literature, which will be sent post-paid to any medical practitioner.

Acne Vaccine (Acne Bacterin)

FYVSI Bio. 176. 20,000,000 in bulb, 4 bulbs in pkg....per pkg. $1 00

FYVTA Bio. 177. 20,000,000 in syringe, 1 in package....per pkg. 50

FYVUM Bio. 178. 20,000,000 in syringe, 4 in package....per pkg. 2 00

FYVVY Bio. 179. 100,000,000 in bulb, 4 bulbs in pkg....per pkg. 1 00

FYVWA Bio. 180. 100,000,000 in syringe, 1 in package....per pkg. 50

FYVXE Bio. 181. 100,000,000 in syringe, 4 in package....per pkg. 2 00

Used in the treatment of non-pustular acne, or come-dones, due to the presence of the Bacillus acne.

Dose: 10 to 100 millions.

Acne Vaccine Combined (Acne Bacterin Combined).

Acne bacillus, 100,000,000; Acne diplococcus, 100,000,000; Staphylococcus albus, aureus, and citreus, of each 100,000,000—total, 500,000,000.

FYWJI Bio. 182. 500,000,000 in bulb, 4 bulbs in pkg....per pkg. $1 00

4

## Acne Vaccine Combined—Continued.

<table><tr><td>FYWLU</td><td>Bio. 183. 500,000,000 in syringe, 1 in package...per pkg.</td><td>$0.50</td></tr><tr><td>FYWKO</td><td>Bio. 184. 500,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

For the treatment of acne characterized by both com- dones and pustules. Dose: Fifty to 500 millions. Begin with the minimum dose, 50 millions of the combined bac- teria, or about one-half of one syringe graduation, increas- ing according to the observed reaction.

### Colon Vaccine (Colon Bacterin).

<table><tr><td>FYPHI</td><td>Bio. 190. 200,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYRRE</td><td>Bio. 191. 200,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRPA</td><td>Bio. 192. 200,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr><tr><td>FYPKU</td><td>Bio. 193. 500,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYPLY</td><td>Bio. 194. 500,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYPMA</td><td>Bio. 195. 500,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

Colon Vaccine is used in the treatment of rectal abscess, fistula in ano, chronic cystitis, pyosalpinx, pyelitis, renal abscess, prostatitis, colon infection of the hepatic duct or the genito-urinary tract, intra-abdominal colon infection, ulceration of the colon, acute jaundice, and vulvo-vaginitis of children.

Dose: Fifty to 100 millions.

### Combined Bacterial Vaccine (Van Cott).

<table><tr><td></td><td>Streptococcus 50,000,000, Staphylococcus Combined 500,000,000, Bacillus coli communis 100,000,000, Pneumococcus 100,000,000—total 750,000,000.</td><td></td></tr><tr><td>FYVNI</td><td>Bio. 225. 750,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYVPO</td><td>Bio. 226. 750,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYVOL</td><td>Bio. 227. 750,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

Used in the treatment of erysipelas, puerperal sepsis, phlegmon, mastoiditis, malignant endocarditis, acute tonsillitis, and obscure suppurative processes. Write for literature.

Dose: ½ to 1 Cc. (400 to 750 millions).

### Furunculosis Vaccine (Furunculosis Bacterin).

<table><tr><td>FYVEJ</td><td>Bio. 240. 400,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYVGI</td><td>Bio. 241. 400,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYVFO</td><td>Bio. 242. 400,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

For the treatment of boils, carbuncles, pustular acne, impetigo contagiosa, and sycosis staphylocogenes. The initial dose should not exceed 100,000,000 to 150,000,000. In six days a second dose, 200,000,000 or 250,000,000, should be given; and the third dose, six days later, may be increased to 300,000,000 or 400,000,000. Subsequent doses as indicated. Write for literature.

5

## Gonococcus Vaccine (Gonococcus Bacterin).

<table><tr><td>FYNE</td><td>Bio. 260. 20,000,000 in bulb, 4 in package...per pkg.</td><td>$1.00</td></tr><tr><td>FYNOF</td><td>Bio. 261. 100,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYRCO</td><td>Bio. 262. 100,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRBE</td><td>Bio. 263. 100,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr><tr><td>FYNNU</td><td>Bio. 264. 500,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYREF</td><td>Bio. 265. 500,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRDI</td><td>Bio. 266. 500,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

Used in the treatment of acute gonorrhea and its complications, including gleet, epididymitis, gonorrheal ophthalmia, prostatitis, arthritis, vulvo-vaginitis.

Dose: Ten to fifty millions in acute cases. In gonorrheal rheumatism (arthritis) from 100 to 200 millions should be given.

### Gonorrheal Vaccine Combined (Gonorrheal Bacterin Combined).

Gonococcus 500,000,000, Staphylococcus Combined 400,000,000—total, 900,000,000.

<table><tr><td>FYVIK</td><td>Bio. 285. 900,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYVKY</td><td>Bio. 286. 900,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYVJU</td><td>Bio. 287. 900,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

For the treatment of gonorrheal infection complicated by the presence of staphylococci. The initial dose is, as a rule, 0.2 to 0.5 Cc. (representing 100,000,000 to 250,000,000 gonococci and 80,000,000 to 200,000,000 combined staphylococci), to be followed if necessary at intervals of five or six days by gradually increasing doses, the quantity to be governed by the symptoms following the previous dose. Write for literature.

### Meningococcus Vaccine (Prophylactic).

<table><tr><td>FYJYC</td><td>Bio. 213. Bulb package (3 bulbs)...per pkg.</td><td>75</td></tr><tr><td>FYJZI</td><td>Bio. 214. Syringe package (3 syringes)...per pkg.</td><td>1.50</td></tr><tr><td>FYKAV</td><td>Bio. 216. Single syringe (3 doses)...per pkg.</td><td>75</td></tr><tr><td>FYKBI</td><td>Bio. 215. Hospital package (30 bulbs)...per pkg.</td><td>3.50</td></tr></table>

For the prevention of cerebro-spinal meningitis. First dose, 500,000,000 bacteria; second and third doses, 1,000,000,000 each. Intervals between doses, seven days.

### Pertussis Vaccine (Pertussis Bacterin).

<table><tr><td>FYJGE</td><td>Bio. 200. 50,000,000 in bulb, 4 in package...per pkg.</td><td>1.00</td></tr><tr><td>FYJHI</td><td>Bio. 201. 50,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYJIX</td><td>Bio. 202. 50,000,000 in syringe, 4 in package...per pkg.</td><td>2.00</td></tr></table>

Employed in the treatment of whooping cough. The usual initial dose is 20,000,000 bacteria, or about one-half the contents of one bulb or syringe, to be increased to 50,000,000 if necessary, the doses being given at intervals of about six days.

6

### Staphylococcus Vaccine (Albus) (Staphylococcus Albus Bacterin).

<table><tr><td>FYNRY</td><td>Bio. 305. 400,000,000 in bulb, 4 in package.....per pkg.</td><td>$1 00</td></tr><tr><td>FYRIG</td><td>Bio. 306. 400,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRHA</td><td>Bio. 307. 400,000,000 in syringe, 4 in package...per pkg.</td><td>2 00</td></tr><tr><td>FYVAG</td><td>Bio. 308. 1,000,000,000 in bulb, 4 in package...per pkg.</td><td>1 00</td></tr><tr><td>FYRSU</td><td>Bio. 309. 1,000,000,000 in syringe, 1 in pkg.....per pkg.</td><td>50</td></tr><tr><td>FYRTO</td><td>Bio. 310. 1,000,000,000 in syringe, 4 in pkg.....per pkg.</td><td>2 00</td></tr></table>

### Staphylococcus Vaccine (Aureus) (Staphylococcus Aureus Bacterin).

<table><tr><td>FYNSA</td><td>Bio. 330. 400,000,000 in bulb, 4 in package.....per pkg.</td><td>1 00</td></tr><tr><td>FYRGY</td><td>Bio. 331. 400,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRFU</td><td>Bio. 332. 400,000,000 in syringe, 4 in package...per pkg.</td><td>2 00</td></tr><tr><td>FYVBU</td><td>Bio. 333. 1,000,000,000 in bulb, 4 in package...per pkg.</td><td>1 00</td></tr><tr><td>FYRUJ</td><td>Bio. 334. 1,000,000,000 in syringe, 1 in pkg.....per pkg.</td><td>50</td></tr><tr><td>FYRVI</td><td>Bio. 335. 1,000,000,000 in syringe, 4 in pkg.....per pkg.</td><td>2 00</td></tr></table>

### Staphylococcus Vaccine (Citreus) (Staphylococcus Citreus Bacterin).

<table><tr><td>FYNTI</td><td>Bio. 350. 400,000,000 in bulb, 4 in package.....per pkg.</td><td>1 00</td></tr><tr><td>FYRKI</td><td>Bio. 351. 400,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRJE</td><td>Bio. 352. 400,000,000 in syringe, 4 in package...per pkg.</td><td>2 00</td></tr><tr><td>FYVCY</td><td>Bio. 353. 1,000,000,000 in bulb, 4 in package...per pkg.</td><td>1 00</td></tr><tr><td>FYRWY</td><td>Bio. 354. 1,000,000,000 in syringe, 1 in pkg.....per pkg.</td><td>50</td></tr><tr><td>FYRXA</td><td>Bio. 355. 1,000,000,000 in syringe, 4 in pkg.....per pkg.</td><td>2 00</td></tr></table>

### Staphylococcus Vaccine (Combined) (Staphylococcus Bacterin, Combined).

<table><tr><td>FYNUG</td><td>Bio. 370. 400,000,000 in bulb, 4 in package.....per pkg.</td><td>1 00</td></tr><tr><td>FYRMU</td><td>Bio. 371. 400,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRLO</td><td>Bio. 372. 400,000,000 in syringe, 4 in package...per pkg.</td><td>2 00</td></tr><tr><td>FYVDA</td><td>Bio. 373. 1,000,000,000 in bulb, 4 in package...per pkg.</td><td>1 00</td></tr><tr><td>FYRYK</td><td>Bio. 374. 1,000,000,000 in syringe, 1 in pkg.....per pkg.</td><td>50</td></tr><tr><td>FYRZE</td><td>Bio. 375. 1,000,000,000 in syringe, 4 in pkg.....per pkg.</td><td>2 00</td></tr></table>

Staphylococcus Vaccine is used in the treatment of furunculosis and carbuncle, sycosis, suppurative acne, eczema, felons, osteomyelitis. If an exact bacteriological diagnosis can be made, the corresponding vaccine should of course be used; if not, use the "Combined." Dose: 50 to 200 millions.

### Streptococcus Vaccine (Streptococcus Bacterin).

<table><tr><td>FYNVO</td><td>Bio. 400. 40,000,000 in bulb, 4 in package.....per pkg.</td><td>1 00</td></tr><tr><td>FYROH</td><td>Bio. 401. 40,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYRNY</td><td>Bio. 402. 40,000,000 in syringe, 4 in package...per pkg.</td><td>2 00</td></tr><tr><td>FYPNE</td><td>Bio. 403. 200,000,000 in bulb, 4 in package.....per pkg.</td><td>1 00</td></tr><tr><td>FYPOG</td><td>Bio. 404. 200,000,000 in syringe, 1 in package...per pkg.</td><td>50</td></tr><tr><td>FYPPO</td><td>Bio. 405. 200,000,000 in syringe, 4 in package...per pkg.</td><td>2 00</td></tr></table>

Used in the treatment of erysipelas, puerperal septicemia, most forms of cellulitis, septic endocarditis, lymphangitis, the secondary infection of pulmonary tuberculosis, etc. Dose: Ten to fifty millions.

7

### Typhoid Vaccine (Prophylactic) (Typhoid Bacterin).

Three-dose packages. First dose, 500,000,000; second dose, 1,000,000,000; third dose, 1,000,000,000.

<table><tr><td>FYDPY</td><td>Bio. 427. Bulb package (3 bulbs)............per pkg.</td><td>$0 75</td></tr><tr><td>FYPGE</td><td>Bio. 426. Syringe package (3 syringes)........per pkg.</td><td>1 50</td></tr><tr><td>FYPFA</td><td>Bio. 428. 1-syringe package (3 doses)........per pkg.</td><td>75</td></tr><tr><td>FYTZE</td><td>Bio. 429. Hospital package (30 doses)........per pkg.</td><td>3 50</td></tr></table>

For preventive inoculation only. The first injection should consist of 500,000,000 bacteria, to be followed at intervals of ten days by a second and a third injection of 1,000,000,000 bacteria each. Write for literature.

### Typhoid-Paratyphoid Vaccine, Prophylactic (Typhoid-Paratyphoid Bacterin).

<table><tr><td>FYHWY</td><td>Bio. 436. Bulb package (3 bulbs)............per pkg.</td><td>75</td></tr><tr><td>FYHXA</td><td>Bio. 435. Syringe package (3 syringes)........per pkg.</td><td>1 50</td></tr><tr><td>FYHYB</td><td>Bio. 437. Single syringe package (3 doses)........per pkg.</td><td>75</td></tr><tr><td>FYHZA</td><td>Bio. 438. Hospital package (30 doses)........per pkg.</td><td>3 50</td></tr></table>

For the prevention of typhoid and paratyphoid infection. Each bulb or syringe contains 2 parts B. typhosus and 1 part B. paratyphosus A and B, killed and ready for injection. To be administered in the same manner and dose as Typhoid Vaccine.

### ERSIPELAS AND PRODIGIOSUS TOXINS (COLEY).

<table><tr><td>FYMJA</td><td>Bio. 451. In packages containing five 1-Cc. bulbs with rubber stoppers................per pkg.</td><td>$1 00</td></tr></table>

Used in the treatment of inoperable sarcoma. Literature on request.

### PHYLACOGENS.

Modified bacterial derivatives manufactured according to the process of Dr. A. F. Schafer. For the treatment of infectious diseases.

#### Erysipelas Phylacogen.

<table><tr><td>FYHOX</td><td>Bio. 585. In 10-Cc. bulbs................per bulb.</td><td>$3 00</td></tr></table>

Dose: Subcutaneous, 5 to 20 Cc.; intravenous, ½ to 5 Cc. The Phylacogen is to be administered daily or according to special indications. Write for literature.

#### Gonorrhea Phylacogen.

<table><tr><td>FYHNY</td><td>Bio. 590. In 10-Cc. bulbs................per bulb.</td><td>3 00</td></tr></table>

8

### Mixed Infection Phylacogen.

FYHMU Bio. 595. In 10-Cc. bulbs...................per bulb. $3.00

For the treatment of surgical and other infections in which no one bacterial type predominates. Dose: Subcutaneous, 5 to 20 Cc.; intravenous, ½ to 5 Cc. The Phylacogen is to be administered daily or according to special indications. Write for literature.

### Pneumonia Phylacogen.

FYHPI Bio. 605. In 10-Cc. bulbs...................per bulb. 3.00

For the treatment of pneumonia. Dose: Subcutaneous, 2 to 10 Cc.; intravenous, ⅛ to 5 Cc. The Phylacogen is to be administered daily or according to special indications. Write for literature.

### Rheumatism Phylacogen.

FYWCA Bio. 580. In 10-Cc. bulbs...................per bulb. 3.00

Not offered as a cure for arthritis deformans, but demonstrated to be of exceptional value in acute and chronic rheumatism.

## TUBERCULINS.

### Purified Tuberculin Discs.

FYMVI Bio. 460. In tubes of 10 discs...................per tube. $2.00

Tuberculin Old is precipitated with alcohol, the residue washed and dried and made into discs, each of which contains 3.3 milligrams.

Directions for use are included in each package.

### Tuberculin B. E.

FYNFU Bio. 470. In glass bulbs, rubber-stoppered, containing 1 milligram of total dry tubercle solids in 1 Cc. liquid...................per bulb. 2.00

Directions for diluting are included in each package and can be had separately in card form.

Dose: The same as of Tuberculin T. R. (concentrated).

### Tuberculin B. F.

FYMWU Bio. 480. In 1-Cc. hermetically sealed bulbs per box of 6. 2.00

This consists of the bouillon in which virulent tubercle bacilli have grown (and therefore contains only the toxins), filtered through porcelain. Used as a therapeutic agent.

Dose: 1-100,000 to 1-1000 milligram. Write for detailed information.

9

### Tuberculin Old (made according to Koch's original process).

FYMYG Bio. 490. In ½-Cc. rubber-stoppered glass bulbs per bulb. $0.60

Used in diagnosis and treatment.

Dose: 1-10 to 1 milligram as a diagnostic test; 1-100,000 to 1-1000 milligram as a therapeutic agent.

### Tuberculin T. R. (Dilute).

FYMXO Bio. 500. In cases of 6 bulbs of 1 Cc. each...................per case. 2.00

Each cubic centimeter contains 1-1000 milligram of dry tubercle solids. Used as a therapeutic agent.

Dose: See Tuberculin T. R. (Concentrated).

### Tuberculin T. R. (Concentrated).

FYNEC Bio. 510. In glass bulbs, rubber-stoppered, containing 1 milligram of total dry tubercle solids in 1 Cc. of liquid...................per bulb. 2.00

Used as a therapeutic agent. Directions for diluting are included in each package and can be had separately in card form.

Dose: 1-1,000,000 to 1-1000 milligram of the tubercle solids, or 1-1,000,000 to 1-1000 Cc. of the liquid.

### Tuberculin Ointment for the Moro Test.

FYNLY Bio. 520. In 2-Gm. collapsible tubes...................per tube. 1.00

About 0.1 Gm. is used in making the diagnosis. Directions are included in each package.

### Tuberculin for the von Pirquet Test.

FYNID Bio. 530. In packages containing three glass tubes hermetically sealed...................per pkg. 50

FYNKI Bio. 531. Scarifier...................per each. 50

Each glass tube contains sufficient material to make one test. Directions are included in each package.

## VACCINE (SMALLPOX).

### Vaccine (Glycerinated) in Tubes.

DOHJI Bio. 560. In cases of 5 capillary tubes (or five vaccinations), with rubber bulb for ejecting and needle for scarifying...................per case. 75

### Vaccine (Glycerinated) Points.

DOJER Bio. 570. In boxes of 5, each point being enclosed in a corked and paraffined glass tube, with the moist glycerinated vaccine in a separate sealed compartment...................per box. 75

10

## GONOCOCCUS ANTIGEN.

FYJWO Bio. 100. In 1-Cc. rubber-stoppered bulbs, 6 in a package...................................per pkg. $5 00

Gonococcus Antigen is the water-soluble portion of polyvalent suspensions of the gonococcus, and is used for the complement fixation test in the diagnosis of obscure cases of gonorrhea. The auxiliary reagents (amboceptor, etc.) are the same as those employed in the fixation test for syphilis, and they, as well as the antigen, are employed in the same proportions. Each bulb contains sufficient antigen for fifteen or sixteen tests.

Send for Illustrated Pamphlet on Bacterial Vaccines and Tuberculins. Mailed Free.

## VETERINARY PRODUCTS.

### ANIMAL VACCINE INJECTOR.

FYBIP Bio. 701. In nickel-plated case, complete...........each. $1 75

FYBJE Bio. 702. In pasteboard box...................each. 1 00

### ANTHRAXOIDS.

FYKZA Bio. 711. In glass vials containing ten each...per vial. 1 75

Anthraxoids are little pills or pellets containing a preparation of killed anthrax germs, and are used for immunizing animals against anthrax, in the same manner and on the same principle as blacklegoids are used for the protection of cattle exposed to blackleg. The Anthraxoids are placed under the animal's skin by means of an animal vaccine injector.

### ANTISTREPTOCOCCIC SERUM, VETERINARY.

FYLVE *Bio. 721. 10 Cc. in syringe container...........per pkg. $1 10

FYMLU Bio. 722. 10 Cc. in rubber-stoppered bottle....per bot. 1 10

FYLUD Bio. 723. In ounce vials...................per pkg. 2 00

The favorable results reported in some forms of streptococcic infection, such as pyemia, arthritis, scirrhous cord, fistula of the withers, poll evil, pneumonia, and general septicemias, naturally lead to the conclusion that this serum may be of considerable value in strangles, bronchitis, distemper, and other conditions due to invasion by streptococci or aggravated by complicating infections brought about by this micro-organism.

Dose: From 10 Cc. to 30 Cc. as frequently as indicated.

### ANTITETANIC SERUM, VETERINARY.

FYHVU Bio. 746. 500 units in syringe container...........per pkg. $0 75

FYMOD Bio. 743. 700 units in syringe container...........per pkg. 1 00

FYMGU Bio. 741. 1500 units in syringe container...........per pkg. 1 25

FYMHY *Bio. 742. 3000 units in syringe container...........per pkg. 2 50

FYLZO Bio. 740. 3000 units in rubber-stoppered vial..per pkg. 2 00

Most valuable as a prophylactic in cases in which tetanus infection is suspected, especially in punctured wounds of the feet to which domestic animals are very much exposed.

Dose: 1500 units, as soon as possible after receipt of the injury. As a therapeutic agent after the development of the characteristic symptoms massive or frequently repeated doses are imperatively indicated, from fifteen to twenty thousand (15,000 to 20,000) units daily until the alarming symptoms have subsided.

11

12

ANTITETANIC SERUM (DRY), VETERINARY.

FYLYF Bio. 752. 1500 units in 1/2-oz. glass-stoppered bottle.... $1 00

FYMIC *Bio. 753. 3000 units in 1-oz. glass-stoppered bottle.... 2 00

Directions for Making Solutions.—Fill the bottle with cold sterilized water, replace glass stopper, and shake till the serum is dissolved.

For prophylactic use in cases of suspected infection, special packages containing 700 and 1500 units respectively are furnished. When a greater quantity of serum is required for prophylactic purposes by the veterinarian a portion or the entire contents of a 3000-unit package may be administered.

For curative purposes inject the contents of one 3000-unit package and repeat the dose as often as the condition of the animal warrants.

INFLUENZA ANTITOXIN (VETERINARY).

FYMPA *Bio. 891. In 30-Cc. rubber-stoppered bottles...per bot. $1 50

FYMRU Bio. 892. In 20-Cc. syringe containers.........per pkg. 1 00

FYJMY Bio. 893. In 10-Cc. syringe containers.........per pkg. 75

An agent for the prevention and treatment of febrile diseases of bacterial origin in horses and mules, such as influenza, often known as catarrhal fever, shipping fever, acclimation fever, yards fever, with its complications and sequelæ of cough, laryngitis, bronchitis, strangles, pneumonia, and purpura hemorrhagica.

Dose: Prophylactic, 20 Cc. ten days before exposure; remedial, 30 to 90 Cc. at intervals of twelve hours. Literature supplied on request.

Canine Distemper Vaccine, Prophylactic.

Bacillus bronchisepticus: 200,000,000 in bulb No. 1, 400,000,000 in bulb No. 2, 600,000,000 in bulb No. 3.

FYWAH Bio. 832. Pkg. of 3 bulbs, No. 1, No. 2 and No. 3..per pkg. $1 00

Begin the treatment about a month before exposure—as at bench shows. Inject the contents of bulb No. 1, following at intervals of three to five days with No. 2 and No. 3.

FYHTO Bio. 811. Packages of 6 tablets, each containing 200,000,- 000 bacteria (B. bronchisepticus)..per pkg.. 1 00

Dissolve one tablet for first hypodermatic injection, two for second, and three for third. Intervals between doses as in the use of the liquid vaccine. If not possible to give more than one dose, this should consist of one tablet only.

Canine Distemper Vaccine, Curative.

Bacillus bronchisepticus, 4 parts; Staphylococcus albus, 1 part; Staphylococcus aureus, 1 part; Streptococcus pyogenes, 1 part. Six doses, containing respectively 175, 350, 525, 700, 875 and 1050 million killed bacteria.

FYWBY Bio. 831. Pkgs. of 6 bulbs, Nos. 1, 2, 3, 4, 5 and 6..per pkg. 2 00

13

Begin the treatment with bulb No. 1, following at intervals of three to five days with No. 2, No. 3, etc., until the six bulbs are used.

FYHUZ Bio. 812. Packages of 21 tablets, each tablet containing 175,000,000 bacteria (B. bronchisepticus, Staphylococcus albus and aureus, and Streptococcus pyogenes)...........per pkg. $2 00

Dissolve one tablet for first hypodermatic injection, two for second, three for third, and so on until six doses are given. Intervals between doses as in the use of the liquid vaccine.

Colon Vaccine, Veterinary (Colon Bacterin).

FYPIF *Bio. 760. In vials of 20 hypodermatic tablets, 100,000,000 bacteria per tablet...................per vial. 2 50

FYPJO Bio. 761. In vials of 10 hypodermatic tablets, 500,000,000 bacteria per tablet...................per vial. 1 30

The hypodermatic form of bacterial vaccines is most convenient, as it permits the veterinarian to make for immediate use any strength of solution desired by simply dissolving a tablet in 5 Cc. or less of sterile water.

Therapeutic Indications.—B. coli communis or its allies are sometimes responsible for such conditions as peritonitis, cystitis, urethritis, renal abscesses, and enteritis. The colon vaccine is especially indicated in these conditions, also for anal fistula, catarrhal jaundice and abdominal abscesses.

Dose: 100 to 500 million, to be increased as indicated.

Equine Influenza Vaccine (Prophylactic).

FYTXY Bio. 771. In vials of 6 tablets, each tablet containing 1 billion killed Streptococcus equi..per vial. 1 00

One tablet represents a single dose; it is to be dissolved in sterile water or salt solution and injected hypodermatically. For more complete immunization a second dose of two tablets and a third of three tablets should be administered at intervals of about ten days. When it is impracticable to give more than one dose, this should consist of one tablet only, precisely as if the dose were the first of a series of three.

Equine Influenza Vaccine Combined (Curative).

FYTYM Bio. 770. In vials of 21 tablets, each tablet containing 300,000,000 killed bacteria (Streptococcus equi, 100,000,000; Staphylococcus pyogenes albus and aureus of equine origin, 200,000,000)...................per vial. 2 00

One vial contains a sufficient number of tablets for six doses, to be administered at intervals of five days and in gradually increasing quantities, as follows: for the first

14

dose, one tablet, dissolved and injected hypodermatically, as in the case of Equine Influenza Vaccine (Prophylactic); for the second dose, two tablets, similarly administered; for the third, three; for the fourth, four; for the fifth, five; for the sixth, six.

### Staphylococcus Vaccine (Combined), Veterinary (Staphylococcus Bacterin, Combined).

<table><tr><td>FYPTA</td><td>*Bio. 781. In vials of 20 hypodermatic tablets, 100,000,000 bacteria per tablet................per vial.</td><td>$2 50</td></tr><tr><td>FYPUH</td><td>Bio. 782. In vials of 10 hypodermatic tablets, 500,000,000 bacteria per tablet................per vial.</td><td>1 30</td></tr></table>

Indicated in the treatment of fistulous withers, poll evil, scirrhous cord, pyemic arthritis, quittor, infected wounds such as nail punctures, calk wounds, barbwire cuts and surgical wounds; also all purulent conditions due to infection with staphylococci.

Initial dose: 100 to 500 million, to be increased if indicated. Write for literature.

### Streptococcus Vaccine, Veterinary (Streptococcus Bacterin).

<table><tr><td>FYPRU</td><td>*Bio. 801. In vials of 20 hypodermatic tablets, 100,000,000 bacteria per tablet................per vial.</td><td>2 50</td></tr><tr><td>FYPSY</td><td>Bio. 802. In vials of 10 hypodermatic tablets, 500,000,000 bacteria per tablet................per vial.</td><td>1 30</td></tr></table>

### Streptococcus and Staphylococcus Vaccine Combined, Veterinary (Streptococcus and Staphylococcus Bacterin, Combined).

<table><tr><td>FYPWI</td><td>*Bio. 821. In vials of 20 hypodermatic tablets, 100,000,000 bacteria per tablet................per vial.</td><td>2 50</td></tr><tr><td>FYPXO</td><td>Bio. 822. In vials of 10 hypodermatic tablets, 500,000,000 bacteria per tablet................per vial.</td><td>1 30</td></tr></table>

*Therapeutic Indications.*—These vaccines are indicated in the treatment of fistulous withers, poll evil, scirrhous cord, quittor, strangles, influenza, lymphangitis, pyemic arthritis, infected wounds such as open joints, nail punctures, calk wounds, wire cuts, and surgical wounds; also in nasal gleet, suppurative ophthalmia, and all purulent conditions in general due to invasion by the staphylococcus or streptococcus, or both. For best results select the vaccine indicated by the nature of the infection and the discharge.

Initial dose: From 100 to 500 millions, to be increased if necessary until desired results are obtained. Write for literature.

15

## BLACKLEGOIDS.

### Blacklegoids, Single (Blackleg Vaccine).

<table><tr><td>FYBMA</td><td>*Bio. 881. In vials of 10 (ten vaccinations).....per vial.</td><td>$1 50</td></tr><tr><td>FYBNY</td><td>Bio. 862. In packages of 50 (five vials of 10)....per vial.</td><td>6 00</td></tr></table>

### Blacklegoids, Double (Blackleg Vaccine).

<table><tr><td>FYBOR</td><td>*Bio. 871. In cases containing two vials of ten Blacklegoids each................per case.</td><td>2 00</td></tr><tr><td>FYBPA</td><td>Bio. 872. In packages containing ten vials of ten Blacklegoids each................per pkg.</td><td>8 00</td></tr></table>

Blacklegoids, the most convenient and accurate form of blackleg vaccine, are little pellets about the size of small bird-shot, to be injected under the animal's skin by means of an animal vaccine injector. They are intended for one specific purpose only—to prevent blackleg in cattle. A single dose will generally protect for a period of three months to a year, according to the age of the animal. A double dose affords greater protection, but not, so far as known, for a greater length of time. Full directions for use accompany each package, and special literature can be had on request.

Single Blacklegoids are for the use of those who handle cattle in large numbers on the range when only one dose can be given, or when it is impossible to give the second injection of Blacklegoids within the time limit required for the use of Double Blacklegoids. Practical experience has proved their efficacy beyond a doubt.

Double Blacklegoids are made to be administered in two doses to complete one vaccination of each animal, No. 2 being injected twelve days after No. 1 has been given. The best authorities agree that two doses given as above confer the greatest immunity against blackleg. They are especially recommended for use on thoroughbred stock and stock in poor condition.

### MALLEIN (CONCENTRATED, for Veterinary Use).

<table><tr><td>FYMSO</td><td>*Bio. 910. In vials containing a quantity sufficient to make one test................per vial.</td><td>35</td></tr><tr><td>FYMTE</td><td>Bio. 911. In vials containing a quantity sufficient to make two tests................per vial.</td><td>65</td></tr><tr><td>FYMUF</td><td>Bio. 912. In vials containing a quantity sufficient to make five tests................per vial.</td><td>1 50</td></tr></table>

A preparation of the toxins of glanders, or farcy, for diagnosing the early stages of the disease in horses, mules, etc. The typical reaction manifests itself by a rise of temperature and a persistent swelling

16

at the site of injection. To provide for dilution of the Mallein without loss or contamination, each vial is of such a size that it has only to be filled with water or 0.5 per cent. carbolic acid solution (preferably the latter) to make a test fluid of the proper strength. Directions for use accompany each vial.

## PHYLACOGENS.

Modified bacterial derivatives, manufactured according to the process of Dr. A. F. Schafer. For the treatment of infectious diseases.

### Mixed Infection Phylacogen (Veterinary).

Prepared from mixed cultures, including the pyogenic staphylococci and streptococci, Bacillus coli communis and Bacillus pyocyaneus of equine origin.

FYWDU Bio. 960. In 30-Cc. bottles........................per bot. $1 50

For the treatment of strangles, abscesses, quittors, fistula of the withers, poll evil, pyemic arthritis, scirrhous cord, and all other suppurative conditions.

Dose, 30Cc. subcutaneously every twelve hours for six or more doses.

### Pneumonia Phylacogen (Veterinary).

Representing mixed bacterial cultures, including the pyogenic staphylococci and streptococci, Bacillus coli communis and Bacillus pyocyaneus of equine origin, combined with cultures of Diplococcus pneumonitis, all being grown on special culture media.

FYWEK Bio. 950. In 30-Cc. bottles........................per bot. 1 50

Dose: 30Cc. subcutaneously every twelve hours, until six or more doses are administered.

## TUBERCULIN FOR VETERINARY DIAGNOSIS.

FYNAZ *Bio. 920. In packages of 4 bulbs, each containing sufficient to make one test............per pkg. 75

FYMZA Bio. 921. In vials containing a quantity sufficient to make four tests................per vial. 60

FYNDA Bio. 922. In vials containing a quantity sufficient to make thirty tests................per vial. 3 75

A preparation of the water-soluble toxins of the tubercle bacillus, made according to the original formula of Prof. Koch, for the diagnosis of obscure tuberculous processes in cattle. Universally endorsed by veterinarians. Directions for use accompany each vial.

68324

# Furunculosis Vaccine

(FURUNCULOSIS BACTERIN)

USED IN THE TREATMENT OF
FURUNCULOSIS AND PUSTULAR ACNE

## PREPARATION.

In the preparation of Furunculosis Vaccine several strains of Staphylococcus pyogenes aureus, isolated from boils and carbuncles, are grown on plain agar, washed off with physiologic salt solution, and the liquid is shaken to separate the organisms thoroughly from one another. The suspension is then sterilized with heat and diluted until each cubic centimeter contains the desired number of bacteria. Trikresol (0.2%) is added as a preservative.

## CLINICAL TESTS.

Before deciding to add this vaccine to our list of biological preparations it was thoroughly tested clinically in our Department of Experimental Medicine. The reports show that of 81 patients treated by means of injections of Furunculosis Vaccine seventy were markedly benefited. In some cases but two or three doses were required; others were kept under treatment two to three weeks. Cases treated with autogenous vaccines and by other means failed to show improvement until recourse was had to Furunculosis

3

4

Vaccine, the use of which was promptly followed by beneficial results.

## THERAPEUTICS AND DOSE.

In the treatment of boils, carbuncle, pustular acne, impetigo contagiosa, and sycosis staphylogenes, this vaccine has proved of value in the hands of a considerable number of clinicians. The initial dose should not exceed 100 to 150 millions. Within six days the second dose, of 200 to 250 millions, should be given; the third dose, six days later, may be increased to 300 or 400 millions. Succeeding doses are administered at such intervals and in such amounts as may be indicated by the clinical manifestations of each case.

## DIRECTIONS FOR USE.

The vaccine is administered subcutaneously by means of the ordinary hypodermatic syringe, in the usual manner—it being a prime requisite that the instrument be sterilized. (A ready means of sterilizing the syringe is to wash it out repeatedly with a warm five-per-cent. solution of carbolic acid; the needle should also be cleansed internally and externally by the same means; finally rinse out the instrument with recently boiled water.)

The skin at the point of injection should be scrubbed with soap and water and then rubbed with a five-per-cent. carbolic solution, this disinfectant acting at the same time as a local anesthetic, diminishing somewhat the pain of injection.

Shake the bulb thoroughly before withdrawing the contents into the syringe. Expel the air from the syringe and inject the vaccine.

If the syringe package be used, note the level of the contained vaccine after the air has been expelled from

5

the needle, and measure the dose by reference to the graduation lines—provided it is desired to administer less than the entire contents at a single dose.

## PACKAGES.

Furunculosis Vaccine is supplied in cases of four 1-Cc. rubber-stoppered bulbs containing 400 million bacteria each; in cases of four graduated syringe containers, of 400 million each, each graduation representing 100 million bacteria; and in cartons containing one graduated syringe, each graduation representing 100 million bacteria.

## PARKE, DAVIS & COMPANY.

### LABORATORIES:

Detroit, Mich., U. S. A.; Walkerville, Ont., Can.; Hounslow, Eng.

### BRANCH HOUSES:

New York, Kansas City, Baltimore, New Orleans, Boston, Chicago, St. Louis, Minneapolis, Seattle, U. S. A.; London, Eng.; Montreal, Que.; Sydney, N. S. W.; St. Petersburg, Russia; Bombay, India; Tokio, Japan.

7

[Journal of the American Medical Association, Aug. 28, 1909.]

## INOCULATIONS OF POLYVALENT STAPHYLOCOCCUS SUSPENSIONS IN STAPHYLOCOCCIC INFECTIONS OF THE SKIN.*

BY HENRY ROCKWELL VARNEY, M.D.

Clinical Professor and Lecturer on Dermatology and Syphilology in the Detroit College of Medicine; Dermatologist to Harper Hospital, Detroit.

Now that time has allowed the smoke of enthusiasm to clear away, we should be able to take an accurate reckoning of the value of artificial immunization of patients with staphylococcic infections of the skin.

Two years ago, before this Section, I reported a series of staphylococcic infections of the skin treated by bacterial inoculations. The conclusions at that time were not unlike those of other investigators along this line of treatment. Autogenous suspensions were found more efficient than monovalent stock suspensions, and inoculations guided by opsonic estimations were found more effectual than those that were not so guided.

Owing to the time consumed in isolating the invading organism and standardizing the suspensions, and the difficulties in making opsonic estimations, opsonic therapy has evoked criticism. The purport of this paper, then, is to discuss the simplifications which assist in placing opsonic therapy on a practical basis. So much progress has been made over our previous knowledge that we are now able to obtain as good results, in selected cases, with polyvalent stock suspensions as with the autogenous. Laborious opsonic esti-

mations are unnecessary as a guide to reinoculations. Experience has proved to me that inoculations of a polyvalent stock suspension, made at intervals indicated by clinical symptoms, produce as good results as when controlled by opsonic indices.

For some time bacteriologists have noted minute differences between cultures of the same species obtained from different sources, although the morphology of the organism shows the typical form on ordinary culture media. A suspension, then, made from a number of strains of the same organism, obtained from various patients suffering from the same disease, is the stock suspension employed. The object of this is to embody the varying properties of a number of strains.

Polyvalent suspensions of staphylococcic strains have been and are being used by many investigators, but, to my knowledge, no large number of strains obtained from the same disease has been employed. My polyvalent suspensions have contained no less than twenty different strains, which have been increased to forty by mixing two or more suspensions. These strains are kept growing slowly, at room temperature, in darkness, and are transferred as infrequently as possible to keep them alive. By this method the virulence of the strain is probably less lowered than might be the case if the strain was frequently transferred. New strains are occasionally being added which give varying ages to the suspensions as well as varying virulence. Such a suspension is as easily prepared and standardized as an autogenous one, and retains its activity, as far as can be determined clinically, for at least six months. Here, then, we have a stock suspension which is ever ready and can be used when the patient first appears, with a saving of days of time over the method of preparing autogenous bacterial suspensions.

*Read in the Section on Dermatology of the American Medical Association, at the Sixtieth Annual Session, held at Atlantic City, June, 1909.

6

8

From comparisons of opsonic indices in a large number of like infections, taken in the laboratory prior to using stock suspensions, we are given further valuable knowledge, not only in estimating the size of the dose to administer, but when to reinoculate. The dose of the first inoculation should be of sufficient size to cause only a slight languor, which means a four to eight hours' negative phase after the inoculation. From 100 to 150 millions is the appropriate initial dose, varying as clinical indications denote. In the immunization of animals toward a given toxin, the dose given must be of gradually increasing strength, to a certain standard, the frequency and size of the dose to be governed by the temperature of the animal and other clinical manifestations, and later by potency tests. The same is true of human artificial immunization with bacterial suspension, the doses varying in size and intervals. Within six times twenty-four hours after the initial dose, the patient's resistance, as proved by opsonic estimations, will have dropped after its positive phase to nearly what it was when the first dose was administered. Then the second dose should be given, which should be from 200 to 250 millions, and the third from 300 to 400 millions. It is seldom necessary to increase the dose to more than 600 millions. The spacing of the first three doses six days apart (six times twenty-four hours) is of importance, and further doses should be given as clinical manifestations indicate. One of the first indications of a lowered resistance and recurrence is a tenderness in the already healed scar, as in boils.

The rebellious types of the following diseases are those to be considered: furunculosis and carbuncle, impetigo contagiosa, sycosis staphylogenes, and pustular acne. In selecting from this group of diseases, we are considering only the rebellious ones, thereby excluding the possibility of spontaneous recovery, con-

9

sequently putting this therapeutic measure to the crucial test.

What is more annoying than the persistently recurring lesion in what is termed the chronic "boiler," or the sycosis condition which presents itself with a history of years of existence? The patient who returns almost annually, usually during February or March, with a multiple furunculosis, has a lowered resistance to staphylococcic infection. We have heretofore reasoned that the condition of such a patient was below normal or he would not be afflicted with such infections. Our medical advice has been governed by such suppositions, and tonics, diet and specific medications, the action of which has never been clearly known, have been prescribed. We had no accurate means of determining the patient's resistance to the infection, or whether our treatment raised his resistance, until Sir A. E. Wright published his most ingenious technic, by the application of which we are able artificially to immunize patients by bacterial inoculations. The further proof that the patient's resistance is not only low during such infection but in the process of artificial immunization, lies in the fact that the patient's resistance shows a prompt rise, as indicated by laboratory indices which are confirmed clinically. The lowered resistance of the patient may not be due wholly to deficiencies in the blood substances or lack of opsonins, but partially to abnormal development or lack of tonicity of the skin structure. General lowered resistance to the staphylococcic family, due to constitutional diseases, will not be considered.

The predisposing qualities of such skin structures to infection must be considered and corrected, or the raising of the patient's resistance will often fail to cure.

Many abnormal conditions in the skin structure predispose to a more easy access of this type of in-

10

fection into the deeper structures of the skin; for example, the thin, oily skin with the gaping sebaceous ducts not only allows easy entrance of the organisms, but such a skin supplies them with an abundance of food in the excess sebaceous material. The walling-off of such an infected area is Nature's means of preventing systemic infection. This process in the infection of the carbuncle or boil is so thorough that the infected area must necrose in order to rid itself of the infection. This process of defense not only practically stops leucocytosis, but prevents the toxins from entering the blood stream, except in limited quantity, which results in the formation of protective substances and only partial immunization. Protective substances are not generated in sufficient quantities to prevent reinoculation; hence the continuance of the infection. The toxins of such an infection must enter the blood stream in safe quantities in order that protective substances may be elaborated to the degree of immunization. While the natural forces of resistance are spending their best efforts in walling off the infection, unable to produce immunizing substances from lack of specific toxic material, our assistance in artificial immunization is of unquestionable value at this time, which is demonstrated clinically.

One can readily see the utter uselessness of attempting to raise the patient's resistance to a given organism when the protective substances or leucocytes are unable to reach the organisms because of the stagnation of circulation in the area of infection. The absolute necessity for other therapeutic means here presents itself to the more successful management and cure of this type of infection. The drawing off of such stagnant fluid by excision and evacuation of the furuncle or carbuncle, and the application of heat, or Bier's hyperemia, cupping to encourage bleeding, is advisable. Such means not only draw off the stagnant in-

11

fected blood and lymph, but produce increased circulation of blood and lymph through the infected area. At this time the assistance brought about by a general raising of the blood resistance may be effected by bacterial inoculations.

In no other staphylococcic infections of the skin have there been such uniformly gratifying results as in multiple furunculosis and carbuncles. This method of treatment has a scientific basis and is rapidly replacing the older methods. It has been possible, in a number of instances, to compare the efficiency of the polyvalent suspensions with that of autogenous suspensions, observations being assisted by patients, who were physicians. Rarely has a new lesion developed after the first inoculation has been administered. A partially developed lesion can often be dwarfed, and within forty-eight hours all pain and discomfort to the patient will have subsided.

In order to ascertain just what percentage of the cases were recurrent, I recently reviewed the histories for the last two years of patients given polyvalent suspensions. I was surprised to find that there had been only three recurrences out of twenty-eight cases of multiple furunculosis. It was also of interest to note that the three patients who suffered recurrences were those to whom no more than two inoculations had been administered. Undoubtedly, only partial immunization had been effected. Previous to this treatment, at least 90 per cent. of these cases had been the chronic recurrent type, and for a period of two years there have been no recurrences of cases who were given four or more inoculations.

Comparing our knowledge of immunization brought about in other infectious diseases, at least four inoculations seem necessary to insure against recurrence.

It is important to instruct the patients when inoculations are given to take precautions against fatigue.

12

The negative phase will then be less pronounced, and the positive phase prolonged. The beneficial effects of inoculations can be completely destroyed by prolonging the negative phase by fatigue, alcoholism, menstruation, or any intemperate indulgence, and new lesions may develop.

## CONCLUSIONS.

Polyvalent staphylococcic stock suspensions administered in appropriate doses have a decided therapeutic value in a group of localized, rebellious infections of the skin. Their administration is practically without danger, bringing about prompt cessation of the active infection and immunizing the patient against a recurrence of the infection for a more or less prolonged interval.

Clinical observations act as guides to the time for reinoculation and the size of dose to be administered.

The appropriate standards for size and frequency of doses have been previously established from opsonic estimations on laboratory patients with like infections, and are not necessary for each specific case.

Failure to immunize the patient artificially may be due to an abnormal condition of the skin, non-specific bacterial suspensions, or incorrect dosage.

Much time is saved in the use of stock suspensions by the elimination of opsonic indices and by the assistance derived from other therapeutic measures.

Less suffering, less deformity, less danger of systemic infection, and less liability to recurrence are the advantages derived from the use of bacterial suspensions as a therapeutic agent.

I am especially indebted, and wish to express my thanks, to L. T. Clark, B. S., of the Research Laboratory of Parke, Davis & Co., for bacteriologic assistance and suggestions.

[Journal of the American Medical Association, Jan. 8, 1910.]

# STOCK VACCINE IN ONE CASE OF STAPHYLOCOCCUS PROSTATITIS AND TWO CASES OF FURUNCULOSIS.

BY A. M. ROOKER, M.D., NIAGARA FALLS, N. Y.

I wish to report on the use of stock vaccines in three cases which have occurred in my practice.

The vaccine was used after all ordinary methods of treatment had failed to give relief, and the prompt results following the vaccine treatment have led me to send in this report.

**CASE 1.**—T. V., aged 29, had a severe attack of gonorrhea in November, 1908, was confined to bed eight weeks, and was a semi-invalid for the two following months. A discharge with severe rectal pain persisted up to May 30, when he first consulted me. The discharge contained a few gonococci, but these soon disappeared under treatment, the discharge continuing. A stricture of the pendulous portion of the urethra and a chronic prostatitis were also found. The former was soon cured by sounds, but the latter persisted after all ordinary treatment had failed. An examination of the expressed secretion showed an abundance of staphylococci in almost pure pus, but no gonococci. Having no facilities for making cultures to determine the variety of staphylococci present, I used the combined aureus, citreus and albus as prepared by Parke, Davis & Co., giving 100,000,000 as an initial dose. This causing no reaction, it was repeated at three-day intervals, the dose being increased at each injection until 400,000,000 was reached. The pain and irritation rapidly subsided, the prostate was nearly normal in three weeks, and the secretion rapidly cleared of pus. In six weeks the patient had no trouble or pain whatever.

An interesting feature of this case is that the patient is afflicted with pulmonary tuberculosis, having had three hemorrhages and a severe cough. Within a week after the beginning of the vaccine treatment the patient's cough was markedly improved and in four

13

14

weeks had practically stopped, and his weight had in-
creased eight pounds. This unlooked-for improve-
ment was evidently due to the effect of the vaccine on
a secondary staphylococcic infection engrafted on a
chronic tuberculous lesion in the lung.

CASE 2.—D. S., aged 8 months, had begun having boils when three months old. I had lanced twelve, and seven had opened spontaneously up to this time. They kept forming, notwithstanding careful asepsis after the opening of each, together with general tonic measures with calcium sulphide. Examination of the pus showing staphylococci present, I resorted to vaccine. Since I did not know whether Young's law of dosage would hold in vaccine therapy, I proceeded cautiously and gave only 5,000,000, again using the combined varieties. When the first injection was given three boils were forming; but in twenty-four hours they had practically disappeared. I gave two more doses at seven-day intervals, with no recurrence up to the present time, four months after the first injection. In two weeks the baby gained three pounds, ate better and slept better than ever before. A possible etiologic factor in this case was a mammary abscess in the mother when the baby was four weeks old. The breast was opened and drained, the breast pumped, and the milk fed to the child with a dropper. Whether the milk could have carried any infection or whether any of the pus was inoculated directly I cannot say.

CASE 3.—D. P., Italian, aged 18, had a secondary specific eruption, during which huge boils began to form all over his body, as many as thirty appearing in five weeks. No care being taken of them, the pus was rubbed over the surrounding skin, easily accounting for their frequency. The syphilitic eruption rapidly subsided under treatment, but the boils were unaffected. The pus showing nothing but staphylococci, I gave the patient three injections, of 100,000,000, 200,000,000 and 300,000,000 each, of the combined vaccine, at four-day intervals. After the first injection one boil formed, but after the second and third there has been no further trouble, three months after the suspension of treatment.

70109

# EPITOME OF PITUITRIN THERAPY.

## PITUITRIN IN OBSTETRICS.

Pituitrin has a stimulating effect upon the muscular fibres of the gravid uterus.

### DOSE AND METHOD OF ADMINISTRATION.

Pituitrin is administered in the form of subcutaneous or intramuscular injections, the average dose being 1 Cc., which may be repeated three or four times a day if necessary.

After the intravenous administration of Pituitrin the labor-pains set in almost immediately, accompanied by a desire to urinate and defecate, syncope, a feeling of warmth, occasional nausea or vomiting (Bogdanovics), and sometimes also profuse perspiration (Hofbauer). On account of these after-effects the intravenous administration of Pituitrin in the practice of obstetrics has not become popular.

### THE ACTION ON THE UTERUS.

If Pituitrin is employed while labor is in progress, the initial effect is evidenced by a single or at the most double tonic contraction of the uterus, which sometimes lasts several minutes (Hofbauer, Hamm, Nagy, Anderes). This is soon followed by rhythmical contractions which gradually increase in intensity and frequency (Hofbauer, Schmid, v. Fellenberg, Studeny, Richter, Weymeersch, Hahl, Vogt).

The action of Pituitrin is not impaired by general anesthesia (Hofbauer, Stiassny, Nagy, Hauch and Meyer).

4

INDICATIONS.

1. Primary and Secondary Uterine Inertia (Hofbauer, Kehrer, Fries, Hahl, Fischer, Hamm, Hauch and Meyer, Anderes, Marek, Richter, Hirsch, Studeny, Nagy, Vogt).

As a prerequisite for the prompt action of Pituitrin, the uterus must be in a state of sufficient sensitiveness, as is the case at the end of pregnancy (Hofbauer, Stern), or when labor pains have already taken place, even if they were but feeble (Schiffmann, Anderes, Hirsch, Kehrer).

In cases of delivery at term in which there is uterine inertia (either before or after the rupture of the membranes) it is possible to institute labor by the administration of Pituitrin alone (Stern, Schiffmann, Fries). In such cases it is necessary to give several doses at intervals of from three to twelve hours (Stern, Fries, Studeny, Schaefer).

The further labor has progressed when the first injection is made, the more intense is the action.

In cases of primiparæ of advanced age Pituitrin is sometimes without effect (Hofbauer).

2. Acceleration of Labor.

(a) In the functional atony of the uterine muscular fibres due to overdistention of the uterus by twins and hydramnion (Hofbauer, Flatau, Marek).

(b) In narrow pelvis of moderate degree (Hofbauer, Fischer, Fries, Vogt).

(c) In albuminuria (Anderes).

(d) On behalf of the mother: After intra-uterine interference (dilatation, combined version). For a high temperature during labor (Hofbauer, Schmid, Fischer, Anderes). In threatened or established eclampsia (Hofbauer).

(e) On behalf of the child: When the heart action is rapid and irregular (Fischer, Cahn, Schmid). If

5

there is a danger of intra-uterine asphyxia (Hauch and Meyer).

3. In Placenta Prævia After Rupture of the Membranes, Version or Dilatation (Hofbauer, Schmid, Fries, Studeny, Fischer, Anderes, Hirsch, Hauch and Meyer, Vogt).

In placenta prævia totalis the action is not absolutely certain (Hauch and Meyer).

4. In Certain Forms of Face and Breech Presentations (Hofbauer, Hamm, Hirsch, Studeny).

5. If the Fetus is Carried Beyond Term on Account of Uterine Inertia (Gottfried, Studeny, Hager).

6. As a Matter of Convenience. The rapid termination of labor without any valid medical reason (Hofbauer).

7. As an Adjunct to the Acceleration of Beginning or Incomplete Abortion, and for the Institution of Premature Labor After Dilatation of the Uterus (Schiffmann, Stern, Voigt, Hamm, Hirsch, Anderes, Flatau).

Pituitrin is not suitable as a means of instituting abortion (Bogdanovics, Hauch and Meyer, Hamm, Hirsch).

8. Postpartum Hemorrhages (Foges and Hofstaetter, Schmid, Bogdanovics, Richter, Jacobs).

Fries and Fischer recommend the injection of Pituitrin before labor as a prophylactic of postpartum hemorrhage.

Pituitrin is superior to ergotin (Schmid) as regards the intensity of the contractions and duration of stimulation (Foges and Hofstaetter), and is particularly indicated in severe atonic hemorrhage after ergot has been given without benefit (Klotz, Hahl).

6

INDICATIONS—continued.

9. As a Preventive of Hemorrhage and a Means to Shorten the Placental Stage in Cæsarean Section (Foges and Hofstaetter, Stern, Kroemer, Cahn, Schmid, Fischer, Hirsch, Bogdanovics).

10. After Abdominal Operations. For intestinal atony or paralysis.

THE ABSENCE OF UNPLEASANT AFTER-EFFECTS (Fries, Hahl, Hauch and Meyer, Vogt).

Sometimes Pituitrin causes a retardation of the fetal heart sounds, which does not endanger the child; and there is no harmful effect upon the mother (Hofbauer, Fischer, Hamm, Anderes, Bogdanovics).

There is no cumulative or toxic effect (Voigt, Le Maire).

DESRIRABLE AFTER-EFFECTS OF PITUITRIN.

A quick separation of the placenta in the last stage of labor (Stern, Schmid, Fries, Voigt).

Complete absence of or only slight secondary hemorrhage (Schmid).

A tonic effect upon the vesical apparatus (Hofstaetter, Klotz, Voigt, Schirmer, Hauch and Meyer) and the intestinal tract (Klotz, Voigt).

Pituitrin medication renders many operative procedures superfluous and thus removes this danger of infection (Klotz, Hofbauer, Fries, Cahn, Schmid, Voigt, Hamm, Anderes, Hauch and Meyer, Bogdanovics).

GALACTAGOGUE ACTION.

Reports have been made that Pituitrin is an efficient galactagogue (Ott and Scott).

7

CONTRA-INDICATIONS.

Nephritis (Klotz, Steuernagel, Studeny, Le Maire, Genter).

A pelvis that is too narrow (Genter, Fries).

Myocarditis (Steuernagel, Genter, Le Maire, Studeny).

Arteriosclerosis (Klotz, Le Maire, Studeny, Genter).

A threatened rupture of the uterus (Genter).

According to Jaschke, caution is indicated in central arteriosclerosis, chronic myocarditis, and perhaps also in many forms of nephritis, while Bogdanovics does not regard these affections as contraindications at all, since the blood-pressure is only slightly raised by Pituitrin. Stern and Hahl also employed Pituitrin in cases of nephritis, and Hofbauer even in a case of nephritis and goitrous heart.

THE USE OF PITUITRIN IN GYNECOLOGY.

In the practice of gynecology Pituitrin is employed as a hemostatic and styptic in a single dose of 2 to 3 Cc., which may be repeated for two or three days and is administered subcutaneously; occasionally there are uterine spasms (Bab).

Indications: Endometritis, metritis, hemorrhage due to myomata or diseases of the adnexa, ovarian cysts (Bab, Jacobs), menorrhagia (Weymeersch). Pituitrin has frequently proved effective after the usual styptics had been used in vain (Bab, Weymeersch, Jacobs). Before the operative removal of fibromata (Bogdanovics).

8

## PITUITRIN AS A VESICAL TONIC.

Pituitrin produces a stimulating effect upon the muscular fibres of the bladder and increases diuresis (Schafer, Frankl-Hochwart, Klotz, Schirmer).

Dose: ½ to 2 Cc. subcutaneously.

Indications: Ischuria paradoxa (Hofstaetter, Ebeler, Cahn). Ischuria in childbed (Schirmer and Fischer). Ischuria after abdominal and vaginal operations (Bogdanovics, Jaschke).

## PITUITRIN IN OSTEOMALACIA.

In this disease good results and in some cases apparent cures were obtained by Bab, Gati Geza, Neu, and Koch, by daily injections of 1 to 2 Cc. of Pituitrin.

According to Bab, caution is indicated in the case of old persons.

Uterine spasms resembling labor-pains have been observed as an after-effect.

## PITUITARY EXTRACT IN OBSTETRICS AND GYNECOLOGY.*

BY A. W. LESCOHIER, M.D., AND O. E. CLOSSON, PH.B.†

[The Journal of the Michigan State Medical Society, October, 1912.]

The significance of uterine inertia as a complication of labor is so universally recognized that it seems unnecessary that we should more than casually refer to it at this time. Disturbances and discomforts connected with a protracted labor, exhaustion, increased danger of infection and psychic depression of the mother, the possibility of asphyxiation for the child, and finally for the busy physician the considerable amount of time required, are all matters of no little consequence. The natural result of these factors is that a slowly progressing labor is frequently terminated by instrumental procedures in the absence of sufficient indications.

Frankl-Hochwart and Frölich,¹ of the Pharmacological Institute of the University of Vienna, have been given the credit for directing attention to the action of pituitary extract on the uterus. As a matter of fact, Dale² had previously called attention to this action of the hypophysis. Dale observed a very marked contraction of the uterus in the cat following the intravenous injection of .4 of a gram of dry ox pituitary. That his observation did not attract general attention

*Read at the Forty-Seventh Annual Meeting of the Michigan State Medical Society, Muskegon, July 10-11, 1912.

†From the Research Laboratory of Parke, Davis & Co., Detroit.

1. Frankl-Hochwart and Frölich: Arch. Pathol. und Pharmakol., 1910, Bd. 63, p. 347.

2. Dale: Jour. Physiol., May, 1907.

9

10

was undoubtedly due to its having been dealt with in
an incidental manner, in the course of a long paper on
the "Physiological Action of Ergot." In 1909 Frankl-
Hochwart and Fröhlich, in a series of experiments on
normal, gravid and lactating rabbits, found that the
uterus after small doses of pituitary extract (0.3 to
0.5 c.c.) was subjected to powerful and often long en-
during contractions, and that the sympathetic nerve
supply became more sensitive to faradic stimulation.
The action of the pituitary extract was very much
more striking in the case of a gravid uterus, or in the
uterus of a lactating animal. Furthermore, it was ob-
served that intravenous injections into dogs of small
amounts of hypophysis extract increased the sensitive-
ness of the bladder nerves and suggested that the ex-
tract should prove of clinical value in atonic conditions
of the bladder as well as in those of the uterus.

To Bell³ belongs the credit for having first employed
pituitary extract for obstetrical purposes. Experiments
conducted by him confirmed the results of Frankl-
Hochwart and Fröhlich regarding the action of pitui-
tary extract on the uterine muscle of pregnant rabbits.
Bell then employed the hypophysis extract in cases of
normal labor, uterine inertia, subinvolution of the
uterus and postpartum hemorrhage, with uniformly
satisfactory results, and concluded that "in the future
we shall rely on the infundibular extract to produce
contractions of the uterus in many serious obstetrical
complications and difficulties."

Shortly after the publication of Fröhlich and Frankl-
Hochwart's works, Hofbauer⁴ employed the pituitary
extract in the treatment of six cases of uterine insuf-
ficiency. The results obtained were very striking,
marked contraction of the uterine muscle being pro-
duced, which was regular and rhythmical in character.
Later work confirmed this earlier observation. In the

3. Bell, W. B.: Brit. Med. Jour., Dec. 4, 1909, p. 1609.

4. Hofbauer: Münch. med. Woch., March 19, 1912, lix, No. 12.

11

following classes of cases, the administration of infun-
dibular extract was followed by prompt and satisfac-
tory results:

1. Primary and secondary labor pains.

2. Slightly contracted pelvis.

3. Cases where it is desired to accelerate labor in
febrile conditions and threatened eclampsia.

4. Placenta prævia lateralis after rupture of the
membranes.

5. Breech presentations.

6. Indications for rapid completion of labor.

Infundibular extract also had an apparently good
effect in atonic conditions of the uterus, checking post-
partum bleeding. Pituitary extract alone did not pro-
duce an abortion, but used in conjunction with instru-
mental procedures it hastened the evacuation. He be-
lieves it, therefore, to be of value in the puerperal
period. No undesirable effects in either mother or
child were observed.

Studeny⁵ used pituitary extract in eighty-nine labor
cases. In the first stage of labor the effect was very
marked, and in the expulsion period the extract was
given with excellent results in thirty-four cases. In
fifteen the birth followed during the first quarter of
an hour after the injection, in thirteen during the next
hour, and in six during the next two hours. On the
other hand, the extract failed in some cases of abnor-
mal resistance of the soft parts or bony pelvis, and
also failed in eight cases of primary uterine inertia.
Pituitary extract was further given in five cases of
rigidity of the soft parts, in two of which it had little
if any effect. The results were strikingly good in six
out of nine cases of placenta prævia, but in two cases
the pains stopped after a short time, and in a third the
pituitary extract had no apparent effect. In one case
of induction of labor infundibular extract was used

5. Studeny, Alfred: Wien. klin. Wchnschr., Dec. 21, 1911, Jahr-
gang 24, No. 51, p. 1766.

12

in combination with operative measures and a definite
opinion as to its value could not be formed. In the
whole series of cases in which labor ended spontane-
ously, there were only two of postpartum hemorrhage.

In the three cases in which Stern⁶ employed pituitary
extract, labor was induced because of complicating
pathologic conditions (tuberculosis, eclampsia, etc.).
In all cases the extract was effective in producing sat-
isfactory contractions of the uterus.

Bondy,⁷ at the Pharmacological Department of the
University of Breslau, employed hypophysis extract
in ten cases of protracted labor. In eight of these the
results were entirely satisfactory, while one was par-
tially successful and the other a failure. The one fail-
ure recorded was a case of an elderly primipara with
a breech presentation. The labor lasted fifty-six
hours, and after fifty-four hours, the pains having
almost ceased, 1 c.c. of pituitary extract was given
subcutaneously.

Voight,⁸ in the University Obstetrical Clinic in Ber-
lin, employed infundibular extract in seventy-five cases.
In sixty of these (80 per cent.) the results were very
good, while in eleven the pains produced were only
weak or temporary, and in four the administration of
the extract appeared to be detrimental to the course of
labor. Among these sixty cases all stages of first and
second periods of labor were encountered. The par-
tial failure of the extract in eleven cases was thought
to be largely due to the use of too small doses in the
earlier cases.

Hahl⁹ employed hypophysis extract in the Obstet-
rical Clinic at the University of Helsingfors. The
drug was administered subcutaneously to thirty-four

6. Stern, Robert: Berl. klin. Wchnschr., Aug. 7, 1911, No. 32, p. 1459.

7. Bondy, Oscar: Berl. klin. Wchnschr., Aug. 7, 1911, No. 32.

8. Voight: Deutsch. med. Wchnschr., Dec. 7, 1911, Jahrgang 37, No. 49, p. 2286.

9. Hahl, C.: Brit. Med. Jour., Dec. 16, 1911, p. 91.

13

patients, and the course of labor in each case before
and after injection carefully recorded. Twice Cæsa-
rean section was performed with the aid of pituitary
extract, which, in one case, was injected directly into
the wall of the uterus. In twenty-two cases the drug
increased the pains and hastened labor to a marked
degree, in six others it had a similar though a some-
what less powerful action, and in two it had no effect
whatever. The characteristic action of the pituitrin
was a shortening of the interval between contractions,
and marked increase of intra-uterine pressure.

Hamm,¹⁰ at a meeting of the Unterelsassischer
Aerzteverein, Strassburg, reported concerning the use
of pituitary extract in twenty-five cases, some of which
were primary and some secondary uterine inertia. In
only one case did it fail entirely; in the remaining
twenty-four it was successful. The drug was found
to be a valuable adjunct in Cæsarean section and in
miscarriages, but valueless in the production of pre-
mature birth.

Richter,¹¹ in the Obstetrical Clinic of the University
of Vienna, used hypophysis extract in the dilatation
period in eighteen primiparæ and eleven multiparæ.
In sixteen of the eighteen primiparæ, the cervical canal
was obliterated and the os uteri large enough for three
or four fingers, while in two cases the patients were
still at the beginning of the dilatation period. The
effect of the pituitary extract appeared within five to
ten minutes, during which time powerful labor pains
set in with regular intervals. The birth followed ac-
cording to the strength of the pains and the condition
of the soft parts, in from two to six hours after the
injection. In no case was any injury to the child ob-
served, and no disturbance occurred during the third
stage of labor. Only one case was observed of tetanic-

10. Hamm: Deutsch. med. Wchnschr., March 7, 1912, xxxviii, No. 10, p. 487.

11. Richter, I.: Wien. klin. Wchnschr., 1912, No. 13, p. 80.

14

like contraction of the uterus. This lasted ten minutes, whereon the intervals became longer and a regular activity of the labor pains set in.

In the multiparæ, the extract was injected in six cases at the end of the dilatation period, because of marked weakness of the labor pains, in all cases with good results. In the expulsion period, the hypophysis extract was used in sixteen cases, nine of which were primiparæ and seven multiparæ. In all cases the effect appeared after five to ten minutes. In multiparæ the birth occurred in all cases within a half hour.

The hypophysis extract was also used in three cases in which it was necessary to induce artificial abortion because of advanced pulmonary tuberculosis, and twice in cases in which abortion had already begun. In no case could abortion be produced with the extract, even when repeated injections were given. In postpartum hemorrhages and hemorrhages in childbirth, pituitary extract was used with good results.

Hirsch,¹² from the School for Midwives at Strassburg, employed infundibular extract in three cases preceding Cæsarean section, in thirteen cases of premature birth, and in nineteen cases to stimulate labor pains. It was found that the action of pituitary extract was greater the closer it was administered to the expulsion period. In the great majority of cases, unless there was momentary danger to either the mother or child, it was possible to entirely avoid the use of forceps. It was impossible to produce any labor pains in a uterus which was in a state of repose, even at the reckoned end of pregnancy and when repeated injections of the extract were administered. In such cases, however, it was possible to arouse the activity by mechanical means and to bring about the delivery much more rapidly by strengthening the contractions with the extract.

12. Hirsch, E.: München. med. Wehnschr., April 30, 1912, Jahrgang 59, No. 18, p. 984.

15

In a recent communication, Benthin¹³ reported favorably on the use of hypophysis extract as a labor-exciting means and stated that it is an important safe differential diagnostic point between true and false labor pains. If the pains present are true labor pains, the administration of the pituitary extract will greatly strengthen the contractions, whereas in false pains no effect is produced.

In September, 1911, Hofstatter¹⁴ stated that by the administration of pituitary extract postpartum and postoperative atony of the bladder can be successfully treated and the necessity for catheterization avoided. In this connection it will be recalled that Frankl-Hochwart and Fröhlich had already shown by animal experiments that pituitary extract stimulates the muscle tissue of the bladder and increases the faradic irritability of the bladder nerves. Hofstatter found that in cases of atony of the bladder the injection of hypophysis extract was almost always followed by spontaneous urination. He next injected 1 to 2 c.c. of the extract in all postpartum cases in which the patient suffered from inability to urinate, the bladder being full. In more than three-quarters of the cases, the patients became able to pass urine. The difficulty in urination did not return when it had been overcome as a result of pituitary extract. The treatment was not successful in cases of severe injury of the bladder.

Fellenberg¹⁵ confirmed Hofstatter's work and found that "the action on the bladder was exquisite and the injection of the extract in postpuerperal urinary retention was followed by a prompt emptying of the bladder."

Numerous other reports have appeared in the lit-

13. Benthin, W.: Deutsch. med. Wehnschr., April 25, 1912, xxxviii, No. 17, p. 823; München. med. Wehnschr., Jahrgang 59, No. 18, p. 994.

14. Hofstatter, R.: Wien. klin. Wehnschr., 1911, No. 49.

15. v. Fellenberg, R.: Wien. klin. Wehnschr., March 7, 1912, xxv, No. 10, p. 390; Korrespondenzblatt f. Schweizer Aerzte, 1911, Jahrgang 41, No. 35.

16

erature regarding the use of pituitary extract in obstet-
rical practice, among which may be mentioned those
of Nagy,¹⁶ Gusew,¹⁷ Besserer,¹⁸ Jaeger,¹⁹ Parisot and
Spire,²⁰ Fries,²¹ Vogt,²² Schaefer,²³ Schirmer,²⁴ and
Hager.²⁵ Other publications in the Hungarian, Danish
and Spanish literature we have not been able to secure.

Our clinical experience with the pituitary extract
has been by no means extensive, but through the co-
operation of a few practitioners in Detroit we have
been able to try out the extract in a number of cases.
Our results conform with those already reported, indi-
cating that the hypophysis extract is a very valuable
agent in the treatment of uterine inertia, and that ad-
ministered in the first and second stages of labor it
greatly strengthens the uterine contractions. Accord-
ing to our observations, the contractions are rhythmical
in character, and in none of our cases was a tetanic
contraction of the uterus produced.

We wish to include the two following case reports
as typical examples of the class of cases in which the
pituitary extract is indicated. That we have the privi-
lege of reporting these cases is due to the courtesy of
Dr. E. J. O'Brien of Detroit, in whose practice they
occurred:

*Case 1.*—Mrs. F. Patient first came under observation May 18, 1912. Gave a history of membranes having ruptured three days previously, and having had pains at irregular intervals since. Examination showed cervix to be dilated sufficiently to admit three fingers and L. O. A. presentation was diagnosed. Fetal heart sounds were readily distinguishable. At the time the patient came under my attention the pains were very weak and labor was at a standstill. A second examination the

16. Nagy, T.: Centralbl. f. Gynäkol., 1912, No. 10.

17. Gusew: Russk. Wratsch, No. 52.

18. Besserer: Medizinische Klinik, April 16, 1912, Jahrgang 8, No. 16, p. 670.

19. Jaeger: München. med. Wehnschr., No. 6.

20. Parisot, J., and Spire, A.: Med. Rec., April 7, 1912, p. 671.

21. Fries: München. med. Wehnschr., 1911, lviii, 2438.

22. Vogt: München. med. Wehnschr., 1911, lviii, 2734.

23. Schaefer: München. med. Wehnschr., 1912, lix, 75.

24. Schirmer, Gustav: Med. Fortnightly, March 25, 1912.

25. Hager: Berl. klin. Wehnschr., April 15, 1912, No. 16, p. 762.

17

following morning showed no change in the patient's condition,
and at noon she was sent to Grace Hospital. During the
morning the patient had no pains whatever. At 12 o'clock a
subcutaneous injection of 1 c. c. of pituitrin was given.
Between 12 and 12:30 the patient had eight very severe pains
with some progress in labor, but after the first half hour the
pains became less marked. A second injection of 1 c. c. was
given at 4:00 P.M., and shortly after its administration strong
contractions set in. Between 4 and 5 P.M., when the child was
born, twelve strong pains occurred. The delivery, both of the
child and the placenta, was accomplished without any difficulty.
The uterus contracted firmly and there was practically no post-
partum bleeding. No untoward effects of any kind in either
the mother or the child were observed, the patient leaving the
hospital two weeks later.

*Case 2.*—Mrs. C. Called to see the patient at 8 A.M. Patient was a multipara, both previous children having been born at seven months. The one child who survived was undersized. Patient gave history of having menstruated during entire pregnancy, and did not know exactly how far pregnancy had progressed. She had had intermittent pains for several days. Examination showed cervix to be sufficiently dilated to admit three fingers. Membranes were not ruptured, but patient was passing considerable blood. L. O. A. presentation was diagnosed. At 3 o'clock in the afternoon no progress in labor had been accomplished. Pains were becoming feeble and the patient was very tired. One c. c. of pituitrin was administered subcutaneously into the left arm. A very few minutes after the injection the pains became exceedingly severe; patient complained bitterly and stated that pains were almost continuous. Progress began within a few minutes after the administration of the pituitrin. The child was born thirty minutes after the injection, full term and perfectly normal. Placenta was removed without difficulty, and no post-partum hemorrhage occurred. Uterus contracted firmly and remained so.

Our laboratory experiments have been directed
toward the determination of the following facts:

1. The character of the contractions induced by the administration of the pituitary extract.

2. The possibility of inducing abortion by the administration of large doses.

3. The toxicity of pituitary extract.

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4. The significance of the glycosuria following the administration of large doses of hypophysis extract in animal experiments which has been reported by Cush- ing and others.

In studying the character of the uterine contraction produced by the infundibular extract, we have used normal, lactating and pregnant dogs. The dogs were anesthetized with chloretone and attached to the kymo- graph in the usual way, the blood-pressure record be- ing taken as well as the uterine contractions. The longi- tudinal contractions were recorded by the use of a myo- cardiograph, the needles of the myocardograph being attached to one horn of the uterus. The volume changes were recorded by enclosing in the opposite horn a small rubber sack which was connected by glass and rubber tubing to a tambour from which the changes were recorded on the drum of the kymograph.

Fig. 1.—*Intravenous injection 0.5 c.c. pituitrin.

Figure 1 shows a tracing from the normal uterus. In this case only the longitudinal contractions were recorded. *A-A'* is the uterine tracing, *B-B'* the blood-pressure and *C-C'* time marker. It will be observed that while the pituitary extract increased the activity of the uterine muscle, the contractions were not espe- cially marked. A slight increase in the uterine tone is observed.

With lactating animals the effects were very much

more marked, decided stimulation of uterine contrac- tions and increase in uterine tone being observed. The susceptibility of the uterus to pituitrin stimulation de- creased as the period of lactation advanced.

With dogs placed on the table a few hours after the delivery of their puppies the uterine sensitiveness to pituitrin stimulation is very decided. Figure 2

Figure 2.

shows a tracing taken in the morning from a bitch which had dropped her puppies some time during the night. In this case both longitudinal contractions and volume changes were recorded. *A-A'* shows longi- tudinal contractions, *B-B'* volume changes, *C-C'* blood- pressure and *D-D'* time marker. The down stroke on the upper tracing indicates the longitudinal con- traction, while the up stroke on the second curve shows decrease in volume. Tracings were taken immediately after the injection, twenty minutes later and an hour later. The curve shown in Figure 2 was the tracing taken an hour after injection. The normal curve (i.e., the tracing taken previous to the injection) showed almost a straight line. In less than a minute after the

19

20

injection, contractions set in, which were rather "stormy" in character. Within a few minutes, however, they became rhythmical and remained so throughout the experiment as shown by the above tracing. At the time the dog was killed (two hours after the injection) contractions were still regular and forcible.

The results of our experiments point to the fact that as pregnancy advances there is a progressively increasing susceptibility of the uterus to pituitary stimulation. In other words, the closer the animal is to term, the more marked are the contractions produced by the administration of the extract. The experiment represented in Figures 3, 4, 5 and 6 is interesting in this connection.

These tracings were taken from a dog in which the onset of labor seemed imminent. In all four A-A' represents tracing from uterus, B-B' the blood-pressure and C-C' time marker. Blood clotted in the cannula during the experiment so that it was impossible to get a picture of the blood-pressure in the last two tracings.

Fig. 3.—*Intravenous injection of 0.5 c.c. pituitrin,

21

It is observed that there is a considerable oscillation in the uterine tracing previous to injection. This was not, as it might appear, due to activity of the uterus, but simply a result of the respiratory movements. The contraction following the injection was very striking

Figure 4.

and the relaxation from this primary contraction delayed.

Figure 4 shows the relaxation from the first contraction and the initiation of the characteristic rhythmic "pains."

Figure 5 shows the contractions thirty minutes, and Figure 6 one and one-half hours, after the injection.

Figure 5.

24

TABLE 2.—DOG 2; WEIGHT 5 KG. (A).

<table><thead><tr><th>Injection.</th><th>Day.</th><th>Sugar.</th><th>Diacetic Acid.</th></tr></thead><tbody><tr><td rowspan="10">25 c.c. pituitrin</td><td>1</td><td>Trace*</td><td>..</td></tr><tr><td>2</td><td>Trace</td><td>..</td></tr><tr><td>3</td><td>Trace</td><td>..</td></tr><tr><td>5</td><td>+</td><td>+</td></tr><tr><td>6</td><td>+</td><td>—</td></tr><tr><td>7</td><td>+</td><td>—</td></tr><tr><td>8</td><td>+</td><td>..</td></tr><tr><td>9</td><td>+</td><td>..</td></tr><tr><td>10</td><td>+</td><td>..</td></tr></tbody></table>

*Twenty-five minutes after injection.

TABLE 3.—DOG 2; WEIGHT 5 KG. (B).

<table><thead><tr><th>Day.</th><th>S. G.</th><th>Sugar.</th></tr></thead><tbody><tr><td>13</td><td>1016</td><td>Trace</td></tr><tr><td>14</td><td>1013</td><td>Trace</td></tr><tr><td>15</td><td>1020</td><td>Trace</td></tr><tr><td>16</td><td>1020</td><td>Trace</td></tr><tr><td>17</td><td>1024</td><td>Trace</td></tr><tr><td>18</td><td>1017</td><td>Trace</td></tr><tr><td>19</td><td>1020</td><td>Trace</td></tr><tr><td>29</td><td>?</td><td>—</td></tr></tbody></table>

TABLE 4.—DOG 3; WEIGHT 15.5 KG.

<table><thead><tr><th>Injection.</th><th>Day.</th><th>Vol.</th><th>S. G.</th><th>Sugar.</th></tr></thead><tbody><tr><td rowspan="10">31 c.c. pituitrin</td><td>1</td><td>...</td><td>...</td><td>..</td></tr><tr><td>2</td><td>...</td><td>1032</td><td>—</td></tr><tr><td>5</td><td>500 c.c.</td><td>1045</td><td>—</td></tr><tr><td>6</td><td>410 c.c.</td><td>1038</td><td>Trace</td></tr><tr><td>8</td><td>745 c.c.</td><td>1026</td><td>+ (1.5%)</td></tr><tr><td>9</td><td>525 c.c.</td><td>1016</td><td>+ (1%)</td></tr><tr><td>10</td><td>700 c.c.</td><td>1012</td><td>Trace</td></tr><tr><td>11</td><td>790 c.c.</td><td>1013</td><td>Trace</td></tr><tr><td>12</td><td>680 c.c.</td><td>1014</td><td>?</td></tr><tr><td>13</td><td>...</td><td>...</td><td>—</td></tr></tbody></table>

TABLE 5.—DOG 4; WEIGHT 14 KG.

<table><thead><tr><th>Injection.</th><th>Day.</th><th>Vol.</th><th>S. G.</th><th>Sugar.</th></tr></thead><tbody><tr><td rowspan="7">14 c.c. pituitrin*</td><td>1</td><td>340 c.c.</td><td>1025</td><td>—</td></tr><tr><td>2</td><td>510 c.c.</td><td>1032</td><td>+</td></tr><tr><td>3</td><td>530 c.c.</td><td>1019</td><td>Trace</td></tr><tr><td>4</td><td>225 c.c.</td><td>1035</td><td>Trace</td></tr><tr><td>5</td><td>500 c.c.</td><td>1024</td><td>—</td></tr><tr><td>7</td><td colspan="3">Seven puppies.</td></tr></tbody></table>

*Four injections, 3.5 c.c., three hours apart.

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TABLE 6.—DOG 5; WEIGHT 10.5 KG.

<table><thead><tr><th colspan="5" style="text-align:center;">(Pregnant)</th></tr><tr><th>Injection.</th><th>Day.</th><th>Vol.</th><th>S. G.</th><th>Sugar.</th></tr></thead><tbody><tr><td rowspan="10">5 c.c. pituitrin</td><td>1</td><td>...</td><td>1028</td><td>—</td></tr><tr><td>2</td><td>245 c.c.</td><td>1032</td><td>—</td></tr><tr><td>3</td><td>260 c.c.</td><td>1022</td><td>?</td></tr><tr><td>4</td><td>280 c.c.</td><td>1035</td><td>—</td></tr><tr><td>5</td><td>130 c.c.</td><td>1038</td><td>Trace</td></tr><tr><td>8</td><td>...</td><td>...</td><td>—</td></tr><tr><td>12</td><td colspan="3">Five puppies, all normal.</td></tr></tbody></table>

From these results we feel justified in concluding that experimental glycosuria which may be produced with pituitary extract is not of any significance as far as the safety of the product is concerned.

We have observed, and the observation has been reported by others, that the administration of the extract produces a temporary decrease in the normal flow of the pancreatic juice, which is followed by a short increase and then a continued decrease in pancreatic activity. Pituitrin also inhibits the stimulant action of secretin on the activity of the pancreas. Whether or not this action on the pancreas has anything to do with the apparent effect of disturbed sugar metabolism, we are of course unable to state, but we hope that some light may be thrown on it by future experiments.

TWO INTERESTING RESULTS FROM THE
USE OF PITUITARY EXTRACT.

By W. G. DOERN, M.D.

Formerly Professor of Anatomy and Principles of Surgery, Milwaukee
Medical College, Attending Surgeon St. Joseph's Hospital,
Milwaukee, Wis.

[Buffalo Medical Journal, September, 1912.]

We now find animal therapy more thoroughly estab-
lished than ever before in present-day treatment by the
advanced medical men of the country. While many of
the theories advanced as to the therapeutic value of
some of these agents are yet problematical, many of
them have been very thoroughly established by the vast
preponderance of evidence in clinical results.

Although the future of this class of agents is prom-
ising, it will require no little time and mass of clinical
reports to prove or disprove the many theories that
have already been advanced.

One of the most recent subjects of investigation is
the extract of the pituitary body. This little organ
snugly hidden away at the base of the brain has long
been and still is an enigma to science. Some of our
early research workers concluded that it had no pur-
pose other than a cushion or protection for the brain.
Modern science long since ceased to doubt that the
pituitary body was of vital importance to the functions
of certain other of the human organs, and it has been
shown by experiments that there is a relationship be-
tween the thyroid gland and the pituitary body and a
possible relation to the suprarenal glands. Just
what their relationship is becomes a matter of consid-
erable speculation. The fact that the organ is situated
so remote in the human anatomy, far from any field
of observation, renders the possibility of human experi-
ments almost impossible. Our knowledge is therefore
based upon animal experimentation and such clinical
observations as have been possible to make.

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27

It has been my privilege to observe two very inter-
esting cases, treated with an extract of the infundibu-
lar body which was prepared by the Department of
Experimental Medicine of Parke, Davis & Co. My
purpose in reporting these cases is to add just so much
to the information which is so eagerly sought by those
who are interested in the scientific advancement of
modern medicine, with the hope of inviting a co-
operation from other medical men who have had as
much or perhaps more experience with the pituitary
extract.

*Case 1.*—Miss G. Seamstress. Age 26. History: Severe headaches continuing for weeks without relief. While the pain was general through the head, it was usually worse on the right side. At times there was noticeable swelling or puffing of the eyelids. The refraction was apparently normal, and there were no objective or subjective symptoms that would indicate the real cause of the condition. Anodyne and sedative treatment afforded temporary relief. A general physical examination revealed nothing of a positive nature, except that the patient would pass about 1½ pints of urine in twenty-four hours; specific gravity, 1.008. There was no evidence of inflammatory condition of the kidney other than a renal insufficiency.

As an experiment, this patient was given 10 drops of pituitary extract three times a day, and within three days the amount of urine was increased from 1½ to 2½ pints in twenty-four hours. With this came a noticeable improvement in the condition of the patient, with practically complete relief from all headache and eye conditions.

*Case 2.*—Mr. B. Age 52. Married. Occupation, business manager of a large manufacturing concern. History: has always been strong and vigorous, with no severe illness during his entire lifetime. For about six months previous to the present time, he had noticed a lack of potentia sexualis; otherwise apparently in perfect health. He was placed on a treatment of 15 drops of the pituitary extract three times a day, with no other treatment. In a short time there was a noticeable improvement in his condition, and at the end of three weeks the potential energies were restored to normal. This patient has reported several times during the past three months and each time has shown permanent benefit without a continuation of the treatment.

28

This medication suggested itself to me owing to the marked stimulating effect which the pituitary substance has upon the sexual organs, as indicated by the lack of sexual development or loss of powers in cases of tumors of the pituitary body.

I trust that the report of these cases will stimulate other physicians to report similar cases should they by chance have had the opportunity to observe them.
415 Grand Avenue.

# PITUITRIN AS AN OXYTOCIC, ESPECIALLY IN THE TREATMENT OF PLACENTA PREVIA.

BY E. HAUCH AND LEOPOLD MEYER, COPENHAGEN.

[From *Archives Mensuelles d'Obstetrique et de Gynecologie*, October, 1912, page 177.]

The publications of recent years (especially those of Hofbauer, Koenigsberg) relative to the influence of the extract of the posterior lobe of the hypophysis gland on the course of labor have not only authorized the chiefs of obstetrical service to investigate this action, but have even made it their duty to do so.

It was with considerable hesitation that we began our researches at the Rigshospitalet, Copenhagen, November 1st, 1911. Without giving here the statistics of our experiences or making a complete enumeration of them, we submit the general result of these researches and a few examples of the frequently surprising effect of this drug.

Has the employment of Pituitrin caused any dangers or had any untoward accidental effects? We have not observed such in our sixty-five observations. Two mothers and nine children have died, but these deaths were without relation to the employment of the Pituitrin. One of the women died of eclampsia; the other, the fifth day of confinement, as the result of chronic broncho-pneumonia, cysto-pyelonephritis, etc. Of the nine children, three had died before the injection of Pituitrin; in three cases there was a placenta previa and the children were born much before term, likewise the seventh, which died four hours after birth; one child died of pneumonia five days after birth. In the case of the ninth child the heart sounds were perceived until the expulsion of the head, 3 3/4

29

30

hours after the injection; the death of the child was
without doubt caused by compression of the umbilical
cord, which was expelled with the shoulders.

In 19 of our 65 cases the Pituitrin failed of effect.
Of these 19 cases 7 were abortions, and 2 confine-
ments much before term; in 3 cases there were no
uterine contractions before injection; finally, in 1
case, adhesions between the uterus and the abdominal
wall, produced by a previous laparotomy, were prob-
ably the cause of the failure. With regard to the re-
maining six cases, the explanation for the failure of
Pituitrin escapes us, but not entirely, for of these
6 cases 5 were observed in the last two months, and
we suspect that the substance we employed had become
less efficacious.

On the whole we may say that our experience taught us, in conformity with the observations of other authors, that Pituitrin is much less efficacious the farther from term the confinement; that the effect is much more considerable if the injection has been preceded by a good and long labor; in other words, the drug is more efficacious against the insufficiency of the secondary uterine contractions than against primary inertia, and that it cannot be used at all to bring about confinement.

After this enumeration of our failures we are going
to give a few cases, taken at hazard in our observa-
tions, showing the efficacy of Pituitrin.

PITUITRIN IN UTERINE INERTIA.

1st Case.—Primipara, 23 years, entered with slight contractions. Six hours later: dilation of 2 centimeters only, water sac intact, the head in the cavity; very weak contractions. Four hours later: dilation of 4 centimeters; aside from this no change. Subcutaneous injection of Pituitrin, 0.5 Cc. A few minutes afterward the contractions become very

31

strong, the first few succeeding each other almost with-
out interval. Ten minutes after injection the water
sac breaks, and twenty-five minutes after injection
(fourteen hours after the commencement of labor) a
living and healthy child is born.

2d Case.—III-para of 27 years; labor had com-
menced with the rupture of the membranes, and one
hour later the contractions appeared; they were fre-
quent, but weak and irregular. Five hours later, dila-
tion of 5 centimeters, neck almost effaced, head in
cavity. The fetal heart sounds becoming less regular,
Pituitrin is given (0.5 Cc.). The contractions after a
few minutes become stronger, regular and less fre-
quent. Three-quarters of an hour after injection, a
child is born apparently dead (three loops of the cord
around the neck), but easily revived.

3d Case.—Primipara, 25 years, entered hardly three hours after the first pains; weak contractions. Nineteen hours after the commencement of labor, dilation almost nil, neck effaced, water sac intact, head in cavity. Injection of Pituitrin 0.5 Cc. Six minutes afterward the contractions became excellent, separated by intervals at first very short, then four to five minutes. Four hours after injection, rupture of the membranes, and birth of a living child one hour and a half later.

4th Case.—Primipara, 32 years; accouchement pro-
gressed very slowly. Seventy hours after the com-
mencement of labor, dilation almost complete (the
water sac had broken six hours before), head in
cavity. A few minutes after injection of Pituitrin
(0.5 Cc.), the contractions became strong and more
frequent, and thirty-five minutes after injection the
head appeared in the vulva. The contractions re-
mained vigorous, but the intervals became longer.
Two hours after injection, a living child was born.

32

**5th Case.**—Primipara, 19 years; entered thirty-six hours after the commencement of labor, which progressed very painfully, and when the head appeared in the vulva after a labor of more than eighty hours there was complete inertia. Two hours later, injection of Pituitrin (0.5 Cc.); almost immediately afterward, the contractions returned, energetic and frequent; a quarter of an hour after the injection, birth of a living child.

**6th Case.**—Primipara of 20 years. At the moment when the head appeared in the vulva, complete inertia occurred. The fetal heart sounds becoming weak, Pituitrin (0.5 Cc.) was injected. Three minutes afterward the contractions became energetic; twenty-five minutes after the injection, birth of a living child.

These few examples (which we could easily multiply) should suffice to demonstrate the excellent, at times almost marvelous, effect of Pituitrin on the course of labor. For inertia during the period of delivery we have tried Pituitrin only once and without effect. We should add that never has the employment of Pituitrin during confinement had any untoward effect on delivery.

As to the indications for the employment of Pituitrin, we believe them to be quite numerous. In the first place is insufficiency of contractions. What obstetrician has not, at a given moment, desired to have at his command some means for rendering the course of labor normal? And this is exactly what Pituitrin can do very frequently—especially when it is a question of secondary insufficiency of contractions; it appears to be less active against primary inertia.

For secondary insufficiency it may be employed in the period of dilation and in the period of expulsion; in this latter period an injection of Pituitrin will frequently take the place of the application of forceps.

33

We shall speak later on of the efficacy and the great usefulness of Pituitrin in uterine hemorrhage during confinement; the following case demonstrates its usefulness in another condition:

**7th Case.**—Primipara of 23 years, having hydramnios (with suspicion of double pregnancy). Labor, which progressed very slowly, had begun about five weeks before term. Seventy hours after the commencement of labor we punctured the sac; the dilation was only 2 to 3 centimeters. There was observed a prolapse of the umbilical cord, which was reduced immediately. Weak contractions. Eight hours later, prolapse of a great arch of the cord. Dilation of 5 to 6 centimeters. Reduction of the prolapse and, directly afterward, injection of Pituitrin (0.5 Cc.). Some minutes afterward strong contractions appeared, and the head descended and prevented the prolapse from occurring again. An hour and a half after the injection, birth of a living child. The second child was born ten minutes after puncture of the second sac.

We have not yet had occasion to employ Pituitrin in cases of faulty pelvis. In this condition there should not be too great a disproportion between the fetal head and the pelvis.

As certain of the cases cited above demonstrate, Pituitrin may be employed to advantage in case of fetal suffering. Preparations for the application of forceps always require time. As soon as the indication for artificial accouchement has been given, Pituitrin is injected and preparations commenced for the application of forceps; in these cases delivery will often occur spontaneously.

Further experience will show us whether Pituitrin may be employed without danger in serious ailments of the heart and lungs, as well as in nephritis and eclampsia, taking into consideration the elevation of arterial pressure which it produces.

34

In the period of delivery the necessity for an ecbolic
drug does not make itself felt as during parturition;
rye ergot generally suffices. In the single case in
which we tried Pituitrin, the result was almost *nil*.

Aside from the indications mentioned above, it
seems to us interesting to study in a more detailed
manner the employment of Pituitrin in hemorrhages
due to *placenta previa*.

The simplest and least dangerous treatment of this
complication is the artificial rupture of the mem-
branes; but in order to have a chance to succeed the
following conditions are necessary:

(1) The woman should not be anemic;

(2) The fetus should be in a longitudinal position;

(3) There should be no mechanical disproportion;

(4) The dilation should be at least about 3 centi-
meters in diameter;

(5) The contractions should be energetic.

It is difficult to modify the three first conditions if
they are not favorable, while there are numerous
means of acting on the dilation of the cervix. But
up to the present it has been impossible to cause con-
tractions of the uterus by means of an internal medi-
cament. Now it is otherwise, for, as our observations
go to prove, Pituitrin has exactly this action, which
permits us in many cases to confine our treatment to
the rupture of the membranes.

But, as we have said above, it is especially in the
cases where pregnancy is at term or almost at term,
where labor is sufficiently advanced, and where we
have to do with secondary insufficiency of the uterine
contractions, that we have the right to expect a good
result from the employment of Pituitrin. In placenta
previa, as a rule, the labor has hardly commenced and
only very weak contractions of the uterus are ob-
served.

35

PITUITRIN IN PLACENTA PREVIA.

We have employed Pituitrin and artificial rupture
of the membranes in all cases of placenta previa ob-
served since the end of November, 1911, in service B
of the Maternité du Rigshospitalet—that is, in seven
cases:

*Case 1.*—Primipara. The orifice of the cervix was scarcely permeable by a finger, and there were no pains, when hemorrhage forced us to interfere. After careful manual dilation to 3 centimeters, the membranes bordering on the placenta were ruptured, and Pituitrin, 0.5 Cc., given. The pains did not appear, and an oozing hemorrhage continued. After a half-hour the injection was repeated; the pains improved, the head entered the pelvis, hemorrhage ceased, and six hours later the patient gave birth to a living child, at term, weighing 3350 grams.

*Case 2.*—Vpara, who had lost much blood at home, entered with a slight hemorrhage; dilation of 4 centimeters; a lateral placenta previa was found. Pituitrin, 0.5 Cc., was injected, when the pains at once became more efficacious, and she was delivered two hours later without further loss of blood. The child was living, and weighed 2400 grams; born about four weeks before term.

*Case 3.*—The woman was a VIIpara with lateral placenta previa, oozing hemorrhage, and very few pains; the orifice was dilated about 2 centimeters. By error, Pituitrin was given and the membranes not broken until an hour and a half later; the hemorrhage during this time was very insignificant. At the time of the rupture of the membranes a prolapse of the cord was caused, which was reduced, and another dose of Pituitrin at once injected in order to fix the head and avoid another prolapse of the cord. For three hours labor progressed very well; no hemorrhage. But

36

at the end of this time the contractions declined and the heart sounds became irregular. It was for this reason that a third dose of Pituitrin was given. Fourteen minutes later the woman gave birth to a living child of 2000 grams, 44 centimeters long—four to six weeks before term. The insertion of the umbilical cord was distant only 3 centimeters from the edge of the orifice of the rupture of the membranes. It is interesting to observe that despite the placenta previa, the prolapse and retropulsion of the cord, despite the very premature confinement and very low insertion of the cord, it was possible to deliver a living child. Such a result would be difficult if not impossible under any other treatment, except perhaps abdominal section.

*Case 4.—*VIII para; had a considerable loss of blood at home; entered the service with slight pains and quite a severe hemorrhage. Dilation was 4 to 5 centimeters; the membranes were ruptured and Pituitrin given. Soon the contractions became stronger; however, as after three-quarters of an hour the head had not yet appeared and the hemorrhage, although slight, continued, a second dose of Pituitrin was given, the effect of which was excellent, and one hour later the woman gave birth to a child at term, living, of 3750 grams and measuring 53 centimeters.

Aside from these four cases in which the method has succeeded well, we have had failures in three cases:

In one of these three cases it was necessary to bring about delivery before term on account of a very grave cysto-pyelonephritis; but the different investigations have demonstrated to us that Pituitrin has almost no effect on abortions and confinements produced long before term.

In the two other failures it was a question of total placenta previa, where the artificial rupture of the membranes always gives a very uncertain result.

37

These cases in which Pituitrin has failed have already been counted in the total of failures given above.

In the four favorable cases the placenta previa was lateral and the patients entered the service at the beginning of labor.

Our results are too few in number to permit us to draw conclusions, but it seems that the treatment may give fine results in cases of lateral placenta previa when labor has commenced, but there is not great hope of success in other cases.

However, it is necessary to continue the experiments and to make them only in a clinic where all is in readiness for further intervention if the rupture of the membranes and Pituitrin are not sufficient. For ordinarily hemorrhage continues (as is seen by the description of cases) some time after the rupture and the injection of Pituitrin, and it is then necessary to try to bring the head into the cavity by external manual maneuvers, and produce contractions by friction. If one could be sure that the treatment would succeed, the loss of blood would be of no importance compared with the hemorrhage which follows other treatments. But if it is necessary anyhow to resort to another treatment, it is entirely useless to permit this hemorrhage to occur.

That is why it is necessary to still wait before explaining this method of treatment of placenta previa as rational. It seems to us nevertheless that the results obtained are sufficiently encouraging to justify continued trial of the method.

We should say finally that we have employed rupture of the membranes and injection of Pituitrin in three cases of premature detachment of the placenta. In two of these cases the result was excellent; the third was an abortion and the Pituitrin was without effect.

38

## TECHNIQUE.

As to the *method of employing* Pituitrin, we have always employed it by subcutaneous injection. It is necessary to entirely avoid alcohol for cleansing the syringe and the needle and for the washing of the skin, since experience has demonstrated that alcohol counteracts the desired effect of the Pituitrin.

Sometimes, quite frequently even, it is necessary to repeat the injection after a certain time, three-quarters of an hour, one hour at most, for the effect is often of short duration. The injections may even be given several times without danger, for there is no cumulative effect of the drug. In all our observations we have employed the preparation of Parke, Davis & Co., the dose of which is 0.5 Cc., and which is sold in ampoules. But as the efficacy of this preparation seems to us to have diminished recently, in future we shall inject a double dose.*

*Pituitrin retains its characteristic properties for about twelve months.
Our packages are stamped with an expiration date.—PARKE, DAVIS & Co.

# DIFFICULTIES OCCURRING AS THE RESULT OF THE EMPLOYMENT OF HYPHOPHYSIS EXTRACT.

BY M. P. LEQUEUX.

[From *Bulletin de la Societe d'Obstetrique et de Gynecologie*, No. 7, July, 1912, page 710.]

The communication which has just been made, by M. Siguret, tempts me to report an observation which I anticipated communicating at the next session of the Society.

The case was that of a young woman, Mme. M—, secundipara, who, in the second month of pregnancy, had some hemorrhagic symptoms, which ceased after the retroverted uterus had been brought back into its normal position. At that time the uterus was irregular, which made me think of the existence of an angular pregnancy. After this incident of the first weeks, everything returned to normal until the eighth month. At this time, June 8th, the membranes were ruptured without any contraction appearing. After prescribing a rigorous asepsis I awaited the commencement of labor. June 13th the temperature rose. There was at no time any sign of labor. I then made a subcutaneous injection of 1 Cc. of hypophysis extract (Parke, Davis & Co.). The woman experienced, half an hour afterward, some very distinct painful contractions, intermittent and regular, with two minutes' interval; they became farther apart after the lapse of an hour and completely disappeared after an hour and a half. The next day, June 14th, the commencement of labor had entirely ceased; I repeated the injection of hypophysis extract, under the same conditions as the evening before, and with the same dose; the same contractions appeared a half-hour afterward and con-

39

40

tinued for an hour and a half, every two minutes; the cervix seemed to be effaced. Then everything calmed down until the next day, June 15th, when the pains reappeared spontaneously in the night for about an hour, then disappeared. Finally, June 16th, some hours after this warning, labor freely set in; the pains were precipitate, returning at first every two or three minutes, then every minute, and in three hours the woman gave birth to a living child of 2500 grams. At the end of a half-hour I found quite an abundant hemorrhage; tried delivery of the placenta without success; waited again. The hemorrhage was not very abundant, but delivery was not effected. I then decided to practice artificial delivery and found a veritable placental incarceration in the right horn; this incarceration was so tight that it was necessary for me to make an effort, in spite of the anesthesia, to force the muscular ring. In the three days which followed the woman presented a peculiar phenomenon, characterized by a condition of almost continuous uterine contracture, shown by an unendurable discomfort and abdominal heaviness. Everything returned to normal, and the remainder of confinement was normal.

I must have had to do in this particular case with an angular pregnancy; and it is to that that I believe I can attribute the major part of the symptoms observed—hemorrhage in the beginning, partial retroversion, premature rupture of the membranes, and complications of delivery.

However, it is also necessary, it seems to me, to seek in this latter phase of the confinement the role played by the Pituitrin. I believe that one may from this observation draw some deductions as to the employment of hypophysis extract.

1st. Hypophysis extract is capable of bringing on labor by itself; this action was not sufficient, in the case reported, to bring on free labor, but perhaps if

41

the injection had been repeated at the time of the abating of the pains better results could have been obtained.

2nd. Hypophysis extract is capable of maintaining its action in the latent state for several hours or days after its administration. This latency is not absolute, and the pains may persist, dull until the moment when, labor setting in, one beholds a veritable tempest of contractions.

3rd. Hypophysis extract is capable of acting on the uterus so as to modify delivery of the placenta; perhaps if the ovular implantation had been normal in our patient we should have had simply a rapid delivery; but the fact that the implantation had been angular must have favored the abnormal retraction of the organ below the horn which contained the placenta, and given rise to its incarceration.

4th. The condition of uterine contraction produced by the employment of hypophysis extract may be continued after delivery for a greater or less length of time and give rise in the woman to a state of malaise at times unendurable.

Such are the deductions which I believe it possible to draw from this observation. I would add that, having had occasion to employ hypophysis extract several times, in the city as well as in the service of my chief, M. le Pr. Bar, I have never had a similar incident occur.

## DISCUSSION.

M. Boissard: Like Dr. Lequeux, I shall make the same reservations on the subject of the action of Pituitrin on delivery; as a result of the intensity of the uterine contractions, the fetus is expelled abruptly, and the uterus continuing to be contracted closes and incarcerates the placenta, which soon, in its turn, is expelled with force, when the membranes are wedged between the retracted uterine walls, which explains the

42

possibility of delivery with uncrowned placenta, as we
have observed in one case when there had been no
traction made on the cord; it is an actual delivery by
uterine expression.

M. Pouliot: I am personally much pleased at the
confirmation which the communication of M. Siguret
and the observations of M. Bar furnish to most of the
conclusions of the communication that I made at the
preceding session in the name of M. Vayssières and
myself.

I would point out again in M. Siguret's communica-
tion the relatively large dose of Pituitrin which he
administers to his patients: 1.8 Cc. three times. At
the Maternité de Lariboisière we have most fre-
quently adhered to 0.6 Cc. I question whether the
slight hemorrhages of delivery pointed out by Siguret
have not for a cause this exaggeration of doses.

The retraction of the uterus on the placenta pointed
out by M. Lequeux has already been observed once.
M. Lequeux's case is, to my knowledge, the second
out of more than 700 cases of the employment of hy-
pophysis extract. It presents another peculiarity that
we ourselves have observed (case No. 5 of our mem-
orandum); that is, the persistence for four days of
intense uterine pains with syncopal tendencies.

Here again I believe it is necessary to attribute it
to the exaggeration of doses. I may conclude by
pointing out that since the last session we have en-
deavored once without success to produce labor by
the aid of Pituitrin.

74872

COAGULOSE

P. D. & CO.

(Hemostatic Ferment)

It has long been recognized that persistent hemorrhage may be due to a variety of causes, the most important of which is diminished or retarded blood coagulation. This is believed to be due, in the majority of cases, to the insufficient production of a specific substance known as "fibrin ferment," which apparently plays an important part in the formation of the blood clot. This view is supported by the fact that many cases of hemorrhage have been successfully controlled by the local application or the hypodermatic injection of fresh normal blood or blood serum. The use of serum for this purpose has not, however, found as wide an application as the results reported warrant, owing to the difficulty of procuring fresh and reliable serum on short notice. Fluid blood serum cannot be preserved for this purpose, since it rapidly loses its efficacy as a hemostatic.

COAGULOSE is obtained by precipitating normal blood serum. It is a sterile, soluble, anhydrous powder, containing the fibrin ferment necessary for clotting the blood. It is readily soluble in cold water at concentrations two or three times that of the original serum; and, according to the statement of Clowes and Busch, the originators of the product, it possesses over fluid blood serum the great advantage of retaining its active principles unimpaired for long periods of time.

COAGULOSE, even when administered in repeated doses, has not, in an experience of upwards of two hundred cases thus far treated, caused any untoward symptoms.

2

## THERAPEUTIC INDICATIONS.

COAGULOSE is indicated in all cases of hemorrhage due to defective clotting of the blood, as seen in hemophilia, hemorrhage of the new-born, etc. The types of hemorrhage which have been successfully treated include the following: nasal hemorrhage, hemorrhage of the new-born, hemorrhage from gastric ulcer, hemorrhage from duodenal ulcer, pulmonary hemorrhage, hemorrhage during and after prostatectomy, hemorrhage from the kidney pelvis, hemorrhage from the bladder, uterine hemorrhage, puerperal hemorrhage, and hemorrhages after turbinectomies and tonsillectomies. COAGULOSE has also been applied as a local styptic to bleeding surfaces, as in oozing after nasal operations and following the separation of peritoneal adhesions. It has been used with apparent success as a prophylactic before operative procedures upon the nose and throat.

## PACKAGES.

COAGULOSE is supplied in 15-Cc. glass bulbs which contain 0.65 gramme of the desiccated powder, equivalent to 10 Cc. of blood serum.

## DIRECTIONS FOR USE.

Add to the powder in the bulb from 6 to 8 Cc. of sterile water, the temperature of which should not be above that of the blood. The water may be conveniently introduced into the bulb through the needle of a 5-Cc. or 10-Cc. syringe. The rubber stopper should then be replaced and the bulb shaken vigorously until the powder is dissolved. The solution may then be drawn up into the syringe through the needle (inverting the bulb if necessary to obtain the last drops). The solution may be injected subcutaneously at any convenient point.

3

## DOSE.

In general the dose consists of the contents of one bulb, but the amount may be increased or diminished as indicated, and administered at such intervals as the condition of the case may warrant. In ordinary cases of hemorrhage (nasal hemorrhages for example) the contents of one bulb may be administered at first, and if the bleeding is not entirely controlled within half an hour a second dose should be given within two or three hours. In all serious cases, particularly hemorrhages of the new-born, a second dose should be administered regardless of the results of the first dose. In persistent hemorrhages three or four injections may be given daily for several days, and these should be continued for a short period after the hemorrhage ceases. In certain cases of pulmonary hemorrhage excellent results have followed the administration of two or three doses a week for several months. It should be particularly noted that the dose is the same for infants as for adults. Considerable latitude is permissible in the administration of this product owing to the fact that the material is apparently non-toxic. It should be remembered, in dealing with hemorrhage, that the chances of successful treatment are far greater if COAGULOSE is administered within a very short time after the commencement of the bleeding. Locally, to stanch persistent oozing of blood, as mentioned under "Therapeutic Indications," the powder may be applied on a tampon or on sterile gauze or cotton.

## ADVANTAGE OVER LIQUID BLOOD SERUM.

COAGULOSE, being permanent, readily available and easily applied, eliminates the delay invariably associated with the preparation of fresh fluid serum, a delay which in a large proportion of cases is likely to prove fatal to the patient.

5

[From the New York Medical Journal, Jan. 4, 1913.]

# TREATMENT OF HEMORRHAGE WITH PRECIPITATED BLOOD SERA.

## Together with a Method of Estimating the Activity of the Latter.

BY G. H. A. CLOWES, PH.D., AND F. C. BUSCH, M.D.

### INTRODUCTION.

Persistent hemorrhage from small vessels may be due to a variety of causes, the most important of which are diminished or delayed blood coagulation, high blood pressure, and persistent vasodilatation. It is proposed in this communication to present a mode of procedure which has proved of considerable value in treating the first and most frequently occurring condition, a low coagulation factor. Abnormally low or retarded blood coagulation may occur as a more or less constant defect in true bleeders or hemophiliacs, as a transient condition in patients suffering from toxemia, and occasionally without any demonstrable cause in apparently normal individuals. It is not the purpose of this article to discuss the probable nature of the defect in question. It may, however, be stated that the view once held that calcium deficiency is the main cause of persistent hemorrhage has been disproved.

Since the commencement of our work on the treatment of hemorrhage, a series of articles has been published by Howell¹ and his associates throwing considerable light on the mechanism of blood coagulation, and indicating a variety of ways whereby, under pathological conditions, coagulation may be retarded or entirely prevented.

4

It has long been known that the fibrin clot results from the coagulating action of thrombin, the so-called fibrin ferment, on fibrinogen, a normal constituent of the blood, in the presence of calcium. There has been considerable speculation regarding the origin of thrombin and the forces which under normal conditions result in the liberation of this body from its precursors when a bloodvessel is sufficiently injured to cause hemorrhage. Howell has demonstrated that retardation or suspension of clotting is frequently attributable to the action of a body designated as antithrombin, which neutralizes thrombin; and that it is only after removal of the antithrombin or the addition of a further amount of thrombin that coagulation can be induced under such circumstances. It is also possible, especially in cases of hepatic cirrhosis, that the fibrinogen content of the blood may fall so low that even in the presence of an adequate proportion of thrombin the clot formed is not sufficiently tough to effect the desired result. For details regarding the processes in question and the extent to which individual constituents of the blood may vary under varying pathological conditions, reference may be made to a recently published paper by Whipple.²

Practical experience would indicate that in the large majority of cases of pathological hemorrhage thrombin is not liberated in sufficient quantity or rapidly enough to produce the desired clot. A rational therapeutic procedure to obviate this defect would be to introduce into the system a supply of the ferment in question, through the instrumentality of which the normal coagulation process might be induced. Fresh normal serum from whatever source contains large quantities of fibrin ferment, and the administration of serum, either locally or by subcutaneous injection, has been found to give excellent results in the hands of a large number of investigators.

For a general review of the literature on the use of

6

serum in the treatment of hemorrhage, reference may be made to recently published papers by Probasco³ and Lescohier.⁴ While serum has been used in isolated cases in the treatment of hemorrhage since 1897, in which year Bienwald⁵ reported the successful treatment of a case of hemophilia by this means, the procedure does not appear to have been generally adopted until recently. The brilliant results reported by Welch⁶ in the treatment of hemorrhage of the newborn have doubtless served to focus attention on this therapy and have led to its use in all cases of otherwise uncontrollable hemorrhage. The sera of a large variety of animals have been employed, but a prejudice seems to exist in favor of fresh human serum, the use of which is considered to entail less risk of toxic effects. Rabbit serum has been successfully employed and does not appear to have given any unfavorable symptoms. Horse serum has been used extensively, but apparently with some hesitation on account of the supposed risk of anaphylaxis. The greatest degree of toxicity has been ascribed to the serum of bullocks and dogs.

SEPARATION AND PRECIPITATION OF BLOOD SERUM.

In our early experiments human and rabbit sera freshly separated from the clot were used with satisfactory results in the treatment of hemorrhage of the new-born and in other hemorrhages. Considerable difficulty was experienced in procuring blood serum when required in emergency; for even when taken with the greatest precaution and preserved sterile in a refrigerator, it rapidly loses its efficiency as an agent for checking hemorrhage. It was obvious that the difficulties in question might most readily be overcome by precipitating fresh serum in the form of a dry powder.

With this end in view we attempted to apply certain

7

principles regarding the precipitation and conservation of enzymes, which had previously been worked out by Clowes⁷ while engaged in researches on zymase, the enzyme of yeast. In these researches, which are still in part unpublished, Buchner's method, which consists of precipitating pressed yeast by means of acetone, was first employed. This method was subsequently modified, a mixture of acetone and ether being used as precipitant. This latter procedure proved peculiarly applicable, as after numerous experiments we succeeded in precipitating from blood serum an anhydrous, sterile, soluble powder containing the desired fibrin ferment in a relatively concentrated form.

Our first preparations were made from human and rabbit serum; but owing to the difficulty experienced in obtaining an adequate supply as the demand increased, we subsequently used the serum of horses, bullocks, sheep, and goats, from all of which satisfactory products were obtained.

Horse serum, for reasons stated above, is considered preferable to that of other animals, and so far as we have been able to judge is readily precipitated and yields a very active product. Consequently, for upwards of a year we have worked almost exclusively with preparations derived from horse serum and have obtained clinical results fully equal to those previously obtained with precipitated rabbit and human sera.

The method of preparation which we have employed consists of precipitating fresh serum by means of an excess of a mixture of acetone and ether, and filtering under pressure to remove the precipitant. The amount of precipitant and the proportions of acetone and ether which it is necessary to employ in order to obtain the best results vary widely with the different animals, and even with animals of the same species. Even such apparently extraneous factors as the temperature and degree of humidity of the atmosphere exert a marked effect on the process. Consequently, it is au

8

visable to make one or two preliminary experiments from which to determine the best working conditions. The best results are obtained when the precipitate separates rapidly and is readily soluble in water. An observant individual easily acquires an appreciation of the factors making for or against the success of the process.

Fortunately, we have at our disposal a very reliable laboratory method (full details regarding which will be found at a later stage in this report) by means of which we are able to determine the relative blood clotting capacity of precipitated sera before using them clinically. This method is obviously of great assistance in controlling the preparation of the product, and serves as a valuable check on the results obtained. All preparations used clinically have been tested in this manner and have been found to exert a clotting action on plasma, varying from three to ten times that of fresh normal serum.

Precipitated blood serum, if properly prepared, is a friable, anhydrous, sterile powder, readily soluble in cold water at a concentration twice that of the original serum, and, so far as we are able to judge from preparations made two years ago, retains its active principles unimpaired for long periods of time. A product of this type possesses over blood serum the advantage not only of permanence, but also of immediate availability, a factor of no small importance in dealing with hemorrhage.

## APPLICATION OF PRECIPITATED BLOOD SERA IN THE TREATMENT OF HEMORRHAGE.

In upwards of one hundred and fifty human cases of hemorrhage thus far treated, products precipitated from the sera of human beings, rabbits and horses by the method described above have been used. Recently, for reasons stated above, precipitated horse

9

serum has been employed exclusively, with excellent results. The types of hemorrhage treated include: Hemorrhage of the new-born; hemorrhage from gastric ulcer; hemorrhage from duodenal ulcer; pulmonary hemorrhage; hemorrhage during and after prostatectomy; hemorrhage from kidney pelvis; hemorrhage from bladder; uterine hemorrhage; hemorrhagic purpura; hemorrhages after turbinectomies and tonsillectomies. The serum powder has been applied as a local styptic to bleeding surfaces, as in oozing after nasal operations and from separated peritoneal adhesions. It has also been used with apparent success as a prophylactic before operative procedures upon the nose and throat. The fear has been expressed, as stated above, that anaphylactic reactions might result from the use of products derived from animal sera; but in our experience with upwards of one hundred and twenty cases treated (many repeatedly) with precipitated sera of horses and rabbits no such symptoms have been noted.

We are indebted to a number of physicians for reports on the use of precipitated serum. The following are a few typical case histories illustrating the range of application of this product. For convenience the dose of serum powder employed has frequently been expressed in terms of its equivalent of fresh serum:

**CASE I.** Hemorrhage of the newborn. Well nourished male infant. Oozing of blood from the base of the cord occurred twelve hours after delivery, and twenty-four hours later a stool was passed which on examination was found to contain a small amount of fresh blood. The bleeding from the cord was partially checked by means of a local dressing with the precipitated horse serum referred to above, but required at each dressing.

Following the discovery of blood in the stools a solution of blood serum powder equivalent to 10 Cc. of fresh serum was injected subcutaneously. The

10

oozing from the cord ceased entirely two hours after the injection and subsequent stools were found to be free from blood. No further hemorrhage occurred and recovery was uneventful.

### CASE II.
Hemorrhage of the newborn. Well nourished male child. Difficulty was experienced in introducing a one per cent. silver nitrate solution into the eyes, the lids being swollen and hard to separate. The necessary manipulation caused the expression of a thin bloodstained fluid, which continued to ooze from beneath the lids of both eyes, gradually increasing in quantity and in blood content until within twenty-four hours from birth a frank hemorrhage had developed. The eyelids at this time were markedly puffed, as if from the accumulation of fluid beneath them, and blood escaped steadily drop by drop, at times forming an actual stream over the cheeks. The tension upon the eyelids at this stage caused so much distress that it was found necessary to press out the blood. The clots were very soft and melted when pressed between the fingers.

The application of adrenalin and cold compresses during a period of sixteen hours failed to relieve the condition; on the contrary, the bleeding steadily increased. At this stage a solution of five c. c. precipitated rabbit serum was injected subcutaneously, and within three hours the bleeding from the right eye had ceased and that from the left eye had markedly diminished. Clots expressed at this time were firm and normal. Two more serum injections, one of five c. c. and one of seven c. c., given at four-hour intervals, caused a complete cessation of bleeding, and the treatment was temporarily discontinued. Thirty-six hours later, hemorrhage suddenly recurred from both eyes but was easily controlled by a single injection of ten c. c. of serum powder. Recovery was complete and further history uneventful. (Reported by Dr. Charles Wall, of Buffalo.)

11

### CASE III.*
Hemorrhage of the newborn. Poorly nourished male infant. The first evidence of hemorrhage was a small bloody stool twenty-four hours after birth, at which stage calcium lactate 0.06 gramme was given *per os* every three hours. On the third day after birth two large bloody stools were passed and small petechial hemorrhages appeared upon the trunk and limbs. The calcium lactate was discontinued, and one injection of ten c. c. of rabbit serum powder solution administered subcutaneously. On the fourth day larger subcutaneous hemorrhages appeared on the thighs and abdomen, there was oozing of blood from the nasal and buccal mucous membrane, and one bloody stool. Three injections of horse serum powder solution (two of ten c. c. and one of five c. c.) were given in the course of the fourth day. On the fifth day three stools were passed containing, however, a smaller amount of blood, and there was no further spread of the subcutaneous hemorrhages.

The treatment was the same as on the previous day, three doses of horse serum powder totaling twenty-five c. c. being injected. On the sixth day three stools passed showed only slight traces of fresh blood and the subcutaneous hemorrhages were found to be rapidly fading. It was, however, decided to continue the treatment for another day, four injections of horse serum powder totaling twenty c. c. and one injection of five c. c. fresh human serum being administered. On the seventh day a stool passed was tarry in character, but all evidence of fresh hemorrhage had disappeared, and the treatment was discontinued. From this time on, there was no further evidence of bleeding either from the intestinal tract or subcutaneously, and

*The majority of cases of hemorrhage of the newborn have, in our experience, been relieved by one or two injections of precipitated serum powder. We have purposely selected this unusually stubborn case of hemorrhage for presentation in order to emphasize the importance of persistence in treatment, and to demonstrate that extremely large doses may safely be administered.

12

recovery was rapid and uneventful. (Reported from
Buffalo General Hospital.)

### CASE IV. Persistent bleeding from a slight cut.
This patient, a boy aged three years and nine months, had a hypertrophied heart, with apparently compensated congenital valvular heart defects. There was no previous history of unusual bleeding. A small cut at the base of the big toe of the right foot was dressed, with apparent control of the hemorrhage, which was not excessive. Hemorrhage however recurred during the night with considerable loss of blood. The bleeding was in large part controlled by passing a ligature through the wound and by the application of pressure; a constant oozing of blood, nevertheless, continued under the dressing. Perchloride of iron was then applied to the wound, after which it was repeatedly painted with collodion. This failed to prevent the oozing of blood, which continued during a period of nearly five weeks. When seen by one of us, in consultation, the child was nearly exsanguinated, and blood was seen to be slowly but steadily oozing from under the collodion dressing.

A subcutaneous injection of 5 c. c. of a solution of human blood serum powder was administered, with the result that two hours later oozing from the wound had ceased and did not recur. The same dose of serum was repeated on three successive days. In five days the dressing came away and the wound was healed. There was no further bleeding and the child made a rapid recovery from the anemia. (Patient of Dr. Ross G. Loop, of Elmira, N. Y.)

### CASE V. Hemorrhage of the newborn.
Mild. A well nourished female child, the fourth day after delivery, had slight hemorrhages from the cord, from the nose, and from the vagina. The stools were normal. When first seen by one of us in consultation, there were a few petechiae on the ears and fingers.

13

A solution of human serum powder equivalent to five c. c. of whole serum was injected subcutaneously, at 5 p. m. During the evening slight oozing recurred from the vagina and the nasal mucous membrane. At 1 a. m. another serum injection of eight c. c. was given, after which there was no further hemorrhage. (Patient of Dr. N. G. Russell, of Buffalo.)

### CASE VI. Pulmonary hemorrhage.
Female, aged thirty-one years, with moderately advanced pulmonary tuberculosis. For three weeks previous to the use of serum, she had had hemoptysis of fair amount, at intervals of one to three days. Rest in bed, codeine, atropine, and finally aconite, failed to relieve the hemorrhages.

She was given, at two-hour intervals, three doses of five c. c. horse serum powder solution. The expectoration on the day following serum injection was only slightly blood-tinged. During the next three months, at the end of which period she was discharged with an arrested lesion, there were no further hemorrhages. (Patient of Dr. George Eckel, of Buffalo, N. Y.)

### CASE VII. Hemorrhage from urinary bladder.
Male, aged twenty-six years, had been passing bloody urine for four days. Microscopic examination of the urine showed numerous erythrocytes and leucocytes, in the ratio of ten of the former to one of the latter. A test with three glasses showed blood in equal amount in all.

A ten c. c. solution of horse serum powder was given by subcutaneous injection. On the following day the urine showed no blood macroscopically. Microscopic examination still showed numerous cells but in the ratio of sixteen leucocytes to one erythrocyte. (Patient of Dr. Carl Topkins, Buffalo, N. Y.)

### CASE VIII. Hemorrhage and purpura in typhoid fever.
A woman, aged fifty-five years, in the fourth week of typhoid fever, had several severe intestinal

14

hemorrhages, following which there was general subcutaneous bleeding over the abdomen and back. The patient was profoundly toxic and comatose. The freedom with which blood flowed from needle pricks of the ear lobes, made for the purpose of blood examination, afforded further proof of the extent to which the blood coagulability had been diminished. This condition had continued for a week before serum treatment was commenced.

Four doses of horse serum powder solution, each equivalent to ten c. c. of fresh serum, were given subcutaneously, on four successive days. No further intestinal hemorrhages occurred; the subcutaneous hemorrhages were rapidly absorbed; the temperature dropped and the coma disappeared. Blood coagulability improved as shown by the rapid clotting of blood after ear punctures. The patient had no further hemorrhage, but three weeks later died as a result of intestinal perforation. (Patient of Dr. William Getman, Buffalo, N. Y.)

### CASE IX.
Hemorrhage from gastric ulcer.
A woman, aged thirty-five years, had had an occasional unusually dark stool for one or two months preceding the attack, noted below. At 9:30 a. m. the patient vomited about 400 c. c. of fresh blood. Six hours later, a large bloody stool was passed, at which time the patient fainted. She was then taken to the hospital, had a moderate sized bloody stool during the night, another large red-black stool the day following, and another that night. The same night she again vomited between 300 and 400 c. c. of blood. There was marked pallor and prostration at this time. The day following there was no stool or hematemesis. A day later there was another large red-black fluid stool, and one again two days later.

At this time patient received a subcutaneous injection of horse serum powder solution, equivalent to ten c. c. of fresh serum. The next day there was another

15

bloody stool, and ten c. c. of serum was again injected, this time intramuscularly. There were no further hemorrhages; the patient made a rapid recovery, and has had no further attacks during the eight months that have elapsed since treatment. (Patient of Dr. Joseph Lewis, of Buffalo, N. Y.)

### CASE X.
Gastric hemorrhage.
A man, aged sixty-five years, had been vomiting blood for one hour, during which time the hemoglobin had dropped to thirty-two per cent. While bleeding was still in progress a solution of ten c. c. horse serum powder was injected subcutaneously, and within fifteen minutes following the injection bleeding had ceased and did not recur. (Patient of Dr. N. G. Russell, of Buffalo.)

### CASE XI.
—Bleeding from mucous membranes.
Male, aged thirty-four years, Italian laborer, who had been in America three years. The only history of previous illness was an attack of chills and fever, six years before, which cleared up in a few days without medication. When first seen, May 25th, he complained of pain in the abdomen, vomiting of blood, and passage of bloody urine. He vomited from four to six times daily, the vomitus containing a large amount of blood; there was also oozing from the gums. On May 26th the hemoglobin reading was seventy-five per cent. Patient was given calcium lactate, fifteen grains every four hours for three days, without affecting the hemorrhages.

On May 30th a solution of horse serum powder equivalent to ten c. c. of fresh serum was injected subcutaneously. The following day hemorrhage from the gums had nearly ceased. There was no more hematemesis, and the bleeding from the gums and the bloody urine cleared up within forty-eight hours. As malaria was considered to be the etiological factor, he was given large doses of quinine. In three weeks he had regained his strength and the hemoglobin reading was

16

between eighty-five and ninety per cent. (Patient of Dr. A. J. Cetola, of Buffalo, N. Y.)

### CASE XII. Hemorrhage following extraction of teeth. S. S., male, aged forty-five years, single. Had diabetes, probably for the last five years up to March this year. Since then, on a low carbohydrate diet, the urine had been sugar-free. Slight cuts, such as those sustained in shaving, bled freely. July 29th, at 10 a. m., the left lower front bicuspid and first molar were extracted under cocaine anesthesia. There was very free bleeding from the molar socket for a short time. This diminished to a slight oozing until 5 p. m., when profuse hemorrhage occurred for a few minutes and again slackened to a steady oozing. The dentist (Dr. A. F. Isham) tried to stop the hemorrhage from 6 to 11:40 p. m. by the use of hot water, Monsell's solution, and by packing with adrenalin tape. At 10 and 10:30 p. m., calcium chloride, fifteen grains, was given. Strong pressure over packing controlled the bleeding, which would however reappear upon release of pressure.

At 11:40 p. m., a subcutaneous injection of horse serum powder solution, equivalent to ten c. c. of fresh serum, was administered. The pressure and packing were continued for thirty minutes, at the end of which time, the packing being removed, bleeding was found to have ceased and did not recur. (Patient of Dr. William Irving Thornton, of Buffalo.)

### CASE XIII. Uterine hemorrhage. Unmarried woman, nullipara, aged forty-two years. Profuse menstruation began July 12th. Hemorrhage practically unchecked in spite of treatment with astringents until July 19th, on which date a solution of cow's serum powder equivalent to ten c. c. of fresh serum was injected subcutaneously. Hemorrhage ceased within two hours of the injection. Curettement was done on July 20th with unusually little hemorrhage.

17

Diagnosis—endometritis. (Patient of Doctor Colton, of Buffalo.)

### CASE XIV. Uterine hemorrhage. Mrs. X. Loss of blood as a result of excessive hemorrhage during three last menstrual periods, occurring at intervals of only two or three weeks, had been sufficient to cause collapse. Bimanual examination revealed a retroverted uterus, the size of a small grapefruit, with a smooth, soft, slightly dilated cervix.

After the subcutaneous injection of horse serum powder solution equivalent to 10 c. c. of serum, hemorrhage began to diminish and at the end of six hours had ceased. A prophylactic dose of ten c. c. was given an hour before curettement with the result that there was little bleeding during curettage and none afterward. Microscopic diagnosis, chronic endometritis. (Patient of Doctor Colton, of Buffalo.)

### CASE XV. Rectal hemorrhage. Young woman, aged eighteen years, well nourished; personal and family history negative. May 11th, consulted physician because of pain in rectum. Mucus and pus were present in stools. Had had a rectal discharge for two weeks previously. Digital and speculum examination was without result, because of accompanying pain. Was put on a restricted diet, with lactic acid milk, and given bowel washes of sodium perborate. For three weeks the condition remained stationary, at the end of which time pain increased and the rectal discharge became bloody. June 12th and 13th had profuse hemorrhages from the bowel.

After the third hemorrhage, a subcutaneous injection of horse serum powder solution, equivalent to ten c. c. of fresh serum, was given. Bleeding rapidly subsided. June 15th, under general anesthesia, examination with the proctoscope revealed an ulcer the size of a quarter. This was painted with ten per cent. silver

18

nitrate, and recovery was uneventful. (Case reported by Doctor Colton, of Buffalo.)

### CASE XVI. Nasal hemorrhage.
Man, aged thirty-five years, railroad switchman; single. Family history negative. Had no severe hemorrhage previously, although as a result of an accident, nine years ago, he lost his left leg. Had drunk (whiskey) to excess up to seven years ago, since which time he had been an abstainer. Wassermann test and tuberculin test both negative. First nasal hemorrhage, October 29th, 1911, bled for an hour; controlled by packing. November 20th bled from left nasal chamber for two hours. Bled almost daily with varying severity up to December 23rd, when he entered the Sisters Hospital of Buffalo. Upon nasal examination, an ulcer on each side of cartilaginous septum was discovered. His red blood cells, at this time, numbered 1,390,000 and his hemoglobin was forty per cent. This was further reduced to thirty-two per cent. by January 19, 1912. Hemorrhages had continued almost daily since entrance.

On February 26th and again on March 7th solutions of five c. c. horse serum powder were injected subcutaneously. Hemorrhages subsided and finally ceased after March 11th, and by March 13th the nasal ulcers were healed. Recovery thereafter was rapid and uneventful. (Reported by Doctor Walsh, of Buffalo.)

### CASE XVII. Pulmonary hemorrhage.
M. B., female, aged twenty-two years, single, occupation school-teacher. Had had several moderate sized hemoptyses in the course of a week, becoming increasingly frequent and severe.

Treatment of the patient by rest in bed and opiates having completely failed to relieve the condition, three doses of horse serum powder solution, each the equivalent of ten c. c. serum, were injected subcutaneously at intervals of two hours. There was no hemorrhage on the following day, and only a very slight hemorrhage

19

on the second day after treatment, since which time no further hemorrhages have occurred. (Reported by Dr. George Eckel, of Buffalo.)

### CASE XVIII. Prophylactic use of serum preceding nasal operation.
E. W. H., aged fifty-seven years, male. Adenocarcinoma of the nose springing from the left ethmoid and sphenoid cells. During previous six months had several severe spontaneous hemorrhages from the nose and very severe bleeding after an operation upon the growth by another physician.

Immediately before the last operation a subcutaneous injection of rabbit serum powder solution equivalent to ten c. c. of serum was given. The new growth was then enucleated so far as possible, with an unusually small amount of bleeding and with remarkable clotting of blood. The exact diagnosis of the new growth was made, later, by histological examination. (Reported by Dr. F. W. Hinkel, of Buffalo.)

### CASE XIX. Nasal hemorrhage.
Mrs. A. E. F., aged fifty-six years. Large mucous polyp, originating in the right maxillary sinus and filling the right nasal chamber. The polyp was removed December 26 and a considerable part of the naso-antral wall was resected in order to reach its point of attachment. December 28th, upon the removal of the tampon, a severe and continuous hemorrhage followed.

This was promptly checked by the injection of a five c. c. serum powder solution (rabbit's serum). January 2, 1912, the patient was awakened at 3 a. m. by a free hemorrhage from the right side of the nose. By the time that medical aid arrived, she had lost much blood. A five c. c. rabbit serum powder solution was injected subcutaneously, after which the hemorrhage rapidly subsided. Although there was no recurrence of hemorrhage, the serum injection was repeated on January 4th. On January 8th more of the antral wall was resected incident to the removal of another small

20

polyp mass, without recurrence of hemorrhage. (Report of Dr. F. W. Hinkel, of Buffalo.)

### CASE XX.
Nasal hemorrhage. Mrs. G. F. S., aged forty-five years, May 7th. Asthmatic. Hypertrophic rhinitis of unusual extent. There was, following thorough removal of hypertrophied tissue, including resection of the turbinates, a severe and continued hemorrhage, in spite of tamponage.

A two c. c. solution of horse serum powder was injected, this small dose being used because of a fear that asthma might be induced in this patient, who had some idiosyncrasy in relation to the odor of horses. The hemorrhage rapidly subsided. A larger dose of serum was given, on May 9th, as a prophylactic, with no untoward effect. (Report of Dr. F. W. Hinkel, of Buffalo.)

### CASE XXI.
Use of serum as a prophylactic. Mr. F. S. S., aged fifty-seven years. Five years previously, following removal of nasal polyps and free exenteration of the right ethmoid cells, there was severe and persistent hemorrhage. This was checked with difficulty by complete nasal tamponage. About ten days later a secondary hemorrhage occurred, of such severity and persistence that it was found necessary to ligate the right common carotid artery.

Recently, after the injection of five c. c. horse serum powder solution, polyps were removed from the right nasal chamber, with very little hemorrhage. This patient had arteriosclerosis and chronic nephritis. (Reported by Dr. F. W. Hinkel, of Buffalo.)

While small doses of the precipitated serum powder will frequently check hemorrhage we have found it advisable to administer relatively large doses, the amount most commonly employed being 0.6 to 0.7 gramme, which is equivalent to ten c. c. of whole serum. In certain cases of persistent hemorrhage injections have been repeated at frequent intervals, in-

21

fants even having received from twenty to forty c. c. daily for periods of several days without any unfavorable effects. For prophylaxis against hemorrhage accompanying or following operation, injections have been given the day preceding and an hour before operation, and, when postoperative hemorrhage was feared, one to two hours after operation.

The fear that anaphylactic reactions might result from the use of precipitated horse serum appears thus far to be groundless. No such reactions have been exhibited in any of the patients under observation, some of whom have received repeated doses. In a case of pulmonary hemorrhage, for example, injections were given at weekly intervals for a period of four months.

The precipitated sera were generally readily dissolved by shaking for two or three minutes with cold water, the volume of water required being less than half that of the serum from which the powder was originally precipitated.

It is particularly important to note that human sera, and preparations derived from human sera, are in no wise superior and seldom equal to those of certain animals.

## METHOD OF ESTIMATING THE RELATIVE ACTIVITY OF FRESH AND PRECIPITATED SERA.

The relative rapidity with which the preparations in question cause coagulation of plasma when admixed with the latter at comparable concentrations affords an index of their coagulating activity. The preparation of plasma is as follows:

The blood of any suitable animal (that of a goat was employed in the majority of our experiments) is drawn into a large graduated tube containing a two per cent. aqueous solution of sodium citrate in the proportion of one part of the latter to three or four parts of the blood. The tube is cooled in ice, shaken gently to insure a thorough admixture of blood and citrate

22

solution, and the contents are centrifugated to remove corpuscles. The clear plasma, which should be almost colorless if the operation has been satisfactorily performed, may be preserved in a refrigerator for several weeks.

The precipitated sera to be tested are dissolved at concentrations comparable with that of fresh serum, and each of the resulting solutions is admixed in at least two strengths with a constant amount of the plasma. The tubes are then shaken and placed in an incubator at 37° C. and observed at varying intervals of time from commencement of incubation, the result being recorded as follows:

+++ indicates the formation of a solid jelly, such that the tube may be inverted and even shaken gently without any indication of fluidity.

++ indicates the formation of a jelly which has not however set firmly enough to retain its form or permit of inversion of the tube.

+ indicates a slight but recognizable increase in viscosity compared with normal controls.

In the accompanying table a series of precipitated rabbit sera are compared with fresh rabbit serum by the method described above, and it will be observed that sera precipitated a year or more previously are fully as active as freshly precipitated serum and that all the preparations in question are apparently more active than fresh rabbit serum. That this effect is not due to traces of the precipitants has been amply demonstrated by control experiments in which the addition of small amounts of the precipitants employed exerted, if anything, a slight retardation.

Similar results may be obtained from precipitated sera of horses and other animals. We have made a comparison of various preparations obtained from rabbit serum rather than of similar products obtained from horse serum, because, having first employed

TABLE.

<table><thead><tr><th>Materials tested.</th><th>Vol. of<br>sol. or<br>serum<br>in c.c.</th><th>Water<br>added<br>in c.c.</th><th>Citrated<br>plasma<br>in c.c.</th><th>Incubated at 37° C.<br>Extent of coagulation after<br>15 min. 30 min. 1 hr.</th><th>Incubated at 37° C.<br>Incubated at 37° C.<br>Incubated at 37° C.</th></tr></thead><tbody><tr><td>Rabbit serum powder prepared 18 months<br>previous; 7 per cent. sol.</td><td>0.25</td><td>...</td><td>0.5</td><td>+++</td><td>+++</td></tr><tr><td>Rabbit serum powder prepared 12 months<br>previous; 7 per cent. sol.</td><td>0.05</td><td>0.2</td><td>0.5</td><td>+++</td><td>+++</td></tr><tr><td>Rabbit serum powder freshly prepared; 7<br>per cent. sol.</td><td>0.25</td><td>0.2</td><td>0.5</td><td>+++</td><td>+++</td></tr><tr><td>Rabbit serum preserved sterile for three<br>months</td><td>0.25</td><td>0.2</td><td>0.5</td><td>+++</td><td>+++</td></tr><tr><td>Fresh rabbit serum</td><td>0.25</td><td>0.2</td><td>0.5</td><td>+++</td><td>+++</td></tr><tr><td>Fresh rabbit serum, heated in advance, 30<br>min. at 60° C.</td><td>0.25</td><td>0.2</td><td>0.5</td><td>+++</td><td>+++</td></tr><tr><td>Control</td><td>...</td><td>0.25</td><td>0.5</td><td>+++</td><td>+++</td></tr></tbody></table>

23

24

rabbit serum and having at our disposal some of the earlier preparations, a better demonstration of the durability of the product is afforded than could be obtained from the more recently precipitated horse serum.

We are well aware that the results obtained by tests of this nature carried out in *vitro* are not necessarily indicative of the results to be anticipated in *vivo*. It has been noted, however, that these preparations give clinical results corresponding so far as can be judged with the test tube results, those causing coagulation most readily in *vitro* being generally most effective in *vivo*. For example, the serum powder preparations which exerted a remarkably strong precipitating action on plasma a year and a half after their preparation were found to be unusually active when subsequently employed clinically.

Similarly, the observation that even carefully preserved serum lost its coagulating effect on plasma in a comparatively short space of time coincides with the general clinical experience that fluid blood serum, unless absolutely fresh, is of little value in checking hemorrhage.

It will also be noted that serum previously heated to 60° C. for thirty minutes has no coagulating action on citrated plasma, from which we may conclude that the action of the product in checking hemorrhage is probably attributable to its content of fibrin ferment. Since water at 60° C. destroys the action of the powder, we consider it advisable when making a solution for clinical purposes to keep the temperature of the water employed below 40° C.

## THEORETICAL CONSIDERATIONS.

It is not proposed to indulge in a theoretical discussion of enzymatic and physicochemical phenomena, but it might not be out of place to point out that the me-

25

what surprising observation that precipitated blood serum powder is more active than the serum from which it was derived may readily be explained on the basis of the physicochemical theory or adsorption.

According to this theory, enzymes may be considered to function in virtue of a process of adsorption taking place on their exposed surfaces. If this be the case, the larger the aggregates the smaller will be the surface exposed, consequently the lower the enzymatic activity. Furthermore, the deposition of foreign bodies on the surfaces in question might be expected to cause the frequently noted phenomena of retardation and ultimately complete suspension of enzymatic action. The precipitation of bodies possessed of enzymatic function by the method adopted in our experiments might be expected to result in a breaking down of the bodies in question into smaller aggregates than those originally present. These smaller aggregates might, according to our theory, be expected to exhibit an increased enzymatic activity on account of their increased and freshly developed surface area. It is possible that the greatly increased activity of precipitated sera may be attributable, at least in part, to elimination of antithrombin and consequent liberation of thrombin. It is proposed to investigate this and other theoretical questions in the near future.

## CONCLUSIONS.

1. Blood serum is found to be of considerable value in the treatment of all forms of hemorrhage due to low blood coagulability resulting from diminished thrombin content.

2. Human serum is in no wise superior to that of a variety of animals.

3. Blood serum precipitated by means of a suitable mixture of acetone and ether is fully as effective as fresh serum, if not superior to it. Precipitated serum is more soluble and possesses the advantage over

26

fluid serum of being sterile, always available, and re-
taining indefinitely its capacity to stimulate coagula-
tion of the blood.

4. The product obtained from horse serum appears to yield more uniformly satisfactory results than that obtainable from the sera of other animals, and exerts no deleterious effect.

5. The determination of the rapidity with which sera and solutions of precipitated sera at comparable concentrations cause coagulation of citrated blood plasma affords a simple means of estimating the relative activity of the preparations in question, and consequently of standardizing precipitated sera for clinical purposes.

REFERENCES.

1. W. H. Howell: *American Journal of Physiology*, xxvi, p. 453, and xxix, p. 187.

2. G. H. Whipple: *Archives of Internal Medicine*, ix, p. 365.

3. E. J. Probasco: *New York State Journal of Medicine*, xii, 1, January, 1912.

4. A. W. Lescohier: *New York Medical Journal*, February 3, 1912.

5. Bienwald: *Deutsche medizinische Wochenschrift*, p. 28, 1897.

6. Welch: *American Journal of Medical Sciences*, p. 800, 1910.

7. G. H. A. Clowes: *Proceedings of Society of Biology and Medicine*, vi, p. 44.

113 High Street.

[From the *New York Medical Journal*, Feb. 3, 1912.]

SERUM TREATMENT OF HEMORRHAGE
AND BLOOD DYSCRASIAS.

BY A. W. LESOCHIER, M.D., DETROIT.

[From the Research Laboratory of Parke, Davis & Co.]

It has been reported by numerous investigators that the injection of fresh serum is a potent factor in controlling certain types of hemorrhage where there is a delay in the coagulation of the blood. This clinical fact does not appear to have received general recognition, and it has seemed worth while to attempt a brief review of the scattered references upon this subject with the object of offering a possible incentive to further clinical experimentation. The treatment of hemorrhage depends upon two factors: first, drugs employed for their action on the vessels; second, agents used to promote the coagulation of the blood. Among those drugs whose value depends on vasomotor effects are adrenalin, pituitrin, atropine, and the nitrites; while the salts of calcium, strontium, magnesium, and solutions of gelatin have been employed with varying success in endeavors to shorten the coagulation period. In certain types of hemorrhage, particularly those in hemophilic subjects, these measures have been inadequate.

Regarding the pathogenesis of hemophilia, there is considerable uncertainty. The older pathologists laid much stress upon abnormities in the walls of the bloodvessels as the principal pathological factor, but it is now thought to depend more upon deficient coagulability of the blood.

In 1910 Addis¹ published the results of an investigation of the pathology of twelve cases of hemophilia. In all of these the coagulation of the blood was de-

27

28

layed, and in those cases which showed the most marked symptoms coagulation required an hour or more. Addis states that this delay in coagulation is the only pathological factor which is constantly present, and he believes it to be due to the long time required by the hemophilic prothrombin to change into thrombin in the presence of calcium salts and thrombokinase. Hemophilic thrombin was found as active as normal thrombin, and hemophiliacs readily coagulable as normal fibrinogen. Furthermore varying quantities of calcium added to hemophilic plasma did not affect the coagulation period, and with varying amounts of thrombokinase the same results were obtained.

Sahli,² in discussing Addis's paper, states that he has found the diminution of the coagulating power to be a constant characteristic of hemophilia, but that he believes it to be due to a lack of thrombokinase. Furthermore, he states that the difference between normal and hemophilic blood resides largely in the blood corpuscles, since normal blood corpuscles, even after careful washing, have a strong coagulating effect on hemophilic blood. Sahli concludes that "hemophilia is a cellular anomaly, both of the blood corpuscles and the endothelial lining of the vessels."

It has been long recognized that incoagulable blood in vitro quickly regains its coagulability upon the addition of fresh serum, but clinical application of this phenomenon was not made until recent years. The name of Weil³ has been widely associated with the first attempts to apply serum therapeutically in the treatment of hemorrhage, but almost ten years before Weil published his work (1906-1907) Bienwald⁴ reported the successful control of a case of hemorrhage in a hemophilic child with fresh serum. The case was that of a baby three years old with a characteristic hemophilic history. The child had received a cut in the temple, which bled profusely, and ordinary

29

measures employed in controlling hemorrhage were used without effect. The child was rapidly becoming exsanguinated, and the prognosis apparently hopeless. As a final resort, the grandmother of the infant was bled from the median vein of the arm and the blood applied locally to the wound. The blood coagulated in the cut and the hemorrhage stopped in a short time.

In the same year, Felz and Pigot⁵ reported the successful treatment of purpura with serum, and suggested its use in hemophilia. In the following year, Fry,⁶ acting on the suggestion of Felz and Pigot, employed serum in the treatment of a family of bleeders which came under his attention. In a family of eight brothers, five were hemophilic, and three of these were treated with fresh serum. The first suffered from joint symptoms and large subcutaneous ecchymoses. The second also had joint symptoms; while the third was subject to periodical meningeal hemorrhages. All three cases made recoveries under the serum treatment, the serum being administered in 20-Cc. doses, and from 200 to 300Cc. being required in each case before permanent results were obtained.

As already indicated, Weil was the first to investigate this field of therapeutics with any degree of thoroughness, and subsequent work owes its impetus largely to his initiative.

Weil distinguishes two forms of hemophilia, the accidental or transitory, and the congenital variety. In the transitory variety he found the blood to be thin and to flow rapidly through a needle inserted into a vein. The leucocyte count was normal, and the coagulation time approximately seventy-five minutes. The coagulum was solid, and the serum copious. In the congenital type of the disease the blood was sticky, flowed slowly, and showed an increase in the uninuclear leucocytes. The coagulation time was from two to nine hours, the coagulum soft, and the amount of serum small. Experiments with blood in vitro showed that if

30

three drops of animal serum were added to three Cc. of blood in either class of patients, the coagulation of blood took place promptly. Weil carried his observations further, and found that the same effect would be produced *in vivo* by injections of the serum. The coagulation time for the blood became practically normal two days after the injection, and remained so for several weeks, the effect being a little less marked in the congenital type of the disease. Weil employed both intravenous and subcutaneous injections, the dose being 15 Cc. by the first method and 30 Cc. if administered under the skin. In children, half of the above doses were given. It was also shown that serum applied locally had a styptic action. The sera of man, rabbit, horse, and ox were all found to be efficacious, but homologous serum had the more marked effect on defective coagulation. He believed that the serum should not be more than a fortnight old, and that serum from the cow or the ox, though very active, should not be employed because of its tendency to produce toxic effects.

Weil's observations were based upon eleven cases of hemophilia, including the prophylactic use of the serum for surgical purposes, as well as the treatment of hemorrhage. Injected into a hemophilic subject, in one patient before the extraction of a tooth, and in another who was operated upon for empyema and incision for a paranephritic abscess, the serum effectively prevented hemorrhage. Cases of primary and secondary purpura, marked hematuria, etc., were treated with gratifying results. From his observations of these eleven cases, Weil concludes: "Fresh serum is an effective remedy for the arresting of hemorrhage in all dyscrasic states, more effective than any other, including calcium salts."

In December, 1907, Broca⁷ reported the treatment of two "bleeders" with fresh antidiphtheric and normal serum, and advocated its use in conditions demanding

31

surgical treatment in hemophilic subjects. Broca agrees with Weil that relatively large doses must be employed, and that while any serum may be used, that of the ox or goat should be avoided if possible because of its tendency to produce toxic symptoms. In a subsequent communication, Broca⁸ states that the use of injections of animal serum in the arrest of hemorrhage is permissible only in cases of genuine hemophilia, diagnosticated either by the clinical history or by the examination of the blood. In his opinion most of the failures reported were due to attempts to apply it in other cases. In four cases, the history of which Broca had followed up for several years, preventive injections of serum given every three months proved very beneficial, coagulation of the blood occurring in twenty to thirty minutes, whereas formerly the coagulation period varied from three to twelve hours.

Toussaint⁹ employed subcutaneous injections of antitetanic serum in treatment of a case of hematorrachis, with favorable response, and Dejardin¹⁰ also employed regular antitoxic serum with satisfactory results. Dejardin obtained results similar to those reported by Weil, and believes that while fresh normal serum (rabbit, horse, or human) affords the best results, "a perfectly efficient substitute is found in antidiphtheric serum."

In August, 1908, Gubb¹¹ reported the serum treatment of a case of marked hematuria following an interarticular hemorrhage, in a typical case of hemophilia, with prompt abatement of the hemorrhage and improvement in the general condition of the patient. In October of the same year, Gilchrist¹² reported the treatment of a case closely resembling in symptomatology the one reported by Gubb, in which he prescribed a semivegetable diet and ovarian extract. The improvement was no less striking than in the case reported by Gubb, and Gilchrist believes the credit is due to the fact that "hemophilia has generally recognized

32

affinities with rheumatism," and that the improvement was due to the antirheumatic diet.

At a meeting of the Royal Society of Medicine, in a discussion relative to purpura hemorrhagica and cerebral hemorrhage, Parkinson¹³ reported that he and Fenwick in 1906 treated two cases of hemorrhage, evidently purpural in character, with "multivalent antistreptococcus serum" per rectum. They evidently ascribed favorable response to the antistreptococcic nature of the serum, but in view of the subsequent data we have on the subject, success was probably a result of the favorable effect of the serum upon the coagulation of blood.

Labbé,¹⁴ from an extensive study of hemophilia, concludes "that an injection of fresh serum is the most efficient means we have for the treatment of hemophilia." He believes that the serum is indicated and is of great value in treating inherited or sporadic hemophilia resulting from insufficiency of the blood plasma, but that it can do little good in hemophilia resulting from abnormal permeability of the vessels. In sporadic hemophilia the period of coagulation was reduced in many cases from an hour or more to a very few minutes, thus making possible many surgical procedures otherwise impossible. Labbé states that the effect of the serum is at its height in forty-eight hours, but entirely passes away by the end of about five weeks. Although the effect was less striking in familial hemophilia, and coagulation was not rendered normal, the hemorrhagic tendency became less marked. The bilious hematuria described in one case was banished by the third day. Labbé confirms Weil's conclusion that the serum should be fresh, not more than fifteen days old, and that beef serum should be avoided, as a febrile reaction is likely to follow its administration. The dose employed was from 10 to 20 Cc. intravenously, or from 20 to 40 Cc. subcutaneously. Labbé also used gauze saturated in serum in bleeding wounds and

33

in plugging cavities after the extraction of teeth, and found it to be a powerful hemostatic.

Leary¹⁵ used serum in a series of twenty cases. In fifteen of these hemorrhage had already occurred; while in the remaining five the serum was used as a prophylactic measure. This series included cases of jaundice, hemorrhages of the newborn, hemophilia, purpura, postoperative cases and cases of typhoid. The results with the serum in these cases were apparently very favorable, and while the series is not extensive enough to draw definite conclusions, Leary believes that, taken with the work already reported, these cases are strongly suggestive of the fact that in normal serum we have an efficient addition to present methods of treating hemorrhage. Serum should preferably be fresh, but where this is not possible regular antitoxic serum may be employed.

Lommel¹⁶ reported a case of hereditary hemophilia in a four-year-old boy. This child had an attack of epistaxis, which resisted all other methods of control, but was promptly checked by a 20-Cc. injection of antistreptococcic serum. Ten days later bleeding reappeared, following a severe coughing spell. At this time local application of the serum afforded relief.

The subject of the serum treatment of hemorrhage has been reviewed by Wirth,¹⁷ who found twenty cases reported in which the use of the serum had been attended with favorable results, whereas only two cases had been reported in which no response to the treatment was obtained. The favorable cases reported were those of Weil, 11; Broca, 3; Wirth, 2; Lommel, Tous saint, Archard, and Salfrazes, 1 each; while the two negative reports were from Bonzani¹⁸ and Mauclair.¹⁹ In Mauclair's case, death occurred, this patient suffering from hepatitis and purpura hæmorrhagica, and the prognosis from the very beginning being exceedingly grave.

Wirth²⁰ treated twenty-three cases of hemorrhage

34

from various causes, including two cases of typical hemophilia. One of these was a boy of fourteen years with persistent hemorrhage from the nose, pharynx, gums, and retropharyngeal wall, which failed to respond to treatment with adrenalin, ergot, and injections of gelatin solution, but which stopped upon the local application and subcutaneous injections of diphtheria antitoxin. Recurrences at periods of fourteen and eight days were controlled by injections of 15 Cc. antidiphtheric and 20 Cc. antistreptococcic serum, respectively. No bad effects were observed and the hemorrhagic tendency was kept under complete control by further injections once each month for six months. Another case was a hemophilic girl of fifteen years with metrorrhagia and epistaxis, who was injected with horse serum, and the uterus and vagina tamponed with gauze dipped in serum, with very pronounced benefit. Among the cases not of a true hemophilic nature, which Wirth treated with serum, was a case of cholemia with advanced hepatic cirrhosis, accompanied with marked bleeding from the skin and mucous membranes. Profuse hemorrhage from mouth and nose of a newly-born infant was treated by local application of sponges dipped in horse serum, which rapidly controlled the bleeding. In a number of cases hemorrhages in the lower part of the bowel or from hemorrhoids were arrested by administration of 10 Cc. of ox or horse serum injected into the bowel. Injections of serum were also successfully employed in controlling postoperative hemorrhage in tonsillectomy. From his experience Wirth concludes that while it may be applicable in other cases, this method of treatment is particularly indicated in affections in which the coagulating power of the blood is reduced. As a rule, 20 Cc. is sufficient, but 40 Cc. may be given without harm. He prefers the subcutaneous method, excepting in cases where the emergency is so grave as to demand immediate results. In such cases, intravenous

35

injections were employed. He believes horse serum to be preferable and that ordinary diphtheria antitoxin can be used by selecting the vials with the latest dates. Wirth also found the local application of serum to be a valuable adjunct to the injections.

Baum²¹ studied the influence of blood serum upon coagulation from both laboratory and clinical standpoints, and his conclusions differ quite markedly from those of other observers. While he was able to demonstrate that the coagulation period in rabbits could be markedly shortened by injections of serum, his clinical results in three cases of hemophilia which came under his observation were by no means as satisfactory as those reported by Weil, Broca, and Wirth. Baum believes that the serum undoubtedly possesses value in certain cases where there is a tendency toward bleeding, but questions its efficiency in true cases of hereditary hemophilia. He does not agree that with the use of serum hemophilic patients can safely undergo surgical procedures, but holds that the proper handling of this class of patients precludes surgical measures except when they are absolutely unavoidable.

At a meeting of the Gesellschaft der Aerzte, May, 1909, Mautner²² presented a typical case of hemophilia. The child was known to have been a "bleeder," and was admitted in nearly moribund condition as a result of a steady loss of blood following the extraction of a molar tooth three days previous. The local application of styptics had proved absolutely useless, and it was decided to try the administration of serum. Twenty Cc. of normal horse serum was injected, and after a few minutes the oozing became less and the bleeding soon stopped. There was a recurrence, however, on the following day, and another injection of the same amount was given. The hemorrhage ceased and did not reappear. The blood count on admission showed the erythrocytes to be 1,700,000 per cubic millimeter; their number rose steadily, and five days after the first

36

injection the count was 2,700,000. There was a co-
incident general improvement in the condition of the
patient.

Trembur's²³ patient was a child of about thirteen
years, who had shown pronounced hemophilic ten-
dencies since the age of five, although otherwise in
good health. The child had been in the hospital two
or three times on account of excessive hemorrhages.
These had previously been controlled by tamponing
and injections of gelatin. While there was no history
of hemophilia in the family, Trembur is inclined to
class this case pathologically as true hereditary hemo-
philia, believing that the child was the first to introduce
it into the family. The patient was brought into the
hospital because of serious hemorrhage from the
mouth, left ear, throat, and gums. Blood examination
showed the red cells to be 3,280,000 and the hemo-
globin fifty per cent. The child was placed in bed, but,
although lying quiet, suffered from epistaxis on the
second day. Five Cc. of sheep serum was injected
in the left arm, and four hours afterward hemorrhage
ceased. A recurrence two days later was controlled by
a gauze tampon soaked in sheep serum. Bleeding from
gums was also arrested by local application, but se-
vere hemorrhage from both ears occurred during the
night. Ten Cc. of sheep serum was then injected into
each thigh, and prompt cessation of bleeding took
place. Two weeks later, as there was still a slight ten-
dency to bleed, the injections were repeated. Three
weeks later 19 Cc. was injected into the abdomen.
Between February 22 and May 1, 1909, when she left
the hospital, the child received a total of 106 Cc. of
serum. At the time the patient was discharged there
had been no tendency toward bleeding for some time,
she was in the best of health, and had gained twenty
pounds.

Patek's²⁴ case was a young woman, twenty-six years
old, with a negative family history, who had been a

37

"bleeder" since childhood. Slight contusions were followed by marked ecchymoses, menstruation was excessive, and epistaxis frequent. At the age of twelve the patient had severe hemorrhage of the bowels, and in April, 1910, an intra-abdominal hemorrhage. At the time patient reported for treatment she was very anemic, mucous surfaces were pale, and arms and legs covered with ecchymoses. Blood examinations showed hemoglobin sixty per cent. and red cells 3,000,000. Dietetic measures and the administration of hematic preparations and calcium lactate were followed by marked improvement of patient's condition. Several months later another severe intra-abdominal hemorrhage occurred, leaving the patient in about six weeks. Four months later another attack developed, which was very transient, patient recovering in a few days. In four subsequent attacks injections of antitoxin were employed, and the hemorrhage was controlled without any difficulty. Severe attacks of epistaxis developed from time to time, in which serum was used both by injection and tampon with somewhat doubtful results.

A striking report of the use of serum in treatment of hemophilia is afforded by Welch,²⁵ pathologist to the New York Lying-in Home. He employed injections of normal human serum in the treatment of nine babies suffering from hemophilia neonatorum, without the loss of a single patient. He believes that all of these babies would have succumbed under any other treatment. Of the eighteen cases of hemophilia neonatorum which had occurred in the previous history of the institution, seventeen had ended fatally.

The bleeding in these nine treated cases varied in
its source, occurring from the cord, mouth, nose,
bowel, stomach, vagina, etc., and began in every case
during week following delivery. The serum was em-
ployed in 10-Cc. doses, administered subcutaneously,
injections being repeated two or three times a day for

38

several days. The total amount varied from 16 Cc. in two days to 209 Cc. in five days. In most cases the bleeding was markedly diminished after the first injection, and ceased entirely in from two to seven days. Welch calls attention to the importance of beginning treatment upon the slightest indication of bleeding, as a very slight hemorrhage from the cord may be accompanied by serious internal bleeding.

Misenthal²⁶ reported a case of successful treatment by transfusion, of uncontrollable hemorrhage in melæna neonatorum. End-to-end anastomosis of the infant's femoral vein to the radial artery of the father was performed. The infant's condition became normal and there was no recurrence. Similar cases have been reported by Lambert²⁷ and by Swain, Jackson, and Murphy.²⁸

Robert and Chody,²⁹ in 1909, reported the use of dried horse-serum as a hemostatic. They were led to try this because of the difficulty in promptlysecuring a supply of fresh normal serum for use in hemorrhagic conditions. The serum was collected under aseptic conditions, dried *in vacuo* at a pressure of about two millimeters of mercury and at a temperature approaching 0° C. They found that the serum retained all its properties, both in the dry state and after having been redissolved in water. Externally it was useful in various profuse hemorrhages, in episaxis, and in operations on the tonsils, removal of adenoid vegetations, or hemorrhoidal protrusions, and rupture of hymen. Internally the dried serum was given in cachets to patients suffering from severe hemophilia and other dyscrasic conditions attended with hemorrhage.

Ricard³⁰ and Micleon³¹ have reported cases in which serum has been successfully employed in treatment of hematoma. In Ricard's case, a hematoma of cicatrix following laparotomy in a hemophilic subject was evacuated, and injections of antidiphtheric serum were

39

effectually employed to check the bleeding. Micleon used the serum in one case in the treatment of hematoma of the hand, and in another instance a hematoma of the floor of the mouth.

Gangani's³² case did not respond to injections of regular antitoxic serum, but prompt cessation of bleeding was accomplished by the use of fresh rabbit serum. Gangani believes that such failures as have been reported in the use of serum in hemophilic conditions were due to the fact that the serum employed was either too old or had been modified in some way.

Hubschei³³ combined the serum treatment with surgical procedures in correcting contractures in knees of a fifteen-year-old boy, a typical "bleeder" with a family history of hemophilia. The serum was used two hours after having been taken from the horse. The various procedures necessary for the correction of the deformity were conducted without marked bleeding, whereas the slightest attempt had previously resulted in the production of a dangerous hemorrhage. By this means Hubschei believes it will be possible to avoid fatalities, such as have been reported following operations on hematomata which had been mistaken for tuberculous joints. He refers to cases of this description which have come under his observation, as well as those which have been reported by others. In operations on joints in doubtful cases, he believes the serum should always be injected as a prophylactic measure.

A résumé of this mass of clinical data indicates certain conclusions as being reasonably well established. Other factors important to the practical application of this phenomenon are suggested as requiring further investigation. The consistency with which certain results have been obtained by different workers appears to justify the following conclusions:

1. The coagulation period in hemophilic subjects is greatly shortened by the injection of fresh serum.

2. The local application of fresh serum in wounds,

40

in patients in whom there is a delayed coagulation of the blood, tends to act as a hemostatic.

3. The serum of any species is efficient in producing this phenomenon.

4. The sera of the ox and dog should be avoided if possible because of the toxic symptoms frequently attending their use.

5. Although possessing some efficiency, regular antitoxic sera are less satisfactory than freshly drawn material.

The first of these conclusions seems established beyond question. The only negative results which have been reported were those of Bonzani and Mauclair. Baum's results were not strikingly positive; one case was very favorably influenced, while in the other two very little effect was observed. These negative results may have been due to the fact that the serum was too old, or modified in some way as suggested by Gangani, or that the pathological conditions present did not justify its use. After reviewing the results obtained in a comparatively large number of cases by Weil, Wirth, Welch, and other investigators, we cannot but be convinced of the efficiency of the serum treatment. In the case reported by Patek the results were only fair, but it is noted that he employed regular antidiphtheric serum.

Although several investigators, notably Dejardin, Ricard, and Micleon, have obtained good results with such serums, it seems to be universally agreed that they are less satisfactory than fresh material.

The value of the local application of serum as a styptic has been attested by numerous workers, first by Bienwald, subsequently by Weil, Labbé, Lommel, Wirth, Trembur, and Robert and Chody.

Two questions arise which have an important bearing upon the clinical value and practical application of this method of treatment.

1. Has the serum any value in promoting coagulation of the blood in conditions in which there is no hemophilic tendency?

41

2. Why are stock sera less satisfactory than freshly drawn material?

In view of our lack of knowledge of the way in which the serum produces its effect, and the limited clinical trial which it has had, we are not warranted in drawing any definite conclusions, but the indications are that the serum will be of use only in those conditions in which there is delayed coagulation. This question can be answered only by a thorough clinical trial of the serum treatment in various types of hemorrhages, and by laboratory experiments conducted to determine the possibility of accelerating normal coagulation.

The difference between antitoxic and fresh serums may be due either to age or to the presence of a preservative, which the former always contain. The clinical reports that antitoxic sera have been strikingly efficient in some cases and disappointing in others would tend to discredit the assumption that the preservative acts as a retardant. The inactivity of the sera in accelerating coagulation probably depends upon the changes which they undergo with age. Rettger³⁴ calls attention to the old observation that serum loses its active thrombin on standing. The older observers stated that the thrombin disappeared entirely, but Rettger demonstrated this to be only apparent, that the loss of its ability to produce coagulation is due to thrombin entering into a combination with the other constituents of the serum. He found that serum inactivated by age, or by heating to 65° C., could be reactivated by the addition of a weak alkali or acid.

The resistance of thrombin toward heat was shown by Rettger to be relatively high, solutions after boiling for several minutes being capable of producing typical clotting. In dry form thrombin resisted a temperature of 135° C. for half an hour. It was further observed

42

that the resistance to heat was increased by the diminu-
tion of the protein substances present in the thrombin
solution and that serum which had been inactivated by
heating to 65° C. could be reactivated by heating to a
higher temperature.

Putrefaction also restores to serum, which has been
inactivated by age or by heating, its ability to pro-
duce clot.

The explanation is advanced that these various
agencies, acid, alkali, putrefaction, high temperature,
break up the combination of thrombin and other con-
stituents of serum, and that the thrombin in its free
state is again capable of acting on fibrinogen.

Rettger, commenting on this phenomenon, states:
> "The parallelism between the gradual disappearance of thrombin from serum on standing, and its recovery by activation, and the disappearance of thrombin from serum when heated to 65° C., and its recovery by a similar activation, all point to the conclusion that these two things are essentially the same phenomenon, and that disappearance of the thrombin is probably due to the combining in a loose way with some substance, possibly the proteins of the serum, from which it may in turn be liberated by agencies which tend to destroy this combination. That the disappearance of the thrombin is due to such a loose combination with some substance, and that activation by alkalies is due to the breaking apart of this connection, seems probable from the further fact that serum which has become completely inactivated on standing, becomes later, if submitted to putrefactive processes, quite active again."

We have here a probable explanation for the clinical
fact that stock sera do not yield uniformly successful
results in treating these hemorrhagic conditions Fur-
thermore, this phenomenon is of peculiar importance
in its relation to the practicability of the serum treat-
ment. The use of the native sera in their liquid state
offers this serious objection, that they very shortly be-

43

come inactivated, probably by combining with the pro-
tein substances present. The complete isolation of
thrombin from these protein bodies has not been ac-
complished. It seems possible that the use of dry
serum will overcome this difficulty, as Chody and
Robert have used it with apparently satisfactory re-
sults. This suggests a field for investigation, and the
future serum therapy of hemorrhagic conditions must
depend very largely upon the preparation of a suitable
product.

In conclusion, it may be well to consider briefly how
the accelerated coagulation is brought about in hemo-
philic subjects, and in order to arrive at any conception
of the action of the serum it will be necessary briefly
to refer to the physiology of the coagulation of the
blood. Coagulation has been shown to be due to the
production of fibrin, brought about by the action in
fibrinogen of a fibrin ferment (thrombin) in the pres-
ence of calcium salts. Fibrinogen and calcium salts
preexist in the circulating blood, but the thrombin ex-
ists as such in certain stages of blood coagulation only.
It is thought that thrombin is produced from a pro-
ferment, which becomes activated by a zymoplastic
substance derived either from the formed elements of
the blood or from the tissues.

Decreased coagulability of the blood may be due
either to a deficiency of the calcium salts, absence of
fibrinogen, or inefficiency of thrombin, either quanti-
tatively or qualitatively. Total absence of fibrinogen
has never been observed. Delayed coagulation is some-
times due to deficiency of the calcium salts, as evi-
denced by laboratory findings and by clinical results
which have occasionally been obtained in treating cer-
tain types of hemophilia with salts of calcium. In the
majority of cases such treatment has not been attended
with marked success. The work of Addis indicates
that variations in the percentage of calcium have very
little effect upon the rate of coagulation. The same

44

observer also shows that hemophilic thrombin is fully
as active as thrombin from the normal blood, and that
deficient coagulation depends upon the delay in the
formation of the thrombin from some preexisting sub-
stances in the blood. In his opinion, hemophilia is due
to an absence or low percentage of this preexisting
ferment, prothrombin.

The ability of serum to promote coagulation may be
due to the substitution of the thrombin or to a zymo-
plastic substance which activates the hypothetical pro-
thrombin of hemophilic subjects. There are certain
reasons for believing the former to be the case. The
work of Addis indicates that the amount of these
zymoplastic substances apparently makes little differ-
ence in the rate of coagulation, and that they are pres-
ent in hemophilic subjects in an equal degree with the
normal individual. Further support to this theory is
afforded by the findings that relatively large doses
(from ten to twenty Cc. intravenously, or from twenty
to thirty Cc. subcutaneously) are required to produce
this phenomenon, and by the laboratory investigation
of Rettger, who showed that the amount of thrombin
present had a very pronounced effect upon both the
rapidity and the completeness of the coagulation of
the blood. "The rapidity of the coagulation was found
to be directly proportional to the amount of thrombin
added, as indicated in the following experiment:

20 c.c fibrinogen + 40 drops thrombin extract, 14 minutes.

20 c.c fibrinogen + 20 drops thrombin extract, 26 minutes.

20 c.c fibrinogen + 10 drops thrombin extract, 50 minutes.

20 c.c fibrinogen + 5 drops thrombin extract, 90 minutes.

"The time required for coagulation was determined
by the moment when the glass could be inverted with-
out spilling the contents. Such a rate, however, holds
good only within certain limits. If the amount of
thrombin becomes excessively large, the rapidity of
coagulation does not vary in similar proportions
There is soon reached a maximum amount, beyond

45

which the further increase of the amount of thrombin
no longer increases the rapidity of coagulation."

Rettger also conducted experiments to determine the
quantitative relationship between fibrin formation and
the amount of thrombin present. "For the experi-
ments on this point, 500 Cc. of clear plasma was
taken, and from this plasma 500 Cc. of fibrinogen so-
lution was prepared. This amount was divided into
four equal parts. To one part, five drops of tested
thrombin solution were added; part two, ten drops;
part three, twenty drops; part four, forty drops. The
glasses of fibrinogen were then allowed to stand un-
touched for twenty-four hours at room temperature to
allow ample time for coagulation. The fibrin from
each glass was then collected on a filter, washed and
placed in the weighing tube, which, together with the
filter, had been previously heated several times at a
temperature of 100° C. to approximately constant
weight. The weighing bottles with the several
amounts of fibrin were then heated for several hours
to 100° C. The final weighing gave the following
results:

5 drops of thrombin.........0.2046 gramme fibrin.

10 drops of thrombin.........0.3573 gramme fibrin.

20 drops of thrombin.........0.6089 gramme fibrin.

40 drops of thrombin.........0.5872 gramme fibrin.

"It will be seen from these results that while they
fall short of exact mathematical proportionality, yet
they indicate very clearly the formation of the fibrin in
definite and direct quantitative proportion. . . . It
need not be pointed out that such quantitative rela-
tionships will appear only when the amount of throm-
bin is below the maximum amount required to affect
the entire fibrinogen. Adding thrombin beyond this
maximum amount can, of course, be of no moment,
there being no further fibrinogen available."

The belief that the action of serum in accelerating
coagulation of blood in hemophilic subjects depends

46

upon the substitution of active thrombin is, therefore,
based upon the following facts:

1. The quantity of zymoplastic substances is of little
importance, as they have been shown to be present in
hemophiliacs in an equal degree with the normal indi-
vidual (Addis).

2. Rapidity and completeness of coagulation is di-
rectly proportional to the amount of thrombin present
(Rettger).

3. There is a direct proportion between the quantity of thrombin present and amount of fibrin produced (Rettger).

4. Clinical experience shows that relatively large amounts of serum must be employed to produce definite results.

REFERENCES.

1. ADDIS. *British Medical Journal*, p. 1422, November 5, 1910.

2. SAHLI. *Ibidem*.

3. WEIL. Etude du sang chez les hémophiles, *Bulletin et mémoires de la Société médicale des hôpitaux de Paris*, October, 1906. Editorial review of paper to Société médicale des hôpitaux de Paris, January 11, 1907, *Lancet*, March 7, 1907. *Revue pratique d'obstétrique et de pédiatrie*, reviewed in *Medical Record*, p. 322, August 22, 1908.

4. BIE NWALD. Deutsche medizinische Wochenschrift, p. 28, 1897.

5. FELZ and PIGOT. *Gazette hebdomadaire*, No. 83, 1897.

6. FRY. *Medical Record*, 1898.

7. BROCA. *Medizinisches Klinik*, p. 1445, December 1, 1907.

8. BROCA. *Lancet*, ii, p. 203, July-December, 1910.

9. TOUSSAINT. Report to the Académie de médecine, Paris, *British Medical Journal*, April 6, 1907.

10. Serum Treatment of Hemophilia. Editorial in *New York Medical Journal*, December 12, 1908.

11. GUBB. *British Medical Journal*, August 22, 1908.

12. GILCHRIST. *Ibidem*, October 17, 1908.

13. PARKINSON and FENWICK. *Ibidem*, March 2, 1908.

14. LABBE. *Revue de médecine*, Paris, February, No. 2, pp. 89-208. (Abstract Journal of the American Medical Association, April 18, 1908.)

15. LEARY. *Boston Medical and Surgical Journal*, clix, p. 73, July 16, 1908.

16. LOMMEL. *Centralblatt für innere Medizin*, No. 27, 1908.

17. WIRTH. Mitteilungen aus dem Grenzgebiete der Medizin und Chirurgie, xii, p. 217, 1909.

18. BONZANI. *Riforma medica*, *Napoli*, xxiv, 454-456, 1908.

19. MAUCLAIR. *Semaine médicale*, No. 14, p. 168, 1907.

20. WIRTH. *Wiener medizinische Gesellschaft*, 1908 (abstract in *Münchener medizinische Wochenschrift*, No. 49, p. 2866, 1908); in *Mitteilungen aus dem Grenzgebiete der Medizin und Chirurgie*, xii, p. 241-288 (abstract in *Journal of the American Medical Association*, June 12, 1909, p. 1962); *Wiener medizinische Wochenschrift*, 1909 (abstract

47

in *Münchener medizinische Wochenschrift*, No. 8, p. 415, February, 1909).

21. BAUM. Mitteilungen aus dem Grenzgebiete der Medizin und Chirurgie, pp. 1-19, 1909.

22. MAUTNER. Report of meeting of Gesellschaft der Aerzte in Lancet, i, p. 1491, May 22, 1909.

23. TREMBUR. Mitteilungen aus dem Grenzgebiete der Medizin und Chirurgie, xx, No. 5, p. 727 (abstract in *Journal of the American Medical Association*, liv, No. 1, p. 87, January 1, 1910).

24. PATEK. Wisconsin Medical Journal, p. 306, November, 1910.

25. WELCH. American Journal of the Medical Sciences, p. 800, 1910.

26. MISENTHAL. Journal of the American Medical Association, p. 1613, May 14, 1910.

27. LAMBERT. Medical Record, lxxii, p. 885, 1908.

28. SWAIN, JACKSON, and MURPHY. *Boston Medical and Surgical Journal*, clix, p. 407, 1909.

29. ROBERT and CHODY. *Lancet*, ii, p. 1472, November 13, 1909.

30. RICARD. *Semaine médicale*, May 14, 1910.

31. MICLEON. *Ibidem*.

32. GANGANI. *Gazz. d. osp.*, Milano, 1909, xxx, 758.

33. HUBSCHEI. Correspondenz-Blatt für Schweizer Aerzte, Basel, April, 1910 (abstract in *Journal of the American Medical Association*, June 4, 1910).

34. RETTGER. *American Journal of Physiology*, xxiv, p. 406, 1909.

[From the *Journal of the American Medical Association*, Oct. 26, 1912.]

SPONTANEOUS HEMORRHAGE OF THE
NEWBORN, WITH RECOVERY.

BY V. M. REICHARD, M.D., FAIRPLAY, MD.

Spontaneous hemorrhage of the newborn is so ob-
secure and so fatal a disease that any experience point-
ing the way out is worth recording. All treatment de-
tailed in the literature of the subject is so difficult a
technic as to require either special skill or special ap-
paratus or both. In view of these facts the following
case is worthy of report:

Mrs. R., aged 42, white, was delivered rapidly and
easily of her ninth child at 4 p. m., Aug. 26, 1912. She
was not in labor more than thirty minutes and the
baby was born fully half an hour before the attend-
ant's arrival. The child, a girl, weighed 9½ pounds
and appeared perfectly well and normal. Of the eight

48

children previously born, two had died, one, the first born, of some bowel complication at four months; and one, the fourth, of hemorrhage on the fourth day. The ninth child was well for thirty-six hours, when the nurse found her listless and flaccid. On examination it was discovered that a large quantity of blood had been passed by the bowel. Some of the blood was red but much the larger part was dark and tarry-looking. I saw her at 9 a. m., August 28. The child was then of a deep lemon color and in profound shock. She had vomited some blood. During the day she had half a dozen bloody stools and at 9 p. m. the pulse was rapid and weak. She had been very languid and relaxed all the day, though she had taken the breast at three-hour intervals. At 9 p. m. she was given about 15 Cc. of normal horse-serum subcutaneously.

August 29 and 30 small amounts of blood were passed, but each time the amount was less, running possibly from half an ounce down to a teaspoonful. At 7 p. m. on the 30th the child was given 20 Cc. normal horse-serum and from that time on there has been no blood. Both injections were made into the buttocks, one on each side. September 1 the stools were the usual yellow color of a nursing infant and have continued so ever since. September 16, when last seen, she was a splendid specimen of baby, skin clear and healthy and nursing well, bowels regular, stools natural, and every evidence of perfect health.

Twenty Cc. is a fairly large subcutaneous dose for an infant and in this case put the skin on the stretch decidedly. This tension subsided rapidly and in an hour's time the tumor had disappeared.

72229

STAPHYLOCOCCUS
TOXOID

IN AN effort to find material which would possess certain advantages in producing active immunization, Ramon in 1923 discovered and introduced Diphtheria Toxoid. Since that time attempts have been made to detoxicate various toxins, bacterial or otherwise, in such a way as not to interfere with their antigenic capacity. Because of their clinical importance, the staphylococcus toxins have received particular attention¹,²,³,⁴,⁵,⁶.

Staphylococcus Toxoid is a modification of staphylococcus toxin; it is prepared by detoxification of the toxin with formaldehyde solution. Detoxification is carried to such a degree that the first strength product will induce production of 2.5 international units (per cubic centimeter) of staphylococcus antitoxin in the blood of rabbits treated according

1

to the method approved by the
National Institute of Health. Second
strength Staphylococcus Toxoid will
induce production of 5 international
units in rabbits treated the same way.

CLINICAL INDICATIONS

Staphylococcus Toxoid is sug-
gested in treatment of certain infec-
tions caused by the staphylococcus
(albus or aureus). Clinical reports
indicate its special value in localized,
subacute, and chronic infectious
processes—such as furunculosis, ab-
scesses, carbuncles, acne vulgaris,
blepharitis, and recurrent styes,
upper respiratory infections, chronic
and subacute osteomyelitis in chil-
dren and adults, and various infec-
tions of the skin and subcutaneous
tissues. Favorable case reports have
also appeared on its use in the treat-
ment of sycosis barbae, prostatitis,
cystitis, pyelitis, chronic cervicitis,
staphylococcic cellulitis, bullous im-
petigo, staphylococcic sinusitis, and
pyopneumothorax.

2

FURUNCULOSIS

Dolman<sup>7</sup>, reported a series of six-
teen cases of severe boils which in
some instances recurred in crops for
several years, and in others the
patients had never been free from
boils for many months. An average
of two cubic centimeters of Staphy-
lococcus Toxoid was given by sub-
cutaneous injection in eight doses
over a period of six weeks. All pa-
tients were free from boils for a
period ranging, at the time of writ-
ing, from two to eight months, and
their circulating antitoxin titre was
on an average tenfold higher than
it was initially. Six cases of a severe
type of pustular acne with furuncu-
losis in adolescence, all of at least
two years duration, were similarly
treated with clinical cures in every
case.

Murray<sup>8</sup>, in reporting thirty-nine
cases of furunculosis treated with
Staphylococcus Toxoid, emphasized
that practically all the infections
considered were very chronic and

3

the patients had previously had various other treatments without success. Other treatment was stop-ped at the beginning of the course of injections. There was recovery in twenty-five cases and improvement in the remaining fourteen. The author said, "the amount of circu-lating antitoxin can be readily in-creased by the injection of Staphy-loccus Toxoid. The injections are attended with very few severe reac-tions. The increase of circulating antitoxin is associated with clinical improvement in a majority of cases of furunculosis."

In 1935, Dolman⁹, published his studies of eighty-one patients with recurrent furunculosis, many of whom had been subjected to various other treatments, including vac-cines. Excellent results were ulti-mately obtained by means of toxoid.

## ABSCESSES AND CARBUNCLES

Clinical data are accumulating showing the value of toxoid in the

4

treatment of staphylococcus ab-scesses and carbuncles. Gohar¹⁰, Dolman⁹, Murray⁸, Parish and O'Meara¹¹, and others have re-ported favorably. Dolman states that Staphylococcus Toxoid has been used very extensively in Can-ada. "Reactions attending its use have rarely been troublesome. The acquisition of clinical immunity could be correlated with an increase of staphylococcus antitoxin titre serum and a general return of infec-tion occurred only after there had been a considerable fall in the titre of circulating antitoxin."

Carbuncles attended by an acute illness should properly receive staph-ylococcus antitoxic serum, but in those cases unattended by evidence of general toxemia, the patient may be spared the "unpleasantness of serum therapy" by active immu-nization with Staphylococcus Tox-oid. Localization with discharge of pus in an indolent carbuncle and accelerated granulation of healing

5

in a carbuncle, which has already
been discharging pus for some time,
are often to be noted very soon after
the first dose or two of toxoid.

ACNE VULGARIS

In appropriate doses, Staphylo-
coccus Toxoid has proven efficacious
in the treatment of acne with super-
imposed staphylococcic infection.
Gohar¹⁰, states that "there is at
first a more or less severe local reac-
tion. The pustules become angry
and inflamed. The temperature rises
by one-half to one degree Centigrade
and the patient usually complains
of a headache which varies in sever-
ity. The local and general reactions
soon subside only to reappear after
the second injection. Ultimately,
however, the pustules become smaller
and smaller . . . in some cases the
result was so satisfactory as to tempt
one to abandon the traditional use
of acne vaccines, whether autogen-
ous or stock, and to resort solely to
the use of Staphylococcus Toxoid."

6

In Murray's⁸ series of thirty cases of acne, three cases recovered, twenty-one were improved, and six cases showed slight or no benefit.

Dolman⁹, believes that "staphylo-
coccus albus and the acne bacilli act
symbiotically as the specific cause of
acne vulgaris, the pustular features
of the disease being primarily due to
staphylococci and the red papules to
acne bacilli. After a few injections of
toxoid less pustulation occurred,
while the lesions became fewer in
number, and underwent more rapid
development and retrogression. In
patients who had periodically de-
veloped a few small pustules without
the characteristic surrounding areas
of red induration, eight doses of
toxoid in general promoted freedom
from recurrences. In the worst types
with pustules and red lumps of
various sizes distributed over the
face, neck, and shoulders, pustula-
tion usually ceased, but papules
continued to develop. Administra-
tion of further amounts of toxoid,

7

up to 1 cc. per dose, led to no addi-
tional improvement in a few of these
patients; but the majority showed a
gradual diminution in the number
of red papules, and several very bad
cases could legitimately be classed
as cured after some twenty doses of
toxoid had been given. The accom-
panying psychological changes in
such patients were striking."

## RECURRENT STYES

Recurrent styes usually respond
promptly to injections of toxoid. In
both children and adults, this con-
dition and the associated systemic
disturbance resulting therefrom have
yielded to toxoid therapy. Relapses
are uncommon. In Dolman's⁹ series
of nine cases, all were promptly
relieved.

UPPER RESPIRATORY
INFECTIONS

Gilchrist and Wilson<sup>12</sup>, state that
staphylococcus infection of the upper
respiratory tract is present in many
cases of chronic ill health; that it

8

has been producing numerous symp-
toms elsewhere in the body; and
that with the use of Staphylococcus
Toxoid these symptoms are improv-
ed or cured. The freedom from colds
of patients on toxoid therapy suggests
that the staphylococcus may be an
etiologic factor in the common cold.

In a previous paper, Gilchrist and
Wilson<sup>13</sup>, stated that a staphylo-
coccic factor was present in all dia-
betics in the vicinity of Toronto,
and that it could be treated effec-
tively with Staphylococcus Toxoid.
They believe the foci to be in the
upper respiratory tract. During the
course of that investigation, 100 non-
diabetics suffering from sinus infec-
tions were investigated, from which
it appeared that "staphylococcic in-
fection is frequently present in
sinuses throughout the Great Lakes
region, and that the toxemia from
this infection is giving a variety of
symptoms elsewhere in the body,
but few local signs or symptoms in
the upper respiratory tract.

9

"Several patients whose clinical picture for years suggested this infection, with symptoms of tachycardia, marked anemia, and fatigue, and who on culture showed only *Pneumococcus*, *Streptococcus viridans* and other organisms found in the upper respiratory tract, were given toxoid in the absence of positive cultures. These showed the greatest improvement on this treatment that they had done for years. Later, with more acid culture media these have all shown the presence of staphylococcus.

"Small ulcers on the tongue and oral mucosa were noted in a number of our cases and improved. Reference has previously been made to the esophageal involvement from the trachea. We have pointed out that 57 per cent of our diabetics have chronic cholecystitis, confirmed radiologically. In our non-diabetic series, not, however, confirmed by radiology, a similar number were found to have this complication on

10

clinical examination. Whenever there was an acute exacerbation of the upper respiratory tract infection, gastro-intestinal symptoms developed. Since Magner and Hutcheson¹⁴ found staphylococcus in the submucosa of 43 per cent of the chronic or fibrotic type of gallbladder in their series, it is not surprising that these cases improve when treated with Staphylococcus Toxoid.

"Several cases of gastric and duodenal ulcer have been met with, and the symptoms from these lesions were found to increase during periods of increased humidity and during the negative phase of toxoid treatment, and to improve or disappear with toxoid treatment and improved weather conditions."

Dolman⁹ has also given special consideration to the significance of staphylococcic infection of the upper respiratory tract and emphasized the probability that in intractable cases of recurrent infection, auto-

11

inoculation of staphylococci from
this source is not uncommon. In a
series of 22 patients whose chief com-
plaint was undue susceptibility to
infection of the upper respiratory
tract, resulting in recurrent heavy
colds, sinusitis, and marked systemic
disturbance (including patients on
whom many radical operations had
been performed and who had since
become almost incapacitated) Dol-
man made the following report:

"Before completion of a series of eight doses of toxoid a very striking improvement had occurred in many of these patients. The discharge had greatly lessened, local discomfort had diminished, mental and physical vigor had been regained, their color was better, and their sleep more restful. The patients with the asthmatic, gastro-intestinal, and rheumatic symptoms, referred to above, reported their alleviation; while those whose chief complaint had been severe recurrent colds enjoyed a degree of freedom from this type of

12

infection which some had not known
for years.”

OSTEOMYELITIS

Ramon and his associates¹⁵ have
reported encouraging results in cases
of osteomyelitis under toxoid ther-
apy. Dolman⁹ studying fifty-nine
patients with chronic or subacute
osteomyelitis stated that: "the re-
sults following toxoid therapy were
very encouraging, having regard to
the special difficulties which arise in
this type of infection.

"The first two or three doses of toxoid were usually followed by an increased discharge of pus from the osteomyelitic focus, but the discharge later tended to diminish. In a few children with several years' history of chronic osteomyelitis, one or more discharging sinuses healed over for the first time during or soon after administration of a course of eight injections, and there have since been no recurrences. In other instances, sinuses healed following

13

toxoid treatment, but broke down again after a few weeks. The general health of all the children appeared to be definitely benefited. Their appetite and color improved, many of them put on considerable weight, and the nursing staff reported that those under treatment expressed eagerness to continue with the injections, and were more alert and cheerful.

"In a few adults with chronic osteomyelitis of long standing very striking local improvement occurred; other similar cases showed little change. In three instances it became possible to retain a limb which had been threatened with amputation. In some instances of well localized subacute osteomyelitis, diagnosed at an early stage, the infection rapidly subsided when toxoid was given; in other more advanced cases surgical drainage was done, but the toxoid injections seemed definitely to accelerate convalescence."

14

## ADMINISTRATION AND DOSAGE

Patients vary greatly in susceptibility to the staphylococcus and to Staphylococcus Toxoid. For that reason, no exact scheme of dosage can be recommended. The initial dose should be 0.1 cc. or 0.2 cc. (preferably the smaller dose) of the first strength product. Subsequent doses should be increased very gradually at intervals of from three to seven days, depending upon the local reaction and systemic response. After the dose has been increased to 1 cc. of the first strength product, the second strength may be used, starting with a 0.1-cc. to 0.2-cc. dose. Injections are made subcutaneously.

## REACTIONS

Local reactions vary from a small red area at the site of injection to a larger reaction manifested by an area of hyperemia several centimeters in diameter, somewhat swollen and manifestly tender to the touch.

15

PACKAGE INFORMATION

Staphylococcus Toxoid, P. D. & Co., is supplied in two strengths in 5-cc. rubber-diaphragm-stoppered vials. First strength Bio. 2121. Second strength Bio. 2122. The required amount can readily be withdrawn with a graduated syringe.

16

Bibliography

1. Burnet, F. M.: *J. Path. & Bact.* 32:717, 1929.

2. Idem *ibid*, 34:471, 1931.

3. Burnet & Freeman: *Ibid*, 35:477, 1932.

4. Panton, Valentine & Dix: *Lancet* 2:1180, 1931.

5. Dolman, C. E.: *Canad. Pub. Health J.* 23:125, 1932.

6. Debere & Bonnet: *Paris med.* 26:494, 1936.

7. Dolman, C. E.: *J. A. M. A.* 100:1007, 1933.

8. Murray, D. S.: *Lancet*, 1:303, 1935.

9. Dolman, C. E.: *Lancet* 1:306, 1935.

10. Gohar, M. A.: *J. Trop. Med.* 38:259, 1935.

11. Parish & O'Meara: *Lancet* 1:1054, 1934.

12. Gilchrist & Wilson: *Canad. M. A. J.* 33:292, 1935.

13. Gilchrist & Wilson: *Canad. M. A. J.* 30:353, 1934.

14. Magner & Hutcheson: *Canad. M. A. J.* 27:469, 1932.

15. Ramon, G. et al: *Presse med.* 44:185, 1936. Idem *ibid*, 43:1137, 1935.

R 45-1

47076 (6-37)

GLUCO-FEDRIN

G LUCO-FEDRIN has been devel-
oped to provide a product
having prompt vasoconstrictor ef-
fect without irritation. It is in-
tended to be applied either by
applicator, nasal pack, dropper, or
atomizer (nebulizer).

Gluco-Fedrin contains 1 per cent
ephedrine in an isotonic aqueous,
dextrose base. The solution is
stable. Clinical observations have
shown this new inhalant to be
relatively free from irritating prop-
erties; yet it usually shrinks the
mucous membranes rapidly. Satis-
factory shrinking of the membrane
is ordinarily obtained within two
to four minutes, and the effect
persists for several hours.

Gluco-Fedrin does not contain
oil or lipid fractions.

3

FORMULA

<table><tr><td>Ephedrine (as lactate)</td><td>1%</td></tr><tr><td>Chloretone</td><td>0.5%</td></tr><tr><td>Menthol</td><td>0.1%</td></tr><tr><td>Alcohol</td><td>2%</td></tr><tr><td>Isotonic Aqueous Dextrose Base. q.s.</td><td></td></tr></table>

USES

Gluco-Fedrin is an efficacious vasoconstrictor in all types of nasal and accessory sinus conditions. It is suggested for use when preparing the patient for rhinologic examination or treatment; for shrinking swollen or congested mucosa of turbinates or septum for any purpose; for establishment of drainage in sinus disease, when drainage is interfered with by congested membranes; in cases of coryza or other nasal, pharyngeal or laryngeal inflammation; for symptomatic relief of hay fever; and for preparation of the nose preceding minor operative work. It is of value for "clearing

4

the head," particularly in public speakers and singers.

Patients using Gluco-Fedrin make fewer complaints of stinging and burning than when other preparations are used. Gluco-Fedrin induces a rapid and prolonged contraction of the membranes with a minimum of reaction, and little or no discomfort to the patient. There is no untoward reaction following its use.

Patients frequently remark about the soothing effect of Gluco-Fedrin, even in acute inflammations of the nasal mucosa. It is free from the unpleasant odor that usually accompanies ephedrine inhalants and has a slightly bitter but not disagreeable taste.

In children there have been no untoward reactions or complaints of excessive irritation.

5

Occasional patients who are ex-
tremely hypersensitive to ephedrine
may experience irritation following
application of Gluco-Fedrin.

APPLICATION

The method of administration will
vary in different cases. In the phy-
sician's office the compressed-air
atomizer or a small hand-operated
nebulizer may be used. The Glasep-
tic Nebulizer is well adapted for
this purpose. Gluco-Fedrin may
also be applied directly by applica-
tor or by means of the nasal pack.
It lends itself to the drop method,
which is of particular value in
young children.

6

PACKAGE INFORMATION

Gluco-Fedrin is supplied in one-
ounce bottles, with dropper, and
in one-pint bottles.

R37-1

(12-36) 44743

# PERTUSSIS VACCINE

(PERTUSSIS BACTERIN)

Sterilized and Ready for Use.

In the preparation of this product, cultures of Bacillus pertussis (Bordet) on ascites agar are washed off with physiologic salt solution and shaken to separate the organisms thoroughly from one another. The suspension is then sterilized and diluted until each Cc. contains the desired number of bacteria; the physiologic salt solution used in this work contains 0.2% trikresol as a preservative.

## DIRECTIONS FOR USE.

The vaccine is administered subcutaneously by means of the ordinary hypodermatic syringe, in the usual manner—it being necessary that the instrument be sterilized. (A ready means of sterilizing the syringe is to wash it out repeatedly with a five-per-cent. solution of carbolic acid; the needle should also be cleansed internally and externally by the same means; finally rinse out the instrument with recently boiled water.)

The skin at point of injection should be scrubbed with soap and water and then rubbed with a five-per-cent carbolic solution. This disinfectant acts as a local anesthetic, thus diminishing the pain of injection.

## DOSAGE.

The dose of Pertussis Vaccine is small when compared with the usual dose of many other bacterial

2

vaccines. Twenty million of the killed bacteria constitute what is regarded as a safe initial dose. Subsequent injections should be given at intervals of 4 to 7 days as indicated either by the opsonic index or the clinical response to the vaccine. As it is quite impracticable with cultures of Bacillus pertussis (Bordet) to control the dosage by readings of the opsonic index, the general clinical condition may be depended upon as a guide both for the size of the dose and frequency of administration. In general it may be stated that treatment should be begun with an initial dose of twenty to twenty-five million bacteria and that subsequent injections should be given at intervals of 4 to 7 days, increasing the dose, if necessary, up to fifty or even one hundred million.

### THERAPEUTIC INDICATIONS.

Pertussis Vaccine is indicated in all cases of throat infection in which a diagnosis of pertussis (whooping-cough) has been made, or early in suspected cases when a definite diagnosis is obscured or lacking.

As a prophylactic agent the value of Pertussis Vaccine has not yet been clinically proved. The vaccine may be used, however, in doses of 5 to 20 million bacteria, during the prevalence of epidemics of pertussis (whooping-cough).

## PARKE, DAVIS & COMPANY.

### BRANCH HOUSES:
New York, Kansas City, Baltimore, New Orleans, Boston, Chicago, St. Louis, Minneapolis, Seattle, U. S. A.; London, Eng.; Montreal, Que.; Sydney, S. W.; St. Petersburg, Russia; Bombay, India; Tokio, Japan.

(Reprinted from the Interstate Medical Journal, October, 1912.)

## THE BACTERIN TREATMENT OF PERTUSSIS.

BY JOHN ZAHORSKY, M.D.,
Professor of Pediatrics, St. Louis University School of Medicine.

In spite of the patient work of numerous investigators, the bacteriology of whooping-cough has had a torturous road to advance. The great difficulty lies in the fact that the upper-air passages contain an innumerable variety of microorganisms even in health, and it is most difficult to find the true offending microbe among the vegetating parasites.

Poulet believed he had discovered the cause in a specific germ which he called *bacterium termo*.

Tshamer found some yellowish bodies in the sputum of pertussis patients, which proved to be spores of a fungus resembling Ustilago maydis, and which he claimed to be constantly present in the disease.

Afanassiew described an anaerobic bacillus in the sputum of pertussis patients, a culture of which produced symptoms of bronchitis and bronchopneumonia in young dogs. His work was corroborated by several investigators.

A diplococcus was described by Ritter, but as diplococci are present in nearly every catarrhal affection of the trachea and throat, his investigation received little attention.

Deichler found horseshoe-shaped protozoa in the sputum, and others (Kourlow, Birch-Hirschfeld, Zursch) reported to have found these bodies.

Czaplewsky discovered a short, thick, bipolar, Gram-positive bacillus, or diplococcus. This microorganism has been recognized as a pneumococcus. Later he described a microorganism which resembled the influenza bacillus, and this finding was corroborated by numerous observers (Koplik, Arnheim, etc.).

A bacillus discovered in the Hamburg Eppendorf Hospital by Jochmann and Krause also resembled

3

4

the influenza bacillus and was called *bacillus pertussis* Eppendorf, but it shows a difference from the preceding bacillus in that it grows only on media containing hemoglobin.

A third type of this bacillus was discovered by Manicatide, which is Gram-positive, and grows on the ordinary culture media. He immunized sheep and horses, and produced a serum which was used with good effect in the cure of whooping-cough.

Leuraux described a similar bacillus in the nasal sputum of children suffering from pertussis. It is a short, thick, motile rod, Gram-positive, and a serum prepared had curative properties.

This by no means concludes the subject, numerous other investigations having found microorganisms in pertussis differing from those mentioned by some cultural peculiarity. It is difficult to formulate a conclusion from all these studies. Conclusive proof of its etiological relationship to pertussis has not been furnished regarding a single one of these microorganisms.

A few years ago Bordet and Gengou* described a bacillus in the sputum of children suffering with pertussis, which has certain physical and cultural peculiarities, and the evidence that it is the specific etiological agent is constantly increasing. This is a small bacillus with rounded ends, not motile, without flagellæ, once or twice the size of the influenza bacillus. It occurs in different lengths, sometimes in pairs with joined ends, very rarely in chains. It stains very well with ordinary aniline dyes. Klimenko recommends a differential stain. A small bit of the bronchial mucus is placed on a cover-glass and dried in the air; it is fixed by heat and after cooling stained two or three seconds in a 5 per cent. carbolized solution of toluidine-blue. While all other microorganisms are stained an intense blue, the

*Ann de l'Inst. Pasteur. Vol. XX.

5

bacillus pertussis shows a beautiful lilac color. This stain also shows the peculiar bipolar staining qualities of this germ. It has no capsules and is Gram-negative.

The bacillus is found in the sputum only in the early stages of the disease, and rapidly diminishes, to disappear entirely at the height of the paroxysmal stage. It is pathogenic to cats, dogs and monkeys. They succeeded in producing typical whooping-cough in monkeys by an insufflation of a culture of this germ. A strong argument that the Bordet-Gengou bacillus is the specific cause of whooping-cough is found in the fact that it is agglutinated in high dilutions by the blood of convalescent pertussis patients. Complement fixation tried by Fraenkel has also resulted in establishing its causative relationship. The germ is not found in any other disease.

Bordet and Gengou attempted immunizing animals against this bacillus, but found that the immunizing process was very imperfect. Immune serum had little or no curative action against the disease. Furthermore, a soluble toxin could not be demonstrated in liquid cultures, but a powerful necrotizing substance could be obtained from the bodies of the bacilli. They conclude that, like typhoid and dysentery bacilli, the bacillus pertussis produces disease by an endotoxin.

We know very little concerning the process where-
by immunity is established against this disease. Is
the immunity a local one? It is true that the per-
tussis toxin produces a local disease of the epithelium
in the upper-air passages, and the new epithelial cells
may acquire an immunity against the endotoxin; but
whether the perfection of the immunity depends
entirely on this local cellular change or an altera-
tion of the serum, cannot be positively declared.
Some intoxication of the body undoubtedly takes
place. The characteristic change in the blood pic-

6

ture, the great irritability of the cerebrospinal nervous system, and finally the presence of antibodies as recently discovered, justify the conclusion that some general reaction and consequent production of a general immunity, at least in a measure, is established.

If, then, the cure of the disease depends, in a measure, on a general immunity, can we not hasten this process by the use of a bacterial vaccine or bacterin?

Several investigators have already reported their deductions from an experimental use of a pertussis bacterin; and without analyzing the various reports, in general it may be stated that in the majority of cases a distinct influence on the course of the disease is manifested. Some of these reports will be referred to later.

The writer has used a pertussis bacterin, prepared by Parke, Davis and Company, in 40 cases of whooping-cough in private practice. These were studied entirely as to the therapeutic result; in only 2 cases were blood examinations made for the purpose of establishing the diagnosis. The effect of the injections on the blood picture was not investigated. At a meeting of the St. Louis Pediatric Society, Dr. James R. Clemens stated that the lymphocytosis was materially diminished on the second and third day after the injection.

It will be most profitable to study the writer's series of cases in answer to questions.

### CAN THE CHILD BE IMMUNIZED EVEN TEMPORARILY AGAINST WHOOPING-COUGH?

In a previous communication* from observations made by several physicians at the Episcopal Orphans' Home and Bethesda Hospital, the writer concurred

*Pediatrics, March, 1912.

7

with Dr. White, who reported the cases, that a protecting influence could be produced in many cases, and we expressed the hope that by a larger injection the disease could be entirely prevented. At that time the writer had two cases in private practice in which this immune-producing power was suggested.

*Case 1.*—M. S., æt. seven, female, had been suffering from rheumatic endocarditis for two months previously. Her brother took whooping-cough and she was associated with him for fully one week. She received two injections of pertussis vaccine, 20 million each, three days apart. She did not take the disease.

*Case 2.*—Baby R., æt. one month, female; brother had whooping-cough for ten days; received 20 million bacteria. Although she remained with her brother throughout its course, she did not contract the disease.

Immunity was also produced in Case 37.

These, of course, are not conclusive. In another case, two previous injections of 20 million bacilli, two months before, failed to prevent the disease. The immune-producing power is, therefore, not lasting.

*Case 3.*—R. S., æt. two and a half years, female, had been suffering from recurrent attacks of asthmatic bronchitis since early infancy. The disease at the outset was diagnosed pertussis by another physician. The attacks of asthma recurred with annoying frequency, and as ordinary therapeutic measures gave little relief, two experimental injections of pertussis vaccine, four days apart, were given. She had another attack of asthma one month later, with a second attack two weeks later. Following this last attack, typical whooping-cough of severe type developed. Because the writer feared a possible anaphylactic effect from the first dose, the child was not treated with vaccine.

The writer can record several failures since the above report, in which prompt injection did not ward off the disease.

*Case 4.*—J. R., æt. one year, male, was exposed to pertussis, his sister having the disease for at least ten days,

8

and received two injections of 20 million each, four days apart. Nevertheless, he developed a cough a few days later which, after a week, revealed the characters of whooping-cough. He was given four more doses at intervals of three and four days, and the disease ran a mild course, but continued for eight weeks.

*Case 5.*—D. S., *æt.* three years, female, exposed for ten days to whooping-cough through another child in the house. Received two prophylactic injections (20 million) two days apart. Whooping-cough began suddenly fifteen days later, the first coughing spell that the mother noticed showing a characteristic whoop. She received a subsequent injection, and the disease remained mild.

The peculiarity in this case is that the onset of the disease was retarded for more than a week, and then began suddenly without the premonitory catarrhal symptoms.

*Case 6.*—B. M., *æt.* six weeks, male; one brother and sister had pertussis for more than a week. Exposure not very intimate nor protracted, as the baby was kept away from the other children. He received a large injection hypodermically, 70 million bacteria. Four days later a cough developed which, in a few days, resulted in very severe paroxysms. In spite of very large injections, the disease assumed a dangerous degree of severity.

The writer must conclude, then, that, during the stage of incubation, prophylactic injections of pertussis vaccine have a doubtful value in preventing the disease, a conclusion opposed to the one previously expressed. It must be admitted that some of the favorable cases were injected in the very early days of the period of incubation, while the cases in private practice were given the prophylactic dose rather late.

## WHAT IS THE EFFECT OF THE PERTUSSIS VACCINE?

When a hypodermic injection of 20 million bacteria or more is administered, no general reaction is observed. In several cases, in which temperature

9

determinations were made, no elevation beyond that usually found in pertussis could be discovered. No local irritation occurred in any of the writer's cases. The pain from the injection is trifling. A few hours afterwards the cough seems to become worse, and this period (negative phase) extends over twenty-four hours with a moderate dose (30 million), but may extend over two or three days after a large dose (100 million). After this period of aggravation of the symptoms, a period of two to four days follows in which a great improvement is observed. Often this improvement is so striking as to be readily noticed. Such expressions as, "he slept all night," "the first night that I have had a rest," "only had one attack," "had several attacks but they were so mild that he did not wake up," were given by the mothers in fully one-half of the cases. Sometimes the effect is really remarkable.

*Case 7.*—W. S., *æt.* seven years, male, has been coughing very hard for three weeks, but according to the mother's statement has never whooped, has repeated attacks through the night—the mother must get up every half-hour—coughs until he nearly strangles. A few days before the writer's first visit, a congestion of one eye was noticed which rapidly became worse. The other eye also became affected. This proved to be a severe subconjunctival hemorrhage of both eyes. The attacks of coughing were very hard and not controlled by full doses of bromides and codeine. On November 27th, 1911, 40 million bacteria were injected hypodermically. On the following night the cough seemed to be worse, but on the second night after this treatment the child had only one coughing spell, having had ten to fifteen a night for ten days. The eyes rapidly cleared up. No more injections were given.

*Case 8.*—C. F., *æt.* four, male, had been coughing for three weeks, the paroxysms had become severe with vomiting and especially frequent at night. On May 14th he received 100 million bacteria hypodermically. For two nights there was little change, on the third night he slept all night and did not cough once, and for several days the mother did not hear him cough a single time. Then a slight paroxysmal cough returned which lasted two weeks

10

longer. He felt weak, however, looked pale and had no appetite for some time after the use of the vaccine.

In about one-fourth of all the cases no effect whatever could be observed at the beginning or height of the disease.

*Case 9*.—E. V., *æt.* four, male, had been sick two weeks and the cough was rapidly increasing in violence. The chest was clear of adventitious sounds. On December 13th, received 25 million bacteria. Cough became much worse, the injection brought out the whoops in full blast, and he had severe choking spells at night. On the 20th of the same month the same dose was repeated. Two days later the writer made the following note: "Bacterin had no effect, coughs harder than ever." The subsequent course does not differ from the average severe case of pertussis. In this patient the bacterin seemed to aggravate the disease. An interesting sequel was a severe relapse six weeks later when the cough had ceased.

*Case 10*.—C. B., *æt.* nine, girl, had been coughing two weeks. April 20th had very severe coughing spells and vomiting. Received 30 million bacteria with no effect whatever that could be ascertained. On the day following she broke out with a morbilliform erythema.

*Case 11*.—C. C., *æt.* four, male, was sick only five days when first injection of 30 million bacteria was given (April 17th). The cough continued, and on the 20th of the same month the nurse counted twenty severe paroxysms in twenty-four hours. Gave 35 million bacteria. On the 24th the following note was made: "No effect as yet, coughs all the time, coughs all night, coughs almost continuously." Gave 50 million bacteria. The cough assumed a more paroxysmal character, but it ran the usual course of seven weeks.

Sometimes a temporary improvement which appears after the first injection does not occur after the repeated dose.

*Case 12*.—V. C., *æt.* eight, girl, had been coughing for ten days when the first dose was given. She had three or four attacks at night and vomited each time. Thirty million bacteria were administered (April 13th). On April 17th, still coughing very hard and the dose was repeated. On April 20th the paroxysms had become very mild; she vom-

11

ited only once in two days. Another dose of 35 million was injected. On April 24th the following note was made: "No effect; coughs very hard; eyes swollen; vomits everything." On this day 50 million bacteria were injected. The disease gradually improved, but even after seven weeks she still vomited her food.

There was quite a number of cases in which the effect was doubtful, but the course was mild and the injections were repeated several times. One example may be given here.

*Case 13*.—F. D., *æt.* seven, male, had been coughing one week, was hoarse, feels tired, but has hard coughing paroxysms at night. Both tonsils red, glands in neck slightly enlarged, soft systolic murmur over heart. Pertussis was suspected and creosote and sodium bromide prescribed. One week later (April 13th) had developed paroxysmal cough of moderate severity. 25 million bacteria. April 22d, whoops and sneezes very much, seven attacks at night, a few attacks severe. Has vomited a few times, complains of pain in stomach. 40 million bacteria. April 26th, comparatively mild case, feels very well, still has several attacks at night. 30 million bacteria. Subsequent course was favorable in every way, but no striking effect of the vaccine. Similar histories might be given in five other cases, Cases 14, 15, 16, 17, and 18.

Rashes occurred in three cases in the writer's series, one of which has already been referred to (Case 10).

*Case 19*.—M. B., *æt.* four, female, was first seen May 10th, and mother stated that she had some coughing attacks at night for several days; otherwise she seemed well. On May 25th, mother reported that she whoops and had five very hard paroxysms that morning. Injected 70 million bacteria. On the following day was broken out with erythematous rash all over the body. The rash was in dusky-red patches, not wheals, and the patient complained that it itched and burned. Coughed very hard during the night. She improved very much after this injection, the effect lasting one week, then the attacks became worse again, but another injection caused the symptoms to abate. (See also Case 30).

12

EFFECT IN COMPLICATED CASES,

In cases in which the whooping cough is compli-
cated with bronchitis or pneumonia the effect is
uncertain and may do harm. In M. H. (Case 20),
*æt.* sixteen months, suffering from pertussis and
bronchitis with moderate fever, three small doses
(10 million each) were injected without any effect.
A beneficial effect was obtained in B. S. (Case 21), a
girl of about three years, seen in consultation with
Dr. Quinn, who gave three injections (20 million
each). She had high fever, great prostration, and
considerable pulmonary engorgement. Dr. Quinn
found quite a marked improvement in the coughing
paroxysms some time after each injection, and the
child recovered.

An unexpected fatal termination occurred in a
little patient seen with Dr. Fuchs, as follows:

*Case 22*.—E. J., *æt.* four months, female, contracted pertussis three weeks ago from her brother. She had been fed on artificial food since birth. She weighed 8 lbs. at birth, and at three months 12 lbs. Is taking a mixture of milk, cream and oatmeal water. About a week ago she began to show high fever, which has continued ever since. The temperature remains high constantly (103-104° F.). A few subcrepitant râles heard over left base. The stools were offensive, and urinary examination (Dr. Fuchs) revealed no urinary infection. Guaiacol was applied externally, in order to reduce the temperature. The coughing paroxysms had been very severe. At 6 p. m. she received 20 million bacteria, and at 9 p. m. a severe convulsive seizure ended in death within a very short time. Now the question was, did the vaccine inoculation aggravate the nervous symptoms? There had been no cerebral symptoms a few hours before the injection.

*Case 23*.—R. C., *æt.* eleven, female, had been sick six weeks with a very severe attack of pertussis. The paroxysms were very severe and not controlled by any therapeutic measure. Bronchopneumonia, accompanied by great prostration and irregular fever, developed about the third week. She was given two injections of 40 million each, three days apart, but no effect was observed either on the

13

cough or the course of the bronchopneumonia, which lasted
altogether about seven weeks.

*Case 24*.—H. K., *æt.* two and a half, female, seen in consultation with Dr. Winter. Pertussis, bronchopneumonia, accompanied by severe cerebral symptoms, had almost destroyed her life. Was treated by stimulants and the injection of human serum, and rallied from a collapse that seemed hopeless. The disease extended over three months, the lungs were very much inflamed, the emaciation extreme, and the healing power, as shown by skin lesions, very low. Yet she gradually improved and more than two months after the onset of the illness the cough, which had been somewhat subdued during the severe part of the disease, became very much worse. An attempt was made to control this cough by injection of pertussis vaccine. Dr. Winter, however, reported that the injections (20 million) invariably made her worse for several days. This was a most remarkable case and deserves to be reported in *extenso* as a valuable addition to the literature of pertussis, but here we are concerned only with the effect of the vaccine.

THE PROPER DOSE.

In the first few cases about 10 million bacteria
were used. Later 20 million, the contents of one
vial, became the dose. The writer's most pronounced
effects occurred when 30 to 50 million bacteria were
injected. An attempt to improve the efficiency of
the treatment by larger doses was met by a great
increase in the length of the negative phase, and
sometimes in a retardation of the period of improve-
ment; for instance, Case 6, already reported on ac-
count of the failure of producing immunity even
with a large initial dose during the stage of incuba-
tion. She was breast-fed, and six weeks old at the
onset of the illness. She received four injections at
intervals of four to five days, each 70 to 100 million,
and yet the coughing paroxysms were as severe as
the writer has ever seen. She had to be watched
day and night by skilled attendants; artificial respi-
ration had to be used several times a day to restore
the breathing. She would become cyanotic and

14

finally pale and limp. Yet a short time after each
attack she felt very well. Stimulants had to be
given; bromides had no effect. Ten to twelve attacks
were usual during the night. No complication oc-
curred, and she made a good recovery after seven
weeks.

On the other hand, one good dose (100 million) may almost cure the disease, as in Case 8. A good effect by one large dose was also observed in another instance:

Case 25.—L. M., *æt.* seven and a half, male, had been coughing for four weeks. Violent attacks of coughing were usually followed by vomiting. Coughs every hour and the attacks last one to three minutes (mother's report). One injection of 100 million changed the entire clinical picture. Four days later the report was that he had stopped vomiting and had had only very few paroxysms that day.

It will be seen that 100 million bacteria is not a
dangerous dose, and yet the results have been equally
as good from half that dose without the correspond-
ing aggravation of symptoms during the twenty-four
to thirty-six hours following the injection.

THE PRODUCTION OF IMMUNITY.

If the Bordet-Gengou bacillus is the real cause of pertussis, the writer's observations would corroborate the experimental work of Bordet in that it is difficult to immunize against the bacillus pertussis. This seems especially true of young infants. Even repeated injections did not seem to shorten the disease. It takes time to produce immunity.

Case 26.—J. T., *æt.* three months, male, had been artificially fed since birth, on account of a nutritive disturbance, and was not well nourished. Weight at birth, 5¾ lbs.; present weight, October 25, 1911, 9 lbs. A few ounces of human milk were obtained and given daily with a cow's milk mixture. During the last week has coughed, the paroxysms becoming more severe. His two sisters have had pertussis for three weeks. He received the following in-

15

jections of pertussis vaccine: October 25th, 10 million; November 3rd, 20 million; November 10th, 20 million; November 17th, 20 million; November 20th, 20 million. After these injections, great improvement. The mother observed that after each injection the cough would be better for several days. During the latter part of November still coughed very hard. By the middle of December cough had almost ceased. In January, 1912, he contracted a "grip" infection, and with this the paroxysms of pertussis recurred with great violence. He received another injection of 20 million bacteria.

It is pertinent to ask, since the vaccine does not show any great value in inducing a permanent immunity, how can we explain its favorable action? Of course this is not yet positively known, but its effect is probably analogous to that produced by other bacterins: the phagocytosis is diminished and then increased. During the positive phase the bacteria are probably diminished in number and toxins enter the blood in lessened quantity.

IS THIS ACTION SPECIFIC?

Here we enter unexplored territory, which can
only be traversed by experiment.

We know that pertussis is often temporarily modi-
fied by other infections; for example, an attack of
pneumonia or tonsillitis usually diminishes the in-
tensity of the paroxysms. Hypodermic injections
of horse-serum also have a modifying influence. The
curative action of vaccinia has been attested by too
many clinicians to permit of any question that the
general disturbance from vaccination often dimin-
ishes the symptoms from pertussis.

THE EFFECT ON THE CHILD'S CONDITION,

An attempt was made to determine the effect of the
bacteria injection on the physical signs. Fully two-
thirds of the cases had some of the physical signs of
bronchitis. It could not be made out whether the

16

pertussis vaccine diminishes or increases the bronchial secretions. In no patient could a bad effect on the nutrition be discovered. In not a single case in which the vaccine was used did any secondary infectious process appear, which indicates that the general immunity was increased. Freedom from complications, then, is one of the favorable effects of the vaccine treatment. The influence of this vaccine, in a subsequent course of pneumonia in the same patient, was illustrated by one case, and indicated that the resistance is not lessened.

### THE INTERVAL FOR INJECTIONS,

Since injections of vaccine diminish for a short period the resistance and often aggravate the clinical symptoms, they should not be repeated too frequently. The interval should not be less than three days when moderate doses are used (10 to 20 million). If large doses (20 to 100 million) are given, the interval should be at least five days.

### EARLY OR LATE INJECTIONS,

Since the writer has not succeeded in aborting the attacks by using the vaccine early, and since his best results were produced at the height of the disease, it has become his practice to wait until the disease is well advanced, and then by giving two or three full doses to modify the severity of the symptoms. Nothing that the writer has tried will act so well as this vaccine, often changing the disease in twenty-four hours to a remarkable degree. In young infants moderate doses should be given early. The whole course, then, will not be so severe and complications will be minimized.

Early injections were given in a number of infants, and all with the exception of B. M. (Case 6) passed through all phases without causing any anxiety.

17

### SYNOPSIS OF ADDITIONAL CASES.

*Case 27.*—F. C., *et*. four, male; injection of 40 million in fourth week of disease. Five days later mother reported that he was doing fine and had had no bad paroxysms. Very good result.

*Case 28.*—V. C., *et*. twenty months, male; sick three weeks when he received first injection (25 million). Diarrhea set in two days later, which complication continued for one week. Another injection, five days after the first, produced a marked change for the better, the coughing attacks becoming very mild.

*Case 14.*—R. B., *et*. eighteen, female; severe attacks of whooping-cough; has very severe attacks of coughing; almost chokes. Received 30 million bacteria on the sixteenth day. Four days later the mother reported that she vomits nearly everything. Another injection of 40 million produced only slight and temporary amelioration of the symptoms, but no complication ensued.

*Case 15.*—F. D., *et*. three years, male, had a moderately severe attack of pertussis. Two injections (20 and 30 million) produced no marked effect.

*Case 16.*—W. H., *et*. three, male, sick with pertussis two weeks with gradually increasing coughing paroxysms. Received 25 million and four days later 30 million. The disease remained mild and showed the physical signs of bronchitis with a subfebrile temperature, 100° to 101°. He received a third injection, and after this a marked amelioration of the paroxysms was noticed; the night attacks fell from 10 to 5 and became much milder.

*Case 17.*—G. K., *et*. four, female, sick about two weeks when one injection was given (40 million). A week later the mother reported that she was doing very well and no other dose was given. She also received bromides and codeine at night.

*Case 18.*—J. P., *et*. three and a half, male, rather delicate boy, had pertussis four weeks, the cough at first continuous, then in severe paroxysms, which terminated in vomiting. Retained very little food. Received one injection of 60 million bacteria. Only temporary improvement; continued to vomit with each paroxysm for three weeks more. He became very much emaciated, but made a good recovery.

18

Case 29.—R. P., æt. seven months, male, breast-fed, contracted the disease from his brother. Had marked catarrhal symptoms at the onset; the coughing attacks were very severe, resulting in cyanosis and apnea. After two weeks of the disease, received 50 million bacteria. Two days later the attacks had rather increased, but an improvement was noticeable after this. Another dose was given fifteen days after the first when the disease was still very severe. Recovery was slow.

Case 30.—L. M., æt. eleven months, male, was exposed to whooping-cough about two weeks before. Bottle-fed but well nourished. Had been coughing for a few days. Received 20 million bacteria. The night following had several vomiting attacks. The vomiting continued for two or three days. Fever developed at the same time (102° F.), and the baby was very sick for several days. On the fourth day of fever, broke out with morbilliform rash. Coughing attacks had become worse, and vomited each time. Received two other injections two weeks after the first, after which the symptoms abated rapidly and the subsequent course remained very mild. The effect after the second injection was striking.

Case 31.—J. L., æt. twenty months, female, began with severe catarrhal symptoms and the disease was not recognized for three weeks. Received 100 million, May 9th. Four days later another 100 million was given, both injections producing very little effect. A marked increase in the coughing occurred after the first injection, and temperature was 99.4° F. on the morning following. May 17th, vomited with coughing attacks but seems very much better. Feels good, slept fine, chest clear. May 19th, the cough being worse again, another injection was given (80 million). Four days later mother reported that she had only one attack during the night but still vomits with each severe paroxysm. She received sodium bromide and codeine during the severest part of the disease.

Case 32.—R. K., æt. fifteen months, female, had severe catarrhal symptoms, began to whoop almost from the first. Was sick one week when she received 60 million bacteria, May 7th. Other injections were: May 9th, 100 million; May 15th, 20 million. May 11th, physical signs of bronchitis the same, but coughing attacks less frequent and less severe. The symptoms continued to improve and two days later the mother thought the disease was almost well. May 17th, great improvement, appetite better, feels good but looks pale.

19

Case 33.—M. R., æt. three, female, moderately severe case of whooping-cough, received one dose (35 million) at two weeks of her illness. The disease remained so mild that no second injection was given.

Case 34.—A. H., æt. six, male, has had a mild spasmodic cough for three weeks which resisted ordinary treatment. A leucocyte count—white corpuscles 11,500, lymphocytes 60 per cent.—suggested pertussis. Received two injections, 35 million each, three days apart. After each injection great reduction in coughing spells.

Case 35.—J. W., æt. ten months, male, moderately severe pertussis. Received two injections, 50 million each, four days apart; the result is unknown.

Case 36.—D. D., æt. two and a half, female, sick three weeks. Received three injections (50 million each) about four days apart. Remained very mild, and she did not whoop.

Case 37.—B. D., æt. six weeks, sister to the preceding patient, breast-fed. Received three injections of 20 million bacteria, four days apart. She did not take the disease. Apparently this was a successful immunization.

Case 38.—J. S., æt. five, male, had a persistent spasmodic cough, lasting for two months. This was finally diagnosed as pertussis by finding a lymphocytosis. He received one injection (50 million), and thereafter the cough became much better.

Case 39.—A. R., æt. eighteen months, female, had been coughing two weeks when first injection was given. Received 20 million (March 19th). Three days later received the same dose. Four days after second injection had only four attacks during the night, but suffered from diarrhea. March 31st, 25 million were administered. April 6th, was much better for a few days after injection, but cough had returned as bad as ever. Diarrhea had ceased. Improvement gradual.

Case 40.—F. S., æt. nine, male, has been suffering with severe recurrent attacks of asthmatic bronchitis. The history indicates that pertussis was the cause. Experimentally, he received two injections of pertussis vaccine (20 million). The effect was very good. The attacks were reduced in number and severity so that he could attend school again, which he had not done for several weeks.

It should be stated that nearly all these children received sodium bromide and codeine in order to

PREFACE

IN THE COMPILATION of this Physicians' Catalog we have had but one object in view: we have endeavored to present, in the clearest possible form, pertinent information on a selected list of our products, so arranged as to make the book of utmost utility to physicians. In furtherance of this object we have omitted mention of our veterinary products, of the few toilet articles, and of a number of other items that have their special appeal to make to the drug trade but are of no particular interest to physicians.

While it cannot therefore be said that the Catalog is complete, it does actually contain more complete information on the products introduced by us to the medical profession than any of its predecessors.

Those of our medical friends who have been in the habit of consulting our catalog in the past cannot fail to note the new arrangement of the various sections. This arrangement is logical rather than alphabetical, and the reader will soon become familiar with it. The Table of Contents, the Materia Medica Index, the Therapeutic Index, and the General Index will remove the last vestige of difficulty in this regard.

An entirely new feature is the Therapeutic Index at the close of the book, and it is hoped that the suggestions therein afforded will prove of substantial service to the physician who wishes to know, as the great majority do, just what we have to offer for the treatment of "cases"—not imaginary conditions, but the

actual flesh-and-blood ailments that appeal to the doctor for relief.

Attention is directed also to the Materia Medica Index. This feature was added for the facility it affords in choosing and utilizing such of our products as may be indicated when the situation calls for, let us say, antiseptics, antispasmodics, cathartics, hemostatics, tonics or other class of products having a typical sphere of applicability.

As to the quality of Parke, Davis & Company products, little can be said that the physician does not already know. Suffice it to say that the *quality ideal of this House is never sacrificed.* The spirit of our organization is such as to imbue every man and woman in it with a deep sense of personal responsibility in the duties of his high calling—in the part that he or she plays in the making of therapeutic products that can be depended on by the medical profession.

By specification of "Parke, Davis & Company" on orders and prescriptions the physician secures for his patient the fruits of over a half-century of research and manufacturing experience, inaugurated by a physician and carried forward by his successors under his inspiration—to make the name of Parke, Davis & Company synonymous with quality, the ne plus ultra of pharmaceutical achievement.

PARKE, DAVIS & COMPANY

TABLE OF CONTENTS

<table><thead><tr><th></th><th>PAGES</th></tr></thead><tbody><tr><td>GENERAL INDEX</td><td>i-vii</td></tr><tr><td>MISCELLANEOUS PRODUCTS</td><td>1-79</td></tr><tr><td>Ointments</td><td>48-53</td></tr><tr><td>Protein Extracts, Diagnostic</td><td>54-58</td></tr><tr><td>Biological Specialties</td><td>61-62</td></tr><tr><td>Gland Products</td><td>63-79</td></tr><tr><td>Emplets</td><td>78-79</td></tr><tr><td>GALENICALS</td><td>81-200</td></tr><tr><td>Fluid Extracts and Tinctures</td><td>81-89</td></tr><tr><td>Medicinal Syrups</td><td>90-95</td></tr><tr><td>Medicinal Elixirs</td><td>96-107</td></tr><tr><td>Soluble Gelatin Capsules, Filled</td><td>108-114</td></tr><tr><td>Solutions and Spirits</td><td>116-118</td></tr><tr><td>Liniments</td><td>118</td></tr><tr><td>Effervescent Salts</td><td>118</td></tr><tr><td>AMPOULES</td><td>119-148</td></tr><tr><td>HYPODERMIC TABLETS</td><td>149-152</td></tr><tr><td>OPHTHALMIC TABLETS</td><td>52</td></tr><tr><td>PILLS AND TABLETS</td><td>153-200</td></tr><tr><td>BIOLOGICAL PRODUCTS</td><td>201-221</td></tr><tr><td>MATERIA MEDICA INDEX</td><td>viii-xv</td></tr><tr><td>THERAPEUTIC INDEX</td><td>xvi-xxxvi</td></tr></tbody></table>

GENERAL INDEX

<table><thead><tr><th></th><th>PAGE</th><th>PAGE</th></tr></thead><tbody><tr><td>Acetanilid Compound Elixir</td><td>96</td><td>Antidysenteric Serum</td><td>201</td></tr><tr><td>Aconite</td><td>81</td><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Adrenalin Ampoules</td><td>2, 3</td><td>Anti-Malarial Elixir</td><td>97</td></tr><tr><td>Adrenalin Chloride Solution 1:1000</td><td>1</td><td>Antimeningococcic Serum</td><td>201</td></tr><tr><td>Adrenalin Inhalant</td><td>3</td><td>Antipneumococcic Serum</td><td>202</td></tr><tr><td>Adrenalin and Cocaine Tablets</td><td>4</td><td>Anti-Rheumatic Elixir</td><td>97</td></tr><tr><td>Adrenalin Ointment, 1:1000 (No. 1)</td><td>48</td><td>Antiseptic Soap, Ethereal</td><td>6</td></tr><tr><td>Adrenalin and Chloretone Ointment (No. 2)</td><td>48</td><td>Antiseptic Solution</td><td>116</td></tr><tr><td>Adrenalin Suppositories (Rectal)</td><td>4</td><td>Antiseptic Tablets</td><td>7</td></tr><tr><td>Adrephine</td><td>5</td><td>Antistreptococcic Serum</td><td>202</td></tr><tr><td>Adrocaine Ampoules</td><td>6</td><td>Antistreptococcic Serum, Refined and Concentrated</td><td>202</td></tr><tr><td>Adrocaine Solution</td><td>6</td><td>Antuitrin</td><td>71</td></tr><tr><td>Adrocaine Tablets</td><td>6</td><td>Apiol Capsules</td><td>108</td></tr><tr><td>Aletris Compound Elixir</td><td>96</td><td>Apnothesine</td><td>8</td></tr><tr><td>Alkaline Aromatic Solution</td><td>117</td><td>Apnothesine Solution</td><td>8</td></tr><tr><td>Alkavena Elixir</td><td>96</td><td>Apnothesine Tablets</td><td>8</td></tr><tr><td>Aloe and Rue Compound Elixir</td><td>96</td><td>Apnothesine Tablets, Oral</td><td>8</td></tr><tr><td>Alophen Pill</td><td>157</td><td>Apnothesine and Adrenalin Tablets</td><td>8</td></tr><tr><td>Ammoniated Mercury Ointment</td><td>49</td><td>Argentide</td><td>9</td></tr><tr><td>Ammonium Valerate Elixir</td><td>96</td><td>Aromatic Elixir</td><td>97</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td><td>Aromatic Spirits of Ammonia</td><td>116</td></tr><tr><td>Ampoules</td><td>119-145</td><td>Aspidium, Oleoresin</td><td>35</td></tr><tr><td>Ampoules, Intravenous</td><td>146-148</td><td>Astringent Suppositories (Vaginal)</td><td>9</td></tr><tr><td>Analgesic Balm</td><td>49</td><td>Bacterial Proteins, Diagnostic</td><td>55</td></tr><tr><td>Anesthone Cream</td><td>48</td><td>Bacterial Vaccines</td><td>203</td></tr><tr><td>Anodyne Cherry Expectorant</td><td>90</td><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Anodyne Pine Expectorant</td><td>90</td><td>Bernays Antiseptic Tablets</td><td>7</td></tr><tr><td>Anodyne Pine Expectorant with Tar</td><td>90</td><td>Biological Products</td><td>201-221</td></tr><tr><td>Anodyne Spruce Expectorant</td><td>90</td><td>Biological Specialties</td><td>61-62</td></tr><tr><td>Anti-Anthrax Serum</td><td>201</td><td>Bismuth, Milk of</td><td>32</td></tr><tr><td>Anti-Asthmatic Elixir</td><td>97</td><td>Bismuth Paste</td><td>49</td></tr></tbody></table>

[i]

GENERAL INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Bismuth Salicylate in Oil</td><td>9, 122</td></tr><tr><td>Blood-typing Serums</td><td>212</td></tr><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Bromide and Choral Compound Elixir</td><td>97</td></tr><tr><td>Bromides Compound Elixir</td><td>97</td></tr><tr><td>Buchu Compound Elixir</td><td>98</td></tr><tr><td>Buchu, Juniper, and Potassium Acetate Elixir</td><td>98</td></tr><tr><td>Caffeine Sodio-Benzoate</td><td>122, 149</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Calisaya Alkaloids Elixir</td><td>98</td></tr><tr><td>Calisaya Bark Elixir</td><td>98</td></tr><tr><td>Calisaya and Iron Elixir</td><td>98</td></tr><tr><td>Calisaya, Iron and Strychnine Elixir</td><td>99</td></tr><tr><td>Calisaya, Iron, Bismuth and Strychnine Elixir</td><td>98</td></tr><tr><td>Calisaya, Iron, Quinine and Strychnine Elixir</td><td>99</td></tr><tr><td>Calobarb Tablets</td><td>166</td></tr><tr><td>Calomelettes</td><td>10</td></tr><tr><td>Calomel Ointment</td><td>50</td></tr><tr><td>Camphor, Spirit of</td><td>116</td></tr><tr><td>Camphor in Oil Ampoules</td><td>123, 124</td></tr><tr><td>Cannabis Americana</td><td>82</td></tr><tr><td>Cannabis Indica</td><td>83</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Capsules, Filled</td><td>108-114</td></tr><tr><td>Carbon Tetrachloride Capsules</td><td>108</td></tr><tr><td>Cascara Evacuant</td><td>11</td></tr><tr><td>Cascara Sagrada, Fluid Extract</td><td>83</td></tr><tr><td>Cascarennna</td><td>12</td></tr><tr><td>Castor Oil Capsules</td><td>108</td></tr><tr><td>Catarrhalis Immunogen</td><td>210</td></tr><tr><td>Cathartic Compound Elixir</td><td>99</td></tr><tr><td>Celery and Guarana Elixir</td><td>99</td></tr><tr><td>Chaulmoogra Oil</td><td>12</td></tr></tbody></table>

[ii]

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Chenopodium Oil Capsules</td><td>110</td></tr><tr><td>Chionanthus Elixir</td><td>99</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Chloretone Capsules</td><td>12, 13</td></tr><tr><td>Chloretone Compound Suppositories (Vaginal)</td><td>14</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Chlorides of Iron, Arsenic and Mercury with Calisaya Elixir</td><td>99</td></tr><tr><td>Chlorodyne Tablets</td><td>171</td></tr><tr><td>Cholera Infantum Mixture</td><td>15</td></tr><tr><td>Cinchona Alkaloids (Palatable)</td><td>90</td></tr><tr><td>Cinchona Detannated Elixir</td><td>100</td></tr><tr><td>Cinchophen</td><td>16</td></tr><tr><td>Citronin</td><td>16</td></tr><tr><td>Coagulose (Precipitated Horse Serum)</td><td>215</td></tr><tr><td>Cocaine Hydrochloride Tablets, Soluble</td><td>17</td></tr><tr><td>Cocillana Compound Syrup</td><td>42</td></tr><tr><td>Codeine Cough Sedative</td><td>17</td></tr><tr><td>Cod-liver Oil Capsules</td><td>109</td></tr><tr><td>Cod-liver Oil, Standardized</td><td>18</td></tr><tr><td>Cod-liver Oil, Phosphorized</td><td>19</td></tr><tr><td>Codrenin</td><td>19</td></tr><tr><td>Colchicine and Methyl Salicylate Capsules</td><td>110</td></tr><tr><td>Coley's Mixture of Toxins</td><td>205</td></tr><tr><td>Combined Hypophosphites Syrup</td><td>91</td></tr><tr><td>Combined Hypophosphites, Cloudy, Syrup</td><td>91</td></tr><tr><td>Copaiba Capsules</td><td>110</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Corrective Laxative Syrup</td><td>91</td></tr><tr><td>Cramp Bark Compound Elixir</td><td>100</td></tr><tr><td>Creosote Capsules</td><td>111</td></tr><tr><td>Creosote and Terpin Hydrate Compound Elixir</td><td>100</td></tr><tr><td>Cresylone</td><td>19</td></tr></tbody></table>

GENERAL INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Cubeb and Santal Capsules</td><td>111</td></tr><tr><td>Culture Media</td><td>205</td></tr><tr><td>Damiana, Nux Vomica, Iron and Phosphorus Elixir</td><td>100</td></tr><tr><td>Damiana, Phosphorus and Nux Vomica Elixir</td><td>100</td></tr><tr><td>Dextrose Ampoules</td><td>125</td></tr><tr><td>Diagnostic Protein Extracts</td><td>54</td></tr><tr><td>Diarrhea Cordial</td><td>19</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digifortis Tablets</td><td>21</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Digitalone Ampoules</td><td>21</td></tr><tr><td>Digitalone Hypodermic Tablets</td><td>150</td></tr><tr><td>Dioscorea Compound Elixir</td><td>100</td></tr><tr><td>Diphtheria Antitoxin</td><td>206</td></tr><tr><td>Diphtheria Toxin for Schick Test</td><td>205</td></tr><tr><td>Diphtheria Toxin-Antitoxin Mixture</td><td>206</td></tr><tr><td>Diphtheria Toxoid</td><td>207</td></tr><tr><td>Diuretic Improved Elixir</td><td>101</td></tr><tr><td>Effervescent Salts</td><td>118</td></tr><tr><td>Elixirs</td><td>96-107</td></tr><tr><td>Emetine Hydrochloride Ampoules</td><td>124</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Emplets</td><td>78-79</td></tr><tr><td>Emulsion Metagen and Cod-liver Oil</td><td>30</td></tr><tr><td>Ephedrine Hydrochloride Capsules</td><td>21</td></tr><tr><td>Ephedrine Sulphate</td><td>21</td></tr><tr><td>Ephedrine Sulphate Solution, Ampoules, and Capsules</td><td>22</td></tr><tr><td>Ephedrine Inhalant</td><td>22</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Ergot, Fluid Extract</td><td>85</td></tr><tr><td>Ergot Aseptic Ampoules</td><td>23</td></tr><tr><td>Erysipelas Antitoxin</td><td>207</td></tr><tr><td>Erysipelas Immunogen</td><td>210</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Erysipelas Phylacogen</td><td>213</td></tr><tr><td>Estrogen Ampoules</td><td>64</td></tr><tr><td>Euthymol</td><td>24</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrocascarin</td><td>116</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Ferrosenicum</td><td>117</td></tr><tr><td>Ferrous Iodide Syrup</td><td>91</td></tr><tr><td>Fluid Extracts and Tinctures</td><td>81-89</td></tr><tr><td>Food Proteins, Diagnostic</td><td>54</td></tr><tr><td>Formidine</td><td>24</td></tr><tr><td>Galenicals</td><td>81</td></tr><tr><td>Gentian Elixir</td><td>101</td></tr><tr><td>Gentian Compound Elixir</td><td>101</td></tr><tr><td>Gentian and Iron Elixir</td><td>101</td></tr><tr><td>Gentian, Iron Chloride and Lactated Pepsin Elixir</td><td>101</td></tr><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Germicidal Soap (Neko)</td><td>32, 33</td></tr><tr><td>Gland Products</td><td>63-77</td></tr><tr><td>Glaseptic Nebulizer</td><td>58</td></tr><tr><td>Glaseptic Syringe and Case</td><td>59-60</td></tr><tr><td>Glucose Ampoules</td><td>125</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Glycerophosphates Calcium and Sodium Elixir</td><td>102</td></tr><tr><td>Glycerophosphates Compound Elixir</td><td>102</td></tr><tr><td>Glycerophosphates Compound with Iron, Quinine and Strychnine Elixir</td><td>102</td></tr><tr><td>Gold Bromide Solution</td><td>117</td></tr><tr><td>Gonococcus Immunogen</td><td>210</td></tr><tr><td>Gonorrhea Phylacogen</td><td>213</td></tr><tr><td>Haarlem Oil Capsules</td><td>111</td></tr><tr><td>Helonias Compound Elixir</td><td>102</td></tr><tr><td>Hematacol</td><td>25</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr></tbody></table>

[iii]

GENERAL INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Hemostatic Serum</td><td>208</td></tr><tr><td>Hexamethylene Tetramine</td><td>47</td></tr><tr><td>Hydrangea and Lithium Elixir</td><td>102</td></tr><tr><td>Hydrastis and Cramp Bark Compound Elixir</td><td>103</td></tr><tr><td>Hydriodic Acid Syrup</td><td>91</td></tr><tr><td>Hypodermic Syringe and Case</td><td>59-60</td></tr><tr><td>Hypodermic Tablets</td><td>149</td></tr><tr><td>Hypophosphites Syrup</td><td>92</td></tr><tr><td>Hypophosphites Compound Syrup</td><td>92</td></tr><tr><td>Hypotensive Tablets</td><td>181</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Immunogens</td><td>209</td></tr><tr><td>Inhalone</td><td>50</td></tr><tr><td>Intravenous Ampoules</td><td>146-148</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Iodalbin Capsules</td><td>26</td></tr><tr><td>Iodalbin and Merurol Tablets</td><td>26</td></tr><tr><td>Ipecac Syrup</td><td>92</td></tr><tr><td>Ipecac and Opium Syrup</td><td>92</td></tr><tr><td>Iron, Arsenic and Strychnine Elixir</td><td>103</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Arsenite and Manganese Ampoules</td><td>127</td></tr><tr><td>Iron Arsenite and Strychnine Ampoules</td><td>128</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Iron Chloride Syrup (Weld)</td><td>92</td></tr><tr><td>Iron Citrate Ampoules</td><td>130</td></tr><tr><td>Iron Citrate and Manganese Ampoules</td><td>131</td></tr><tr><td>Iron and Manganese Solutions</td><td>116, 117</td></tr><tr><td>Iron, Quinine and Strychnine Elixirs</td><td>103</td></tr><tr><td>Iron and Quinine with Strychnine Phosphate Elixir</td><td>103</td></tr><tr><td>Iron and Quinine with Strychnine Phosphate and Lactated Pepsin Elixir</td><td>103</td></tr></tbody></table>

[iv]

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Kahn Standard Antigen</td><td>212</td></tr><tr><td>Kolmer Antigen</td><td>212</td></tr><tr><td>Laboratory Diagnostic Agents</td><td>211</td></tr><tr><td>Lactated Pepsin Elixir</td><td>104</td></tr><tr><td>Lactated Pepsin and Bismuth Elixir</td><td>104</td></tr><tr><td>Lactated Pepsin, Bismuth and Strychnine Elixir</td><td>104</td></tr><tr><td>Lafayette Mixture</td><td>117</td></tr><tr><td>Lassar's Paste</td><td>53</td></tr><tr><td>Lavacol</td><td>26</td></tr><tr><td>Lens Extract, Diagnostic</td><td>58</td></tr><tr><td>Liniments</td><td>118</td></tr><tr><td>Lipo-Lutin Ampoules</td><td>65</td></tr><tr><td>Liquid Taka-Diastase</td><td>43</td></tr><tr><td>Liquor Sedans</td><td>26</td></tr><tr><td>Liver Extract</td><td>27</td></tr><tr><td>Locosthetic</td><td>27</td></tr><tr><td>Magma Magnesiae</td><td>32</td></tr><tr><td>Magnesium Sulphate Ampoules</td><td>131</td></tr><tr><td>Male Fern (Oleoresin Aspidium)</td><td>35</td></tr><tr><td>Male Fern and Kamala Capsules</td><td>111</td></tr><tr><td>Malt Preparations</td><td>28</td></tr><tr><td>Mammary Substance</td><td>65</td></tr><tr><td>Manaca and Salicylates Elixir</td><td>104</td></tr><tr><td>Medicinal Elixirs</td><td>96-107</td></tr><tr><td>Medicinal Syrups</td><td>90-95</td></tr><tr><td>Menthol Expectorant</td><td>92</td></tr><tr><td>Mentholated Cough Balsam</td><td>93</td></tr><tr><td>Menthum</td><td>50</td></tr><tr><td>Mercurettes</td><td>28</td></tr><tr><td>Mercurial Ointment</td><td>51</td></tr><tr><td>Mercuric Iodide Ampoules</td><td>132</td></tr><tr><td>Mercurosal</td><td>28</td></tr><tr><td>Mercurosal Solution and Ampoules</td><td>29</td></tr><tr><td>Mercury Cyanide Ampoules</td><td>132</td></tr><tr><td>Mercury Salicylate Ampoules</td><td>133</td></tr><tr><td>Mercury Salicylate Cream</td><td>30</td></tr><tr><td>Mercury Succinimide Ampoules</td><td>134</td></tr></tbody></table>

GENERAL INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Metagen</td><td>30</td></tr><tr><td>Metagen Capsules</td><td>30</td></tr><tr><td>Metagen and Cod-liver Oil, Emulsion</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Methylene Blue Compound Capsules</td><td>111, 112</td></tr><tr><td>Migraine Elixir</td><td>104</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Mixed Infection Phylacogen</td><td>213</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr><tr><td>Nebulizer, Glaseptic</td><td>58</td></tr><tr><td>Neko (Germicidal Soap)</td><td>32, 33</td></tr><tr><td>Neo-Silvol Capsules and Vaginal Suppositories</td><td>34</td></tr><tr><td>Neo-Silvol Ointment</td><td>51</td></tr><tr><td>Neutralizing Cordial</td><td>105</td></tr><tr><td>Nitroglycerin Compound Elixir</td><td>105</td></tr><tr><td>Nuclein Ampoules</td><td>134</td></tr><tr><td>Nutritive Liquid Peptone</td><td>33</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr><tr><td>Ointments</td><td>48-53</td></tr><tr><td>Oleoresin Aspidium</td><td>35</td></tr><tr><td>Olgar</td><td>35</td></tr><tr><td>Olgar Compound</td><td>35</td></tr><tr><td>Ophthalmic Tablets</td><td>152</td></tr><tr><td>Orchic Substance</td><td>66</td></tr><tr><td>Ovarian Residue</td><td>66</td></tr><tr><td>Ovarian Substance</td><td>67</td></tr><tr><td>Palatol</td><td>35</td></tr><tr><td>Palatol Compound</td><td>36</td></tr><tr><td>Pancreatin, Triple Strength</td><td>36</td></tr><tr><td>Panteric Tablets and Capsules</td><td>36</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Pepsin and Bismuth Elixir</td><td>105</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Pepsin, Bismuth and Strychnine Elixir</td><td>105</td></tr><tr><td>Pertussis Immunogen</td><td>210</td></tr><tr><td>Petrolatum, Liquid, Light</td><td>37</td></tr><tr><td>Petroleum Emulsion with Hypophosphites</td><td>37</td></tr><tr><td>Phenichthol</td><td>51</td></tr><tr><td>Phenolated Camphor</td><td>37</td></tr><tr><td>Phosphates Compound with Calisaya, Elixir</td><td>105</td></tr><tr><td>Phosphorized Cod-liver Oil</td><td>19</td></tr><tr><td>Phosphorus Elixir</td><td>105</td></tr><tr><td>Phylacogens</td><td>213</td></tr><tr><td>Pills and Tablets</td><td>153-200</td></tr><tr><td>Pineal Gland</td><td>69</td></tr><tr><td>Pitocin Ampoules</td><td>69</td></tr><tr><td>Pitressin Ampoules</td><td>70</td></tr><tr><td>Pituitary Preparations</td><td>71, 72, 73</td></tr><tr><td>Pituitrin Ampoules</td><td>72</td></tr><tr><td>Placenta</td><td>73</td></tr><tr><td>Pneumococcus Immunogen</td><td>210</td></tr><tr><td>Pneumonia Phylacogen</td><td>213</td></tr><tr><td>Poliomyelitis Antistreptococcic Serum</td><td>214</td></tr><tr><td>Pollen Extracts, Diagnostic</td><td>55, 57</td></tr><tr><td>Pollen Extracts for Treatment</td><td>214</td></tr><tr><td>Potassium Bromide Elixir</td><td>105</td></tr><tr><td>Proposote Capsules</td><td>112</td></tr><tr><td>Protein Extracts, Diagnostic</td><td>54</td></tr><tr><td>Puerperal Septicema Antistreptococcic Serum</td><td>215</td></tr><tr><td>Quinine, Pills, Tablets and Gelatin Capsules</td><td>38, 39</td></tr><tr><td>Quinine Dihydrochloride Ampoules</td><td>135</td></tr><tr><td>Quinine Hydrobromide, Neutral, Capsules</td><td>112</td></tr><tr><td>Quinine Hydrochloride and Urethane Ampoules</td><td>136</td></tr><tr><td>Quinine and Urea Hydrochloride Ampoules</td><td>137, 151</td></tr></tbody></table>

[v]

MISCELLANEOUS PRODUCTS

It is a valuable addition to local anesthetics because it blanches the operative area, giving the surgeon a clear field, and it confines the local anesthetic to the area into which it is injected, thus prolonging and intensifying the anesthesia.

In the paroxysm of asthma it has a most striking effect. Three to eight minims of the 1:1000 solution injected hypodermically will give the gasping asthmatic almost instantaneous relief, and when the effect begins to wear off it can be renewed repeatedly, we are told, by gently massaging the area of injection. There are very few patients who cannot be relieved of an asthmatic paroxysm by the injection of Adrenalin; but when a patient is encountered who does not respond readily it should not be pushed.

In cutaneous rashes from serums or arsenical compounds, Adrenalin has proved of such value that its systematic use as a preventive is recommended, the Adrenalin being administered just prior to the administration of the antitoxin or arsphenamine; the dose is usually ½ to 1 cc of the 1:1000 solution.

So many cases of apparent death have exhibited the remarkable reviving effect of Adrenalin injected directly into the heart that the 1:1000 solution should always be kept on hand as an emergency agent, especially in the surgical wards of hospitals and at life-saving stations. The intracardiac dose is 1 cc.

### Ampoule No. 88 (Adrenalin Chloride Solution, 1:1000)

<table><tr><td>in boxes of one dozen 1-cc ampoules</td><td>per box</td><td>$1.20</td></tr><tr><td>in boxes of one hundred 1-cc ampoules</td><td>per box</td><td>7.40</td></tr></table>

### Ampoule No. 1 (Adrenalin Chloride Solution, 1:10,000)

<table><tr><td>in boxes of one dozen 1-cc ampoules</td><td>per box</td><td>1.20</td></tr><tr><td>in boxes of one hundred 1-cc ampoules</td><td>per box</td><td>7.40</td></tr></table>

[2]

MISCELLANEOUS PRODUCTS

### Ampoule No. 2 (Adrenalin Chloride Solution, 1:2600)

### ADRENALIN INHALANT (Alcohol 15%)

<table><tr><td>in 1-fl.oz. amber bottles</td><td>per oz.</td><td>1.10</td></tr></table>

Each fluid ounce contains:

Adrenalin 9/20 gr.

Chloretone (chlorbutanol) 13½ grs.

In an aromatized blend oil base.

Adrenalin Inhalant, when applied to the mucous membrane of the nose and throat, has the same astringent and hemostatic action as Adrenalin Chloride Solution, but the effect is more prolonged.

In rhinitis, coryza, chronic nasal catarrh, hay fever, pharyngitis, tonsillitis, laryngitis, etc., it is applied by spray with the aid of a good hand nebulizer (such as the P. D. & Co. "glaseptic" instrument) or the stationary office outfit. It may be diluted to any extent desired with olive oil or cottonseed oil, but is not miscible with liquid petroleum. As a lubricant for urethral instruments it facilitates the introduction of catheter, sound or cystoscope by reducing the turgescence of the mucosa.

[3]

MISCELLANEOUS PRODUCTS

## ADRENALIN AND COCAINE TABLETS

(Hypodermic Tablet No. 151)

<table><tr><td>in tubes of 20</td><td>per tube</td><td>$.45</td></tr><tr><td>in bottles of 100</td><td>per package of 5 tubes</td><td>2.00</td></tr><tr><td>Adrenalin</td><td>per bottle</td><td>1.70</td></tr><tr><td>Cocaine hydrochloride (crystals)</td><td>1/1300 gr.</td><td></td></tr><tr><td></td><td>1/6 gr.</td><td></td></tr></table>

One tablet dissolved in 1 cc (16 minims) of physiologic salt solution makes a 1% solution of Cocaine in Adrenalin 1:20,000—said to be equal in local anesthetic potency to a 2% solution of Cocaine. Of narrow cylindrical shape, adapted to insertion in the cavity of a tooth. For pressure anesthesia.

### ADRENALIN SUPPOSITORIES (Rectal)

<table><tr><td>in boxes of one dozen</td><td>per doz. boxes</td><td>6.35</td></tr></table>

Each suppository contains one part of Adrenalin combined with 1000 parts of Oil Theobroma base.

The suppositories are conical, with a flat base, and, owing to both size and form, are easily introduced. They are recommended in proctitis, bleeding hemorrhoids, rectal ulceration, and the hemorrhage of rectal cancer. In rectal irritation the insertion of one of the suppositories will sometimes facilitate the administration and retention of nutrient and medicinal enemata.

### ADRENALIN AND CHLORETONE SUPPOSITORIES (Rectal)

Each suppository contains:

<table><tr><td>Adrenalin</td><td>3/200 gr. (1:1000)</td></tr><tr><td>Chloretone (chlorbutanol)</td><td>3 grs. (20%)</td></tr></table>

The Chloretone is added for its antiseptic and local anesthetic influence. See note under Adrenalin Suppositories.

### ADRENALIN COMPOUND SUPPOSITORIES (Rectal)

<table><tr><td>in boxes of one dozen</td><td>per doz. boxes</td><td>7.65</td></tr></table>

Each suppository contains, in a cacao-butter base:

<table><tr><td>Adrenalin</td><td>1/300 gr. (1:6000)</td></tr><tr><td>Apothesine (local anesthetic)</td><td>½ gr.</td></tr><tr><td>Formidine</td><td>1 gr.</td></tr><tr><td>Ext. Hamamelis</td><td>1 gr.</td></tr></table>

These suppositories are intended for use in cases of proctitis, rectal turgescence, prolapse, bleeding piles, and uncomplicated hemorrhoids amenable to astringent treatment.

*Narcotic order form required.

[4]

MISCELLANEOUS PRODUCTS

## ADREPHINE (Adrenalin-Ephedrine Compound)

<table><tr><td>in 1-ounce amber bottles</td><td>per bottle $1.50</td></tr></table>

Each fluid ounce contains:

<table><tr><td>Adrenalin</td><td>1:10,000</td></tr><tr><td>Ephedrine sulphate</td><td>2%</td></tr><tr><td>Chloretone (chlorbutanol)</td><td>0.5%</td></tr><tr><td>Distilled water</td><td>q.s.</td></tr></table>

Adrephine is suggested for use as a topical application when preparing the patient for rhinologic examination; for shrinking swollen or congested turbinates; for establishing drainage in cases of sinus occlusion from congested membranes; for its astringent effect in coryza, hay fever, or other nasal, pharyngeal or laryngeal inflammation; for toning up the voice and clearing the head in cases of "relaxed" throat in public speakers and singers; and for the relief of conjunctivitis or the eye symptoms of hay fever.

It may be applied by spray or directly on gauze or cotton pledgets (in shrinking turbinates, for example), and in very young children it may be desirable to drop it into the nares with a medicine dropper. Should a sensation of undue dryness or local discomfort of any kind follow the application of the undiluted Adrephine, water may be added to the mixture for subsequent application.

[5]

MISCELLANEOUS PRODUCTS

## ADROCAINE AMPOULES, B "A" (No. 155)

<table><tr><td>in boxes of one dozen 1-cc ampoules</td><td>per box</td><td>$1.35</td></tr><tr><td>in boxes of one hundred 1-cc ampoules</td><td>per box</td><td>8.75</td></tr></table>

Each cubic centimeter contains:

<table><tr><td>Procaine</td><td>0.02 Gm. (1/3 gr.)</td></tr><tr><td>Adrenalin</td><td>0.00002 Gm. (1/3200 gr.)</td></tr></table>

In other words, 1 cc of a 2% solution of Procaine, with Adrenalin 1:50,000.

Intended for use as a local anesthetic. The Adrenalin localizes the anesthetic effect of the Procaine and by its hemostatic action inhibits, to a great extent, operative and postoperative hemorrhage.

## ADROCAINE SOLUTION

<table><tr><td>in 2-oz. rubber-diaphragm capped bottles</td><td>per bottle</td><td>1.50</td></tr><tr><td colspan="3">A 1.5% solution of Procaine, with Adrenalin 1:100,000 and Chloro- tone (chlorbutanol) 0.5%.</td></tr></table>

Used for the same purpose as the foregoing.

## ADROCAINE TABLETS, B "A" (Hypodermic Tablet No. 187)

<table><tr><td>in tubes of 20</td><td>per tube</td><td>.35</td></tr><tr><td>in bottles of 100</td><td>per package of 5 tubes</td><td>1.50</td></tr><tr><td>Procaine</td><td>per bottle</td><td>1.20</td></tr><tr><td>Adrenalin</td><td>1/3 gr.</td><td></td></tr><tr><td></td><td>1/3200 gr.</td><td></td></tr></table>

One tablet dissolved in 1 cc (16 minims) of water will make a 2% Procaine solution containing Adrenalin 1:50,000, corresponding to the solution contained in Ampoule No. 155 (above).

## ADROCAINE TABLETS, B "B" (Hypodermic Tablet No. 234)

<table><tr><td>in tubes of 10</td><td>per tube</td><td>1.30</td></tr><tr><td>Procaine</td><td>4 3/8 grs.</td><td></td></tr><tr><td>Adrenalin</td><td>1/200 gr.</td><td></td></tr></table>

One tablet dissolved in 30 cc (1 fl. oz.) of water will make a 1% solution of Procaine containing Adrenalin 1:100,000 (approximately). See note under Adrocaine Ampoules, above.

American Oil, see Mineral Oil, Heavy, page 32.

## ANTISEPTIC SOAP, ETHEREAL (P. D. & Co.) (liquid)

<table><tr><td>in 4-fl.oz. sprinkler-top bottles</td><td>per doz.</td><td>5.75</td></tr><tr><td>in 16-fl.oz. sprinkler-top bottles</td><td>per doz.</td><td>10.80</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>5.10</td></tr></table>

Contains 20 per cent. of ether and 5 per cent. of alcohol.

Ethereal Antiseptic Soap is a good cleansing agent that leaves the hands in a condition of velvety sensitiveness; it has no hardening or drying effect.

[6]

MISCELLANEOUS PRODUCTS

## ANTISEPTIC TABLETS

For external use only

### SPECIAL (Blue), COFFIN SHAPE

<table><tr><td>Tablet Triturate No. 986</td></tr><tr><td>Mercuric chloride, corrosive, 7.3 grs.</td></tr></table>

<table><tr><td>bottles of 25, per doz.</td><td>$ 4.65</td></tr><tr><td>1/4-gross lots</td><td>11.75</td></tr><tr><td>1/2-gross lots</td><td>23.00</td></tr><tr><td>1-gross lots</td><td>43.50</td></tr></table>

<table><tr><td>Compressed Tablet No. 619</td></tr><tr><td>Mercuric chloride, corrosive, 7.7 grs.</td></tr><tr><td>Sodium chloride, q. s.</td></tr></table>

<table><tr><td>screw-cap bottles of 25<br>in carton, per doz.</td><td>4.65</td></tr><tr><td>1/4-gross lots</td><td>11.75</td></tr><tr><td>1/2-gross lots</td><td>23.00</td></tr><tr><td>1-gross lots</td><td>43.50</td></tr><tr><td>per bottle of 100</td><td>.95</td></tr><tr><td>per bottle of 1 lb. (500)</td><td>3.55</td></tr><tr><td>per 1000</td><td>6.90</td></tr></table>

### B "B," BERNAYS (White)

Tablet Triturate No. 615

<table><tr><td>screw-cap bottles of 25<br>in carton, per doz.</td><td>4.65</td></tr><tr><td>1/4-gross lots</td><td>11.75</td></tr><tr><td>1/2-gross lots</td><td>23.00</td></tr><tr><td>1-gross lots</td><td>43.50</td></tr><tr><td>per bottle of 100</td><td>.95</td></tr><tr><td>per bottle of 1 lb.</td><td>4.25</td></tr><tr><td>per bottle of 1000</td><td>6.90</td></tr></table>

### B "B," BERNAYS (Blue)

<table><tr><td>Tablet Triturate No. 696</td></tr><tr><td>Mercuric chloride, corrosive, 7.3 grs.</td></tr><tr><td>Citric acid, 3.8 grs.</td></tr></table>

### B "W" (White)

Compressed Tablet No. 332

<table><tr><td>screw-cap bottles of 25<br>in carton, per doz.</td><td>4.65</td></tr><tr><td>1/4-gross lots</td><td>11.75</td></tr><tr><td>1/2-gross lots</td><td>23.00</td></tr><tr><td>1-gross lots</td><td>43.50</td></tr><tr><td>per bottle of 100</td><td>.95</td></tr><tr><td>per bottle of 1 lb.</td><td>3.75</td></tr><tr><td>per bottle of 1000</td><td>6.90</td></tr></table>

### B "W" (Blue)

<table><tr><td>Compressed Tablet No. 358</td></tr><tr><td>Mercuric chloride, corrosive, 7.7 grs.</td></tr><tr><td>Ammonium chloride, 7.3 grs.</td></tr></table>

### BERNAYS (White)

Tablet Triturate No. 180

<table><tr><td>bottles of 100, per doz.</td><td>4.65</td></tr><tr><td>1/4-gross lots</td><td>11.75</td></tr><tr><td>1/2-gross lots</td><td>23.00</td></tr><tr><td>1-gross lots</td><td>43.50</td></tr><tr><td>per bottle of 1000</td><td>2.35</td></tr></table>

### BERNAYS (Blue)

<table><tr><td>Tablet Triturate No. 695</td></tr><tr><td>Mercuric chloride, corrosive, 1.82 grs.</td></tr><tr><td>Citric acid, 0.87 gr.</td></tr></table>

To make a 1:1000 bichloride solution, dissolve one Tablet Triturate No. 180 or No. 695 in 4 fl. ozs. of water; or any of the other tablets in 16 fl. ozs. of water.

[7]

MISCELLANEOUS PRODUCTS

APOTHESINE

in ½-ounce bottles in carton...................................per bottle $3.75

Local anesthetic. The hydrochloride of gamma-diethyl-amino-propyl cinnamate. Equal to cocaine on subcutaneous or submucous injection and relatively non-toxic. When combined with Adrenalin the process of general absorption is so far retarded as to practically eliminate the toxic factor, the Apothesine being largely destroyed before it has a chance to reach the heart.

APOTHESINE SOLUTION

in 2-ounce bottles...................................per bottle 1.10

A 1.5% solution of Apothesine containing Chloretone (chlorbutanol) 0.5%. As required, Adrenalin Chloride Solution, 1:1000, may be added to the portion of Apothesine to be used, in the proportion of 1 to 100—5 minims to an ounce.

APOTHESINE TABLETS, 1¼ grs. (Hypodermic Tablet No. 216)

in tubes of 20...................................per tube 70

in bottles of 100...................................per package of 5 tubes 3.20

One tablet dissolved in 60 minims of water makes a 2% solution.

APOTHESINE TABLETS, R "B" (Hypodermic Tablet No. 221)

in tubes of 10...................................per tube 1.35
per package of 5 tubes 5.70

Apothesine...................................4¼ grs.

Adrenalin...................................1/200 gr.

One tablet dissolved in 1 oz. of distilled water or physiologic salt solution makes a 1% solution of Apothesine containing Adrenalin 1:100,000 (approximately).

APOTHESINE TABLETS, ORAL, ½ gr. (C. T. No. 653)

in bottles of 100...................................per bottle 1.70

Apothesine administered by mouth has a quieting effect upon the stomach; it is prescribed in nausea not due to indigestion.

APOTHESINE AND ADRENALIN TABLETS

(Hypodermic Tablet No. 217)

in tubes of 20...................................per tube .45

in bottles of 100...................................per package of 5 tubes 2.00

Apothesine...................................per bottle 1.70

Adrenalin...................................3/5 gr.

Adrenalin...................................1/1600 gr.

One tablet dissolved in 60 minims of water makes a 1% solution of Apothesine containing Adrenalin 1:100,000 (approximately).

[8]

MISCELLANEOUS PRODUCTS

ARGENTIDE (Concentrated Solution Silver Iodide)

in 1-oz. amber glass-stoppered bottles...................per bottle $1.35

Each ounce contains 100 grains of Silver Iodide. When added to water, the silver iodide immediately separates out in the form of a very finely divided yellow flocculent precipitate, ready for use as an antiseptic application in urethritis, vulvo-vaginitis, cystitis, rhinitis, etc. The dilutions employed range in strength from 1:1000 to 1:30; they are odorless, and do stain the tissues or linen.

ASTRINGENT SUPPOSITORIES (Vaginal), Cacao-butter base

in boxes of 1 dozen...................................per doz. boxes 8.50

Each suppository contains:

Extract Hyoscyamus...................................1 gr.

Extract Hamamelis...................................1 gr.

Tannic Acid...................................½ gr.

Thymol...................................½ gr.

Extract Helonias...................................½ gr.

Salicylic Acid...................................1 gr.

Boric Acid...................................5 grs.

Alum...................................1 gr.

Eucalyptol...................................1/16 min.

Individually wrapped in wax tissue and tinfoil.

For use in the treatment of leucorrhea or any atonic condition of the vaginal mucous membrane. Antiseptic as well as astringent.

ASTRINGENT SUPPOSITORIES, R "B" (Vaginal)

Elastic, with glycero-gelatin base, in soft tin capsules

in boxes of one dozen...................................per doz. boxes 12.75

Differs from the preceding only in form and in the fact that there is no alum in the formula. The soft tin capsules hold the suppository in shape in hot weather. Before clipping off the capsule (with scissors) dip suppository in cold water for hardening.

BISMUTH SALICYLATE IN OIL

in 2-oz. glass-stoppered bottles...................per bottle 2.15

Each cubic centimeter contains Bismuth Salicylate, 0.13 Gm.(2 grs.), suspended in an oil base, with 3% Chloretone (chlorbutanol).

Our laboratory experiments on rabbits indicate, by the uniformity of their results, that Bismuth Salicylate is a powerful spirocheticide. Two injections (2 mg. per kilo of body weight) caused the complete disappearance of the spirochetes in eight cases, and a third injection was necessary in only one of the nine animals experimented upon. All were cases of artificially induced syphilis.

The usual dose of Bismuth Salicylate in Oil is ½ to 1 cc (1 to 2 grains) once a week until twelve to fifteen injections have been

[9]

MISCELLANEOUS PRODUCTS

administered. Injections should be made slowly and deeply into the muscles. See also Ampoules, page 122.

BORO-CHLORETONE (P. D. & Co.)

<table><tr><td>in P. D. & Co. oval flint bottles, with aluminum sprinkler-tops</td><td>per doz.</td><td>$4.25</td></tr><tr><td>in pound bottles</td><td>per lb.</td><td>2.50</td></tr></table>

Each ounce contains 110 grains of Chloretone (chlorbutanol) and 110 grains of boric acid, with an inert diluent. An antiseptic dressing powder that does not stain or smell.

BOROL (P. D. & Co.)

(Alcohol 5%)

<table><tr><td>in 4-fl.oz. bottles</td><td>per doz.</td><td>3.20</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>9.60</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>3.75</td></tr></table>

Each fluid ounce represents:

<table><tr><td>Sodium borate</td><td>16 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>8 grs.</td></tr><tr><td>Sodium benzoate</td><td>5 grs.</td></tr><tr><td>Glycerin</td><td>90 mins.</td></tr><tr><td>Eucalyptol</td><td>¼ min.</td></tr><tr><td>Thymol</td><td>⅝ gr.</td></tr><tr><td>Menthol</td><td>½ gr.</td></tr><tr><td>Oil Pinus Pumilio</td><td>q.s.</td></tr></table>

An alkaline aromatic and emollient lotion, gargle, mouth-wash, douche, and irrigating fluid. Usually employed full strength.

BROMETONE (P. D. & Co.)

<table><tr><td>in ounce bottles</td><td>per oz.</td><td>1.50</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>5.30</td></tr></table>

Brometone Capsules, 5 grs. (No. 407)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.85</td></tr></table>

Brometone is a product of the interaction of bromoform and acetone, and contains 77% of bromine. It possesses the therapeutic properties of the bromides, but does not disturb the stomach. Prescribed in nervous headache, asthma, paroxysmal cough, epilepsy, chorea, and other neurotic disturbances. Dose, 5 grs. Literature supplied on request.

CALOMELETTES (P. D. & Co.)

<table><tr><td>in boxes of 6</td><td>per box</td><td>.85</td></tr><tr><td>in packages of 50</td><td>per package</td><td>5.85</td></tr><tr><td>in packages of 100</td><td>per package</td><td>10.60</td></tr></table>

Oblong blocks or briquettes weighing 100 grains, containing 50 grains of Calomel finely subdivided and thoroughly distributed in a

[10]

MISCELLANEOUS PRODUCTS

cacao-butter base; colored pink and delicately perfumed. Each briquette is wrapped in wax tissue and tinfoil. The wrappers may be cut through in dividing the dose, thus protecting the fingers from contact with the ointment.

Intended especially for the application of mercury by inunction in the treatment of syphilis. See also Mercurettes, page 28.

CASCARA EVACUANT

(Alcohol 18%)

<table><tr><td>in 4-fl.oz. bottles</td><td>per doz.</td><td>$ 8.90</td></tr><tr><td>in 8-fl.oz. bottles</td><td>per doz.</td><td>15.90</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>28.60</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>14.85</td></tr></table>

Cascara Evacuant represents genuine Cascara Sagrada bark (Rhamnus Purshiana) from which the bitter constituents have been removed (not merely neutralized) by a special process which does not weaken the activity of the remaining constituents.

Cascara Evacuant, a tonic laxative, is indicated in the treatment of all forms of constipation. Best administered just as it comes from the bottle, without dilution with water. The most palatable active preparation of Cascara on the market. Small doses of 10 to 15 minims three times a day are recommended; the treatment should be continued until the desired tonic action on the intestinal tract has been produced, when the dose should be gradually reduced and the Evacuant finally withdrawn.

[11]

MISCELLANEOUS PRODUCTS

CASCARENNA

(Alcohol 7%)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz. $17.90</td></tr><tr><td>in gallon bottles</td><td>per gal. 9.75</td></tr></table>

Each fluid ounce represents:

<table><tr><td>Cascara sagrada</td><td>120 grs.</td></tr><tr><td>Senna</td><td>120 grs.</td></tr><tr><td>Potassium and Sodium tartrate</td><td>24 grs.</td></tr><tr><td>Chenopodium</td><td>8 grs.</td></tr><tr><td>Pumpkin seed</td><td>8 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>4 grs.</td></tr></table>

Agreeably flavored with aromatics.

A gentle purgative and anthelmintic, intended especially for use in the treatment of children. Dose, for a child of ten, 1/2 to 1 fluid drachm.

CHAULMOOGRA OIL

<table><tr><td>in 1/4-lb. bottles</td><td>per lb. 4.65</td></tr><tr><td>in pound bottles</td><td>per lb. 4.25</td></tr></table>

A remedy for leprosy; also used by topical application in the treatment of eczema, sprains, bruises, etc. Internal dose, 10 to 20 minims. For external use, make into ointment with lanolin.

•CHLOR-ANODYNE

(Alcohol 67%)

<table><tr><td>in ounce vials</td><td>per oz. .65</td></tr><tr><td>in 4-fl.oz. bottles</td><td>per bottle 1.95</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per bottle 6.90</td></tr></table>

Each fluid ounce contains:

<table><tr><td>Morphine hydrochloride</td><td>2 7/8 grs.</td></tr><tr><td>Fluid Extract Cannabis, U. S. P.</td><td>46 mins.</td></tr><tr><td>Diluted Hydrocyanic acid</td><td>9 mins.</td></tr><tr><td>Chloroform</td><td>46 grs.</td></tr><tr><td>Oil Peppermint</td><td>1 1/2 mins.</td></tr><tr><td>Tincture Capsicum, U. S. P.</td><td>3/4 min.</td></tr></table>

A promptly efficient and pleasant remedy for colic, cholera morbus, neuralgia, spasmodic pains, etc. Dose, 15 minims, to be repeated in half an hour if necessary.

CHLORETONE (P. D. & Co.) (Chlorbutanol)

<table><tr><td>in ounce vials</td><td>per oz. 1.10</td></tr><tr><td>in 1/4-lb. bottles</td><td>per bottle 4.00</td></tr></table>

Capsules, 3 grs. (No. 410)

<table><tr><td>in bottles of 100</td><td>per bottle .95</td></tr><tr><td>in bottles of 500</td><td>per bottle 4.50</td></tr></table>

•Narcotic order form required.

[ 12 ]

MISCELLANEOUS PRODUCTS

Chloretone Capsules, 5 grs. (No. 411)

<table><tr><td>in bottles of 100</td><td>per bottle $1.60</td></tr><tr><td>in bottles of 500</td><td>per bottle 7.60</td></tr></table>

Chloretone (chlorbutanol) is an efficient hypnotic that does not affect the heart; a prompt and powerful gastric sedative and antinauseant; an antiseptic of varied applicability; and a mild local anesthetic. Chloretone dissolves freely in alcohol or ether, but only to the extent of about 0.7 per cent. in water. It is stable in the presence of dilute acids.

As a hypnotic in sthenic cases of nervous excitement, Chloretone is administered in a dose of 10 grains on retiring, to be repeated in half an hour if necessary.

Chloretone is employed for its quieting, antispasmodic effect in epilepsy, chorea, asthma, pertussis, persistent hiccough, and delirium tremens. The dose varies from 3 to 30 grains, repeated according to the indications. No reactionary effect follows, as a rule, nor is a drug habit formed by the frequent use of Chloretone.

To control tetanic convulsions the dose is 40 to 60 grains, per rectum, the crystals being first dissolved in olive oil with the aid of gentle heat. This dose may be repeated as often as is found necessary to control the convulsions. The prospects of the patient are materially improved by the symptomatic relief which the Chloretone injections afford; but the specific treatment is of course Tetanus Antitoxin in full doses.

In protracted labor, especially in primiparæ, Chloretone has the happy effect of enabling the patient to relax completely between the "pains," thus conserving her strength; at the same time it takes the cutting edge off the pains themselves, without interfering with the force of the rhythmic contractions. It is to be administered in the first stage of labor in a dose of 10 grains, subsequent doses of 5 grains being given, if necessary, as the case progresses.

This use of Chloretone does not interfere with the action of Pituitrin when the latter drug is indicated.

The sedative and antinauseant effects of Chloretone are manifested strikingly under two diverse conditions: first, in hospital practice prior to surgical operations; and second, on sea voyages, as the vessel begins to swing. In the hospital it subdues the nervous excitement of the patient, diminishes the quantity of ether required, and controls post-operative nausea. At sea, it soothes the traveler into tranquil indifference. The dose as a pre-operative measure is 10 to 20 grains; in threatened sea-sickness 5 to 15 or 20 grains in single or divided doses.

As will be noted by reference to the two following pages, Chloretone is the title drug of several of our special preparations, and it enters into the composition of a number of others, either for its local anesthetic effect or as a preservative agent.

[ 13 ]

MISCELLANEOUS PRODUCTS

## CHLORETONE COMPOUND SUPPOSITORIES (Vaginal)

<table><tr><td>Elastic, with glycero-gelatin base, in soft tin capsules</td></tr><tr><td>in boxes of 1 dozen</td><td>per doz. boxes $12.75</td></tr></table>

Each suppository contains:

<table><tr><td>Chloretone (chlorbutanol)</td><td>1 gr.</td></tr><tr><td>Acetanilid</td><td>1 gr.</td></tr><tr><td>Zinc borate</td><td>1/2 gr.</td></tr><tr><td>Fluid Golden-seal colorless</td><td>2 mins.</td></tr><tr><td>Euthymol</td><td>15 mins.</td></tr><tr><td>Boric Acid or Boroglyceride</td><td>q.s.</td></tr></table>

These suppositories are antiseptic, astringent and tonic to mucous membrane, and exert a direct anesthetic or sedative effect.

## CHLORETONE EMOLLIENT (P. D. & Co.)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>12.75</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>6.35</td></tr></table>

Contains 5 grains of Chloretone (chlorbutanol) in each fluid ounce (1 gram per 100 grams), with Camphor and Menthol in proper proportions, dissolved in pure liquid petrolatum. It serves as an excellent emollient dressing for burns and wounds.

## CHLORETONE INHALANT

<table><tr><td>in 2-fl.oz. bottles</td><td>per doz.</td><td>3.20</td></tr><tr><td>in 4-fl.oz. bottles</td><td>per doz.</td><td>5.10</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>15.90</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>9.55</td></tr></table>

Each 100 grams contains:

<table><tr><td>Chloretone (chlorbutanol)</td><td>1.0 Gm.</td></tr><tr><td>Camphor</td><td>2.5 Gm.</td></tr><tr><td>Menthol</td><td>2.5 Gm.</td></tr><tr><td>Oil Cinnamon</td><td>0.25 Gm.</td></tr><tr><td>Refined Liquid Petrolatum</td><td>93.75 Gm.</td></tr></table>

Three distinct therapeutic properties are blended in Chloretone Inhalant. The first is furnished by the petrolatum base, which, when the Inhalant is applied to either mucous membrane or skin, makes a perfect though almost invisible insulation for the irritated tissues. It affords ideal protection against atmospheric or other external influences. Although there is not very much Chloretone in the Inhalant, the 1 per cent. present has an obtundent, local anesthetic effect, and this effect is seconded by the antiphlogistic action of the camphor and the menthol. Pain is relieved, not only negatively by protection of the irritated tissues, but positively by modifying the sensitiveness of the nerve endings and reducing the inflammation. But these effects are not sufficient when there is bacterial infection. Chloretone is antiseptic, as are also menthol and the oil of cinnamon.

[ 14 ]

MISCELLANEOUS PRODUCTS

As the name indicates, Chloretone Inhalant was designed for inhalation in the treatment of rhinitis, pharyngitis, laryngitis, and bronchitis. It is especially efficacious in the early treatment of these affections, before the sinuses have become inflamed and infected. It is to be applied, frequently, full strength or diluted, by means of a good oil atomizer operated by hand or air pressure; our Glaseptic Nebulizer is recommended. For diluting the Inhalant, use liquid petrolatum, light. Topically applied, Chloretone is often of marked service in insect bites and stings, burns, earache, fissured nipples and other breaks in the continuity of the skin.

## CHOLERA INFANTUM MIXTURE (Alcohol 8%)

Each fluid ounce contains:

<table><tr><td>Zinc sulphocarbolate</td><td>4/5 gr.</td></tr><tr><td>Bismuth hydroxide</td><td>5 3/5 grs.</td></tr><tr><td>Salol</td><td>1 3/5 grs.</td></tr><tr><td>Pepsin, U. S. P.</td><td>4 grs.</td></tr></table>

Intestinal inflammation is responsible for nearly all cases of cholera infantum. This mixture is especially designed for alleviating this condition. The bismuth hydroxide supplies a protective covering for the inflamed tissues; the salol and zinc sulphocarbolate are antiseptic in action; and pepsin aids the digestive process. Dose: one teaspoonful, repeated as required.

[ 15 ]

MISCELLANEOUS PRODUCTS

CINCHOPHEN

<table><tr><td>in 1-oz. bottles</td><td>per bottle</td><td>$ .60</td></tr></table>

Tablets, 7½ grs. (Compressed Tablet No. 691)

<table><tr><td>in boxes of 20</td><td>per doz. boxes</td><td>4.80</td></tr><tr><td>in bottles of 100</td><td>per bottle</td><td>1.30</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>6.00</td></tr></table>

Cinchophen is an active diuretic which increases to a marked degree the excretion of uric acid, and is believed to possess analgesic and antiphlogistic properties. It is used with success in the treatment of acute gout and in certain types of rheumatism, neuralgia, sciatica, lumbago, etc. Dose: 7½ to 15 grains three times a day, immediately after meals, with a liberal amount of water.

♦CITRONIN

(Alcohol 10%)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>12.75</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>7.40</td></tr></table>

Each fluid ounce represents:

<table><tr><td>Ethylmorphine hydrochloride</td><td>¼ gr.</td></tr><tr><td>Sodium citrate</td><td>20 grs.</td></tr><tr><td>Citric Acid</td><td>4 grs.</td></tr><tr><td>Potassium Guaiacol sulphonate</td><td>8 grs.</td></tr><tr><td>Cascara Evacuant.</td><td>6 mins.</td></tr><tr><td>Fluid Extract Ipecac</td><td>3 mins.</td></tr></table>

♦Narcotic registry number required.

[16]

MISCELLANEOUS PRODUCTS

Bronchitis, acute, subacute or chronic, suggests the use of Citronin. By virtue of the expectorant properties of the combination, the dry cough is promptly loosened up, while at the same time the infective factor is modified by the action of the guaiacol, and the irritation allayed by the morphine derivative. The Cascara Evacuant in the formula prevents constipation, and the ipecac has not only an expectorant effect upon the bronchi but a stimulating effect upon the digestive tract. Literature supplied on request.

♦COCAINE HYDROCHLORIDE TABLETS, SOLUBLE

1⅛ Grain Tablets

<table><tr><td>in vials of 20</td><td>per vial</td><td>$1.95</td></tr><tr><td>in bottles of 100</td><td>per bottle</td><td>9.35</td></tr></table>

One tablet dissolved in 60 minims of distilled water makes a 2-per-cent. solution of Cocaine.

2¼ Grain Tablets

<table><tr><td>in vials of 12</td><td>per vial</td><td>2.25</td></tr><tr><td>in bottles of 100</td><td>per bottle</td><td>18.00</td></tr></table>

One tablet dissolved in 60 minims of distilled water makes a 4-per-cent. solution of Cocaine.

♦CODEINE COUGH SEDATIVE (Alcohol 20%)
(Syrupus Codeinae Compositus)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>24.80</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>14.30</td></tr></table>

Each fluid ounce represents:

<table><tr><td>Codeine phosphate</td><td>1 gr.</td></tr><tr><td>Extract Cannabis, U. S. P.</td><td>½ gr.</td></tr><tr><td>White Pine bark</td><td>32 grs.</td></tr><tr><td>Wild Cherry</td><td>32 grs.</td></tr><tr><td>Eriodictyon</td><td>16 grs.</td></tr><tr><td>Balsam Poplar buds (Balm of Gilead)</td><td>4 grs.</td></tr><tr><td>Chloroform</td><td>2 grs.</td></tr><tr><td>Glycerin</td><td>120 mins.</td></tr></table>

Dose: 1 to 2 fluid drachms.

This combination is recommended for use in the treatment of dry bronchitis and irritating night cough. It is suitable for administration to children as well as adults, and can be continued from day to day in cases of subacute bronchitis with a minimum of "drug" risk—for not only is codeine the safest of all opium derivatives, there is very little of it in this formula. A special indication for the use of Codeine Cough Sedative is the headache and nervous excitement that frequently attend paroxysms of coughing.

♦Narcotic order form required

[17]

MISCELLANEOUS PRODUCTS

COD-LIVER OIL, STANDARDIZED, P. D. & Co.

<table><tr><td>in 4-fl.oz. bottles, each in carton</td><td>per doz. $ 4.25</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz. 10.60</td></tr></table>

This product is extracted from selected and strictly fresh codfish livers, and refined and bottled by improved methods which conserve its vitamin potency. Each fluid ounce contains at least 13,500 units of vitamin "A" (antiophthalmic and growth-promoting) and at least 3000 units of the antirachitic vitamin "D." The vitamin strength is carefully determined by prolonged tests on small animals.

The value of pure cod-liver oil as a preventive of rickets, and as a remedy for this condition when given in due time and in adequate amount, is universally acknowledged; and there is little room for doubting the practically specific action of the oil in bronchial disorders, particularly the persistent bronchial irritation that threatens involvement of the lungs.

The high vitamin content of Standardized Cod-liver Oil, P. D. & Co., renders comparatively small doses effective; and the purity of the oil is such that any objection the patient may have to cod-liver oil in general is easily overcome when this product is used.

The average dose for children is ½ to 1 teaspoonful three times a day. Orange or lemon juice, or a little table salt, masks the oily taste.

[18]

MISCELLANEOUS PRODUCTS

COD-LIVER OIL, PHOSPHORIZED

<table><tr><td>in 4-fl.oz. bottles, each in carton</td><td>per doz. $ 4.25</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz. 10.60</td></tr><tr><td>in gallon bottles</td><td>per gal. 5.00</td></tr></table>

Each fluid ounce contains 1/25 grain of Phosphorus dissolved in Standardized Cod-liver Oil, P. D. Co. (see page 18).

CODRENIN

<table><tr><td>in 1-oz. glass-stoppered bottles</td><td>per oz. 1.10</td></tr></table>

Each fluid ounce contains: Cocaine hydrochloride, 9 1/5 grs. (2%); Adrenalin, 1/33 gr. (1:15,000); Chloretone (chlorbutanol), 2¼ grs.

Codrenin is designed especially for the use of dentists, rhinologists, laryngologists, ophthalmologists, and all who have occasion to perform minor operations on mucous membrane. The adrenalin "localizes" the cocaine and prevents its rapid general absorption.

CRESYLONE

Carbolic acid coefficient, 3 to 3.5 (by Rideal-Walker method)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz. 9.55</td></tr><tr><td>in gallon bottles</td><td>per gal. 5.10</td></tr></table>

Readily miscible with water in all proportions. Cresylone dilutions of the strength required for disinfecting hands, instruments, etc., or for any other practical purpose, are not corrosive to the skin or to metal instruments.

♦DIARRHEA CORDIAL (Alcohol 20%)

(Cordiale Astringens, P. D. & Co.)

<table><tr><td>in 4-fl.oz. bottles</td><td>per doz. 5.75</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz. 17.00</td></tr><tr><td>in gallon bottles</td><td>per gal. 10.10</td></tr></table>

Each fluid ounce represents:

<table><tr><td>Krameria</td><td>40 grs.</td></tr><tr><td>Rubus</td><td>40 grs.</td></tr><tr><td>Ginger</td><td>24 grs.</td></tr><tr><td>Tincture Opium camphorated, U. S. P.</td><td>40 mins.</td></tr><tr><td>Chloretone</td><td>4 grs.</td></tr></table>

A mild and pleasant, yet effective, remedy for summer diarrhea. Dose: for a child under ten, 10 to 30 minims; over ten, 30 to 60 minims, to be repeated according to indications.

♦Narcotic order form required.

[19]

MISCELLANEOUS PRODUCTS

DIGIFORTIS

(Alcohol 65%)

in 1-fl.oz. amber-colored bottles...................per bottle $.65

This is a fat-free tincture prepared from specially selected drug grown in our own botanical gardens. It is biologically assayed to an activity 50% greater than that of Tincture Digitalis, U. S. P. Supplied only in 1-fl.oz. bottles, from which all air is displaced by carbon dioxide for the better preservation of the activity of the product. Each package is stamped with date of manufacture. Average dose, 8 mins. (0.5 cc). Our literature on Digifortis covers in detail the various indications for digitalis therapy, with special reference to the latest methods of rapid digitalization of the patient.

[20]

MISCELLANEOUS PRODUCTS

Digifortis Tablets (Compressed Tablet No. 687)

in bottles of 50...................................per bottle $.80

Each tablet contains 1 grain of powdered digitalis leaves of high potency, equivalent to 15 minims of Tincture Digitalis, U. S. P. Assayed physiologically.

Digifortis Tablets, half-strength (Compressed Tablet No. 696)

in bottles of 50...................................per bottle .65

Each tablet contains 1/2 grain powdered digitalis leaves of high potency, equivalent to 7 1/2 minims of Tincture Digitalis, U. S. P. Assayed physiologically.

DIGITALONE, P. D. & Co.

in 1-fl.oz. rubber-stoppered bottles, in carton...........per bottle .65

Digitalone is a purified extract of digitalis leaves, sterilized and
physiologically standardized. It contains a minimum of the resins
or crude extractive matter of the drug, and no alcohol; it is therefore
suitable for subcutaneous or intramuscular administration.

Ampoule No. 130

in boxes of one dozen 1-cc ampoules...................per box 1.20

in boxes of one hundred 1-cc ampoules...................per box 7.40

Each cubic centimeter is equivalent to the same amount of Tincture Digitalis, U. S. P. Chloretone (chlorbutanol), 0.5%, is added as a preservative.

The customary dose is 1/2 to 1 cc as determined by the effect on the volume and rate of the pulse, etc.

EPHEDRINE HYDROCHLORIDE

Capsules (pink), 3/8 gr. (No. 456)

in bottles of 40...................................per bottle 1.60

in bottles of 500...................................per bottle 14.85

Capsules (pink), 3/4 gr. (No. 457)

in bottles of 40...................................per bottle 2.50

in bottles of 500...................................per bottle 26.50

Indications are the same as for the sulphate; see below.

EPHEDRINE SULPHATE

in 30-grain vials...................................per vial 1.50

in 1/4-ounce vials...................................per vial 4.25

Ephedrine is an alkaloid obtained from *Ephedra Sinica*, formerly known as *Ephedra vulgaris* (Ma Huang).

[21]

MISCELLANEOUS PRODUCTS

Recent investigations indicate that this alkaloid, administered orally or hypodermically, produces vasoconstriction of moderate intensity but of unusual persistency. Ephedrine is also possessed of definite mydriatic properties.

Ephedrine Solution, administered intramuscularly, has been used successfully in treating the paroxysms of asthma.

### Ephedrine Sulphate Solution, 3%

in 1-fl.oz. bottles...................................per bottle $1.10

### Ampoules, ¾ gr. (No. 158)

in boxes of one dozen 1-cc ampoules...................per box 3.00

in boxes of one hundred 1-cc. ampoules..............per box 21.75

### Capsules (pink), ¾ gr. (No. 454)

### Capsules (pink), ¾ gr. (No. 453)

## EPHEDRINE INHALANT

in 1-fl.oz. bottles...................................per bottle 1.05

in 16-fl.oz. bottles...................................per bottle 10.60

Each fluid ounce contains:

Ephedrine................................1.5%

Menthol................................0.1%

Camphor................................0.5%

Oil Cinnamon................................0.25%

In a liquid petrolatum base.

Recommended in the treatment of inflammatory conditions of the nose and throat, such as rhinitis, laryngitis, bronchitis, and especially in subacute or chronic cases when the nasal sinuses have become involved.

## ERGONE (P. D. & Co.)

in 1-fl.oz. rubber-stoppered bottles...................per bottle 1.10

in 4-fl.oz. rubber-stoppered bottles...................per bottle 3.80

A purified and physiologically standardized fluid preparation of Ergot, free from much of the inert and irritating extractive so largely present in the fluid extract. Equal in strength to the official fluid extract made from best quality drug. Ergone is preserved by means of a small percentage of Chloretone (chlorbutanol). Every package is stamped with the date of manufacture. It may be administered in any manner the practitioner may prefer; the usual internal dose is 30 to 60 minims, the hypodermic 15 to 30 minims.

[22]

MISCELLANEOUS PRODUCTS

## ERGOT ASEPTIC AMPOULES (No. 29)

in boxes of three 1-cc ampoules...................per box $.60

in boxes of six 1-cc ampoules...................per box $.95

in boxes of one hundred 1-cc ampoules...........per box 10.90

Each ampoule contains 1 cc of a physiologically standardized, sterilized preparation of Ergot from which much of the inert and irritating extractive, so largely present in the fluid extract, has been removed. Chloretone (chlorbutanol), 0.5%, is added as a preservative.

Ergot Aseptic is assayed to the strength of Fluid Extract Ergot, U. S. P., each cubic centimeter being equivalent to one gram of prime ergot. It contains no alcohol.

Ergot is used generally for the contraction of dilated blood-vessels and the prevention of hemorrhage. Many obstetricians recommend its use in the third stage of labor as a prophylactic against postpartum hemorrhage, but when administered intramuscularly its action is so prompt that its use in obstetric cases may be advisedly postponed until there is evidence of postpartum hemorrhage—especially in cases in which Pituitrin has been given as a corrective of uterine inertia.

Ergot is employed as a stimulant to the non-pregnant uterus to check bleeding in menorrhagia and metrorrhagia. It has also been recommended as an arterial tonic in cases of constitutional collapse following the withdrawal of morphine or other narcotic drug.

The usual dose of Ergot Aseptic is 1 to 2 cc, preferably by intramuscular injection.

[23]

MISCELLANEOUS PRODUCTS

EUTHYMOL

(Alcohol 20%)

<table><tr><td>in 4-fl.oz. bottles</td><td>per doz.</td><td>$3.20</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>9.60</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>3.75</td></tr></table>

Each fluid ounce contains:

<table><tr><td>Eucalyptol</td><td>11/32 min.</td></tr><tr><td>Oil Wintergreen (synthetic)</td><td>9/32 min.</td></tr><tr><td>Boric acid</td><td>11 grs.</td></tr><tr><td>Benzoic acid</td><td>1/2 gr.</td></tr><tr><td>Menthol</td><td>9/64 gr.</td></tr><tr><td>Thymol</td><td>13/32 gr.</td></tr></table>

A liquid antiseptic, slightly acid in reaction, which may be used as an emollient lotion, gargle, mouth wash, or douche. It is usually diluted before use with three to six parts of water.

FORMIDINE

<table><tr><td>in sprinkler-top bottles (about 5 drachms)</td><td>per doz.</td><td>10.60</td></tr></table>

An iodized condensation product of formaldehyde and salicylic acid—an impalpable dusting powder containing about 50 per cent. of iodine. It is antiseptic, non-toxic, and odorless; practically non-irritating to wounds or denuded surfaces; tends to cause disappearance of pus; stimulates granulation.

GERMICIDAL DISCS. Formula of Dr. Chas. T. McClintock.

<table><tr><td>in oval screw-cap vials of 25</td><td>per doz. vials</td><td>3.50</td></tr><tr><td>in bottles of 100</td><td>per bottle</td><td>.65</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>2.65</td></tr></table>

Each disc contains:

<table><tr><td>Mercuric iodide</td><td>3/8 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>16 grs.</td></tr><tr><td>Potassium iodide</td><td>3/8 gr.</td></tr></table>

One of these discs dissolved in 4 ounces of water makes a 1:5000 solution of mercuric iodide, which is at least equal in germicidal activity to a 1:1000 solution of mercuric chloride, and is, of course, much less irritating, as it contains so much less mercury; moreover, the solution is alkaline in reaction. Germicidal Disc solutions, made as directed, do not injure steel or nickel, nor do they coagulate albumin.

The discs dissolve promptly (within a few seconds) in water, hot or cold.

GERMICIDAL DISCS (large) (Dr. Chas. T. McClintock)

<table><tr><td>in bottles of 25</td><td>per doz. bottles</td><td>5.10</td></tr><tr><td>in bottles of 100</td><td>per doz. bottles</td><td>1.20</td></tr><tr><td>in bottles of 500</td><td>per doz. bottles</td><td>5.00</td></tr></table>

[24]

MISCELLANEOUS PRODUCTS

Each disc (large) contains:

<table><tr><td>Mercuric iodide</td><td>1 1/2 grs.</td></tr><tr><td>Potassium iodide</td><td>1 1/2 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>q.s.</td></tr></table>

One disc dissolved in one pint of water makes a 1:5000 solution of mercuric iodide. See preceding note.

HEMATACOL

<table><tr><td>in 12-fl.oz. (1-lb.) bottles</td><td>per doz. $10.00</td></tr></table>

Containing Standardized Cod-Liver Oil, 25%, Hemoglobin 4%, in combination with Malt Extract. The cod-liver oil is of the highest vitamin standard, the hemoglobin a readily assimilable form of iron, and the malt extract a digestive agent.

HEMATIC HYPOPHOSPHITES

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>10.60</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>4.65</td></tr></table>

A permanently clear syrup. Each fluid ounce contains:

<table><tr><td>Potassium hypophosphite</td><td>1 1/2 grs.</td></tr><tr><td>Manganese hypophosphite</td><td>1 gr.</td></tr><tr><td>Strychnine hypophosphite</td><td>1/8 gr.</td></tr><tr><td>Ferrous hypophosphite</td><td>1 1/4 grs.</td></tr><tr><td>Calcium hypophosphite</td><td>1 gr.</td></tr><tr><td>Quinine hypophosphite</td><td>7/16 gr.</td></tr></table>

Dose: 1 to 2 fluid drachms.

[25]

MISCELLANEOUS PRODUCTS

## IODALBIN

<table><tr><td>in ounce bottles</td><td>per oz.</td><td>$.90</td></tr><tr><td>in ¼-lb. bottles</td><td>per lb.</td><td>11.65</td></tr></table>

### Capsules, 5 grs. (No. 414)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.10</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>5.10</td></tr><tr><td>in bottles of 1000</td><td>per bottle</td><td>9.60</td></tr></table>

Iodalbin is a compound of iodine and albumin occurring as a brown powder. It contains about 21.5 per cent. of iodine; is almost insoluble in water, alcohol, acids, and other ordinary solvents, but soluble in alkaline liquids. Administered when the secretions of the stomach are unquestionably acid, it passes through that organ unchanged, producing therefore no gastric disturbance, and is slowly dissolved in the small intestine. The iodine in Iodalbin is not nearly so rapidly excreted as in the case of potassium iodide; hence less of it is required for therapeutic effect. Average dose, 5 grains, after meals.

## IODALBIN AND MERCUROL TABLETS (chocolate-coated)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.45</td></tr></table>

Each tablet contains:

<table><tr><td>Iodalbin</td><td>5 grs.</td></tr><tr><td>Mercurol</td><td>1 gr.</td></tr></table>

Both the ingredients of these tablets are organic compounds, and both have been found to be better borne, when administered internally, than the inorganic salts of iodine and mercury. The combination is offered as a very superior "mixed treatment." See note under "Iodalbin."

## LAVACOL (a rubbing alcohol) scented or unscented (Alcohol 70%)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>5.60</td></tr></table>

The scented Lavacol has a slight lavender odor. To distinguish the two products the scented is supplied with regular brown label and the unscented with a blue label.

The bottles are of such a design that they can be easily held in one hand while the other is used for rubbing. The bottle is narrower in the middle than at either end, thus preventing it from slipping out of the hand even though it may be wet.

## LIQUOR SEDANS

<table><tr><td>in 16-fl.oz. bottles</td><td>(Alcohol 28%)</td><td></td></tr><tr><td>in gallon bottles</td><td>per doz.</td><td>25.50</td></tr><tr><td></td><td>per gal.</td><td>15.25</td></tr></table>

Each fluid ounce represents: Black Haw, 60 grs.; Hydrastine, representing 30 minims Fluid Extract Hydrastis; Jamaica Dogwood, 30 grs.; combined with aromatics. A utero-ovarian sedative and

[26]

MISCELLANEOUS PRODUCTS

anodyne that has been found extremely useful in dysmenorrhea, menorrhagia, and related functional disorders.

In dysmenorrhea a teaspoonful may be given in hot water every half-hour, with hot compresses applied over the lower abdomen. Attacks may frequently be prevented by giving Liquor Sedans three or four times a day for several days previous to the expected onset of the period.

Liquor Sedans is peculiarly effective in checking the hemorrhage in cases of menorrhagia and metrorrhagia. Care should, naturally, be taken with women approaching the climacteric to exclude incipient cancer as the cause of the bleeding.

In threatened abortion, Liquor Sedans should be administered in doses of 30 to 60 minims at intervals of one or two hours.

In cases of menstrual abnormalities associated with vertigo, neuralgia, headache, chills, convulsions, cardiac palpitation, weakness, dragging pains, frequent urination, leucorrhea, clotty discharge, and nervous spells, these symptoms frequently yield to the sedative influence of Liquor Sedans.

The average dose is ½ to 1 fluid drachm. If the patient objects to the taste, Compressed Tablet No. 226, Sedans, may be prescribed (see page 194). Literature supplied on request.

## LIVER EXTRACT, P. D. & Co.

<table><tr><td>in packages of 24 vials, of approximately 2 grams</td><td></td><td></td></tr><tr><td>each</td><td>per package</td><td>$6.20</td></tr></table>

This preparation is intended especially for the treatment of pernicious anemia, to take the place of a liver diet. It is a highly concentrated extract, very palatable. The dose is never more than one drachm (4 grams), and the extract, in salty granules, may be sprinkled on the food as a flavoring agent, or dissolved in milk, coffee or other fluid, according to the patient's taste.

The beginning dose is the contents of two vials at each of the three daily meals, but after the red cell count has risen to normal, or approximately so, the dose may be reduced to one vial three times a day.

Liver Extract, P. D. & Co., has been found, on clinical trial, to be equal to fresh liver in the treatment of pernicious anemia and the anemia of sprue. It may also be expected to be of service in some cases of secondary anemia. Literature supplied on request.

### LOCOSTHETIC

<table><tr><td>in 1-oz. bottles</td><td>per oz.</td><td>.65</td></tr></table>

Each fluid ounce contains: Cocaine hydrochloride, 0.75%; Adrenalin, 1:50,000; Thymol, 1:1500; Potassium sulphate, 4½ grs.; Chloretone (chlorbutanol), 0.5%; and Sodium chloride, q.s.

Equal in local anesthetic power to a 1½ or 2 per cent. solution of cocaine alone.

[27]

MISCELLANEOUS PRODUCTS

## MALT PREPARATIONS

Our Malt Extract is made from selected barley, by a process of vacuum evaporation that conserves the digestive principle, so that the finished product is not only a concentrated nutrient but a valuable diastatic agent. The dose of either of the two products quoted below is 4 fluid drachms (one tablespoonful) during or immediately after eating.

### Malt Extract (unmedicated)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>$8.00</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>4.25</td></tr></table>

### Malt Extract with Cod-liver Oil (P. D. & Co.)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>11.50</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>6.35</td></tr></table>

Contains 25% of Standardized Cod-liver Oil, P. D. & Co., by volume.

## MERCURETTES (for Inunction)

(Tabellæ Hydragyri cum oleo Theobromatis)

Mercurettes are oblong cakes of cacao-butter, each containing 50 grains of metallic mercury, finely subdivided and uniformly distributed throughout the base. They are pleasantly perfumed and are wrapped in tin foil.

This product is recommended for use in the administration of mercury by inunction, especially in the treatment of syphilis. Accuracy of dose, cleanliness and proper absorption are assured by the use of Mercurettes.

See also Calomelettes, page 10.

## MERCUROSAL

### For Intravenous Use

<table><tr><td>in packages of one dozen tubes, each containing 0.1 Gm. per pkg.</td><td>3.20</td></tr></table>

### For Intramuscular Use

<table><tr><td>in packages of one dozen tubes, each containing 0.05 Gm. per pkg.</td><td>2.65</td></tr></table>

The name Mercurosal is used to designate di-sodium-hydroxy-mercuri-salicyl-oxy acetate, a synthetic organic mercury compound manufactured by Parke, Davis & Company.

Mercurosal contains about 44%, by weight, of metallic mercury. Administered intravenously in the treatment of syphilis, it does not obliterate or otherwise injure the vein; neither does it cause kidney irritation when given in therapeutic doses.

[ 28 ]

MISCELLANEOUS PRODUCTS

Mercurosal has been demonstrated to be capable of promptly destroying the spirochetes of syphilis when administered in non-toxic doses to test animals.

The usual intravenous dose is 0.1 gram—more or less as determined by the tolerance of the patient.

Some patients show a high degree of intestinal intolerance to mercury. In such cases bismuth subnitrate or Milk of Bismuth should be given orally at the same time the intravenous injection of Mercurosal is given, or the dose of Mercurosal should be reduced.

From fifteen to twenty injections may be given, at intervals of 24 to 48 hours, after a course of arsphenamine has been given, the Mercurosal course to be followed by a course of Thio-Bismol—these courses to be repeated at appropriate intervals until recovery is thoroughly established.

## MERCUROSAL SOLUTION

<table><tr><td>in 50-cc rubber-diaphragm-stoppered bottles</td><td>per bottle</td><td>$1.60</td></tr></table>

Each cubic centimeter contains 0.025 Gm. Mercurosal. For intravenous or intramuscular use. This solution is slightly stronger than that in our 5-cc ampoules (No. 215), below, in that 4 cc (instead of 5) contains 0.1 Gm. Mercurosal.

### Ampoule No. 215, 0.1 Gm. (Intravenous)

<table><tr><td>in boxes of six 5-cc ampoules</td><td>per box</td><td>1.60</td></tr><tr><td>in boxes of twenty-five 5-cc ampoules</td><td>per box</td><td>6.10</td></tr><tr><td>in boxes of one hundred 5-cc ampoules</td><td>per box</td><td>22.25</td></tr></table>

[ 29 ]

MISCELLANEOUS PRODUCTS

## MERCURY SALICYLATE CREAM

in 2-ounce jars...................................per jar $1.60

Mercury Salicylate...................0.065 Gm. (1 gr.)

Basic Apothesine...................1%

Oil base.................................q.s.

Mercury Salicylate is indicated in syphilis when an insoluble mercury salt is desired. Administered intramuscularly, it is slowly absorbed, and for this reason not likely to produce salivation or toxic action.

The injections should be made slowly and deep into the muscular tissues—never intravenously.

Our formula for this product has recently been so improved that very little shaking is required to obtain a complete suspension of the mercury salicylate in the oil. Apothesine is added for its anesthetic action in lessening the local irritation so frequently evident when mercurials are administered hypodermically.

The usual dosage is 1 to 2 grains (1 to 2 cc) at weekly intervals.

## METAGEN (Vitamins)

in ounce bottles...................................per bottle 1.00

### Metagen Capsules, 5 grs. (No. 437)

in bottles of 50...................................per doz. 9.60

in bottles of 500...................................per bottle 6.90

Metagen is a P. D. & Co. preparation containing fat-soluble and water soluble vitamins, in extract form. The presence of these vitamins is determined by suitable tests on animals.

Metagen is suggested in cases of malnutrition, the most obvious indications being marasmus, anorexia, beriberi, xerophthalmia, and rickets; it is also often of value as an adjuvant in the treatment of anemia. Dose: For infants and children, ½ to 1 capsule two or three times daily; for adults, 1 to 5 capsules or a corresponding amount of the powder.

The word "Metagen" designates the vitamin products manufactured by Parke, Davis & Company.

## METAGEN AND COD-LIVER OIL, EMULSION (Alcohol 10%)

in 16-fl.oz. bottles...................................per doz. 12.75

This preparation contains approximately 40% of Parke, Davis & Co.'s Standardized Cod-liver Oil, supplemented with: Vitamin "B," as contained in Metagen; fresh eggs, the emulsifying agent; and a small amount of phosphoric acid. It is evident that these additions must enhance the reconstructive and nutritive properties of the cod-liver oil.

[30]

MISCELLANEOUS PRODUCTS

The emulsion contains at least 5400 units of vitamin "A" and at least 1200 units of antirachitic vitamin "D" in each fluid ounce. Metagen contributes the water-soluble vitamin "B."

This product is indicated in disorders of nutrition, in rickets, and as a nutritive and reconstructive tonic for persons in a debilitated condition following acute or chronic infections or other diseases.

## METATONE

(Alcohol 16%)

in 12-fl.oz. bottles...................................per doz. $12.75

Each fluid ounce contains:

Vitamin B Extract...................10 grs.

Nucleic Acid...........................2 grs.

Calcium Glycerophosphate...................4 grs.

Potassium Glycerophosphate...................4 grs.

Sodium Glycerophosphate...................2 grs.

Manganese Glycerophosphate...................½ gr.

Strychnine Glycerophosphate...................8/200 gr.

Metatone is a palatable liquid preparation the distinguishing feature of which is its content of vitamin "B" and nucleinic acid—two substances which have a natural place in the daily diet but are not always adequately represented there. Usually, too, when the digestion is poor, these ingredients of the food are only tardily or partially utilized. In Metatone they are instantly available.

Metatone is prescribed during convalescence from acute illness, such as influenza, pneumonia, typhoid fever, and the eruptive fevers of children; in neurasthenia, anemia, and chlorosis; in neuritis and malnutrition; after surgical operations; and in general to assist digestion and the hematopoietic function.

Favorable reports have been made on the use of Metatone in the treatment of pellagra.

Metatone is an acceptable tonic for children, and it is also of particular service in the treatment of the aged.

The adult dose is 1 to 2 fluid drachms.

[31]

MISCELLANEOUS PRODUCTS

MILK OF BISMUTH

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>$15.90</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>7.40</td></tr></table>

Each fluid drachm represents the bismuth equivalent of 5 grains of bismuth subnitrate. A suspension of the hydrated oxide of bismuth in water; free from starch, sugar, gums, etc., and from preservatives of all kinds.

Recommended especially for its prompt astringent and sedative effect upon the lining membrane of the alimentary canal, as in gastritis, diarrhea, intestinal colic, enteritis, or to prevent the occurrence of the latter condition as a result of the exhibition of Mercury. Dose: ¼ to 4 fluid drachms.

MILK OF MAGNESIA

(Magma Magnesiae, P. D. & Co., of U. S. P. strength)

<table><tr><td>in 6-fl.oz. bottles (packers of 2 dozen)</td><td>per doz.</td><td>2.40</td></tr><tr><td>in large size bottles</td><td>per doz.</td><td>4.80</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>2.65</td></tr></table>

Parke, Davis & Co.'s Milk of Magnesia consists wholly of hydrated oxide of magnesium, suspended in water, approximately 32 grains in each fluid ounce. It is used chiefly as a mild laxative, and for its antacid effect.

MINERAL OIL, HEAVY

(Formerly known as American Oil, P. D. & Co., and Natol)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>8.50</td></tr><tr><td>in gallon bottles</td><td>per bottle</td><td>4.80</td></tr></table>

A pure, heavy mineral oil or liquid petrolatum, of high specific gravity and extraordinary viscosity, colorless, odorless, tasteless, and guaranteed free from impurities, especially unsaturated carbon compounds. It is a petroleum oil of the naphthene series and will not become cloudy or solidify at freezing temperatures. Suitable for the treatment of constipation when active purgatives are contra- indicated.

Dose: 1 to 4 tablespoonfuls during the day, before meals.

NEKO, 1% (Germicidal Soap, P. D. & Co.)

<table><tr><td>in packages of 12 large cakes</td><td>per package</td><td>2.40</td></tr></table>

Contains 1% of mercuric iodide, with the same percentage of potassium iodide, in a base of high-grade neutral soap which con- serves the germicidal action of the mercury to a remarkable degree.

Neko is well known to the profession under its former title, Germicidal Soap, P. D. & Co. It is invaluable to the physician and surgeon, for use in aseptically cleansing the hands or the site of a

[32]

MISCELLANEOUS PRODUCTS

proposed operation. It may be used freely, like any toilet soap, but the last trace of the lather should be rinsed off before drying.

The moistened cake applied to new-forming furuncles, the lather being allowed to dry there, has been said to have an abortive action.

Neko, 1%, is also of value in certain eczematous conditions.

NEKO, 2% (Germicidal Soap, P. D. & Co.)

<table><tr><td>in large cakes</td><td>per doz.</td><td>$2.75</td></tr></table>

Contains 2% of mercuric iodide and the same percentage of potassium iodide. Intended especially for the use of surgeons. Acts in the same manner as 1% Neko, but more energetically and with somewhat more risk of injury to individuals with sensitive skin unless carefully handled.

NEKO, LIQUID (Germicidal Soap, P. D. & Co.)

<table><tr><td>in gallon bottles</td><td>per gal.</td><td>5.00</td></tr></table>

Contains 0.25% of mercuric iodide and the same percentage of potassium iodide.

A modified Germicidal Soap intended for toilet use, like any other liquid soap, but possessing the decided advantage of being disin- fectant, while at the same time it is bland and not irritating to the hands.

NEO-SILVOL, see page 34.

NUTRITIVE LIQUID PEPTONE

(Alcohol 22%)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>15.90</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>8.50</td></tr></table>

A combination of beef extract and malted barley. The extract of beef consists of prime lean beef digested with bromelin, a ferment found in pineapple juice. All the nutritive elements of beef are present. The malt has a decided diastatic action. Dose, ½ to 1 fluid ounce.

NUTRITIVE LIQUID PEPTONE WITH CREOSOTE

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>18.50</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>9.90</td></tr></table>

Each fluid ounce contains, in addition to the nutritive constituents of beef and malt, 1¼ minims of creosote and ¾ minim of guaiacol. This combination is of value in the treatment of subacute and chronic bronchitis, and also of flatulence and intestinal fermenta- tion attending or following acute disease. It contains 18% of alcohol.

[33]

MISCELLANEOUS PRODUCTS

### NEO-SILVOL (Colloidal Silver Iodide Compound)

<table><tr><td>in ounce bottles</td><td>per oz.</td><td>$1.60</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>5.00</td></tr></table>

Neo-Silvol is a compound of silver iodide with a soluble gelatin base: it contains 18 to 22% of silver iodide in colloidal form.

Neo-Silvol solutions are non-irritating to mucous membrane, do not coagulate albumin, and are practically non-staining.

Neo-Silvol is intended for the treatment of infections of accessible mucous membrane, especially of the genito-urinary tract and of the eye, ear, nose, and throat. In general it is equal to pure carbolic acid as a germicide, and 20 times as active on contact with the gono-coccus. Literature supplied on request.

### Neo-Silvol Capsules, 6 grs. (No. 438)

(For convenience in making up solutions)

<table><tr><td>in bottles of 50</td><td>per bottle</td><td>1.60</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>13.80</td></tr></table>

### Neo-Silvol Suppositories, 5% (Vaginal)

<table><tr><td>in boxes of 1 dozen</td><td>per doz. boxes</td><td>12.75</td></tr></table>

These suppositories are made with a glycero-gelatin base and enclosed in soft tin capsules to preserve their shape in warm weather.

[34]

MISCELLANEOUS PRODUCTS

### NUTRITIVE LIQUID PEPTONE, see page 33.

### OLEORESIN ASPIDIUM, U. S. P. (Male-fern)

<table><tr><td>in 1-oz. bottles</td><td>per oz.</td><td>$ .75</td></tr></table>

A remedy for tapeworm. One dose is often sufficient (¼ to 1 fluid drachm). Administer in the morning, on an empty stomach, and have the patient fast until the bowels move; if this does not occur within two or three hours, give a saline purge—not castor oil.

See also Soluble Gelatin Capsules Male-fern and Kamala, page 111.

### OLGAR

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>12.75</td></tr></table>

Olgar is an agreeably flavored emulsion containing 65% of Mineral Oil (Heavy), combined with Agar. The mineral oil, formerly known as American Oil and Natol, is an unusually pure oil of high viscosity and specific gravity, especially suitable for use in the treatment of constipation. The effect is not immediate; it may be necessary to take the treatment for three or four days before free evacuation of the bowels occurs. Olgar contains no sugar.

Dose: For adults, one or more tablespoonfuls daily. For children, one teaspoonful or more. After the desired effect has been produced, the dose may be gradually lessened.

### OLGAR COMPOUND

This product is identical with Olgar except that it contains 1½ grains of phenolphthalein in each fluid ounce.

### PALATOL

(Alcohol 9%)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>10.00</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>5.95</td></tr></table>

Each fluid ounce represents:

Syrup Hematic Hypophosphites 90 mins.

Malt Extract 60 mins.

Syrup, Wild Cherry 120 mins.

Combined with Gaduol.

The hypophosphites of calcium, potassium, iron, manganese, quinine and strychnine are skilfully combined in Palatol with the other medicinal ingredients. The malt extract is from selected barley. The wild cherry is an agreeable flavoring agent possessing expectorant and stomachic properties.

Palatol may be expected to stimulate the central nervous system and the appetite; it is a valuable tonic and alterative in chlorotic anemias; it aids in the treatment of coughs due to colds and other bronchial irritations, and is helpful as a tonic during convalescence.

Usual dose, one teaspoonful to one tablespoonful t.i.d.

[35]

MISCELLANEOUS PRODUCTS

## PALATOL COMPOUND

(Alcohol 9%)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>$11.90</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>7.00</td></tr></table>

This preparation is the same as the foregoing, with the addition of 4 minims of creosote (equivalent) and 2 minims of guaiacol to each ounce. While not quite so pleasant to take as the plain Palatol, it is to be preferred in resistant cases of bronchitis and winter cough. Dose, 1 to 4 fluid drachms.

## PANTERIC CAPSULES (No. 455)

(Pancreatin, U. S. P., triple-strength, 5 grs.)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>2.35</td></tr><tr><td>in bottles of 1000</td><td>per bottle</td><td>21.20</td></tr></table>

The granules of pancreatin in these capsules are specially prepared in an enteric-coated form. The capsules themselves are not coated. Dose for adults, 1 or 2 capsules after each meal. When smaller doses are required the capsules may be opened and the desired amount of the granules administered. See note under Panteric Tablets.

## PANTERIC TABLETS (Chocolate-coated Tablet No. 503)

(Pancreatin, U. S. P., triple strength, 5 grs.)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.60</td></tr><tr><td>in bottles of 1000</td><td>per bottle</td><td>15.00</td></tr></table>

If pancreatin as a therapeutic agent is to remedy defective secretion of the pancreatic ferments, it must be administered in such a form or manner as to avoid contact with the hydrochloric acid of the

[ 36 ]

MISCELLANEOUS PRODUCTS

stomach. The need of a satisfactory vehicle was urged upon us by Dr. W. D. Sansum, director of the Potter Metabolic Clinic, Santa Barbara, Cal., in 1924, and we undertook the task of devising an enteric coating that would be at once physiologically inert, insoluble in HCl, and readily soluble in the alkaline liquids that are naturally present in the small intestine. The result of our researches is Panteric Tablets and Capsules.

The indications for the use of these tablets are suggested by the fact that they make pancreatin therapeutically available. In many cases of diabetes the pancreas is doubly damaged, being unable to secrete either the insulin required for the utilization of sugar, or the full quota of digestive ferments—amylopsin, trypsin and steapsin. In these cases Panteric Tablets or Capsules supplement insulin (they are not offered as a substitute). And any case of malnutrition due to defective pancreatic function (such as intestinal fermentation, scrawniness, food asthmas or urticarias) may be expected to benefit from the systematic use of Panteric Tablets or Capsules.
Dose: 1 or 2 after each meal.

## Petrolatum, Liquid, Heavy, see Mineral Oil, Heavy, page 32.

## PETROLATUM, LIQUID, LIGHT (Light Mineral Oil)

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>$6.35</td></tr><tr><td>in gallon cans</td><td>per gal.</td><td>3.20</td></tr></table>

A bland, odorless, tasteless, colorless liquid, of the highest purity, especially recommended for its emollient effect when applied to the nose or throat by means of a nebulizer. Suitable for use as a solvent of certain medicaments to be applied by spray.

## PETROLEUM EMULSION WITH HYPOPHOSPHITES

<table><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>11.50</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>5.95</td></tr></table>

<table><tr><td>Each fluid ounce represents:</td><td>(Alcohol 7%)</td></tr><tr><td>Liquid Petrolatum</td><td>33.3%</td></tr><tr><td>Calcium hypophosphite</td><td>8 grs.</td></tr><tr><td>Sodium hypophosphite</td><td>4 grs.</td></tr></table>

Dose, 1 to 4 fluid drachms.

## PHENICHTHOL, see Ointments, page 51.

## PHENOLATED CAMPHOR

<table><tr><td>in 4-fl.oz. bottles</td><td>per doz.</td><td>10.20</td></tr><tr><td>in 16-fl.oz. bottles</td><td>per doz.</td><td>31.80</td></tr><tr><td>in gallon bottles</td><td>per gal.</td><td>19.15</td></tr></table>

Contains: Carbolic Acid, 22%; Camphor, 66%. For external and dental use only.

[ 37 ]

MISCELLANEOUS PRODUCTS

## QUININE

Supplied in Pills, Tablets, and Gelatin Capsules as follows:

<table><thead><tr><th>QUININE</th><th>Pills</th><th>Pills, Choco-<br>late-coated,<br>soft</th><th>Com-<br>pressed<br>Tablets,<br>plain</th><th>Com-<br>pressed<br>Tablets,<br>Sugar-<br>coated</th><th>Com-<br>pressed<br>Tablets,<br>Sugar-<br>coated<br>PINK</th><th>Choco-<br>late-<br>coated<br>Tablets</th><th>Hard<br>Gelatin<br>Capsules<br>filled</th></tr></thead><tbody><tr><td>Bisulphate,<br>5 grs.</td><td>No.</td><td>No.</td><td>No.</td><td>No.</td><td>No.</td><td>No.</td><td>No.</td></tr><tr><td>Sulphate,<br>1 gr.</td><td>559*</td><td>...</td><td>...</td><td>89</td><td>...</td><td>...</td><td>440</td></tr><tr><td>2 grs.</td><td>560§</td><td>969</td><td>91</td><td>95</td><td>329</td><td>128</td><td>417</td></tr><tr><td>3 grs.</td><td>561*</td><td>...</td><td>92</td><td>...</td><td>...</td><td>...</td><td>418</td></tr><tr><td>4 grs.</td><td>...</td><td>...</td><td>...</td><td>...</td><td>...</td><td>...</td><td>419</td></tr><tr><td>5 grs.</td><td>563*</td><td>...</td><td>93</td><td>97</td><td>...</td><td>...</td><td>420</td></tr></tbody></table>

*Gelatin coated, oval, only.

§Sugar coated and gelatin coated, oval.

### Pills and Tablets

<table><tbody><tr><td>1 gr.</td><td>per bottle of 100</td><td>$ .45</td></tr><tr><td>(pills only)</td><td>per bottle of 500</td><td>1.60</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>2.70</td></tr><tr><td>2 grs.</td><td>per bottle of 100</td><td>.60</td></tr><tr><td>(pills only)</td><td>per bottle of 500</td><td>2.55</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>4.60</td></tr><tr><td>3 grs.</td><td>per bottle of 100</td><td>.80</td></tr><tr><td>(pills only)</td><td>per bottle of 500</td><td>3.45</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>6.40</td></tr><tr><td>4 grs.</td><td>per bottle of 100</td><td>.95</td></tr><tr><td>(pills only)</td><td>per bottle of 500</td><td>4.30</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>8.10</td></tr><tr><td>5 grs.</td><td>per bottle of 100</td><td>1.15</td></tr><tr><td>(pills only)</td><td>per bottle of 500</td><td>5.10</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>9.70</td></tr></tbody></table>

### Gelatin Capsules (hard capsules, filled)

<table><tbody><tr><td>2 grs.</td><td>per bottle of 100</td><td>.80</td></tr><tr><td>per bottle of 500</td><td>per bottle of 500</td><td>3.50</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>6.45</td></tr><tr><td>3 grs.</td><td>per bottle of 100</td><td>.95</td></tr><tr><td>per bottle of 500</td><td>per bottle of 500</td><td>4.45</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>8.40</td></tr><tr><td>4 grs.</td><td>per bottle of 100</td><td>1.20</td></tr><tr><td>per bottle of 500</td><td>per bottle of 500</td><td>5.35</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>10.25</td></tr><tr><td>5 grs.</td><td>per bottle of 100</td><td>1.35</td></tr><tr><td>per bottle of 500</td><td>per bottle of 500</td><td>6.20</td></tr><tr><td>per bottle of 1000</td><td>per bottle of 1000</td><td>11.90</td></tr></tbody></table>

[ 38 ]

MISCELLANEOUS PRODUCTS

## Soluble Gelatin Capsules (Quinine Sulphate)

<table><tbody><tr><td>2 grs. (No. 202)</td><td>per doz. boxes of 12</td><td>$3.90</td></tr><tr><td></td><td>per box of 100</td><td>1.80</td></tr><tr><td>3 grs. (No. 203)</td><td>per doz. boxes of 12</td><td>4.45</td></tr><tr><td></td><td>per box of 100</td><td>2.15</td></tr><tr><td>5 grs. (No. 205)</td><td>per doz. boxes of 12</td><td>5.10</td></tr><tr><td></td><td>per box of 100</td><td>2.65</td></tr></tbody></table>

## SCARLET RED EMULSION

(Alcohol 4%)

in 1-oz. bottles...................................per bottle .65

Contains 4 per cent. of Scarlet Red Sulphonate. An epithelial stimulant, valuable in the treatment of ulcers of various kinds, ozena, atrophic rhinitis, and slow-healing wounds, accidental or surgical. Adheres tenaciously to mucous membrane.

In the treatment of ozena or atrophic rhinitis, the parts should first be thoroughly cleansed with warm saline solution or diluted Euthymol, then dried with cotton, and the Scarlet Red Emulsion immediately applied, with gentle massage, by means of a cotton-tipped applicator. This operation should be repeated on alternate days until a cure is effected. See also *Scarlet Red Ointment*, page 52.

## SEDATIVE CORDIAL

(Alcohol 16%)

in 16-fl.oz. bottles...................................per doz. 19.15

in gallon bottles...................................per gal. 10.60

Each fluid ounce represents:

<table><tbody><tr><td>Potassium bromide</td><td>40 grs.</td></tr><tr><td>Ammonium bromide</td><td>40 grs.</td></tr><tr><td>Sodium bromide</td><td>40 grs.</td></tr><tr><td>Zinc bromide</td><td>1 gr.</td></tr><tr><td>Extract Belladonna leaves</td><td>1/8 gr.</td></tr><tr><td>Extract Cannabis, U. S. P.</td><td>1/8 gr.</td></tr><tr><td>Elixir Lupulin</td><td>80 mins.</td></tr><tr><td>Elixir Cascara sagrada</td><td>80 mins.</td></tr></tbody></table>

Dose, 1 fluid drachm.

## SILVER NITRATE SOLUTION, 1%, IN CAPSULES

in packages containing 12 enameled tin boxes of 2 capsules each...................................per package 1.85

These capsules are made of wax and paraffin, to render them compressible and at the same time without effect upon the silver nitrate solution they contain. Each capsule contains an aqueous solution of pure Silver Nitrate 1%, intended solely for instillation into the eyes of newborn infants to prevent gonorrheal ophthalmia. To expel the solution the capsule is pierced at one end with a needle, and the other end is compressed between thumb and finger. Two drops are to be placed in each eye.

[ 39 ]

MISCELLANEOUS PRODUCTS

SILVOL

<table><tr><td>in 1-oz. bottles</td><td>per oz.</td><td>$1.30</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>4.50</td></tr></table>

Silvol is a compound of colloidal silver with an alkaline protein. It contains about 20% of silver and is readily soluble in water, yielding a solution that is not precipitated by alkalies, albuminoid solutions, or normal serum.

Meets all tests for Mild Silver Protein, U. S. P.

Silvol in solution is employed topically in inflammatory affections of accessible mucous membrane. It is remarkably free from irritating or toxic effects and is germicidal when used properly. See also Neo-Silvol.

Silvol Capsules, 6 grs. (No. 421)

One capsule makes one fluid drachm of a 10% solution of Silvol. This solution should be protected from light.

Silvol Bougies, 5%

<table><tr><td>in packages of 25 with introducer</td><td>per package</td><td>1.10</td></tr><tr><td>in packages of 100 with introducer</td><td>per package</td><td>3.45</td></tr></table>

Each bougie contains 5% of Silvol in a cacao-butter base.

Silvol Suppositories, 5% (Vaginal)

The suppositories are elastic, with glycero-gelatin base, enclosed in soft tin capsules. The capsules preserve the shape of the suppositories in hot weather or in a warm room. Before use, the capsule should be dipped in cold water to harden the suppository; then by clipping off the folded wings of the capsule with scissors the suppository is liberated.

See also Ointments, page 52.

STEARODINE TABLETS (Compressed Tablet No. 697)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.10</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>3.70</td></tr></table>

These are chocolate tablets, each containing Calcium Iodostearate in a quantity equivalent to 1/6 gr. (0.01 Gm.) of Iodine in organic combination. They are intended for the prevention and treatment of simple goiter, particularly for prophylaxis in the case of children during the adolescent period. Stearodine is non-toxic and non-irritating, and the tablets are very palatable. The usual prophylactic dosage is one tablet per week throughout the year, or one tablet daily for a month, twice a year.

[ 40 ]

MISCELLANEOUS PRODUCTS

In goitrous regions it is very important that iodine should be taken during pregnancy for the benefit of both mother and child, and Stearodine Tablets are both convenient and accurate for this purpose. One or two tablets twice a week may be stated as the average dosage in such cases.

STERILE SALT, for making physiologic salt solution

<table><tr><td>in packages containing 6 hermetically sealed tubes</td><td>per package</td><td>$2.65</td></tr></table>

Each tube consists of a hermetically sealed glass-dome container enclosing an inner glass tube in which is a combination of chemically pure sterilized salts for making extemporaneously physiologic saline solution of the following composition: Calcium chloride, 0.25 Gm.; Potassium chloride, 0.10 Gm.; Sodium chloride, 9.00 Gm.; Sterile water, to 1000 cc (1 liter). Dissolve the contents of one tube in one liter of sterile water for hypodermic or intravenous injection.

STROPHANTHONE

<table><tr><td>in 1-fl.oz. rubber-stoppered bottles</td><td>per bottle</td><td>.85</td></tr><tr><td>in 4-fl.oz. rubber-stoppered bottles</td><td>per bottle</td><td>1.60</td></tr></table>

A purified and physiologically standardized preparation of strophanthus seed, for oral administration. It is preserved by the addition of a small percentage of Chloretone (chlorbutanol). Every package is stamped with the date of manufacture. Dose, internal, 2 to 10 minims.

Ampoule No. 24 (Strophanthone Dilute, 1 cc)

<table><tr><td>in boxes of one dozen</td><td>per box</td><td>1.20</td></tr></table>

Each cubic centimeter contains 0.15 cc of Strophanthone, P. D. & Co., diluted to 1 cc with physiologic salt solution containing Chloretone (chlorbutanol), 0.5%.

The activity of Strophanthone Dilute, as determined by physiologic test, is one-thirteenth that of Tincture Strophanthus, U. S. P.

Strophanthone Dilute is an aseptic, non-alcoholic solution of the essential constituents of strophanthus seed, prepared especially for subcutaneous and intravenous administration.

It is a cardiac stimulant and tonic, of particular value when a marked rise in blood pressure is to be avoided.

Strophanthone should be used with caution in cases previously treated with digitalis.

Average initial dose: subcutaneous, 1 cc (16 mins.); intravenous, ½ cc (8 mins.). Subsequent doses are to be determined by the response of the patient.

SUPPOSITORIES, see Adrenalin, Astringent, Chloretone Compound, Neo-Silvol, Silvol, and Thiodine Suppositories.

SUPRARENAL GLANDS, see Gland Products, page 74.

[ 41 ]

["MISCELLANEOUS PRODUCTS", "Thio-Bismol is best given by deep intramuscular injection, the usual dose being 0.2 gram for a person weighing 150 pounds. Injections should be given twice a week for 10 to 12 doses, and may be preceded or followed by arsphenamine or mercury if these are well borne. Literature on Bismuth Therapy supplied on request.", "### TARTALAX", "in 8-oz. bottles with measuring cap, cartoned. . . . . . . . . . .

MISCELLANEOUS PRODUCTS

## OINTMENTS

### ADRENALIN OINTMENT, 1:1000 (No. 1)

in 1/2-oz. collapsible tin tubes with elongated nozzle... per doz. $4.25

Contains 1:1000 Adrenalin in a bland oleaginous base. Indicated in the treatment of inflamed mucous membranes.

### ADRENALIN AND CHLORETONE OINTMENT (No. 2)

in 1/2-oz. collapsible tin tubes with elongated nozzle... per doz. 4.25

Each ounce contains:

Adrenalin 2/5 gr. (1:1000)

Chloretone (chlorbutanol) 20 grains (4.5%)

### AMMONIATED MERCURY, see page 49.

### ANESTHONE CREAM (No. 5)

in 1/2-oz. collapsible tubes with elongated nozzle... per doz. 4.25

Contains Adrenalin chloride 1:20,000, and Para-amido-ethyl-benzoate (anesthesin) 10%—the latter a local anesthetic agent that dissolves slowly in the nasal secretions and thus produces a prolonged effect. The use of Anesthone Cream does not, so far as known, lead to the formation of a "habit." In the symptomatic treatment of rose-cold, hay-fever, etc., this ointment has acquired a nation-wide reputation. The Adrenalin in the formula has an immediate effect, and the anesthesin a lasting effect. Literature supplied on request.

[48]

MISCELLANEOUS PRODUCTS

### AMMONIATED MERCURY OINTMENT, U. S. P. (No. 46)

in 1-lb. opal jars... per lb. $2.15

in 5-lb. cans... per lb. 1.85

### AMMONIATED MERCURY OINTMENT, 5% (No. 3)

(One-half the strength of Ointment Ammoniated, Mercury, U. S. P.)

in 1-oz. collapsible tubes... per doz. 3.60

in 1-lb. opal jars... per lb. 1.80

in 5-lb. cans... per lb. 1.55

### ANALGESIC BALM (No. 4)

in collapsible tubes, small size (about 5/8 oz.)... per doz. 3.20

in collapsible tubes, large size (about 1 1/2 oz.)... per doz. 5.30

in 1-lb. cans... per lb. 4.25

A combination of Methyl salicylate and Menthol with a suitable base, for the external treatment of rheumatic and other pains, particularly those due to inflammatory processes in nerve or muscle.

### ANESTHONE CREAM, see page 48.

### BELLADONNA OINTMENT, U. S. P. (No. 47)

in 1-lb. opal jars... per lb. 2.00

in 5-lb. cans... per lb. 1.80

### BISMUTH PASTE, Surgical (formula of Dr. E. G. Beck) (No. 6)

in collapsible tubes, with nozzle for filling syringe... per doz. 8.90

in 1-lb. opal jars... per lb. 3.80

in 5-lb. cans... per lb. 3.60

Contains 1 part bismuth subnitrate (c.p.) to 2 parts yellow petrolatum. Suggested for the treatment of tuberculous sinuses, fistulæ, abscesses, bone tuberculosis, and chronic suppurative conditions in general. Directions for use accompany the package as marketed.

### BORIC ACID OINTMENT, P. D. & Co. (No. 49)

in 1-oz. collapsible tubes... per doz. 2.15

in 1-lb. opal jars... per lb. 1.15

in 5-lb. cans... per lb. 1.00

This ointment is of U. S. P. strength, but is made with a base which gives a white product, the U. S. P. being yellow.

### BOROSEPTIC OINTMENT (No. 9)

in 5-lb. cans... per lb. 1.00

Incorporating boric acid, zinc oxide, and eucalyptol, in a suitable base. Indicated in conditions which require a bland, soothing, mildly antiseptic dressing.

[49]

MISCELLANEOUS PRODUCTS

## CALOMEL OINTMENT, 5% (No. 10)

<table><tr><td>in 1-oz. collapsible tubes</td><td>per doz.</td><td>$3.20</td></tr><tr><td>in 1-lb. opal jars</td><td>per lb.</td><td>1.65</td></tr></table>

## CALOMEL OINTMENT, N. F., 30% (Prophylactic) (No. 38)

<table><tr><td>in 1-drachm tubes with detachable label for dispensing</td><td>per doz.</td><td>1.80</td></tr></table>

## CAPSOLIN (No. 11)

<table><tr><td>in collapsible tubes</td><td>per doz.</td><td>2.40</td></tr><tr><td>in 1-lb. tins</td><td>per lb.</td><td>1.30</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>1.20</td></tr></table>

Contains oleoresin capsicum, camphor, croton oil, cajuput oil, and oil of turpentine. A convenient, efficient, non-vesicating substitute for the mustard plaster and other counterirritants used in the treatment of articular and muscular rheumatism, neuralgias, and subdermal inflammations.

## EMOLLIENTINE (P. D. & Co.) (No. 12)

<table><tr><td>in collapsible tubes</td><td>per doz.</td><td>2.65</td></tr><tr><td>in 1-lb. cans</td><td>per lb.</td><td>.85</td></tr><tr><td>in 5-lb. cans</td><td>per lb.</td><td>.80</td></tr></table>

A combination of aluminum hydrate, carbolic acid, isarol, lead oxide, corrosive sublimate, and zinc sulphocarbolate, constituting, as the name implies, an emollient ointment applicable in the treatment of burns, scalds, bruises, sprains, and inflammatory conditions of the skin.

## ICHTHYOL OINTMENT, 10% (No. 41)

<table><tr><td>in collapsible tubes (about 1 oz.)</td><td>per doz.</td><td>3.45</td></tr><tr><td>in 1-lb. cans</td><td>per lb.</td><td>2.30</td></tr></table>

## INHALONE (No. 37)

<table><tr><td>in collapsible tubes with elongated nozzle</td><td>per doz.</td><td>2.15</td></tr></table>

A combination of phenol, menthol and eucalyptol in a bland oleaginous base, agreeably aromatized. For the local treatment of rhinitis and nasal catarrh.

## MENTHUM (No. 14) (Ointment Camphor and Menthol)

<table><tr><td>in 2-oz. opal glass jars</td><td>per doz.</td><td>3.80</td></tr><tr><td>in 1-lb. opal glass jars</td><td>per lb.</td><td>1.60</td></tr></table>

Contains Camphor 6%, and Menthol 3%, in an appropriate base. Analgesic, cooling and healing. For chapped hands, "cold sores," sprains, burns, chilblains, or insect bites.

[ 50 ]

MISCELLANEOUS PRODUCTS

## MERCURIAL OINTMENT, STRONGER, U. S. P. (No. 15)

<table><tr><td>in 1-oz. collapsible tubes</td><td>per doz.</td><td>$3.60</td></tr><tr><td>in 1-lb. tins</td><td>per lb.</td><td>2.65</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>2.50</td></tr></table>

Contains 50% Metallic Mercury; made after the U. S. P. process, and a superior product for dispensing on physicians' prescriptions.

See also Calomelettes, page 10, and Mercurettes, page 28.

## MERCURIAL OINTMENT, MILD, U. S. P. (No. 16)

(Blue Ointment)

<table><tr><td>in 1-oz. collapsible tubes</td><td>per doz.</td><td>3.20</td></tr><tr><td>in 1-lb. tins</td><td>per lb.</td><td>2.15</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>1.95</td></tr></table>

Contains 30% of Metallic Mercury.

## MERCURIAL OINTMENT CAPSULES (No. 17)

<table><tr><td>in boxes of 20</td><td>per box</td><td>1.10</td></tr><tr><td>in boxes of 100</td><td>per box</td><td>4.25</td></tr></table>

Each capsule contains 60 grs. of a 33.3% ointment made by combining Redistilled Metallic Mercury with a suitable base.

## NEO-SILVOL OINTMENT, 5% (No. 50)

<table><tr><td>in 1-drachm collapsible tubes with elongated nozzle</td><td>per doz.</td><td>3.20</td></tr></table>

The tubes are finished in individual cartons with a detachable label. See Neo-Silvol, page 34.

## PHENICHTHOL (No. 19)

<table><tr><td>in 1-lb. cans</td><td>per lb.</td><td>.85</td></tr><tr><td>in 5-lb. cans</td><td>per lb.</td><td>.75</td></tr></table>

Contains 2 per cent. of carbolic acid in combination with ammonium sulphichthyolate, alum, and lead plaster. Stimulating and antiseptic; allays inflammation and pruritus.

## RESORCO (No. 20)

<table><tr><td>in 1-lb. opal glass jars</td><td>per lb.</td><td>2.65</td></tr><tr><td>in 5-lb. cans</td><td>per lb.</td><td>2.50</td></tr></table>

Contains resorcin, bismuth subnitrate, tannic acid, boric acid, zinc oxide, and a suitable base. An astringent ointment which has been found of value as a dressing for wounds and abrasions.

## SCARLET RED OINTMENT, 5% (No. 21)

<table><tr><td>in 1-oz. collapsible tubes</td><td>per doz.</td><td>3.20</td></tr></table>

See also Scarlet Red Ointment, 10%, page 52.

[ 51 ]

MISCELLANEOUS PRODUCTS

## SCARLET RED OINTMENT, 10% (No. 22)

<table><tr><td>in 1/2-lb. jars</td><td>per jar</td><td>$1.35</td></tr></table>

This is scarlet red sulphonate in ointment form. It is used for the stimulation of epithelial cell growth in ulcers following burns, infection and trauma, and in varicose ulcers, syphilitic ulcers, bedsores, skin-grafts, and all slow-healing breaks in the continuity of the skin. The 10% ointment can be reduced to any strength desired by the addition of petrolatum.

See also Scarlet Red Ointment, 5%, page 51, and Scarlet Red Emulsion, page 39.

## SILVOL OINTMENT, 5% (No. 23)

<table><tr><td>in collapsible long-nozzled tubes (dispensing package)</td><td>per doz.</td><td>3.20</td></tr><tr><td>in collapsible long-nozzled tubes (large)</td><td>per doz.</td><td>6.35</td></tr></table>

Recommended especially for ophthalmic use. See Silvol, page 40.

## STORAXOL (No. 24)

<table><tr><td>in 2-oz. jars</td><td>per doz.</td><td>4.25</td></tr><tr><td>in collapsible tubes</td><td>per doz.</td><td>4.25</td></tr><tr><td>in 1-lb. opal jars</td><td>per lb.</td><td>1.60</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>1.50</td></tr></table>

Contains storax, resorcin, menthol, camphor, carbolic acid (4.8%), and lac sulphur. It is used in the treatment of eczema (particularly the itching variety), varicose ulcers, pruritus ani and pruritus vulvæ, ringworm, scabies, hemorrhoids, lupus erythematosus, and all skin diseases due to the presence of parasites or fungi. Literature supplied on application.

[52]

MISCELLANEOUS PRODUCTS

## SULFOL (No. 25)

<table><tr><td>in 1-lb. opal jars</td><td>per lb.</td><td>$1.35</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>1.25</td></tr></table>

Each ounce contains 5 grains of chloretone (chlorbutanol), with precipitated sulphur, resorcin, cresylic acid, oil of cade, and turpentine (U.S.P.), incorporated in a suitable ointment base.

## SULPHUR OINTMENT, P. D. & Co. (No. 48)

<table><tr><td>in 1-lb. opal jars</td><td>per lb.</td><td>1.50</td></tr><tr><td>in 5-lb. cans</td><td>per lb.</td><td>1.30</td></tr></table>

This ointment is of U. S. P. strength but is made with a petrolatum base and will not become rancid or granular.

## YELLOW OXIDE OF MERCURY OINTMENT, 1% (No. 26)

<table><tr><td>in dispensing packages—small, collapsible, long-nozzled tubes, each in individual carton, with detachable label</td><td>per doz. tubes</td><td>1.50</td></tr><tr><td>in 1/4-lb. collapsible tubes</td><td>per doz.</td><td>5.85</td></tr></table>

## YELLOW OXIDE OF MERCURY OINTMENT, 2% (No. 40)

<table><tr><td>in dispensing packages—small, collapsible, long-nozzled tubes, each in individual carton, with detachable label</td><td>per doz. tubes</td><td>1.50</td></tr></table>

To obviate the irritating features of yellow oxide of mercury ointments made up by the ordinary process in laboratory or dispensary, we prepare this Ointment by the "wet" process, the oxide never being allowed to become dry, but being incorporated in the ointment in the form in which it is precipitated from solution.

Caution.—The ointment will quickly discolor when exposed to air.

## ZINC OXIDE OINTMENT, U. S. P. IX (No. 27)

<table><tr><td>in 1-lb. tins</td><td>per lb.</td><td>1.10</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>.90</td></tr></table>

Made with a high grade of anhydrous lard, which is thoroughly benzoated and in which is incorporated a fine quality of pure oxide of zinc.

## ZINC OXIDE OINTMENT, U. S. P. X (No. 28)

<table><tr><td>in 1-oz. collapsible tubes</td><td>per doz.</td><td>1.85</td></tr><tr><td>in 1-lb. tins</td><td>per lb.</td><td>.90</td></tr><tr><td>in 5-lb. tins</td><td>per lb.</td><td>.80</td></tr></table>

This ointment is prepared with a base of hardened petrolatum in accordance with the U. S. P. (X). It is identical with the Ointment formerly supplied as Zinc Oxide Ointment, unofficial.

## ZINC PASTE, N. F. (Lassar's) (No. 45)

<table><tr><td>in 1-lb. opal jars</td><td>per lb.</td><td>1.10</td></tr><tr><td>in 5-lb. cans</td><td>per lb.</td><td>.95</td></tr></table>

[53]

MISCELLANEOUS PRODUCTS

GLASEPTIC SYRINGE, 5 cc (No. 13)

<table><tr><td>Syringe only with adapter, in cardboard box.</td><td>$1.85</td></tr><tr><td>Piston only (barrel must be returned with order).</td><td>1.10</td></tr><tr><td>Barrel only (piston must be returned with order).</td><td>1.10</td></tr></table>

This syringe is similar to the syringe illustrated on page 59 except that it is of 5-cc capacity. The adapter (No. 960) may be used for either mounted or Schimmel needles.

TUBERCULIN SYRINGE AND CASE (No. 30)

This syringe is entirely of glass, the piston ground to fit the barrel. It is graduated in hundredths of a cubic centimeter, the graduation lines, of white, showing clearly against the blue background. The capacity of the syringe is 1 cc. A spring clip to prevent the piston from falling out is also supplied. The syringe is very convenient for injecting bacterial vaccines, pollen extracts, etc., as well as tuberculin.

<table><tr><td>Tuberculin Syringe, complete, with 2 steel needles (No. 427), 5/8 inch, 25 gauge, in nickel-plated case.</td><td>$2.75</td></tr><tr><td>Syringe only.</td><td>1.85</td></tr><tr><td>Piston only (barrel must be returned with order).</td><td>1.10</td></tr><tr><td>Barrel only (piston must be returned with order).</td><td>1.10</td></tr><tr><td>Needles only, 5/8 inch, 25 gauge (No. 427).</td><td>each .25</td></tr></table>

[ 60 ]

BIOLOGICAL SPECIALTIES

BIOLOGICAL SPECIALTIES

THE PRODUCTS quoted in this section as Biological Specialties are described and their uses indicated in the section devoted to Biological Products, pages 201 to 221.

COLEY'S MIXTURE (Erysipelas and Prodigiosus Toxins, Coley)

<table><tr><td>Bio. 451.</td><td>Package of five 1-cc rubber-capped bulbs.</td><td>per package $3.00</td></tr><tr><td>Bio. 455.</td><td>15-cc rubber-diaphragm-capped vial.</td><td>per vial 3.00</td></tr></table>

CULTURE MEDIA

No. 8. Blood Serum (Loeffler's mixture for growing *Bact. diphtheriæ*), with swab, wrapped in parchment, for obtaining culture material from throat; in cotton-plugged, rubber-capped tube.. .30

Any Culture Medium in our list, including the above, in "breakable" glass-sealed tubes, each tube in an individual carton accompanied by a sterilized vial containing cotton plug. per tube .45

HEMOSTATIC SERUM, LaPenta (Hemoplastin)

<table><tr><td>Bio. 70.</td><td>2-cc bulb.</td><td>per bulb 1.50</td></tr><tr><td>Bio. 72.</td><td>5-cc bulb.</td><td>per bulb 2.50</td></tr><tr><td>Bio. 73.</td><td>5-cc rubber-stoppered vial (for oral use).</td><td>per vial 2.25</td></tr></table>

IMMUNOGENS

<table><tr><td>Bio. 340.</td><td>Catarrhalis Immunogen Combined.</td><td>per vial 3.00</td></tr><tr><td>Bio. 355.</td><td>Erysipelas Streptococcus Immunogen.</td><td>per vial 3.00</td></tr><tr><td>Bio. 295.</td><td>Gonococcus Immunogen.</td><td>per vial 3.00</td></tr><tr><td>Bio. 300.</td><td>Gonococcus Immunogen Combined.</td><td>per vial 3.00</td></tr><tr><td>Bio. 315.</td><td>Pertussis Immunogen.</td><td>per vial 3.00</td></tr><tr><td>Bio. 320.</td><td>Pertussis Immunogen Combined.</td><td>per vial 3.00</td></tr><tr><td>Bio. 305.</td><td>Pneumococcus Immunogen.</td><td>per vial 3.00</td></tr><tr><td>Bio. 310.</td><td>Pneumococcus Immunogen Combined.</td><td>per vial 3.00</td></tr><tr><td>Bio. 335.</td><td>Staphylococcus Immunogen.</td><td>per vial 3.00</td></tr><tr><td>Bio. 325.</td><td>Streptococcus Immunogen.</td><td>per vial 3.00</td></tr><tr><td>Bio. 330.</td><td>Streptococcus Immunogen Combined.</td><td>per vial 3.00</td></tr></table>

LABORATORY DIAGNOSTIC AGENTS

Acetone-insoluble Antigen, in 5-cc vial (Bio. 80) per vial 4.50

Antidysenteric Serum, Agglutinating:

Shiga strain, in 5-cc vial (Bio. 175) per vial 5.30

Hiss-Y strain, in 5-cc vial (Bio. 176) per vial 5.30

Flexner strain, in 5-cc vial (Bio. 177) per vial 5.30

Antihuman Ambroceptor, in 1-cc bulb (Bio. 126) per bulb 3.75

Antihuman Precipitin Serum, in 1-cc bulb (Bio. 129) per bulb 5.30

[ 61 ]

BIOLOGICAL SPECIALTIES

## LABORATORY DIAGNOSTIC AGENTS—Continued

Antimeningococcic Serum, Agglutinating (Gordon Groups), in 5-cc rubber-diaphragm-capped vials:

<table><tr><td>Group 1 (Bio. 161)</td><td>per vial</td><td>$3.75</td></tr><tr><td>Group 2 (Bio. 162)</td><td>per vial</td><td>3.75</td></tr><tr><td>Group 3 (Bio. 163)</td><td>per vial</td><td>3.75</td></tr><tr><td>Group 4 (Bio. 164)</td><td>per vial</td><td>3.75</td></tr></table>

Antimeningococcic Serum, Agglutinating, Polyvalent, in 5-cc rubber-diaphragm-capped vial (Bio. 165)...................per vial 3.75

Antityphoid Serum, Agglutinating, in 5-cc vial (Bio. 135). per vial 4.50

Antiparatyphoid Serum, Agglutinating, in 5-cc vials:

Bio. 136 representing B. paratyphosus "A"...................per vial 4.50

Bio. 138 representing B. paratyphosus "B"...................per vial 4.50

Antipneumococcic Serum, Agglutinating, in 5-cc rubber-diaphragm-capped vials:

Type 1 (Bio. 41)....................................................per vial 3.20

Type 2 (Bio. 42)....................................................per vial 3.20

Type 3 (Bio. 43)....................................................per vial 3.20

Antisheep Amboceptor, in 1-cc bulb (Bio. 127)...........per bulb 4.25

Cholesterinized Antigen, in 5-cc vial (Bio. 82)...........per vial 4.50

Gonococcus Antigen (Polyvalent), in 5-cc rubber-stoppered vial (Bio. 102)...................................................per vial 5.30

Human Blood-typing Serums:

Package containing two capillary tubes of test serum A and two of test serum B (Bio. 131)...................per package 2.65

Test Serum A, in 1-cc bulb (Bio. 132)...................per bulb 5.30

Test Serum B, in 1-cc bulb (Bio. 133)...................per bulb 5.30

Kahn Standard Antigen, in 10-cc vial (Bio. 104)...........per vial 4.50

Kolmer Antigen, in 5-cc vial (Bio. 84)...................per vial 8.00

Paratyphoid Bacillus "A" Suspension (Concentrated), in 5-cc vial (Bio. 33)...................................................per vial 1.60

Paratyphoid Bacillus "B" Suspension (Concentrated), in 5-cc vial (Bio. 34)...................................................per vial 1.60

Plain Alcoholic Antigen, in 5-cc vial (Bio. 83)...........per vial 4.50

Tubercle Antigen, in 5-cc vial (Bio. 103)...................per vial 5.30

Typhoid Bacillus Suspension (Concentrated), in 5-cc vial (Bio. 31)...................................................per vial 1.60

## PHYLACOGENS

Bio. 585. Erysipelas Phylacogen...................per vial 3.00

Bio. 590. Gonorrhea Phylacogen...................per vial 3.00

Bio. 595. Mixed Infection Phylacogen...................per vial 3.00

Bio. 605. Pneumonia Phylacogen...................per vial 3.00

Bio. 580. Rheumatism Phylacogen...................per vial 3.00

Bio. 600. Typhoid Phylacogen...................per vial 3.00

## PRECIPITATED HORSE SERUM (Coagulase)

Bio. 90. 0.65 Gm. in 15-cc rubber-stoppered vial...........per vial 2.00

[ 62 ]

GLAND PRODUCTS

## GLAND PRODUCTS

IN THE MANUFACTURE and marketing of this line of products it is necessary to guard against injury to the active principles by the application of heat, though complete desiccation is desirable. The moisture is extracted at a low temperature with the aid of vacuum apparatus and the desiccated glands reduced to powder form with like regard to the risk of injury. Needless to say, the glands are identified by experts and all adherent tissue carefully dissected away. As a final safeguard to the desiccated powder it is compressed into tablets and these are coated with an inert substance that resists the action of the gastric juice and dissolves in the small intestine (emplets).

## ADRENALIN AND COMBINATIONS, see pages 1-6.

### CORPORA LUTEA, Desiccated (powder)

in ounce bottles...................................................per oz. $ 4.00

in ¼-lb. bottles...................................................per bottle 14.30

Corpora Lutea is prepared from the corpora lutea of cattle and swine. It is prescribed in the treatment of the nervous disturbances of the menopause, natural or surgical, and in sthenic cases of dysmenorrhea, menorrhagia and metrorrhagia. Favorable reports have also been made on the use of Corpora Lutea in the nausea of pregnancy. Each grain of the desiccated product is equivalent to 5 grains of fresh gland substance. The usual dose is 2 to 5 grains, t.i.d.

[ 63 ]

GLAND PRODUCTS

Ampoule No. 97 (Corpora Lutea Soluble Extract, 1 cc)

<table><tr><td>in boxes of 6 ampoules</td><td>per box $ 1.20</td></tr><tr><td>in boxes of 100 ampoules</td><td>per box $ 13.10</td></tr></table>

Each cubic centimeter contains 0.02 Gm. (3/10 gr.) soluble extract, in physiologic salt solution containing chloretone (chlorbutanol) 0.5%.

The contents of one ampoule two or three times a week is the usual dose, to be administered intramuscularly or subcutaneously.

Capsules, 5 grs. (No. 412)

<table><tr><td>in bottles of 50</td><td>per bottle 3.20</td></tr><tr><td>in bottles of 100</td><td>per bottle 5.95</td></tr><tr><td>in bottles of 500</td><td>per bottle 28.90</td></tr></table>

*Emplets, 2 grs. (No. 2)

<table><tr><td>in bottles of 100</td><td>per bottle 2.45</td></tr><tr><td>in bottles of 500</td><td>per bottle 11.15</td></tr></table>

*Emplets, 5 grs. (No. 3)

<table><tr><td>in bottles of 100</td><td>per bottle 5.85</td></tr><tr><td>in bottles of 500</td><td>per bottle 27.50</td></tr></table>

Chocolate-coated Tablets, 2 grs. (No. 480)

<table><tr><td>in bottles of 50</td><td>per bottle 1.20</td></tr><tr><td>in bottles of 100</td><td>per bottle 2.15</td></tr><tr><td>in bottles of 500</td><td>per bottle 10.20</td></tr></table>

Compressed Tablets, 5 grs. (No. 668)

<table><tr><td>in bottles of 50</td><td>per bottle 2.75</td></tr><tr><td>in bottles of 500</td><td>per bottle 25.45</td></tr></table>

ESTROGEN AMPOULES (No. 157)

<table><tr><td>in bottles of six 1-cc ampoules</td><td>per box 3.00</td></tr></table>

Estrogen is an extract, in colloidal suspension, of reproductive gland tissue containing a high percentage of a hormone which, in the lower animals, has a demonstrated relationship to the estrous cycle—the so-called ovarian follicular hormone.

It is standardized by the Allen and Doisy method to contain 25 rat units in each cubic centimeter, a rat unit being the amount required to initiate the estrous cycle in 2 days in an ovariectomized rat.

Estrogen is suggested for use in functional amenorrhea, the subjective disturbances of either the natural or the surgical menopause, sexual frigidity, delayed puberty, inadequate development of sec-

*Enteric-coated gland tablets.

[ 64 ]

GLAND PRODUCTS

ondary sex characteristics, and in mental depression due to utero-ovarian imbalance.

It is said that the effect of Estrogen is enhanced by the prior or simultaneous administration of a corpus luteum preparation containing lipoids, such as Lipo-Lutin.

Estrogen should be administered intramuscularly, never intravenously. The usual dose is 1 to 2 cc daily for six or eight days. This course of treatment may be repeated every month until the desired effect follows. Literature supplied on request.

LIPO-LUTIN AMPOULES (No. 159)

(Lipoidal Extract Corpus Luteum)

<table><tr><td>in boxes of six 1-cc ampoules</td><td>per box $2.65</td></tr></table>

Lipo-Lutin is a protein-free, lipoid-bearing extract of the corpus luteum. It is intended especially for use in association with Estrogen for the relief of amenorrhea and oligomenorrhea, and is also indicated in cases of "functional" hemorrhage at puberty or the clomacteric.

The usual dose is 1 to 2 cc administered daily for six or eight days. The injections may be given subcutaneously or intramuscularly, never intravenously.

MAMMARY SUBSTANCE (Lactating Glands), Desiccated

<table><tr><td>in ounce bottles</td><td>per oz. 1.10</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle 3.70</td></tr></table>

Each grain of the desiccated product is equivalent to 8 grains of fresh gland substance. Dysmenorrhea due to ovarian hyperactivity may be relieved by the administration of Mammary Gland Substance,

[ 65 ]

GLAND PRODUCTS

and it may also be used in the treatment of functional menorrhagia and metrorrhagia. Dose, 5 to 10 grs. t.i.d.

*Emplets Mammary Substance, Desiccated, 5 grs. (No. 4)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>$1.55</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>7.00</td></tr></table>

Tablets, 5 grs. (Compressed Tablet No. 665)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.35</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>5.95</td></tr></table>

ORCHIC SUBSTANCE, Desiccated

<table><tr><td>in ounce bottles</td><td>per oz.</td><td>1.10</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>3.70</td></tr></table>

Used experimentally in the treatment of neurasthenia, impotence, prostatitis, eczema, and obesity. Each grain is equivalent to 7 grains of fresh animal testicle. Dose, 5 to 10 grains.

*Emplets, 5 grs. (No. 5)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.70</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>7.85</td></tr></table>

Tablets, 5 grs. (Compressed Tablet No. 657)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.50</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>7.15</td></tr></table>

OVARIAN RESIDUE, Desiccated

(Ovarian Substance without Corpora Lutea)

<table><tr><td>in ounce bottles</td><td>per oz.</td><td>1.30</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>4.50</td></tr></table>

Each grain is equivalent to 6 grains of fresh gland substance. Used in menstrual irregularities—in particular dysmenorrhea with scanty flow. Dose, 5 to 20 grains.

Ampoule No. 148 (Soluble Extract Ovarian Residue, 1 cc)

<table><tr><td>in boxes of 12</td><td>per box</td><td>2.25</td></tr><tr><td>in boxes of 100</td><td>per box</td><td>14.85</td></tr></table>

Each cubic centimeter contains 0.04 Gm. (3/5 gr.) soluble extract ovarian residue, and Chloretone (chlorbutanol) 0.5%.

This product should be of value in the treatment of menstrual irregularities associated with asthenia, dysmenorrhea with scanty flow, and the nervous disturbances of the menopause. Inject intramuscularly.

[ 66 ]

GLAND PRODUCTS

Capsules Ovarian Residue, Desiccated, 5 grs. (No. 436)

<table><tr><td>in bottles of 50</td><td>per bottle</td><td>$1.30</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>9.55</td></tr></table>

*Emplets, 5 grs. (No. 7)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>2.25</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>10.35</td></tr></table>

Tablets, 5 grs. (Compressed Tablet No. 655)

<table><tr><td>in bottles of 50</td><td>per bottle</td><td>1.10</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>8.50</td></tr></table>

OVARIAN SUBSTANCE, Desiccated (Whole Ovary)

<table><tr><td>in ounce bottles</td><td>per oz.</td><td>3.20</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>11.15</td></tr></table>

Made from entire ovaries, mostly pregnant. Each grain of the desiccated product represents 6 grains of fresh gland substance. Used in cases of delayed sex development and for the relief of the nervous and trophic disturbances incidental to the menopause; also in the compensatory goiter of young women. Dose, 5 grains, to be repeated daily, and increased if necessary.

Ampoule No. 147 (Soluble Extract Ovarian Substance, 1 cc)

Each cubic centimeter contains 0.04 Gm. (3/5 gr.) soluble extract representing the entire substance of the ovary, including the corpus luteum; and Chloretone (chlorbutanol), 0.5%.

Ovarian substance is suggested for use in the treatment of disorders resulting from hyposecretion of the ovaries. It is indicated especially in delayed or imperfect development of the female generative organs; disturbances of the menopause, natural or surgical; amenorrhea; and simple compensatory goiter. Inject intramuscularly.

Capsules, 5 grs. (No. 452)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>4.25</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>20.15</td></tr></table>

*Emplets, 5 grs. (No. 6)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>4.60</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>21.20</td></tr></table>

Tablets, 5 grs. (Chocolate-coated Tablet No. 485)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>4.00</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>18.80</td></tr></table>

[ 67 ]

GLAND PRODUCTS

Oxytocin, see Pitocin, page 69.

## PARATHYROID, Desiccated

*Emplets, 1/10 gr. (No. 8)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>$2.15</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>9.80</td></tr></table>

### Tablets, 1/10 gr. (Compressed Tablet No. 669)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.80</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>8.50</td></tr></table>

Each 1/10-grain tablet or emplet represents one grain of fresh parathyroid gland substance. Used experimentally in the treatment of paralysis agitans, tetany, eclampsia, chorea, ulcerations, and toxemias. The concurrent administration of calcium, orally or intravenously, may be indicated in some cases, since the parathyroid hormone acts upon the organism through the agency of calcium. Average dose, one tablet or emplet once or twice daily.

## PAROIDIN (Parathyroid Extract, Hanson)

<table><tr><td>in 5-cc rubber-diaphragm-capped bottles</td><td>per bottle</td><td>2.15</td></tr></table>

Paroidin is an extract obtained from fresh bovine parathyroid glands. It is prepared and standardized according to the methods devised by Dr. A. M. Hanson.

[68]

GLAND PRODUCTS

Each cubic centimeter of Paroidin contains 150 Hanson units. This unit is one-hundredth of the amount of extract required to raise the calcium level of the blood 1 mg. per 100 cc in parathyroidectomized dogs.

Paroidin is a highly purified product which is of decided value in the treatment of tetany and has also been used experimentally in chorea, gastric and duodenal ulcers, and delayed healing of wounds. This product is to be administered subcutaneously or intramuscularly—*never intravenously*. Excessive dosage must be avoided, and frequent calcium determinations are most desirable. The average dose for an adult is 0.2 to 0.4 cc every twelve hours for not more than ten days. The treatment may be repeated in eight to fourteen days.

## PINEAL GLAND, Desiccated

*Emplets, 1/10 gr. (No. 9)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>$1.85</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>8.75</td></tr></table>

### Tablets, 1/10 gr. (Tablet Triturate No. 1002)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.60</td></tr></table>

Each 1/10-grain tablet or emplet contains the equivalent of 3/5 grain fresh pineal gland substance from young cattle. Used experimentally in the treatment of juvenile cases of retarded mental development without apparent physical defect. Dose, 1 tablet or emplet.

## PITOCIN AMPOULES (No. 160) (Alpha-Hypophamine)

<table><tr><td>in boxes of six 1/2-cc ampoules</td><td>per box</td><td>1.40</td></tr><tr><td>in boxes of six 1-cc ampoules</td><td>per box</td><td>1.85</td></tr><tr><td>in boxes of one hundred 1-cc ampoules</td><td>per box</td><td>21.20</td></tr></table>

The name "Pitocin" has been selected to designate the oxytocic principle of the posterior lobe of the pituitary gland in a solution that contains little or none of the pressor principle.

As demonstrated and announced by our research staff as a result of experiments carried on over a period of several years, the posterior lobe of the pituitary body contains two active principles. Each of these two principles (Pitocin and Pitressin) has been isolated by us in a relatively pure form.

Pitocin is adjusted to contain in each cubic centimeter 10 oxytocic units (International), according to the official standard as described in the U. S. Pharmacopœia.

Pitocin very happily takes the place of Pituitrin Obstretical in cases of uterine inertia in which increase of blood pressure is undesirable—for example, pre-eclamptic cases. It should be administered intramuscularly in doses of 0.3 to 0.5 cc (5 to 8 minims), to be repeated, if necessary, in 20 to 30 minutes.

[69]

GLAND PRODUCTS

PITRESSIN AMPOULES (No. 161) (Beta-Hypophamine)

<table><tr><td>in boxes of six 1-cc ampoules</td><td>per box $ 3.00</td></tr><tr><td>in boxes of one hundred 1-cc ampoules</td><td>per box 33.90</td></tr></table>

The name "Pitressin" has been selected to designate the pressor principle (beta-hypophamine) of the posterior lobe of the pituitary gland, in a solution containing little or none of the oxytocic principle. (See note under "Pitocin," page 69.)

Pitressin is adjusted to contain 20 pressor units in each cubic centimeter. One pressor unit is the vasopressor activity exhibited by 0.5 milligram of Standard Powdered Pituitary, U. S. P.

Pitressin is indicated in hemorrhage due to impaired arterial tonus, in postoperative intestinal stasis, in postpartum anuria, nocturnal enuresis, and diabetes insipidus, for the prevention and control of operative shock, and generally for increasing or maintaining the blood pressure. Dose, 0.3 to 1 cc (5 to 16 minims); should be administered intramuscularly.

[70]

GLAND PRODUCTS

PITUITARY BODY—WHOLE GLAND (Desiccated)

<table><tr><td>in ounce bottles</td><td>per oz. $ 4.25</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle 15.40</td></tr></table>

Each grain of the desiccated product represents 5 grains of fresh gland substance. Prescribed in sexual infantilism, especially the obese type, and experimentally in bronchial asthma. Dose, 1 to 4 grains.

*Emplets, 1 gr. (No. 11)

Tablets, 1 gr. (Compressed Tablet No. 666)

<table><tr><td>in bottles of 100</td><td>per bottle 2.15</td></tr><tr><td>in bottles of 500</td><td>per bottle 9.55</td></tr></table>

PITUITARY BODY—ANTERIOR LOBE (Desiccated)

<table><tr><td>in ounce bottles</td><td>per oz. 4.25</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle 15.40</td></tr></table>

Each grain of the desiccated product represents 5 grains of fresh anterior lobe substance. The anterior lobe hormone stimulates skeletal development and, at the time of puberty, activates the reproductive system. The desiccated gland substance is prescribed in cases of retarded sexual or general development.

*Emplets, 2½ grs. (No. 1)

<table><tr><td>in bottles of 100</td><td>per bottle 3.90</td></tr><tr><td>in bottles of 500</td><td>per bottle 18.00</td></tr></table>

Tablets, 2½ grs. (Compressed Tablet No. 670)

<table><tr><td>in bottles of 50</td><td>per bottle 1.90</td></tr><tr><td>in bottles of 100</td><td>per bottle 3.40</td></tr><tr><td>in bottles of 500</td><td>per bottle 15.90</td></tr></table>

Tablets, 5 grs. (Compressed Tablet No. 671)

<table><tr><td>in bottles of 50</td><td>per bottle 3.20</td></tr><tr><td>in bottles of 100</td><td>per bottle 5.85</td></tr><tr><td>in bottles of 500</td><td>per bottle 27.60</td></tr></table>

Ampoule No. 128 (Antuitrin, 1 cc)

<table><tr><td>in boxes of 6</td><td>per box 1.10</td></tr><tr><td>in boxes of 100</td><td>per box 12.20</td></tr></table>

Antuitrin is a therapeutically active solution prepared from the anterior lobe of the pituitary body. Each ampoule contains Chlorotone (chlorbutanol), 0.5%. Dose, 1 cc daily. Subcutaneous administration is recommended.

[71]

GLAND PRODUCTS

PITUITARY BODY—POSTERIOR LOBE, (Desiccated)

*Emplets, 1/10 gr. (No. 10)

Tablets, 1/10 gr. (Compressed Tablet No. 667)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.60</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>7.40</td></tr></table>

Each 1/10-grain emplet or tablet represents 3/5 grain of fresh posterior lobe substance. Indicated in girdle obesity the result of posterior lobe dysfunction. Dose, 4 to 8 emplets or tablets per day.

PITUITRIN AMPOULES

The word "Pituitrin" identifies the extract of the posterior lobe of the pituitary gland manufactured by Parke, Davis & Co.

Pituitrin—the original pituitary extract, developed in our research laboratories—excels in uniform potency and stability. The protein content has been reduced to a very low point, thus greatly improving its keeping qualities, and lessening the element of local irritation on injection and the risk of undesirable reaction. Pituitrin is doubly standardized—for oxytocic activity by the isolated guinea-pig uterus method; and for its effect on blood pressure by intravenous administration to anesthetized dogs.

The chief indication for the use of Pituitrin in obstetric practice is uterine inertia. Its administration also tends to prevent postpartum hemorrhage. It is contra-indicated in nephritis, myocarditis, ar-

[72]

GLAND PRODUCTS

teriosclerosis, threatened rupture of the uterus, or any anatomical impediment to normal delivery.

Owing to its stimulant action on unstriped muscle fiber, Pituitrin is used in the treatment of postoperative intestinal stasis, hemorrhage and shock; also in enuresis and diabetes insipidus.

Ampoule No. 110, which contains double-strength Pituitrin, is intended for use in surgical cases.

Ampoule No. 47 (0.5 cc)—Obstetrical

<table><tr><td>in boxes of 6</td><td>per box</td><td>$ 1.40</td></tr><tr><td>in boxes of 100</td><td>per box</td><td>14.85</td></tr></table>

Each ampoule contains 0.5 cc (8 minims) of a physiologically standardized solution of the active principles of the posterior lobe of the pituitary gland, together with Chloretone (chlorbutanol), 0.5%. Adjusted to contain five International Units in each ampoule.

Ampoule No. 16 (1 cc)—Obstetrical

<table><tr><td>in boxes of 6</td><td>per box</td><td>1.85</td></tr><tr><td>in boxes of 100</td><td>per box</td><td>21.20</td></tr></table>

Each ampoule contains 1 cc (16 minims) of a physiologically standardized solution of the active principles of the posterior lobe of the pituitary gland, together with Chloretone (chlorbutanol), 0.5%. Adjusted to contain ten International Units in each ampoule.

Ampoule No. 110 (1 cc)—Surgical

<table><tr><td>in boxes of 6</td><td>per box</td><td>3.05</td></tr><tr><td>in boxes of 100</td><td>per box</td><td>33.90</td></tr></table>

Each ampoule contains 1 cc (16 minims) of a physiologically standardized solution of the active principles of the posterior lobe of the pituitary gland, together with Chloretone (chlorbutanol), 0.5%. Adjusted to contain 20 International Units in each ampoule.

PLACENTA, Desiccated

Each grain of the desiccated material is equivalent to 6 grains of fresh bovine placenta. Used as a galactagogue and for improving the quality of the milk; also in menorrhagia. Dose, 5 grains t. i. d.

Capsules, 5 grs. (No. 435)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.85</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>8.75</td></tr></table>

*Emplets, 5 grs. (No. 12)

[73]

GLAND PRODUCTS

SUPRARENAL GLANDS, Desiccated (Adrenal Substance)

<table><tr><td>in ounce vials</td><td>per oz.</td><td>$2.15</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>9.20</td></tr></table>

Represents the entire gland, cortex as well as medulla. Each grain of the desiccated product is equivalent to 5 grains of fresh gland substance. Prescribed in many varieties of asthenia, especially those that may be attributed to inadequate functioning of the suprarenal glands. Dose, 2 to 4 grains.

### Capsules, 2 grs. (No. 422)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.20</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>5.50</td></tr></table>

*Emplets, 2 grs. (No. 13)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.15</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>5.15</td></tr></table>

### Tablets, 2 grs. (Compressed Tablet No. 672)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.95</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>4.50</td></tr></table>

Testicular Substance, see Orchic Substance, page 66.

### THYMUS GLAND, Desiccated

<table><tr><td>in ounce vials</td><td>per oz.</td><td>1.10</td></tr><tr><td>in ¼-lb. bottles</td><td>per bottle</td><td>3.70</td></tr></table>

Of reputed value in cases of sexual precocity or hyperactivity, and, on the prolonged use of large doses, in arthritis deformans. Each grain is equivalent to 8 grains of fresh gland substance. Average dose, 2 grains.

*Emplets, 2 grs. (No. 14)

### Tablets, 2 grs. (Chocolate-coated Tablet No. 494)

### THYROID GLANDS, Desiccated

One grain of the desiccated product is equivalent to 5 grains of fresh thyroid gland substance.

Specific in the treatment of cretinism and myxedema, supplying, as it does, a missing or deficient secretion. The treatment, after cure is

[74]

GLAND PRODUCTS

established, may have to be continued indefinitely, though not in full doses. Other pathological conditions that have yielded to thyroid treatment include: Obesity (of hypothyroid origin), scleroderma and dry scaly skin diseases, simple goiter, chlorotic anemia, enuresis, and a subthyroid condition of undernourishment in children. Dose, 1/10 grain to 5 grains.

Thyroid Glands, Desiccated, is assayed and guaranteed to contain not less than 0.3 per cent. of iodine in organic combination.

### Capsules, 2 grs. (No. 431)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>$1.10</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>4.90</td></tr></table>

### Tablets, 1/10 gr. (Compressed Tablet No. 673)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.35</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>1.20</td></tr></table>

### Tablets, 1/5 gr. (Chocolate-coated Tablet No. 495)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.40</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>1.45</td></tr></table>

### Tablets, 1/4 gr. (Compressed Tablet No. 695)

See also Emplets, page 76.

### Tablets, 1/2 gr. (Compressed Tablet No. 686)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.45</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>1.60</td></tr></table>

See also Emplets, page 76.

### Compressed Tablets, 1 gr. (C. T. No. 674)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.55</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>2.15</td></tr></table>

See also Emplets, page 76.

### Chocolate-coated Tablets, 1 gr. (C. C. T. No. 496)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.60</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>2.30</td></tr></table>

### Compressed Tablets, 2 grs. (C. T. No. 675)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.85</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>3.45</td></tr></table>

### Chocolate-coated Tablets, 2 grs. (C. C. T. No. 497)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.90</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>3.60</td></tr></table>

[75]

GLAND PRODUCTS

## THYROID GLANDS, Desiccated—Continued

### *Emlets, 1/4 gr. (No. 15)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>$ .55</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>2.30</td></tr></table>

### *Emlets, 1/2 gr. (No. 16)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.60</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>2.50</td></tr></table>

### *Emlets, 1 gr. (No. 17)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>.75</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>3.20</td></tr></table>

### *Emlets, 3 grs. (No. 18)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.20</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>5.30</td></tr></table>

### *Emlets, 5 grs. (No. 19)

<table><tr><td>in bottles of 100</td><td>per bottle</td><td>1.50</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>6.65</td></tr></table>

[76]

GLAND PRODUCTS

## THYROPROTEIN (P. D. & Co.)

### Ampoule No. 30 (Thyroprotein, 1/50 gr. in 1 cc)

<table><tr><td>in boxes of 12</td><td>per box</td><td>$1.20</td></tr><tr><td>in boxes of 100</td><td>per box</td><td>7.40</td></tr></table>

Each cubic centimeter contains 0.00125 Gm. (1/50 grain) of Thyroprotein in physiologic salt solution, with 0.5% Chloretone (chlorbutanol).

The usual hypodermic dose is 1/50 grain, the intervals between doses being adjusted to the tolerance of the patient.

Thyroprotein is a concentrated and purified extract of thyroid gland, adjusted to a definite organic iodine standard—0.33%.

The indications for the use of Thyroprotein are the same as for the use of desiccated thyroid gland, but the dose is very much smaller —1/50 to 1/10 grain.

### Tablets 1% (Compressed Tablet No. 676)

<table><tr><td>in bottles of 50</td><td>per bottle</td><td>1.10</td></tr></table>

Each tablet contains 1/50 grain of Thyroprotein.

### Tablets 2% (Compressed Tablet No. 677)

Each tablet contains 1/25 grain of Thyroprotein.

### Tablets 5% (Compressed Tablet No. 678)

Each tablet contains 1/10 grain of Thyroprotein.

In prescribing gland products, specification of the manufacturer will often determine the therapeutic result.

[77]

GLAND PRODUCTS

## EMPLETS

### Enteric-coated Gland Tablets

THE word "EMPLETS" designates the enteric-coated endocrine gland tablets manufactured by Parke, Davis & Company. Emplets pass unchanged through the stomach into the small intestine, where the protective coating is promptly broken down and the active gland material is released and made available for absorption. The enteric coating is the result of years of research work in the Parke, Davis & Co. laboratories. It contains no salol, and is therapeutically inert.

The following is a complete list of Emplets. They will also be found listed among Gland Products in the preceding pages, to which the reader is referred for additional information.

Ask for our booklet on Emplets.

### ANTERIOR LOBE PITUITARY BODY, Desiccated, 2½ grs. (No. 1)

<table><tr><td>in bottles of 100</td><td>per bottle $ 3.90</td></tr><tr><td>in bottles of 500</td><td>per bottle 18.00</td></tr></table>

### CORPORA LUTEA, Desiccated, 2 grs. (No. 2)

### CORPORA LUTEA, Desiccated, 5 grs. (No. 3)

### MAMMARY SUBSTANCE, Desiccated, 5 grs. (No. 4)

<table><tr><td>in bottles of 100</td><td>per bottle 1.55</td></tr><tr><td>in bottles of 500</td><td>per bottle 7.00</td></tr></table>

### ORCHIC SUBSTANCE, Desiccated, 5 grs. (No. 5)

<table><tr><td>in bottles of 100</td><td>per bottle 1.70</td></tr><tr><td>in bottles of 500</td><td>per bottle 7.85</td></tr></table>

### OVARIAN SUBSTANCE, Desiccated, 5 grs. (No. 6)

<table><tr><td>in bottles of 100</td><td>per bottle 4.60</td></tr><tr><td>in bottles of 500</td><td>per bottle 21.20</td></tr></table>

### OVARIAN RESIDUE, Desiccated, 5 grs. (No. 7)

#### (Ovarian Substance without Corpora Lutea)

<table><tr><td>in bottles of 100</td><td>per bottle 2.25</td></tr><tr><td>in bottles of 500</td><td>per bottle 10.35</td></tr></table>

### PARATHYROID, Desiccated, 1/10 gr. (No. 8)

<table><tr><td>in bottles of 100</td><td>per bottle 2.15</td></tr><tr><td>in bottles of 500</td><td>per bottle 9.80</td></tr></table>

[78]

GLAND PRODUCTS

### PINEAL GLAND, Desiccated, 1/10 gr. (No. 9)

<table><tr><td>in bottles of 100</td><td>per bottle $1.85</td></tr><tr><td>in bottles of 500</td><td>per bottle 8.75</td></tr></table>

### PITUITARY BODY, POSTERIOR LOBE, Desiccated, 1/10 gr. (No. 10)

<table><tr><td>in bottles of 100</td><td>per bottle 1.85</td></tr><tr><td>in bottles of 500</td><td>per bottle 8.75</td></tr></table>

### PITUITARY BODY, WHOLE GLAND, Desiccated, 1 gr. (No. 11)

### PLACENTA, Desiccated, 5 grs. (No. 12)

### SUPRARENAL GLAND, Desiccated, 2 grs. (No. 13)

<table><tr><td>in bottles of 100</td><td>per bottle 1.15</td></tr><tr><td>in bottles of 500</td><td>per bottle 5.15</td></tr></table>

### THYMUS GLAND, Desiccated, 2 grs. (No. 14)

### THYROID GLAND, Desiccated, ¼ gr. (No. 15)

<table><tr><td>in bottles of 100</td><td>per bottle .55</td></tr><tr><td>in bottles of 500</td><td>per bottle 2.30</td></tr></table>

### THYROID GLAND, Desiccated, ½ gr. (No. 16)

<table><tr><td>in bottles of 100</td><td>per bottle .60</td></tr><tr><td>in bottles of 500</td><td>per bottle 2.50</td></tr></table>

### THYROID GLAND, Desiccated, 1 gr. (No. 17)

<table><tr><td>in bottles of 100</td><td>per bottle .75</td></tr><tr><td>in bottles of 500</td><td>per bottle 3.20</td></tr></table>

### THYROID GLAND, Desiccated, 3 grs. (No. 18)

<table><tr><td>in bottles of 100</td><td>per bottle 1.20</td></tr><tr><td>in bottles of 500</td><td>per bottle 5.30</td></tr></table>

### THYROID GLAND, Desiccated, 5 grs. (No. 19)

<table><tr><td>in bottles of 100</td><td>per bottle 1.50</td></tr><tr><td>in bottles of 500</td><td>per bottle 6.65</td></tr></table>

[79]

GALENICALS

MELCAMINA
CO
FERA

[ 80 ]

A section of the percolation room where Galenicals, such as Fluid Extracts, Tinctures, Cascara products, etc., are made.

FLUID EXTRACTS AND TINCTURES

MELCAMINA
CO
FERA

GALENICALS

FLUID EXTRACTS AND TINCTURES

<table><thead><tr><th></th><th>Per pint<br>(16 fl.ozs.)</th></tr></thead><tbody><tr><td>ACONITE, N. F.: Fluid Extract No. 3............(Alcohol 65%)..</td><td>$4.40</td></tr><tr><td>Tincture No. 1............(Alcohol 63%)..</td><td>2.80</td></tr><tr><td colspan="2">Standardized physiologically. Physiologic standardization was introduced by Parke, Davis & Co.</td></tr><tr><td colspan="2">Aconite is a circulatory sedative; sudorific; antineuralgic; anodyne. Employed in sthenic fevers; acute inflammations such as tonsillitis, bronchitis, pleurisy, meningitis, erysipelas, neuralgia; also locally in rheumatic and other pains. Best results are obtained when the drug is administered in minute and frequently repeated doses.</td></tr><tr><td colspan="2">Average dose of fluid extract, 1/2 minim (0.03 cc); of tincture, 10 minims (0.65 cc).</td></tr><tr><td colspan="2">The stability of both the fluid extract and the tincture of Aconite, as manufactured by us, has been much increased by making them slightly acid in reaction.</td></tr><tr><td>ARNICA, N. F. (Flowers): Fluid Extract No. 32). (Alcohol 55%)..</td><td>6.80</td></tr><tr><td>Tincture No. 2............(Alcohol 45%)..</td><td>2.60</td></tr><tr><td colspan="2">Average dose of fluid extract, 1 1/2 minims (0.1 cc); of tincture, 15 minims (1 cc).</td></tr><tr><td>BELLADONNA LEAVES, U.S.P.: Fl. Ext. No. 49 (Alcohol 60%)..</td><td>3.00</td></tr><tr><td>Tinct. No. 3..(Alcohol 46%)..</td><td>2.40</td></tr><tr><td colspan="2">Standard of fluid extract, 0.27 to 0.33 Gm. total alkaloids per 100 cc; of tincture, 0.027 to 0.033 Gm. mydriatic alkaloids per 100 cc.</td></tr><tr><td colspan="2">Dose of fluid extract, 1 to 2 minims (0.06-0.13 cc); average dose of tincture, 10 minims (0.6 cc).</td></tr><tr><td>BELLADONNA ROOT, U.S.P.: Fl. Ext. No. 50..(Alcohol 71%)..</td><td>4.00</td></tr><tr><td colspan="2">Standard 0.405 to 0.495 Gm. total alkaloids per 100 cc. Average dose, 1 minim (0.06 cc).</td></tr><tr><td>BENZOIN, U. S. P.: Tincture No. 4............(Alcohol 79%)..</td><td>3.60</td></tr><tr><td colspan="2">Average dose, 15 minims (1 cc).</td></tr><tr><td>BENZOIN COMPOUND, U.S.P.: Tinct. No. 5..(Alcohol 77%)..</td><td>3.80</td></tr><tr><td colspan="2">Average dose, 30 minims (2 cc).</td></tr><tr><td>BUCHU, U. S. P.: Fluid Extract No. 84........(Alcohol 81%)..</td><td>5.00</td></tr><tr><td colspan="2">Average dose, 30 minims (2 cc).</td></tr></tbody></table>

Ask for quotations on larger than listed quantities of liquid Galenicals—Fluid Extracts, Tinctures, Syrups, Elixirs, etc.

[ 81 ]

FLUID EXTRACTS AND TINCTURES

Per pint
(16 fl. ozs.)

GENTIAN COMPOUND, U.S.P.: Tinct. No. 11. (Alcohol 45%).. $ 2.00
Average dose, 1 fl. dr. (4 cc).

GINGER, U. S. P.: Fluid Extract No. 219... (Alcohol 80%).. 4.60
Average dose, 8 mins. (0.5 cc).

GOLDEN SEAL, COLORLESS (Solution Hydrastine colorless): Liquid No. 224... (Alcohol none).. 6.00
Dose, 10 to 60 mins. (0.6 to 4 cc). Free from the objectionable bitterness of ordinary preparations of Golden-seal; does not stain the clothing when locally applied. Golden-seal, Colorless, depends upon the white alkaloid hydrastine for its activity.

GOLDEN SEAL, AQUEOUS: Liquid No. 226... (Alcohol 7%).. 20.00
Standard 1 Gm. hydrastine per 100 cc. Average dose, 60 mins. (4 cc). This fluid is preferred to the official fluid extract by many physicians because it is miscible with water and less irritating when used as an injection.
See also Hydrastis.

GREEN SOAP: Tincture No. 55... (Alcohol 30%).. 1.40
Of same concentration as Linimentum Saponis Mollis, U. S. P., but superior, being made with a potash soap and without glycerin.

GUARANA, N. F.: Fluid Extract No. 238... (Alcohol 60%).. 13.00
Standard 3.6 to 4.4 Gm. caffeine per 100 cc. Average dose, 30 mins. (2 cc). Introduced to the medical profession by us.

HYDRASTIS, U. S. P.: Fluid Extract No. 225... (Alcohol 50%).. 24.00
Golden-seal. Standard 1.8 to 2.2 Gm. ether-soluble alkaloids per 100 cc. Useful in gonorrhea, metritis, atonic gastritis, leucorrhea, and locally in hemorrhoids, stomatitis and pharyngitis. Average dose, 30 mins. (2 cc).
See also Golden seal (colorless and aqueous).

HYOSCYAMUS, U. S. P.: Fluid Extract No. 224. (Alcohol 60%).. 4.00
Tincture No. 13... (Alcohol 45%).. 2.40

Henbane. Standard of fluid extract, 0.055 to 0.075 Gm. mydriatic alkaloids per 100 cc; tincture, 10%. Antispasmodic, sedative, hypnotic. Employed in insomina, hysteria, spasmodic cough, headache, delirium tremens, and emphysema. Average dose of fluid extract, 3 mins. (0.2 cc); of tincture, 30 mins. (2 cc).

For quarter-pint bottles add 80c. per pint to the price given for pints.

[ 86 ]

FLUID EXTRACTS AND TINCTURES

Per pint
(16 fl. ozs.)

IODINE, U. S. P.: Tincture No. 42... (Alcohol 83%).. $3.00
Standard 6.5 to 7.5 Gm. iodine per 100 cc. Average dose, 1½ mins. (0.1 cc). This tincture is quite stable if the bottle be kept tightly corked.

IPECAC, U. S. P.: Fluid Extract No. 261... (Alcohol 31%).. 20.00
Cephaelis, U. S. P. varieties. Standard 1.35 to 1.65 Gm. ether-soluble alkaloids per 100 cc. Average doses: expectorant, 1 min. (0.06 cc); emetic, 15 mins. (1 cc).

•IPECAC AND OPIUM, N. F.: Tincture No. 19. (Alcohol 17%).. 10.80
Represents about 1 gr. Dover Powder in each minim (1/10 gr. powd. opium). Average dose, 8 mins. (0.5 cc).

JAMAICA DOGWOOD: Fluid Extract No. 266... (Alcohol 70%).. 4.00
Analgesic, hypnotic, sedative. Dose, ½ to 2 fl. drs. (2 to 8 cc). Introduced to the medical profession by us.

KAVA, N. F. (Kavakava): Fluid Extract No. 276... (Alcohol 52%).. 3.60
Used in gonorrhea, cystitis and related genito-urinary affections. Average dose, 15 mins. (1 cc). Introduced to the medical profession by us.

NUX VOMICA, N. F.: Fluid Extract No. 335... (Alcohol 60%).. 3.60
Standard 2.37 to 2.63 Gm. total alkaloids per 100 cc. Average dose, 1 min. (0.06 cc). This fluid extract may be used for preparing the tincture; of positive and uniform activity.

NUX VOMICA, U. S. P.: Tincture No. 18... (Alcohol 70%).. 2.20
Standard 0.237 to 0.263 Gm. total alkaloids per 100 cc. Average dose, 8 mins. (0.5 cc).

•OPIUM, U. S. P.: Tincture No. 23... (Alcohol 18%).. 10.80
Laudanum. Standard 0.95 to 1.05 Gm. anhydrous morphine per 100 cc. Average dose, 8 mins. (0.5 cc).
Tincture of Opium, U. S. P. Tenth Revision, as listed above, is identical with the product formerly supplied by us as Tinct. Opium Deordorized.

♦OPIUM CAMPHORATED, U.S.P.: Tr. No. 20. (Alcohol 45%).. 2.20
Paregoric. Standard 0.04 to 0.042 Gm. anhydrous morphine per 100 cc. Each fluid ounce contains approximately 1/5 gr. Average dose, 1 fluid drachm (4 cc).

[ 87 ]

FLUID EXTRACTS AND TINCTURES

Per pint
(16 fl. ozs.)

## *OPIUM CAMPHORATED, for U. S. P. Tincture:

<table><tr><td>Liquid No. 338</td><td>(Alcohol 60%)</td><td>$7.00</td></tr><tr><td colspan="2">Standard 0.32 to 0.34 Gm. anhydrous morphine per 100 cc. This fluid is exactly 8 times the strength of Tincture Opium Camphorated (Paregoric), U. S. P., and is designed for preparing the tincture by direct dilution. May be used instead of Paregoric in proportionately smaller doses. Dose, 8 to 20 mins. (0.5 to 1.3 cc); for infants, 1 to 3 mins. (0.06 to 0.2 cc).</td><td></td></tr></table>

## *OPIUM CONCENTRATED, for U. S. P. Tincture:

<table><tr><td>Liquid No. 336</td><td>(Alcohol 18%)</td><td>36.00</td></tr><tr><td colspan="2">Dose, 1 to 4 mins. (0.06 to 0.25 cc). Four times the strength of the official tincture. Standard 3.8 to 4.2 Gm. anhydrous morphine per 100 cc. Designed for the extemporaneous preparation of the tincture.</td><td></td></tr></table>

<table><tr><td>PILOCARPUS (Jaborandi): Fl. Ext. No. 264</td><td>(Alcohol 55%)</td><td>3.80</td></tr><tr><td colspan="2">Standard 0.55 to 0.65 Gm. alkaloids per 100 cc. Diaphoretic, diuretic, expectorant, sialagogue. Used in uremia, renal dropsy, gout, and chronic rheumatism. Average dose, 30 mins. (2 cc). Introduced to the medical profession by us.</td><td></td></tr></table>

## PINUS CANADENSIS COMPOUND (colorless):

<table><tr><td>Liquid No. 550</td><td>(Alcohol 10%)</td><td>2.00</td></tr><tr><td colspan="2">For local use only. Each fluid ounce contains volatile constituents from 1 ounce Pinus canadensis; Zinc sulphate, 5 grs.; Alum, 5 grs.; Thymol, 3/8 gr.; Eucalyptol, 3/8 min.</td><td></td></tr></table>

<table><tr><td>RHUBARB, U. S. P.: Fluid Extract No. 387</td><td>(Alcohol 59%)</td><td>5.00</td></tr><tr><td colspan="2">Average dose, 15 mins. (1 cc).</td><td></td></tr></table>

<table><tr><td>RHUS AROMATICA: Fluid Extract No. 392</td><td>(Alcohol 47%)</td><td>3.40</td></tr><tr><td colspan="2">Dose, 5 to 30 mins. (0.3 to 2 cc). Introduced to the medical profession by us.</td><td></td></tr></table>

<table><tr><td>SABAL, N. F. (Saw Palmetto): Fl. Ext. No. 407</td><td>(Alcohol 65%)</td><td>4.00</td></tr><tr><td colspan="2">Average dose, 15 mins. (1 cc). Tonic, expectorant, diuretic and aphrodisiac. Employed in chronic bronchitis, asthma, prostatitis, and impotence.</td><td></td></tr><tr><td colspan="2">Our product was the first fluid extract of Saw Palmetto berries to be offered to the medical profession.</td><td></td></tr></table>

<table><tr><td>SARSAPARILLA, U.S.P.: Fluid Extract No. 399</td><td>(Alcohol 40%)</td><td>4.00</td></tr><tr><td colspan="2">Smilax, U. S. P. varieties. Average dose, 30 mins. (2 cc).</td><td></td></tr></table>

[ 88 ]

FLUID EXTRACTS AND TINCTURES

Per pint
(16 fl. ozs.)

## SARSAPARILLA COMPOUND, N. F.:

<table><tr><td>Fluid Extract No. 400</td><td>(Alcohol 35%)</td><td>$4.00</td></tr></table>

100 cc represents: Each fl.oz. represents about:

<table><tr><td>75 Gm.</td><td>Sarsaparilla</td><td>342 grs.</td></tr><tr><td>12 Gm.</td><td>Glycyrrhiza</td><td>55 grs.</td></tr><tr><td>10 Gm.</td><td>Sassafras</td><td>46 grs.</td></tr><tr><td>3 Gm.</td><td>Mezereum</td><td>14 grs.</td></tr></table>

<table><tr><td>SENNA, U. S. P.: Fluid Extract No. 586</td><td>(Alcohol 25%)</td><td>2.80</td></tr></table>

Average dose, 30 mins. (2 cc). Purgative. A favorite remedy in acute and habitual constipation; its action is stated to be more prompt and powerful than that of aloes.

<table><tr><td>SQUILL, U. S. P.: Fluid Extract No. 442</td><td>(Alcohol 50%)</td><td>4.20</td></tr></table>

Tested physiologically. Every package stamped with the date of manufacture. Diuretic; stimulant expectorant. Employed in the treatment of dropsy, croup, bronchitis, etc. Average dose, 1 1/2 mins. (0.1 cc).

<table><tr><td>STROPHANTHUS, U. S. P.: Tincture No. 25</td><td>(Alcohol 90%)</td><td>5.00</td></tr><tr><td colspan="2">in 1-oz. bottles</td><td>per oz. $ .55</td></tr></table>

Tested physiologically. Every package stamped with the date of manufacture. Average dose, 8 mins. (0.5 cc). Physiologic standardization was introduced by Parke, Davis & Co.

See also Strophanthone, page 41.

## VERATRUM VIRIDE (American Hellebore):

<table><tr><td>Fluid Extract No. 19</td><td>(Alcohol 80%)</td><td>4.80</td></tr></table>

Standard 1 Gm. alkaloids per 100 cc. Cardiac depressant; diuretic; diuretic; febrifuge. Useful in eclampsia, acute fevers, and mania. Average dose, 1 1/2 mins. (0.1 cc).

## VIBURNUM PRUNIFOLIUM, N. F. (Black Haw):

<table><tr><td>Fluid Extract No. 66</td><td>(Alcohol 56%)</td><td>4.00</td></tr></table>

Average dose, 30 mins. (2 cc). Uterine and ovarian sedative. Employed in threatened abortion and as a corrective of chronic tendency to miscarry; in dysmenorrhea; in after-pains; and in the nervous distress and other irregularities of the menopause. Introduced to the medical profession by us.

[ 89 ]

MEDICINAL SYRUPS

MEDICINAL SYRUPS

Unless otherwise stated, each fluid ounce represents
the quantity of ingredients specified.

Per doz. pints Per gallon bottle
(16 fl.ozs.)

♦ANODYNE CHERRY EXPECTORANT

<table><tr><td>(No. 66)</td><td>(Alcohol 7%)</td><td>$19.80</td><td>$10.00</td></tr><tr><td>Morphine sulphate</td><td>3/16 gr.</td><td></td><td></td></tr><tr><td>Chloroform</td><td>4 grs.</td><td></td><td></td></tr><tr><td>White Pine bark</td><td>30 grs.</td><td></td><td></td></tr><tr><td>Wild Cherry</td><td>30 grs.</td><td></td><td></td></tr><tr><td>Oil Sassafras</td><td>1/16 min.</td><td></td><td></td></tr><tr><td>Balsam Poplar buds (Balm of Gilead)</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Marrubium</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Sanguinaria</td><td>3 1/2 grs.</td><td></td><td></td></tr></table>

♦ANODYNE PINE EXPECTORANT

<table><tr><td>(No. 90)</td><td>(Alcohol 7%)</td><td>19.20</td><td>9.60</td></tr><tr><td>White Pine bark</td><td>30 grs.</td><td></td><td></td></tr><tr><td>Wild Cherry</td><td>30 grs.</td><td></td><td></td></tr><tr><td>Balsam Poplar buds (Balm of Gilead)</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Spikenard root</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Sanguinaria</td><td>3 1/2 grs.</td><td></td><td></td></tr><tr><td>Sassafras</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Morphine acetate</td><td>3/16 gr.</td><td></td><td></td></tr><tr><td>Chloroform</td><td>4 grs.</td><td></td><td></td></tr></table>

♦ANODYNE PINE EXPECTORANT WITH TAR

<table><tr><td>(No. 91)</td><td>(Alcohol 7%)</td><td>19.20</td><td>9.60</td></tr><tr><td colspan="4">Same as above, with addition of Tar.</td></tr></table>

♦ANODYNE SPRUCE EXPECTORANT

<table><tr><td>(No. 67)</td><td>(Alcohol 7%)</td><td>25.80</td><td>14.00</td></tr><tr><td>Red Spruce gum</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Wild Cherry bark</td><td>24 grs.</td><td></td><td></td></tr><tr><td>Sanguinaria</td><td>8 grs.</td><td></td><td></td></tr><tr><td>Codeine</td><td>2/3 gr.</td><td></td><td></td></tr><tr><td>Benzoic acid</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Chloroform</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Ammonium chloride</td><td>4 grs.</td><td></td><td></td></tr></table>

CINCHONA ALKALOIDS (PALATABLE), 16 grs.

<table><tr><td>(No. 69)</td><td></td><td>28.80</td><td>16.00</td></tr><tr><td colspan="4">(Also known as Syrup Quinine, Tasteless.)</td></tr></table>

[ 90 ]

MEDICINAL SYRUPS

CINCHONA ALKALOIDS (PALATABLE), 40 grs.

<table><tr><td>(No. 70)</td><td>$52.20</td><td>$31.60</td></tr><tr><td colspan="3">(Also known as Syrup Quinine, Tasteless.)</td></tr></table>

COCILLANA COMPOUND, see Syrup Cocillana

Compound page 42.

COMBINED HYPOPHOSPHITES (No. 71)

<table><tr><td>Calcium hypophosphite</td><td>1 gr.</td></tr><tr><td>Sodium hypophosphite</td><td>1/2 gr.</td></tr><tr><td>Ferrous hypophosphite</td><td>1 gr.</td></tr><tr><td>Manganese hypophosphite</td><td>1 gr.</td></tr><tr><td>Quinine hypophosphite</td><td>7/16 gr.</td></tr><tr><td>Strychnine hypophosphite</td><td>1/8 gr.</td></tr><tr><td>Potassium hypophosphite</td><td>1 gr.</td></tr></table>

13.20 ...

COMBINED HYPOPHOSPHITES, CLOUDY

(No. 72) 13.20 ...

<table><tr><td>Calcium hypophosphite</td><td>1 gr.</td></tr><tr><td>Potassium hypophosphite</td><td>1 1/2 grs.</td></tr><tr><td>Manganese hypophosphite</td><td>1 gr.</td></tr><tr><td>Quinine hypophosphite</td><td>7/16 gr.</td></tr><tr><td>Strychnine hypophosphite</td><td>1/16 gr.</td></tr><tr><td>Iron hypophosphite</td><td>1 gr.</td></tr></table>

CORRECTIVE LAXATIVE (No. 73) (Alcohol 3%)

<table><tr><td>Senna</td><td>178 grs.</td></tr><tr><td>Pumpkin seed</td><td>7 grs.</td></tr><tr><td>Chenopodium</td><td>28 grs.</td></tr><tr><td>Potassium and Sodium tartrate</td><td>2 grs.</td></tr><tr><td>Sodium benzoate</td><td>1 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1 gr.</td></tr><tr><td>Manna</td><td>28 grs.</td></tr><tr><td>Fennel</td><td>14 grs.</td></tr></table>

17.40 8.40

FERROUS IODIDE, U. S. P. (No 60) 24.00 ...
100 cc contains 6.5 to 7.5 grams of Ferrous Iodide, repre-
senting approximately 5% by weight.

HEMATIC HYPOPHOSPHITES, see page 25.

HYDRIODIC ACID, U. S. P. (No. 58) 15.60 7.20
100 cc contains 1.3 to 1.5 Gm. absolute hydriodic acid.

[ 91 ]

MEDICINAL SYRUPS

<table><thead><tr><th></th><th>Per doz.<br>pints<br>(16 fl.ozs.)</th><th>Per<br>gallon<br>bottle</th></tr></thead><tbody><tr><td>Unless otherwise stated, each fluid ounce represents<br>the quantity of ingredients specified.</td><td></td><td></td></tr><tr><td>HYPOPHOSPHITES COMPOUND, P. D. & Co.<br>(No. 12)</td><td>$16.80</td><td>$8.00</td></tr><tr><td>Calcium hypophosphite</td><td>16 grs.</td><td></td></tr><tr><td>Potassium hypophosphite</td><td>8 grs.</td><td></td></tr><tr><td>Sodium hypophosphite</td><td>16 grs.</td><td></td></tr><tr><td>Ferrous hypophosphite</td><td>2 grs.</td><td></td></tr><tr><td>HYPOPHOSPHITES COMPOUND, N. F. (No. 62)</td><td>16.20</td><td>7.60</td></tr><tr><td>Each fluid ounce contains about:</td><td></td><td></td></tr><tr><td>Calcium hypophosphite</td><td>16 grs.</td><td></td></tr><tr><td>Sodium hypophosphite</td><td>8 grs.</td><td></td></tr><tr><td>Strychnine</td><td>1/20 gr.</td><td></td></tr><tr><td>Potassium hypophosphite</td><td>8 grs.</td><td></td></tr><tr><td>Manganese hypophosphite</td><td>1 gr.</td><td></td></tr><tr><td>Quinine</td><td>1/2 gr.</td><td></td></tr><tr><td>Ferric hypophosphite</td><td>1 gr.</td><td></td></tr><tr><td colspan="3">See also Combined Hypophosphites and Combined Hypophosphites, Cloudy, page 91.</td></tr><tr><td>IPECAC, U. S. P. (No. 38)</td><td>31.80</td><td>18.00</td></tr><tr><td>Each 100 cc contains 7 Gm. ipecac.</td><td></td><td></td></tr><tr><td>•IPECAC AND OPIUM, N. F. (Alcohol 2%)</td><td>28.80</td><td>16.00</td></tr><tr><td>(Dover Powder.) Ipecac and Opium powder, 40 grains in each fluid ounce (powd. opium, 4 grs.)</td><td></td><td></td></tr><tr><td>IRON CHLORIDE, WELD (non-official)<br>(No. 95)</td><td>15.00</td><td>6.80</td></tr><tr><td>Each fluid ounce represents 20 minims of Tincture Ferric Chloride, U. S. P. Has no effect upon the teeth. Introduced by us in 1891 according to the formula of Dr. G. W. Weld.</td><td></td><td></td></tr><tr><td>Iron Iodide, see Ferrous Iodide, page 91.</td><td></td><td></td></tr><tr><td>MENTHOL EXPECTORANT (No. 93)</td><td>13.80</td><td>6.00</td></tr><tr><td>Wild Cherry bark</td><td>24 grs.</td><td></td></tr><tr><td>Marrubium</td><td>8 grs.</td><td></td></tr><tr><td>Inula</td><td>8 grs.</td><td></td></tr><tr><td>Balsam Poplar buds</td><td>4 grs.</td><td></td></tr><tr><td>Sanguinaria</td><td>3 grs.</td><td></td></tr><tr><td>Chloroform</td><td>2½ grs.</td><td></td></tr><tr><td>Honey</td><td>q.s.</td><td></td></tr><tr><td>Pine Tar</td><td>q.s.</td><td></td></tr><tr><td>Menthol</td><td>q.s.</td><td></td></tr></tbody></table>

[92]

MEDICINAL SYRUPS

<table><thead><tr><th></th><th>Per doz.<br>pints<br>(16 fl.ozs.)</th><th>Per<br>gallon<br>bottle</th></tr></thead><tbody><tr><td>Unless otherwise stated, each fluid ounce represents<br>the quantity of ingredients specified.</td><td></td><td></td></tr><tr><td>MENTHOLATED COUGH BALSAM<br>(No. 94)</td><td>$14.40</td><td>$6.40</td></tr><tr><td>Squill</td><td>4 grs.</td><td></td></tr><tr><td>Gelsemium</td><td>4/5 gr.</td><td></td></tr><tr><td>Ammonium chloride</td><td>4 grs.</td><td></td></tr><tr><td>Senna</td><td>60 grs.</td><td></td></tr><tr><td>Cannabis Americana</td><td>4 grs.</td><td></td></tr><tr><td>Chloroform</td><td>1 gr.</td><td></td></tr><tr><td>Menthol</td><td>q.s.</td><td></td></tr><tr><td colspan="3">Neutralizing Cordial, see Elixir Rhubarb and Potassium with Pancreatin, page 105; and Syrup Rhubarb and Potassium, below.</td></tr><tr><td colspan="3">Quinine Tasteless, see Cinchona Alkaloids, pages 90-91.</td></tr><tr><td>RED CLOVER COMPOUND (No. 74) (Alcohol 6%)</td><td>21.00</td><td>10.80</td></tr><tr><td>Red Clover blossoms</td><td>32 grs.</td><td></td></tr><tr><td>Stillingia</td><td>16 grs.</td><td></td></tr><tr><td>Juglans</td><td>16 grs.</td><td></td></tr><tr><td>Glycyrrhiza</td><td>16 grs.</td><td></td></tr><tr><td>Senna</td><td>32 grs.</td><td></td></tr><tr><td>Potassium iodide</td><td>8 grs.</td><td></td></tr><tr><td>Lappa</td><td>16 grs.</td><td></td></tr><tr><td>RUBARB AND POTASSIUM (Neutralizing Cordial, Special) (No. 42)</td><td>39.60</td><td>23.20</td></tr><tr><td>Rhubarb</td><td>55 grs.</td><td></td></tr><tr><td>Potassium carbonate</td><td>7 grs.</td><td></td></tr><tr><td>Hydrastis</td><td>27 grs.</td><td></td></tr><tr><td>Cinnamon</td><td>27 grs.</td><td></td></tr><tr><td>Oil Peppermint</td><td>½ min.</td><td></td></tr><tr><td>SARSAPARILLA COMPOUND, U. S. P.<br>(No. 44)</td><td>22.80</td><td>12.00</td></tr><tr><td>Each fluid ounce contains about:</td><td></td><td></td></tr><tr><td>Fl. ext. Sarsaparilla</td><td>96 mins.</td><td></td></tr><tr><td>Fl. ext. Glycyrrhiza</td><td>7 mins.</td><td></td></tr><tr><td>Methyl salicylate</td><td>1/10 min.</td><td></td></tr><tr><td>Oil Sassafras</td><td>1/10 min.</td><td></td></tr><tr><td>Oil Anise</td><td>1/10 min.</td><td></td></tr></tbody></table>

[93]

MEDICINAL SYRUPS

Per doz. pints (16 fl.ozs.) Per gallon bottle

## THYME COMPOUND, P. D. & Co. (non-official)

<table><tr><td>(No. 104)</td><td>$10.00</td></tr><tr><td>Thyme leaves</td><td>40 grs.</td></tr><tr><td>Potassium bromide</td><td>4 grs.</td></tr><tr><td>Sodium bromide</td><td>4 grs.</td></tr><tr><td>Ammonium bromide</td><td>2 grs.</td></tr><tr><td>Aromatic flavoring agents</td><td>q.s.</td></tr></table>

Differs from N. F. formula in medication and flavor.

## TRIFOLIUM COMPOUND, P. D. & Co.

<table><tr><td>(No. 78)</td><td>($21.00)</td><td>10.80</td></tr><tr><td>Xanthoxylum</td><td>4 grs.</td><td></td></tr><tr><td>Lappa</td><td>16 grs.</td><td></td></tr><tr><td>Berberis</td><td>16 grs.</td><td></td></tr><tr><td>Red Clover blossoms</td><td>32 grs.</td><td></td></tr><tr><td>Stillingia</td><td>16 grs.</td><td></td></tr><tr><td>Phytolacca</td><td>16 grs.</td><td></td></tr><tr><td>Cascara Amarga</td><td>16 grs.</td><td></td></tr><tr><td>Potassium iodide</td><td>8 grs.</td><td></td></tr></table>

We retain, for this product, our original formula, which differs from that given in the National Formulary.

## WHITE PINE COMPOUND, N. F. (without morphine)

<table><tr><td>(No. 80)</td><td>($14.40)</td><td></td></tr><tr><td>White Pine bark</td><td>40 grs.</td><td></td></tr><tr><td>Wild Cherry bark</td><td>40 grs.</td><td></td></tr><tr><td>Spikenard</td><td>5 grs.</td><td></td></tr><tr><td>Balsam Poplar buds</td><td>5 grs.</td><td></td></tr><tr><td>Sanguinaria</td><td>4 grs.</td><td></td></tr><tr><td>Sassafras</td><td>3¼ grs.</td><td></td></tr><tr><td>Chloroform</td><td>3 grs.</td><td></td></tr><tr><td>Oil Sassafras</td><td>1/10 min.</td><td></td></tr></table>

## ♦ WHITE PINE COMPOUND, N. F., WITH

<table><tr><td>MORPHINE (No. 83)</td><td>($16.20)</td><td></td></tr><tr><td>White Pine bark</td><td>40 grs.</td><td></td></tr><tr><td>Wild Cherry</td><td>40 grs.</td><td></td></tr><tr><td>Spikenard</td><td>5 grs.</td><td></td></tr><tr><td>Balsam Poplar buds</td><td>5 grs.</td><td></td></tr><tr><td>Sanguinaria</td><td>4 grs.</td><td></td></tr><tr><td>Sassafras</td><td>3¼ grs.</td><td></td></tr><tr><td>Morphine sulphate</td><td>1/5 gr.</td><td></td></tr><tr><td>Chloroform</td><td>3 grs.</td><td></td></tr><tr><td>Oil Sassafras</td><td>1/10 min.</td><td></td></tr></table>

♦ Narcotic registry number required.

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## WHITE PINE COMPOUND EXPECTORANT

<table><tr><td>WITH TAR (No. 108)</td><td>($13.80)</td><td></td></tr><tr><td>White Pine bark</td><td>30 grs.</td><td></td></tr><tr><td>Wild Cherry</td><td>30 grs.</td><td></td></tr><tr><td>Sassafras</td><td>3¼ grs.</td><td></td></tr><tr><td>Sanguinaria</td><td>3¼ grs.</td><td></td></tr><tr><td>Balsam Poplar buds</td><td>4 grs.</td><td></td></tr><tr><td>Chloroform</td><td>4 grs.</td><td></td></tr><tr><td>Spikenard root</td><td>4 grs.</td><td></td></tr><tr><td>Pine Tar</td><td>q.s.</td><td></td></tr></table>

## WHITE PINE COUGH SYRUP, MENTHOLATED

<table><tr><td>(No. 87)</td><td>($6.40)</td><td></td></tr><tr><td>Chloroform</td><td>4 grs.</td><td></td></tr><tr><td>White Pine bark</td><td>30 grs.</td><td></td></tr><tr><td>Wild Cherry</td><td>30 grs.</td><td></td></tr><tr><td>Balsam Poplar buds</td><td>4 grs.</td><td></td></tr><tr><td>Spikenard root</td><td>4 grs.</td><td></td></tr><tr><td>Sanguinaria</td><td>3½ grs.</td><td></td></tr><tr><td>Sassafras</td><td>2 grs.</td><td></td></tr><tr><td>Menthol</td><td>q.s.</td><td></td></tr></table>

See also Syrup Mentholated Cough Balsam, page 93.

## WHITE PINE COUGH SYRUP, MENTHOLATED, WITH TAR (No. 88)

Same as the preceding, with the addition of Tar.

14.40 6.40

## WILD CHERRY, U. S. P. (No. 53)

100 cc represents Wild Cherry, 15 Gm.

14.40 6.40

Wild Thyme Compound, see Thyme Compound, page 94.

## YERBA SANTA AROMATIC, P. D. & Co.

<table><tr><td>(No. 89)</td><td>($16.80)</td><td>8.00</td></tr><tr><td>Eriodictyon</td><td>60 grs.</td><td></td></tr></table>

We retain, for this product, our original formula of superior flavor, which differs in medication from that given in the National Formulary.

Yerba Santa was introduced to the medical profession by us.

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MEDICINAL ELIXIRS

<table><tr><td>♦ACETANILID COMPOUND (No. 139)(Alcohol 30%)</td><td>$34.80</td><td>$20.00</td></tr><tr><td>Acetanilid</td><td>16 grs.</td><td></td></tr><tr><td>Caffeine</td><td>2 grs.</td><td></td></tr><tr><td>Sodium bromide</td><td>40 grs.</td><td></td></tr><tr><td>Codeine sulphate</td><td>½ gr.</td><td></td></tr><tr><td>Tinct. Gelsemium</td><td>36 mins.</td><td></td></tr></table>

See also Elixir Migraine.

<table><tr><td>ALETRIS COMPOUND, P. D. & Co. (No. 126)</td><td>25.20</td><td>13.60</td></tr><tr><td>(Alcohol 27%)</td><td></td><td></td></tr><tr><td>Aletris (star grass)</td><td>30 grs.</td><td></td></tr><tr><td>Viburnum Opulus (cramp bark)</td><td>15 grs.</td><td></td></tr><tr><td>Mitchella (squaw vine)</td><td>30 grs.</td><td></td></tr><tr><td>Helonias (false unicorn)</td><td>30 grs.</td><td></td></tr><tr><td>Caulophyllum (blue cohosh)</td><td>30 grs.</td><td></td></tr></table>

This is our original formula. It has the same drug strength as the National Formulary elixir, but differs in the aromatic base employed.

<table><tr><td>ALKAVENA (No. 166)</td><td>(Alcohol 12%)</td><td>22.80</td><td>12.00</td></tr><tr><td colspan="4">(Elixir Hydrastis Compound, P. D. & Co.)</td></tr><tr><td>Avena sativa</td><td>8 grs.</td><td></td><td></td></tr><tr><td>Hydrastis</td><td>8 grs.</td><td></td><td></td></tr><tr><td>Xanthoxylum</td><td>8 grs.</td><td></td><td></td></tr><tr><td>Ginger</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Gentian</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Sodium bicarbonate</td><td>4 grs.</td><td></td><td></td></tr></table>

This is our original formula. It has the same medicinal strength as the National Formulary elixir, but differs in the aromatic base employed.

<table><tr><td>ALOE AND RUE COMPOUND (No. 133)</td><td>20.40</td><td>10.40</td></tr><tr><td colspan="3">(Alcohol 22%)</td></tr><tr><td>Purified Aloes</td><td>12 grs.</td><td></td></tr><tr><td>Safflower</td><td>6 grs.</td><td></td></tr><tr><td>Rue</td><td>6 grs.</td><td></td></tr><tr><td>Savin</td><td>6 grs.</td><td></td></tr></table>

<table><tr><td>AMMONIUM VALERATE, N. F., 16 grs. (No. 2)</td><td>22.80</td><td>12.00</td></tr><tr><td colspan="3">(Alcohol 21%)</td></tr></table>

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<table><tr><td>ANTI-ASTHMATIC (Dr. Hare) (No. 132)</td><td>$28.20</td><td>$15.60</td></tr><tr><td colspan="3">(Alcohol 25%)</td></tr><tr><td>Sodium iodide</td><td>16 grs.</td><td></td></tr><tr><td>Sodium bromide</td><td>16 grs.</td><td></td></tr><tr><td>Tinct. Lobelia</td><td>32 mins.</td><td></td></tr><tr><td>Fluid extract Euphorbia</td><td>24 mins.</td><td></td></tr><tr><td>Nitroglycerin (glyceryl trinitrate)</td><td>1/25 gr.</td><td></td></tr></table>

This is our original formula. It has approximately the same drug strength as the National Formulary elixir, but differs in the aromatic base employed.

<table><tr><td>ANTI-MALARIAL (No. 160)</td><td>(Alcohol 13%)</td><td>25.20</td><td>13.60</td></tr><tr><td>Quinidine sulphate</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Canada Snakeroot</td><td>22½ grs.</td><td></td><td></td></tr></table>

<table><tr><td>ANTI-RHEUMATIC (No. 169)</td><td>(Alcohol 5%)</td><td>24.60</td><td>13.20</td></tr><tr><td>Potassium iodide</td><td>10 grs.</td><td></td><td></td></tr><tr><td>Sodium salicylate</td><td>40 grs.</td><td></td><td></td></tr><tr><td>Colchicum seed</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Trifolium</td><td>32 grs.</td><td></td><td></td></tr><tr><td>Berberis</td><td>16 grs.</td><td></td><td></td></tr><tr><td>Syrup Sarsaparilla Compound</td><td>32 mins.</td><td></td><td></td></tr></table>

<table><tr><td>AROMATIC (No. 201)</td><td>(No alcohol)</td><td>12.00</td><td>.....</td></tr></table>

<table><tr><td>BROMIDE AND CHLORAL COMPOUND (No. 127)</td><td>27.60</td><td>15.20</td></tr><tr><td>Chloral hydrate</td><td>120 grs.</td><td></td></tr><tr><td>Potassium bromide</td><td>120 grs.</td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>1 gr.</td><td></td></tr><tr><td>Ext. Cannabis</td><td>1 gr.</td><td></td></tr></table>

See also Elixir Three Bromides, P. D. & Co., page 106.

<table><tr><td>BROMIDES COMPOUND No. 1, P. D. & Co. (Five Bromides) (No. 136)</td><td>(Alcohol 8%)</td><td>19.80</td><td>10.00</td></tr><tr><td>Potassium bromide</td><td>40 grs.</td><td></td><td></td></tr><tr><td>Sodium bromide</td><td>40 grs.</td><td></td><td></td></tr><tr><td>Ammonium bromide</td><td>24 grs.</td><td></td><td></td></tr><tr><td>Calcium bromide</td><td>12 grs.</td><td></td><td></td></tr><tr><td>Lithium bromide</td><td>4 grs.</td><td></td><td></td></tr></table>

This is our original formula. It differs in medication and flavor from that given in the National Formulary.

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<table><thead><tr><th></th><th>Per doz. pints<br>(16 fl.ozs.)</th><th>Per gallon<br>bottle</th></tr></thead><tbody><tr><td>Unless otherwise stated, each fluid ounce represents the quantity of ingredients specified.</td><td></td><td></td></tr><tr><td><strong>BUCHU COMPOUND, P. D. & Co.<br>(No. 10)</strong>..................(Alcohol 30%)..</td><td>$31.80</td><td>$18.00</td></tr><tr><td>Buchu..................60 grs.</td><td></td><td></td></tr><tr><td>Cubeb..................15 grs.</td><td></td><td></td></tr><tr><td>Juniper berries...........15 grs.</td><td></td><td></td></tr><tr><td>Uva ursi..................15 grs.</td><td></td><td></td></tr><tr><td>Spirit Nitrous Ether........15 mins.</td><td></td><td></td></tr><tr><td>This is our original formula. It differs in medication from that given in the National Formulary.</td><td></td><td></td></tr><tr><td><strong>BUCHU, JUNIPER, AND POTASSIUM ACETATE,<br>P. D. & Co. (No. 11)</strong>...........(Alcohol 30%)..</td><td>21.60</td><td></td></tr><tr><td>Buchu..................45 grs.</td><td></td><td></td></tr><tr><td>Juniper berries...........12 grs.</td><td></td><td></td></tr><tr><td>Potassium acetate...........16 grs.</td><td></td><td></td></tr><tr><td>This is our original formula. It differs in medication from that given in the National Formulary.</td><td></td><td></td></tr><tr><td><strong>CALISAYA ALKALOIDS, P. D. & Co. (No. 15)</strong>......<br>(Alcohol 18%)</td><td>19.80</td><td>10.00</td></tr><tr><td>Each fluid ounce represents 40 grs. of the bark.</td><td></td><td></td></tr><tr><td>This is our original formula. It contains more medication than the N. F. formula.</td><td></td><td></td></tr><tr><td><strong>CALISAYA BARK, 40 grs. (No. 16)</strong>...(Alcohol 20%)..</td><td>19.80</td><td>10.00</td></tr><tr><td><strong>CALISAYA & IRON, R "A" (No. 18)</strong>.(Alcohol 18%)..</td><td>18.60</td><td>9.20</td></tr><tr><td>Cinchona Calisaya bark, 12½ grs., and Iron and Ammonium citrate equivalent to ⅞ gr. ferrous sulphate.</td><td></td><td></td></tr><tr><td>This is our original formula. It differs in medication and flavor from that given in the National Formulary.</td><td></td><td></td></tr><tr><td><strong>CALISAYA, IRON, BISMUTH AND STRYCHNINE,<br>P. D. & Co. (No. 23)</strong>...........(Alcohol 11%)..</td><td>25.20</td><td>13.60</td></tr><tr><td>Cinchona Calisaya bark...........40 grs.</td><td></td><td></td></tr><tr><td>Tinct. citro-chloride of iron........24 mins.</td><td></td><td></td></tr><tr><td>Bismuth and Sodium tartrate........8 grs.</td><td></td><td></td></tr><tr><td>Strychnine..................8/100 gr.</td><td></td><td></td></tr><tr><td>Glycerin......................q.s.</td><td></td><td></td></tr><tr><td>This is our original formula. It differs in medication from that given in the National Formulary.</td><td></td><td></td></tr></tbody></table>

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<table><thead><tr><th></th><th>Per doz. pints<br>(16 fl.ozs.)</th><th>Per gallon<br>bottle</th></tr></thead><tbody><tr><td>Unless otherwise stated, each fluid ounce represents the quantity of ingredients specified.</td><td></td><td></td></tr><tr><td><strong>CALISAYA, IRON, QUININE AND STRYCHNINE<br>(No. 27)</strong>..................(Alcohol 12%)..</td><td>$24.60</td><td>$13.20</td></tr><tr><td>Cinchona Calisaya bark...........40 grs.</td><td></td><td></td></tr><tr><td>Strychnine..................8/100 gr.</td><td></td><td></td></tr><tr><td>Tinct. citro-chloride of Iron........24 mins.</td><td></td><td></td></tr><tr><td>Quinine hydrochloride...........2 grs.</td><td></td><td></td></tr><tr><td><strong>CALISAYA, IRON AND STRYCHNINE, P. D. & Co.<br>(No. 28)</strong>..................(Alcohol 12%)..</td><td>16.80</td><td>8.00</td></tr><tr><td>Cinchona Calisaya bark...........40 grs.</td><td></td><td></td></tr><tr><td>Strychnine..................8/100 gr.</td><td></td><td></td></tr><tr><td>Tinct. citro-chloride of Iron........24 mins.</td><td></td><td></td></tr><tr><td>Glycerin......................q.s.</td><td></td><td></td></tr><tr><td><strong>CALISAYA, IRON AND STRYCHNINE, R "B"<br>(No. 153)</strong>..................(Alcohol 12%)..</td><td>21.60</td><td>11.20</td></tr><tr><td>Cinchona Calisaya bark...........80 grs.</td><td></td><td></td></tr><tr><td>Strychnine sulphate...........8/30 gr.</td><td></td><td></td></tr><tr><td>Tinct. citro-chloride of Iron........48 mins.</td><td></td><td></td></tr><tr><td><strong>CATHARTIC COMPOUND, P. D. & Co. (No. 38)</strong>..<br>(Alcohol 16%)</td><td>25.80</td><td>14.00</td></tr><tr><td>Cascara sagrada...........32 grs.</td><td></td><td></td></tr><tr><td>Senna......................60 grs.</td><td></td><td></td></tr><tr><td>Leptandra...................16 grs.</td><td></td><td></td></tr><tr><td>Juglans......................16 grs.</td><td></td><td></td></tr><tr><td>Potassium and Sodium tartrate....32 grs.</td><td></td><td></td></tr><tr><td>This is our original formula. It differs greatly from that given in the National Formulary.</td><td></td><td></td></tr><tr><td><strong>CELERY AND GUARANA (No. 39)</strong>...(Alcohol 25%)..</td><td>37.80</td><td>22.00</td></tr><tr><td>Celery seed...................60 grs.</td><td></td><td></td></tr><tr><td>Guarana......................60 grs.</td><td></td><td></td></tr><tr><td>This is our original formula. It differs from that given in the National Formulary under the title Elixir Guarana and Celery.</td><td></td><td></td></tr><tr><td><strong>CHIONANTHUS (No. 170)</strong>...........(Alcohol 20%)..</td><td>21.00</td><td>10.80</td></tr><tr><td>Chionanthus (fringe tree)........96 grs.</td><td></td><td></td></tr><tr><td><strong>CHLORIDES OF IRON, ARSENIC AND MERCURY,<br>WITH CALISAYA (No. 171)</strong>...........(Alcohol 10%)..</td><td>16.80</td><td>8.00</td></tr><tr><td>Cinchona Calisaya bark...........4 grs.</td><td></td><td></td></tr><tr><td>Ferrous chloride...........1 gr.</td><td></td><td></td></tr><tr><td>Mercuric chloride, corrosive........1/16 gr.</td><td></td><td></td></tr><tr><td>Arsenic chloride...........1/35 gr.</td><td></td><td></td></tr></tbody></table>

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<table><thead><tr><th></th><th>Per doz.<br>pints<br>(16 fl.ozs.)</th><th>Per<br>gallon<br>bottle</th></tr></thead><tbody><tr><td>Unless otherwise stated, each fluid ounce represents<br>the quantity of ingredients specified.</td><td></td><td></td></tr><tr><td><strong>CINCHONA, DETANNATED (No. 44)</strong> (Alcohol 20%)..</td><td>$20.40</td><td>$10.40</td></tr><tr><td colspan="3">Contains the equivalent of 40 grs. Red Cinchona bark,<br>combined with choice aromatics; suitable for combination<br>with Iron salts.</td></tr><tr><td><strong>CRAMP BARK COMPOUND, P. D. & Co. (No. 49)</strong>..</td><td>25.80</td><td>14.00</td></tr><tr><td colspan="3">(Alcohol 36%)</td></tr><tr><td>Crank Bark (Viburnum Opulus)...</td><td>30 grs.</td><td></td></tr><tr><td>Skunk Cabbage...</td><td>15 grs.</td><td></td></tr><tr><td>Scutellaria...</td><td>30 grs.</td><td></td></tr><tr><td>Aromatics</td><td></td><td></td></tr><tr><td><strong>CREOSOTE AND TERPIN HYDRATE COMPOUND, P. D. & Co. (No. 172)</strong> (Alcohol 22%)..</td><td>24.60</td><td>...</td></tr><tr><td>Creosote...</td><td>2 mins.</td><td></td></tr><tr><td>Terpin hydrate...</td><td>2 grs.</td><td></td></tr><tr><td>Chloroform...</td><td>1 min.</td><td></td></tr><tr><td>Sodium glycerophosphate...</td><td>4 grs.</td><td></td></tr><tr><td>Calcium glycerophosphate...</td><td>4 grs.</td><td></td></tr><tr><td colspan="3">This is our original formula. It differs from the N. F.<br>formula only in the aromatic base employed.</td></tr><tr><td><strong>DAMIANA, NUX VOMICA, IRON AND PHOSPHORUS (No. 52)</strong> (Alcohol 32%)..</td><td>33.60</td><td>19.20</td></tr><tr><td>Damiana...</td><td>60 grs.</td><td></td></tr><tr><td>Nux vomica...</td><td>8 grs.</td><td></td></tr><tr><td>Tinct. citro-chloride of Iron...</td><td>16 mins.</td><td></td></tr><tr><td>Phosphorus...</td><td>8/200 gr.</td><td></td></tr><tr><td><strong>DAMIANA, PHOSPHORUS AND NUX VOMICA (No. 53)</strong> (Alcohol 30%)..</td><td>33.60</td><td>19.20</td></tr><tr><td>Damiana...</td><td>60 grs.</td><td></td></tr><tr><td>Nux Vomica...</td><td>8 grs.</td><td></td></tr><tr><td>Phosphorus...</td><td>8/200 gr.</td><td></td></tr><tr><td colspan="3">Digestive Compound, see Lactated Pepsin, 200 grs.</td></tr><tr><td><strong>DIOSCOREA COMPOUND (No. 173)</strong> (Alcohol 17%)..</td><td>24.00</td><td>12.80</td></tr><tr><td>Wild Yam...</td><td>4 grs.</td><td></td></tr><tr><td>Star Grass...</td><td>16 grs.</td><td></td></tr><tr><td>Crank Bark (Viburnum Opulus)...</td><td>8 grs.</td><td></td></tr><tr><td>Viburnum Prunifolium...</td><td>40 grs.</td><td></td></tr><tr><td>Mitchella (squaw vine)...</td><td>16 grs.</td><td></td></tr><tr><td>Scutellaria...</td><td>8 grs.</td><td></td></tr><tr><td>Caulophyllum...</td><td>8 grs.</td><td></td></tr><tr><td>Helonias...</td><td>8 grs.</td><td></td></tr></tbody></table>

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<table><thead><tr><th>Unless otherwise stated, each fluid ounce represents<br>the quantity of ingredients specified.</th><th>Per doz.<br>pints<br>(16 fl.ozs.)</th><th>Per<br>gallon<br>bottle</th></tr></thead><tbody><tr><td><strong>DIURETIC IMPROVED (No. 174)</strong> (Alcohol 20%)..</td><td>$19.20</td><td>$9.60</td></tr><tr><td>Triticum...</td><td>16 grs.</td><td></td></tr><tr><td>Juniper berries...</td><td>12 grs.</td><td></td></tr><tr><td>Corn silk...</td><td>12 grs.</td><td></td></tr><tr><td>Uva Ursi...</td><td>8 grs.</td><td></td></tr><tr><td>Potassium acetate...</td><td>16 grs.</td><td></td></tr><tr><td colspan="3">Emmenagogue, see Aloe and Rue Compound.</td></tr><tr><td colspan="3"><strong>FIVE BROMIDES, see Bromides Compound No. 1.</strong></td></tr><tr><td><strong>GENTIAN, N. F. (No. 57)</strong> (Alcohol 16%)..</td><td>21.60</td><td>11.20</td></tr><tr><td>Gentian...</td><td>16 grs.</td><td></td></tr><tr><td><strong>GENTIAN (Glycerinated), P. D. & Co. (No. 202)</strong> (Alcohol 12%)</td><td>19.20</td><td>...</td></tr><tr><td>Fluid extract Gentian...</td><td>4½ mins.</td><td></td></tr><tr><td>Phosphoric Acid...</td><td>2½ mins.</td><td></td></tr><tr><td>Fluid extract Taraxacum...</td><td>7½ mins.</td><td></td></tr><tr><td>Glycerin...</td><td>192 mins.</td><td></td></tr><tr><td colspan="3">This is our original formula. It has the same medicinal strength<br>as the National Formulary elixir, but differs in the aromatic<br>base employed.</td></tr><tr><td><strong>GENTIAN COMPOUND (Glycerinated) (No. 140)</strong> (Alcohol 12%)</td><td>19.20</td><td>...</td></tr><tr><td>Gentian...</td><td>4 grs.</td><td></td></tr><tr><td>Extract Taraxacum...</td><td>16 grs.</td><td></td></tr><tr><td>Glycerin...</td><td>168 mins.</td><td></td></tr><tr><td>Diluted Phosphoric Acid...</td><td>32 mins.</td><td></td></tr><tr><td><strong>GENTIAN AND IRON, R "A," P. D. & Co. (No. 58)</strong> (Alcohol 15%)</td><td>18.60</td><td>9.20</td></tr><tr><td>Gentian...</td><td>16 grs.</td><td></td></tr><tr><td>Tinct. citro-chloride of Iron...</td><td>16 mins.</td><td></td></tr><tr><td colspan="3">This is our original formula. It differs from that given in the<br>National Formulary.</td></tr><tr><td><strong>GENTIAN, IRON CHLORIDE AND LACTATED PEPSIN (No. 59)</strong> (Alcohol 20%)..</td><td>19.80</td><td>10.00</td></tr><tr><td>Gentian...</td><td>16 grs.</td><td></td></tr><tr><td>Lactated Pepsin...</td><td>40 grs.</td><td></td></tr><tr><td>Tinct. citro-chloride of Iron...</td><td>16 mins.</td><td></td></tr></tbody></table>

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<table><tr><td>Unless otherwise stated, each fluid ounce represents the quantity of ingredients specified.</td><td>Per doz. pints (16 fl.ozs.)</td><td>Per gallon bottle</td></tr></table>

<table><caption>GLYCEROPHOSPHATES CALCIUM AND SODIUM, P. D. & Co. (No. 138) (Alcohol 16%)</caption><tbody><tr><td>Calcium glycerophosphate</td><td>4 grs.</td><td>$19.20</td><td>$9.60</td></tr><tr><td>Sodium glycerophosphate</td><td>8 grs.</td><td></td><td></td></tr><tr><td colspan="3">This is our original formula. It differs from that given in the National Formulary.</td><td></td></tr></tbody></table>

<table><caption>GLYCEROPHOSPHATES COMPOUND, P. D. & Co. (No. 141) (Alcohol 8%)</caption><tbody><tr><td>Iron glycerophosphate</td><td>2 grs.</td><td>21.60</td><td>11.20</td></tr><tr><td>Potassium glycerophosphate</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Sodium glycerophosphate</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Calcium glycerophosphate</td><td>4 grs.</td><td></td><td></td></tr><tr><td colspan="3">This is our original formula. It differs from that given in the National Formulary.</td><td></td></tr></tbody></table>

<table><caption>GLYCEROPHOSPHATES COMPOUND WITH IRON, QUININE AND STRYCHNINE, No. 1 (without sugar) (No. 145) (Alcohol 4%)</caption><tbody><tr><td>Calcium glycerophosphate</td><td>8 grs.</td><td>22.20</td><td>11.60</td></tr><tr><td>Sodium glycerophosphate</td><td>16 grs.</td><td></td><td></td></tr><tr><td>Iron glycerophosphate</td><td>1½ grs.</td><td></td><td></td></tr><tr><td>Manganese glycerophosphate</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Quinine glycerophosphate</td><td>½ gr.</td><td></td><td></td></tr><tr><td>Strychnine glycerophosphate</td><td>¾ gr.</td><td></td><td></td></tr><tr><td colspan="3">This is our original formula. It has approximately the same medicinal strength as the National Formulary elixir, but differs in the aromatic base employed.</td><td></td></tr></tbody></table>

<table><caption>HELONIAS COMPOUND, P. D. & Co. (No. 65) (Helonias Cordial) (Alcohol 22%)</caption><tbody><tr><td>Helonias (false unicorn)</td><td>15 grs.</td><td>25.20</td><td>13.60</td></tr><tr><td>Cramp Bark (Viburnum Opulus)</td><td>15 grs.</td><td></td><td></td></tr><tr><td>Caulophyllum (blue cohosh)</td><td>15 grs.</td><td></td><td></td></tr><tr><td>Mitchella (squaw vine)</td><td>60 grs.</td><td></td><td></td></tr><tr><td colspan="3">This is our original formula. It has the same medicinal strength as the N. F. formula but differs in flavor.</td><td></td></tr></tbody></table>

<table><caption>HYDRANGEA AND LITHIUM, P. D. & Co. (No. 129) (Alcohol 25%)</caption><tbody><tr><td>Hydrangea</td><td>192 grs.</td><td>31.80</td><td>18.00</td></tr><tr><td>Lithium salicylate</td><td>12 grs.</td><td></td><td></td></tr><tr><td>Lithium benzoate</td><td>12 grs.</td><td></td><td></td></tr><tr><td colspan="3">This is of the same drug strength as the National Formulary elixir, but differs in the aromatic base employed.</td><td></td></tr></tbody></table>

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MEDICINAL ELIXIRS

HYDRASTIS COMPOUND, see Alkavena, page 96.

<table><caption>HYDRASTIS AND CRAMP-BARK COMPOUND (No. 176) (Alcohol 17%)</caption><tbody><tr><td>Hydrastis</td><td>30 grs.</td><td>$34.80</td><td>$20.00</td></tr><tr><td>Cramp Bark (Viburnum Opulus)</td><td>40 grs.</td><td></td><td></td></tr><tr><td>Jamaica Dogwood</td><td>20 grs.</td><td></td><td></td></tr><tr><td>Pulsatilla</td><td>10 grs.</td><td></td><td></td></tr></tbody></table>

IODIDES, see Six Iodides, page 106.

<table><caption>IRON, ARSENIC AND STRYCHNINE (No. 159) (Alcohol 12%)</caption><tbody><tr><td>Tinct. citro-chloride of Iron</td><td>20 mins.</td><td>18.60</td><td>9.20</td></tr><tr><td>Arsenic trioxide</td><td>¼ gr.</td><td></td><td></td></tr><tr><td>Strychnine</td><td>8/100 gr.</td><td></td><td></td></tr></tbody></table>

<table><caption>IRON, QUININE AND STRYCHNINE, P. D. & Co. (No. 75) (Alcohol 10%)</caption><tbody><tr><td>Tinct. citro-chloride of Iron</td><td>24 mins.</td><td>16.20</td><td>....</td></tr><tr><td>Quinine sulphate</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Strychnine</td><td>8/240 gr.</td><td></td><td></td></tr><tr><td>Glycerin</td><td>q.s.</td><td></td><td></td></tr></tbody></table>

<table><caption>IRON, QUININE AND STRYCHNINE, N. F. (No. 203) (Alcohol 24%)</caption><tbody><tr><td>Quinine hydrochloride</td><td>4 grs.</td><td>21.00</td><td>....</td></tr><tr><td>Strychnine sulphate</td><td>8/100 gr.</td><td></td><td></td></tr><tr><td>Tinct. citro-chloride of Iron</td><td>60 mins.</td><td></td><td></td></tr></tbody></table>

<table><caption>IRON AND QUININE WITH STRYCHNINE PHOSPHATE, P. D. & Co. (No. 77) (Alcohol 10%)</caption><tbody><tr><td>Tinct. citro-chloride of Iron</td><td>48 mins.</td><td>16.20</td><td>....</td></tr><tr><td>Quinine hydrochloride</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Strychnine phosphate</td><td>8/60 gr.</td><td></td><td></td></tr><tr><td>Glycerin</td><td>q.s.</td><td></td><td></td></tr></tbody></table>

<table><caption>IRON AND QUININE WITH STRYCHNINE PHOSPHATE AND LACTATED PEPSIN (No. 78) (Alcohol 11%)</caption><tbody><tr><td>Tinct. citro-chloride of Iron</td><td>48 mins.</td><td>18.60</td><td>9.20</td></tr><tr><td>Strychnine phosphate</td><td>⅛ gr.</td><td></td><td></td></tr><tr><td>Lactated Pepsin</td><td>40 grs.</td><td></td><td></td></tr></tbody></table>

[103]

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<table><thead><tr><th></th><th>Per doz.<br>pints<br>(16 fl.ozs.)</th><th>Per<br>gallon<br>bottle</th></tr></thead><tbody><tr><td>Unless otherwise stated, each fluid ounce represents<br>the quantity of ingredients specified.</td><td></td><td></td></tr><tr><td>LACTATED PEPSIN, 40 grs. (No. 200).. (No alcohol)..</td><td>$12.60</td><td>$ 5.20</td></tr><tr><td>LACTATED PEPSIN, 200 grs. (No. 193)(Alcohol 15%)..<br>(Elixir Digestive Compound, P. D. & Co.)<br>Equivalent to 16 grs. U. S. P. Pepsin.<br>This is our original formula. It is stronger than that given in<br>the National Formulary.</td><td>16.80</td><td>...</td></tr><tr><td>LACTATED PEPSIN AND BISMUTH<br>(No. 80)..........................(Alcohol 14%)..</td><td>22.20</td><td>11.60</td></tr><tr><td>Lactated Pepsin....................40 grs.</td><td></td><td></td></tr><tr><td>Bismuth and Sodium tartrate.........8 grs.</td><td></td><td></td></tr><tr><td>LACTATED PEPSIN, BISMUTH AND STRYCH-<br>NINE (No. 81)........................(Alcohol 14%)..</td><td>22.20</td><td>11.60</td></tr><tr><td>Lactated Pepsin....................40 grs.</td><td></td><td></td></tr><tr><td>Strychnine......................8/100 gr.</td><td></td><td></td></tr><tr><td>Bismuth and Sodium tartrate.........8 grs.</td><td></td><td></td></tr><tr><td>Lactated Pepsin with Iron, Quinine and Strychnine<br>Phosphate, see No. 78, foot of page 103.</td><td></td><td></td></tr><tr><td>Lithia and Hydrangea, see Hydrangea and Lithium,<br>page 102.</td><td></td><td></td></tr><tr><td>MANACA AND SALICYLATES (No. 86)(Alcohol 25%)<br>(Compound Elixir Manaca, P. D. & Co., non-official)</td><td>30.00</td><td>16.80</td></tr><tr><td>Manaca..........................80 grs.</td><td></td><td></td></tr><tr><td>Sodium salicylate................64 grs.</td><td></td><td></td></tr><tr><td>Potassium salicylate...........32 grs.</td><td></td><td></td></tr><tr><td>Lithium salicylate................8 grs.</td><td></td><td></td></tr><tr><td>MIGRAINE (No. 137)..................(Alcohol 30%)..</td><td>29.40</td><td>16.40</td></tr><tr><td>Acetanilid......................16 grs.</td><td></td><td></td></tr><tr><td>Caffeine.........................2 grs.</td><td></td><td></td></tr><tr><td>Sodium bromide..................40 grs.</td><td></td><td></td></tr><tr><td>See also Elixir Acetanilid Compound.</td><td></td><td></td></tr><tr><td>NEUTRALIZING CORDIAL, see Elixir Rhubarb<br>and Potassium with Pancreatin, page 105, and Syrup<br>Rhubarb and Potassium, page 93.</td><td></td><td></td></tr></tbody></table>

[ 104 ]

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<table><thead><tr><th>Unless otherwise stated, each fluid ounce represents<br>the quantity of ingredients specified.</th><th>Per doz.<br>pints<br>(16 fl.ozs.)</th><th>Per<br>gallon<br>bottle</th></tr></thead><tbody><tr><td>NITROGLYCERIN COMPOUND (No. 134)............(Alcohol 25%)</td><td>$19.80</td><td>$10.00</td></tr><tr><td>Nitroglycerin (glyceryl trinitrate) 8/100 grs.</td><td></td><td></td></tr><tr><td>Fluid extract Digitalis............4 mgs.</td><td></td><td></td></tr><tr><td>Tincture Strophanthus............8 mgs.</td><td></td><td></td></tr><tr><td>Strychnine sulphate............8/50 gr.</td><td></td><td></td></tr><tr><td>PEPSIN, LACTATED, see Lactated Pepsin.</td><td></td><td></td></tr><tr><td>PEPSIN AND BISMUTH, P. D. & Co.<br>(No. 89)..........................(Alcohol 14%)..</td><td>22.80</td><td>12.00</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)............4 grs.</td><td></td><td></td></tr><tr><td>Bismuth and Sodium tartrate.........8 grs.</td><td></td><td></td></tr><tr><td>This is our original formula, which differs in medication and<br>flavor from that given in the National Formulary.</td><td></td><td></td></tr><tr><td>PEPSIN, BISMUTH AND STRYCHNINE,<br>P. D. & Co. (No. 100)..................(Alcohol 14%)..</td><td>22.80</td><td>12.00</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)............4 grs.</td><td></td><td></td></tr><tr><td>Bismuth and Sodium tartrate.........8 grs.</td><td></td><td></td></tr><tr><td>Strychnine......................8/100 gr.</td><td></td><td></td></tr><tr><td>This is our original formula, which differs in medication and<br>flavor from that given in the National Formulary.</td><td></td><td></td></tr><tr><td>PHOSPHATES COMPOUND WITH CALISAYA<br>(No. 104)..........................(Alcohol 5%)..</td><td>19.80</td><td>10.00</td></tr><tr><td>Sodium phosphate....................4 grs.</td><td></td><td></td></tr><tr><td>Calcium phosphate, precipitated......2 grs.</td><td></td><td></td></tr><tr><td>Ferric phosphate, soluble............1 gr.</td><td></td><td></td></tr><tr><td>Phosphoric Acid, diluted............30 mins.</td><td></td><td></td></tr><tr><td>Cinchona alkaloids representing:<br>Fluid extract Cinchona............12 mins.</td><td></td><td></td></tr><tr><td>PHOSPHORUS, N. F. (No. 105)...........(Alcohol 30%)..</td><td>26.40</td><td>14.40</td></tr><tr><td>Phosphorus.........................1/9 gr.</td><td></td><td></td></tr><tr><td>PISCIDIA COMPOUND, see Utrovol, page 107.</td><td></td><td></td></tr><tr><td>POTASSIUM BROMIDE, N.F. (No.107) (Alcohol 7%)</td><td>19.80</td><td>10.00</td></tr><tr><td>Potassium bromide..................80 grs.</td><td></td><td></td></tr><tr><td>RHUBARB AND POTASSIUM WITH PANCRE-<br>ATIN (No. 112)...................(Alcohol 20%)..</td><td>24.00</td><td>....</td></tr><tr><td>(Neutralizing Cordial, P. D. & Co.)</td><td></td><td></td></tr><tr><td>Rhubarb..........................18 grs.</td><td></td><td></td></tr><tr><td>Hydrastis.........................9 grs.</td><td></td><td></td></tr><tr><td>Saccharated Pancreatin...........10 grs.</td><td></td><td></td></tr><tr><td>Potassium bicarbonate...........18 grs.</td><td></td><td></td></tr></tbody></table>

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MEDICINAL ELIXIRS

## SALICYLIC ACID COMPOUND, P. D. & Co.

<table><tr><td>(No. 113)</td><td>(Alcohol 10%)</td><td>$19.20</td></tr><tr><td>Salicylic Acid (as Sodium salicylate)</td><td>40 grs.</td><td></td></tr><tr><td>Cimicifuga</td><td>15 grs.</td><td></td></tr><tr><td>Potassium iodide</td><td>4 grs.</td><td></td></tr><tr><td>Gelsemium</td><td>8 grs.</td><td></td></tr></table>

This is our original formula. It differs from that given in the National Formulary.

## SAW PALMETTO AND SANTAL COMPOUND,

<table><tr><td>P. D. & Co. (No. 124)</td><td>(Alcohol 20%)</td><td>19.80</td><td>$10.00</td></tr><tr><td>Sabal (Saw Palmetto berries)</td><td>120 grs.</td><td></td><td></td></tr><tr><td>Green Corn Silk</td><td>120 grs.</td><td></td><td></td></tr><tr><td>Sandalwood</td><td>30 grs.</td><td></td><td></td></tr></table>

## SIX IODIDES (No. 155)

<table><tr><td>Arsenous iodide</td><td>8/125 gr.</td><td>22.80</td><td>12.00</td></tr><tr><td>Ferrous iodide</td><td>8/12 gr.</td><td></td><td></td></tr><tr><td>Mercuric iodide, red</td><td>8/125 gr.</td><td></td><td></td></tr><tr><td>Manganese iodide</td><td>8/10 gr.</td><td></td><td></td></tr><tr><td>Potassium iodide</td><td>8 grs.</td><td></td><td></td></tr><tr><td>Sodium iodide</td><td>8 grs.</td><td></td><td></td></tr></table>

## SODIUM BROMIDE, N. F. (No. 116)

<table><tr><td>(Alcohol 6%)</td><td>18.00</td><td>8.80</td></tr><tr><td>Sodium bromide</td><td>80 grs.</td><td></td></tr></table>

## SODIUM SALICYLATE, N. F. (No. 117)

<table><tr><td>(Alcohol 7%)</td><td>17.40</td><td>8.40</td></tr><tr><td>Sodium salicylate</td><td>38 grs.</td><td></td></tr></table>

## ♦TERPIN HYDRATE AND CODEINE, P. D. & Co.

<table><tr><td>(No. 130)</td><td>(Alcohol 35%)</td><td>42.60</td><td>....</td></tr><tr><td>Terpin hydrate</td><td>8 grs.</td><td></td><td></td></tr><tr><td>Codeine sulphate</td><td>1 gr.</td><td></td><td></td></tr></table>

## THREE BROMIDES, P. D. & Co. (No. 157)

<table><tr><td>(Alcohol 5%)</td><td>18.60</td><td>....</td></tr><tr><td>Caffeine bromide</td><td>8 grs.</td><td></td></tr><tr><td>Sodium bromide</td><td>8 grs.</td><td></td></tr><tr><td>Potassium bromide</td><td>8 grs.</td><td></td></tr></table>

[ 106 ]

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## TONGA COMPOUND, P. D. & Co.

<table><tr><td>(No. 183)</td><td>(Alcohol 18%)</td><td>$27.00</td><td>$14.80</td></tr></table>

(Elixir of Tonga and Salicylates, P. D. & Co.)

<table><tr><td>Tonga</td><td>64 grs.</td></tr><tr><td>Extract Cimicifuga</td><td>16 grs.</td></tr><tr><td>Sodium salicylate</td><td>40 grs.</td></tr><tr><td>Pilocarpine salicylate</td><td>8/100 gr.</td></tr><tr><td>Colchicine salicylate</td><td>8/500 gr.</td></tr></table>

This is our original formula. It is stronger than that given in the National Formulary.

## URITONE, 40 grs. (No. 149)

21.00 10.80

For note on Uritone, see page 47.

## URITONE COMPOUND (No. 154)

27.60 15.20

<table><tr><td>Uritone</td><td>10 grs.</td></tr><tr><td>Sandalwood</td><td>30 grs.</td></tr><tr><td>Corn Silk</td><td>120 grs.</td></tr><tr><td>Sabal (Saw Palmetto berries)</td><td>120 grs.</td></tr></table>

## URITONE COMP., R "B" (No. 164)

31.80 18.00

<table><tr><td>Uritone</td><td>40 grs.</td></tr><tr><td>Sandalwood</td><td>30 grs.</td></tr><tr><td>Corn Silk</td><td>120 grs.</td></tr><tr><td>Sabal (Saw Palmetto berries)</td><td>120 grs.</td></tr></table>

## UTROVOL (No. 167)

39.00 22.80

(Piscidia Compound)

<table><tr><td>Squaw Vine</td><td>40 grs.</td></tr><tr><td>Viburnum Prunifolium</td><td>60 grs.</td></tr><tr><td>Cimicifuga</td><td>30 grs.</td></tr><tr><td>Jamaica Dogwood</td><td>30 grs.</td></tr><tr><td>Hydrastis</td><td>30 grs.</td></tr><tr><td>Cascara Sagrada</td><td>10 grs.</td></tr><tr><td>Hyoscyamus</td><td>10 grs.</td></tr><tr><td>Potassium bromide</td><td>20 grs.</td></tr><tr><td>Extract Cannabis, U. S. P.</td><td>1 gr.</td></tr></table>

In ordering Medicinal Syrups or Elixirs, specify

P. D. & Co.

For Palatability

Pharmaceutical Elegance

Accuracy of Composition

[ 107 ]

["SOLUBLE GELATIN CAPSULES, FILLED", "SOLUBLE GELATIN CAPSULES, FILLED", "THE CAPSULES are made from the finest grade of gelatin procurable, and filled by the most modern machine method, which excludes all air from the inside of the capsule, thereby eliminating any danger of the capsule collapsing or becoming distorted in shape upon ageing.", "All capsules in this list, *unless otherwise specified*, are oval in shape, and are made of a soft and elastic gelatin composition.", "<table><thead><tr><th></th><th>Per doz.<br>bxs. of<br>12</th><th>Per<br>box of<br>100</th></tr></thead><tbody><tr><td>APIOL, GREEN, 5 minims (No. 1)</td><td>$4.50</td><td>$2.00</td></tr><tr><td>APIOL COMPOUND (No. 2)</td><td>5.40</td><td>2.60</td></tr><tr><td>Apiol, green</td><td>2 mins.</td><td></td></tr><tr><td>Oil Tansy</td><td>1½ mins.</td><td></td></tr><tr><td>Oil Savin</td><td>1½ mins.</td><td></td></tr><tr><td>APIOL AND ERGOTIN COMPOUND (No. 5)</td><td>4.50</td><td>2.00</td></tr><tr><td>Apiol, green</td><td>5 mins.</td><td></td></tr><tr><td>Ergotin</td><td>1 gr.</td><td></td></tr><tr><td>Oil Savin</td><td>½ min.</td><td></td></tr><tr><td>Aloin</td><td>⅛ gr.</td><td></td></tr><tr><td>BENZYL BENZOATE, 5 minims (No. 182)</td><td>4.80</td><td>2.20</td></tr><tr><td>Each capsule contains 5 minims of Benzyl Benzoate, diluted with 5 minims of vegetable oil. Antispasmodic.</td><td></td><td></td></tr><tr><td>CARBON TETRACHLORIDE, 20 minims (for human use) (No. 185)</td><td>5.40</td><td>2.60</td></tr><tr><td>Used as an anthelmintic, especially for the expulsion of hookworms. Directions for use accompany each package.</td><td></td><td></td></tr><tr><td>CASTOR OIL, 10 minims (No. 4)</td><td>3.60</td><td>1.40</td></tr><tr><td>CASTOR OIL, 15 minims (No. 167)</td><td>4.20</td><td>1.80</td></tr><tr><td>CASTOR OIL, 20 minims (No. 8)</td><td>4.50</td><td>2.00</td></tr><tr><td>CASTOR OIL, 2½ Gm. (No. 60)</td><td></td><td></td></tr><tr><td>in pasteboard boxes of 6 capsules. per doz. boxes $3.50</td><td></td><td></td></tr><tr><td>in pasteboard boxes of 50 capsules.....per box $1.50</td><td></td><td></td></tr></tbody></table>", "[108]", "SOLUBLE GELATIN CAPSULES, FILLED", "CASTOR OIL, 5 Gm. (No. 61)", "in pasteboard boxes of 6 capsules. . . . . . . . . . .

SOLUBLE GELATIN CAPSULES, FILLED

<table><thead><tr><th></th><th>Per doz.<br>bxs. of<br>12</th><th>Per<br>box of<br>100</th></tr></thead><tbody><tr><td>CHENOPODIUM OIL (American Wormseed), 5 min-<br>ims (No. 176)....................................</td><td>......</td><td>$3.40</td></tr><tr><td>in pasteboard boxes of 9 capsules. per doz. boxes $5.00</td><td></td><td></td></tr></tbody></table>

<table><thead><tr><th></th><th>Per doz.<br>bxs. of<br>12</th><th>Per<br>box of<br>100</th></tr></thead><tbody><tr><td>CHENOPODIUM OIL (American Wormseed), 10 min-<br>ims (No. 177)....................................</td><td>......</td><td>6.40</td></tr><tr><td>in pasteboard boxes of 9 capsules. per doz. boxes $8.40</td><td></td><td></td></tr><tr><td>Employed in the treatment of hookworm disease, or un-<br>cinariasis, especially for children. Directions for use<br>accompany each package.</td><td></td><td></td></tr></tbody></table>

COD-LIVER OIL, see page 109.

## COLCHICINE AND METHYL SALICYLATE

(No. 102) (Hard round gelatin capsule)

<table><tbody><tr><td>Colchicine..................</td><td>1/250 gr.</td></tr><tr><td>Methyl salicylate...........</td><td>3 mins.</td></tr><tr><td>in bottles of 50............</td><td>per doz. bottles $9.00</td></tr><tr><td>in bottles of 500...........</td><td>per bottle 4.00</td></tr><tr><td>in bottles of 1000...........</td><td>per bottle 7.50</td></tr></tbody></table>

Dose, 5 to 15 capsules during the day.

<table><tbody><tr><td>COPAIBA, 10 minims (No. 17)..................</td><td>$4.50</td><td>2.00</td></tr></tbody></table>

<table><tbody><tr><td>COPAIBA AND OIL OF CUBEB (No. 26)........</td><td>6.90</td><td>3.60</td></tr><tr><td>Copaiba.......................</td><td>7 mins.</td><td></td></tr><tr><td>Oil Cubeb.......................</td><td>3 mins.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>COPAIBA AND OLEORESIN CUBEB (No. 19).....</td><td>6.45</td><td>3.30</td></tr><tr><td>Copaiba.......................</td><td>7 mins.</td><td></td></tr><tr><td>Oleoresin Cubeb...............</td><td>3 mins.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>COPAIBA, CUBEB, MATICO and SANTAL (No. 39)</td><td>9.00</td><td>5.00</td></tr><tr><td>Copaiba.......................</td><td>3 mins.</td><td></td></tr><tr><td>Oleoresin Cubeb...............</td><td>3 mins.</td><td></td></tr><tr><td>Oleoresin Matico...............</td><td>1 min.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)....</td><td>3 mins.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>COPAIBA, CUBEB AND SANTAL (No. 23)........</td><td>6.90</td><td>3.60</td></tr><tr><td>Copaiba.......................</td><td>6 mins.</td><td></td></tr><tr><td>Oil Cubeb.......................</td><td>2 mins.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)....</td><td>2 mins.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>COPAIBA AND SANTAL (No. 28)..................</td><td>7.50</td><td>4.00</td></tr><tr><td>Copaiba.......................</td><td>5 mins.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)....</td><td>5 mins.</td><td></td></tr></tbody></table>

[110]

<table><thead><tr><th></th><th>Per doz.<br>bxs. of<br>12</th><th>Per<br>box of<br>100</th></tr></thead><tbody><tr><td>COPAIBA AND SANTAL COMPOUND (No. 11)....</td><td>$6.90</td><td>$3.60</td></tr><tr><td>Copaiba.......................</td><td>3½ mins.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)....</td><td>3½ mins.</td><td></td></tr><tr><td>Haarlem Oil.......................</td><td>3½ mins.</td><td></td></tr><tr><td>Oil Cinnamon...............</td><td>½ min.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>CREOSOTE, U. S. P., 2 minims (No. 151)........</td><td>3.90</td><td>1.60</td></tr><tr><td>With vegetable oil, 8 mins.</td><td></td><td></td></tr></tbody></table>

<table><tbody><tr><td>CREOSOTE, U. S. P., 5 minims (No. 169)........</td><td>5.40</td><td>2.60</td></tr><tr><td>With vegetable oil.</td><td></td><td></td></tr></tbody></table>

<table><thead><tr><th></th><th>(Hard round gelatin capsule)</th></tr></thead><tbody><tr><td>in bottles of 50..................</td><td>per doz. bottles $15.00</td></tr><tr><td>in bottles of 500..................</td><td>per bottle 6.25</td></tr></tbody></table>

<table><tbody><tr><td>CREOSOTE TONIC COMPOUND (Dr. D. F. Monash)<br>(No. 164)....................................</td><td>4.80</td><td>2.20</td></tr><tr><td>Creosote, U. S. P.......................</td><td>4 mins.</td><td></td></tr><tr><td>Cod-liver Oil.......................</td><td>8 mins.</td><td></td></tr><tr><td>Arsenous Acid.......................</td><td>1/500 gr.</td><td></td></tr><tr><td>Atropine.......................</td><td>1/2000 gr.</td><td></td></tr><tr><td>Strychnine sulphate...............</td><td>1/150 gr.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>CUBEB AND SANTAL (No. 48)..................</td><td>12.00</td><td>7.00</td></tr><tr><td>Oil Cubeb.......................</td><td>5 mins.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)....</td><td>5 mins.</td><td></td></tr></tbody></table>

<table><tbody><tr><td>HAARLEM OIL, 10 minims (No. 33)........</td><td>4.00</td><td>1.70</td></tr></tbody></table>

<table><tbody><tr><td>MALE-FERN AND KAMALA (No. 44)........</td><td>10.50</td><td>6.00</td></tr><tr><td>Oleoresin Aspidium...............</td><td>7 mins.</td><td></td></tr><tr><td>Kamala, sifted.......................</td><td>4 grs.</td><td></td></tr></tbody></table>

For expulsion of tapeworm. Directions with package.

## METHYLENE BLUE COMPOUND No. 2 (No. 104)
(Hard round gelatin capsule)

<table><tbody><tr><td>Methylene Blue.......................</td><td>1 gr.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)....</td><td>1½ mins.</td><td></td></tr><tr><td>Copaiba.......................</td><td>1½ mins.</td><td></td></tr><tr><td>Haarlem Oil.......................</td><td>1¼ mins.</td><td></td></tr><tr><td>Methyl salicylate...............</td><td>½ min.</td><td></td></tr><tr><td>in bottles of 50..................</td><td>per doz. bottles $18.60</td><td></td></tr><tr><td>in bottles of 500..................</td><td>per bottle 11.00</td><td></td></tr></tbody></table>

A variation upon the formula of Dr. Horwitz (page 112). Used principally in the treatment of gonorrhea; dose, 1 or 2 capsules three times a day.

[111]

<table><thead><tr><th></th><th>Per doz.<br>bxs. of<br>12</th><th>Per<br>box of<br>100</th></tr></thead><tbody><tr><td>METHYLENE BLUE COMPOUND (Dr. Orville<br>Horwitz) (No. 162)</td><td>$6.00</td><td>$3.00</td></tr><tr><td>Methylene Blue</td><td>1 gr.</td><td></td></tr><tr><td>Methyl salicylate</td><td>½ min.</td><td></td></tr><tr><td>Copaiba</td><td>1½ mins.</td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td>1½ mins.</td><td></td></tr></tbody></table>

<table><tr><td>PROPOSOTE, 5 minims (No. 105)</td><td>6.75</td><td>3.50</td></tr></table>

<table><tr><td>PROPOSOTE, 10 minims (No. 106)</td><td>10.50</td><td>6.00</td></tr><tr><td colspan="3">Proposote is a chemical combination of creosote and phe-<br>nylpropionic acid. Being insoluble in acid media, it does<br>not disturb the stomach when given after meals. Pre-<br>scribed in the early stages of whooping cough and in sub-<br>acute and chronic bronchitis.</td></tr></table>

<table><tr><td>QUININE HYDROBROMIDE, NEUTRAL, 5 grs.<br>(No. 206)</td><td>6.00</td></tr><tr><td colspan="2">Has been highly recommended for continuous treatment<br>of exophthalmic goiter, these patients being usually very<br>tolerant of quinine.</td></tr></table>

[112]

## SAL-ETHYL, 5 minims (No.107) (Hard round gelatin capsule)

<table><tr><td>in bottles of 50</td><td>per doz. bottles</td><td>$9.60</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>4.50</td></tr></table>

Sal-Ethyl is a chemically pure ethyl salicylate, transparent, colorless, and volatile, with a pleasant characteristic odor and taste. Our experiments have demonstrated that it is less likely to disturb the stomach than either natural or artificial methyl salicylate.

Dose, 2 to 4 capsules three or four times a day.

<table><tr><td>SALOL AND CASTOR OIL, No. 1 (No. 10)</td><td>$4.80</td><td>$2.20</td></tr><tr><td>Salol</td><td>5 grs.</td><td></td></tr><tr><td>Copaiba</td><td>5 mins.</td><td></td></tr></table>

<table><tr><td>SALOL COMPOUND (No. 85)</td><td>7.50</td><td>4.00</td></tr><tr><td>Salol</td><td>3½ grs.</td><td></td></tr><tr><td>Copaiba</td><td>10 mins.</td><td></td></tr><tr><td>Oleoresin Cubeb</td><td>5 mins.</td><td></td></tr></table>

[113]

<table><thead><tr><th></th><th>Per doz.<br>bxs of<br>12</th><th>Per<br>box of<br>100</th></tr></thead><tbody><tr><td><strong>SALOL AND METHYLENE BLUE COMPOUND (No. 14)</strong></td><td>$9.00</td><td>$5.00</td></tr><tr><td>Salol</td><td></td><td></td></tr><tr><td>Methylene Blue</td><td></td><td></td></tr><tr><td>Copaiba</td><td></td><td></td></tr><tr><td>Oleoresin Cubeb</td><td></td><td></td></tr><tr><td><strong>SALOL AND SANTAL, R "B" (No. 22)</strong></td><td>7.80</td><td>4.20</td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td></td><td></td></tr><tr><td>Salol</td><td></td><td></td></tr><tr><td><strong>SALOL AND SANTAL COMPOUND (No. 92)</strong></td><td>10.50</td><td>6.00</td></tr><tr><td>Salol</td><td></td><td></td></tr><tr><td>Oleoresin Cubeb</td><td></td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td></td><td></td></tr><tr><td><strong>SANTAL OIL, U. S. P. (East Indian), 5 mins. (No. 89) (Hard round gelatin capsule)</strong></td><td>6.90</td><td>3.60</td></tr><tr><td>(No. 111)</td><td></td><td></td></tr><tr><td>in bottles of 50</td><td>per doz. bottles</td><td>$22.20</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>11.15</td></tr><tr><td>in bottles of 1000</td><td>per bottle</td><td>20.65</td></tr><tr><td><strong>SANTAL OIL, U. S. P. (East Indian), 10 minims (No. 46)</strong></td><td>11.25</td><td>6.50</td></tr><tr><td><strong>SANTAL OIL COMPOUND (No. 112) (Hard round gelatin capsule)</strong></td><td></td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td>2 mins.</td><td></td></tr><tr><td>Copaiba</td><td>2 mins.</td><td></td></tr><tr><td>Oil Haarlem</td><td>1/2 min.</td><td></td></tr><tr><td>Methyl salicylate</td><td>1/2 min.</td><td></td></tr><tr><td>in bottles of 50</td><td>per doz. bottles</td><td>$16.20</td></tr><tr><td>in bottles of 500</td><td>per bottle</td><td>8.50</td></tr><tr><td>in bottles of 1000</td><td>per bottle</td><td>16.00</td></tr><tr><td><strong>SANTAL AND METHYLENE BLUE COMPOUND (No. 16)</strong></td><td>6.00</td><td>3.00</td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td>1 min.</td><td></td></tr><tr><td>Methylene Blue</td><td>1 gr.</td><td></td></tr><tr><td>Oleoresin Cubeb</td><td>1 min.</td><td></td></tr><tr><td>Salol</td><td>2 grs.</td><td></td></tr><tr><td>Copaiba</td><td>3 mins.</td><td></td></tr><tr><td>Oleoresin Matico</td><td>1 min.</td><td></td></tr><tr><td>Oil Cloves</td><td>1/4 min.</td><td></td></tr><tr><td><strong>WINTERGREEN OIL, 10 minims (Oil Sweet Birch) (No. 72)</strong></td><td>6.00</td><td>3.00</td></tr></tbody></table>

[ 114 ]

SOLUBLE GELATIN CAPSULES

## A Corner In Our Capsule Building

The Capsules enumerated on the preceding pages (108 to 114) are, of necessity, seamless, since the medication they contain is in liquid form. In all cases the gelatin makes a complete, unbroken investment, being built up around the contents by hydraulic pressure.

The capsules are adjusted to a definite minim capacity, so that when completely filled, as they invariably are when finished, they contain neither more nor less medicament than they should.

[ 115 ]

SOLUTIONS AND SPIRITS

SOLUTIONS AND SPIRITS

Alkaline Aromatic Solution, see Liquor Aromaticus Alkalinus, N. F.

ANTISEPTIC SOLUTION, N. F. (No. 31) (Alcohol 27%) in 16-fl.oz. bottles...................................................per dozen $12.00

AMMONIA, AROMATIC SPIRITS OF, U. S. P. (No. 2) (Alcohol 65%) in 16-fl.oz. glass-stoppered bottles...................................................per dozen 24.00

CAMPHOR, SPIRIT OF, U. S. P. (No. 24) (Alcohol 84%) in 16-fl.oz. bottles...................................................per dozen 30.00

Copaiba Mixture, N. F., see Lafayette Mixture.

FERROARSINE (No. 17) (Alcohol 15%) (Solution Iron Peptonate and Manganese with Arsenic and Strychnine) in 16-fl.oz. bottles...................................................per dozen 17.40

Represents 0.6% Iron and 0.1% Manganese, with Arsenic peptonate 8/50 grain and Strychnine sulphate 8/100 grain in each fluid ounce. Dose, 1 to 2 fluid drachms.

FERROCASCARIN (No. 18) (Alcohol 15%) (Solution Iron Peptonate and Manganese with Cascara Sagrada) in 16-fl.oz. bottles...................................................per dozen 18.60 in gallon bottles...................................................per gallon 9.20

Represents 0.6% Iron and 0.1% Manganese, with 40 minims fluid extract Cascara Sagrada in each fluid ounce. Dose, 1 to 2 fluid drachms.

FERROCHONINE (No. 19) (Alcohol 14%) (Solution Iron Peptonate and Manganese with Cinchona and Strychnine) in 16-fl.oz. bottles...................................................per dozen 18.60 in gallon bottles...................................................per gallon 9.20

Represents 0.6% Iron and 0.1% Manganese, with 40 grains Cinchona and 8/200 grain Strychnine sulphate in each fluid ounce. Dose, 1 to 2 fluid drachms.

[116]

SOLUTIONS AND SPIRITS

FERROSENICUM (No. 16) (Alcohol 15%) (Solution Iron Peptonate and Manganese with Arsenic) in 16-fl.oz. bottles...................................................per dozen $17.40

Represents 0.6% Iron and 0.1% Manganese, with 8/50 grain Arsenic peptonate in each fluid ounce. Dose, 1 to 2 fluid drachms.

GOLD BROMIDE WITH ARSENIC SOLUTION (No. 9) in 1 fl.oz. glass-stoppered bottles...................................................per dozen 8.40 in 4 fl.oz. glass-stoppered bottles...................................................per bottle 2.50 in 16-fl.oz. glass-stoppered bottles...................................................per bottle 9.00

Ten minims of this solution contains 1/32 grain tribromide of Gold, and Arsenic equivalent to 1/16 grain of arsenic tribromide. An alternative combination, recommended in diabetes mellitus and in skin diseases due to perverted metabolism. Dose, 5 to 10 minims.

IRON AND MANGANESE SOLUTION (AROMATIC) (No. 14) (Alcohol 15%) in 16-fl.oz. bottles...................................................per dozen 17.40 in gallon bottles...................................................per gallon 8.40

Contains 0.6% Iron and 0.1% Manganese. Dose, 1 to 4 fl. drs.

IRON PEPTONATE AND MANGANESE SOLUTION (No. 15) (Alcohol 15%) in 16-fl.oz. bottles...................................................per dozen 17.40

Contains 0.6% Iron and 0.1% Manganese. Dose, 1 to 4 fl. drs. Parke, Davis & Company retain, for this product, their original formula, which differs from that given in the National Formulary.

LAFAYETTE MIXTURE (No. 30) (Alcohol 20%) (Copaiba Mixture, N. F.) in 16-fl.oz. bottles...................................................per dozen 19.20 in gallon bottles...................................................per gallon 9.60

Each fluid ounce contains:

<table><tr><td>Spirit Ethyl Nitrite, U. S. P.</td><td>60 mins.</td></tr><tr><td>Copaiba</td><td>60 mins.</td></tr><tr><td>Compound Tincture Lavender, U. S. P.</td><td>60 mins.</td></tr><tr><td>Solution Potassium Hydroxide, U. S. P.</td><td>15 mins.</td></tr></table>

LIQUOR ANTISEPTICUS, N. F., see Antiseptic Solution, N. F.

LIQUOR AROMATICUS ALKALINUS, N. F. (No. 1) (A red solution) (Alcohol 4%) in 16-fl.oz. bottles...................................................per dozen 12.00

[117]

LINIMENTS

LINIMENTS

<table><thead><tr><th>ANODYNE LINIMENT (No. 1)</th><th>(Alcohol 30%)</th><th></th></tr></thead><tbody><tr><td>in 16-fl.oz. bottles</td><td>per dozen</td><td>$12.60</td></tr><tr><td>in gallon bottles</td><td>per gallon</td><td>5.20</td></tr></tbody></table>

Contains Camphor, Capsicum, Aqua Ammonia, Oil Wintergreen artificial, and Oils of Cloves, Mustard, Peppermint, Cajuput, and Sassafras.

<table><thead><tr><th>CAMPHOR LINIMENT, U. S. P. (Camphorated Oil) (No. 12)</th><th></th><th></th></tr></thead><tbody><tr><td>in 16-fl.oz. bottles</td><td>per dozen</td><td>21.00</td></tr></tbody></table>

A special grade of purified oil of cottonseed is used in making our Camphor Liniment; this, however, does not prevent it from becoming quite hazy when chilled and partly solidifying when kept in a freezing temperature. It is, therefore, advisable to keep it in a reasonably warm place.

<table><thead><tr><th>CHLOROFORM LINIMENT, U. S. P. (No. 3)</th><th>(Alcohol 45%)</th><th></th></tr></thead><tbody><tr><td>in 16-fl.oz. bottles</td><td>per dozen</td><td>16.80</td></tr></tbody></table>

<table><thead><tr><th>SOAP LINIMENT, U. S. P. (No. 5)</th><th>(Alcohol 63%)</th><th></th></tr></thead><tbody><tr><td>in 16-fl.oz. bottles</td><td>per dozen</td><td>12.00</td></tr></tbody></table>

<table><thead><tr><th>WHITE LINIMENT, CAMPHORATED (No. 6)</th><th></th><th></th></tr></thead><tbody><tr><td>in 16-fl.oz. bottles</td><td>per dozen</td><td>12.00</td></tr><tr><td>in gallon bottles</td><td>per gallon</td><td>4.80</td></tr></tbody></table>

Contains Camphor, Oil Turpentine, Ammonia, and Oil Origanum, with a suitable saponaceous base. For external use only.

EFFERVESCENT SALTS

<table><thead><tr><th>SODIUM PHOSPHATE, U. S. P. (No. 21)</th><th></th><th></th></tr></thead><tbody><tr><td>in 4-oz. bottles</td><td>per dozen</td><td>$6.60</td></tr><tr><td>in 1-lb. bottles</td><td>per bottle</td><td>1.40</td></tr></tbody></table>

Each 100 Gm. contains 20 Gm. exsiccated Sodium phosphate, equal to 50 Gm. Sodium phosphate, U. S. P.

[ 118 ]

AMPOULES

AMPOULES

Average single doses, sterile and ready for use, enclosed in glass.

A SUFFICIENT slight excess of solution is placed in each ampoule to permit the physician to obtain in his hypodermic syringe the amount specified on the label.

The following list is complete except for the fact that certain items otherwise classified (as gland products, miscellaneous preparations, etc.) are merely mentioned, with cross-reference to the page where quotations and other data are given.

The ampoule solutions and suspensions are intended, with the few exceptions noted in the list, for hypodermic administration —subcutaneous or intramuscular except as otherwise advised; and all are ready for instant use except the Glucose Solution, which should be further diluted.

In case of necessity, many of the simple aqueous solutions not specifically designed for intravenous use can be given intravenously, with proper care—which, in a word, means intravenous technique and very gradual introduction of the solution into the vein. In case of solutions containing protein, if given intravenously, special care must be taken to avoid shock.

The physician cannot test, except clinically, the ampoule solutions he uses; he must depend upon the manufacturer for their identity and quality, the accuracy of the dose, and other important details. In the manufacture of the Parke, Davis & Company Ampoules the following problems have been met and mastered:

1. FORM. Aqueous or saline solution, or suspension in a readily absorbable oil.

2. STERILIZATION. Not always a simple matter. Some chemical combinations are injured by heat.

(Continued on page 121)

[ 119 ]

AMPOULES

P
M
O
U
L
E
S

CO

LEERS

The potentiometric method of determining the
hydrogen-ion concentration of solutions

A sectional view of our Ampoule department

[ 120 ]

AMPOULES

P
M
O
U
L
E
S

CO

LEERS

3. STANDARDIZATION. Both chemistry and pharmacology contribute.

4. STABILITY. A question of purity *and* chemical balance.

5. PRESERVATION. In alkali-free glass—none other.

6. ACID-BASE EQUILIBRIUM (hydrogen-ion concentration). Assured by potentiometer tests.

We have an illustrated booklet of over 50 pages, with therapeutic index, on Ampoules, which we shall be glad to send to any physician who may make request for it.

ADRENALIN CHLORIDE SOLUTION, see page 1.

ADROCAINE, see page 6.

AMYL NITRITE, 5 minims (for inhalation, not injection) (No. 50)
in decorated tin boxes of 12 ampoules..........per box $2.00

The Amyl Nitrite is intended for inhalation—NOT for hypodermic injection. The Ampoules are about 1⅜ inches in length and ⅛ inch in diameter, with a file mark in the center to secure clean fracture when needed. Each ampoule is enclosed in a knitted covering of absorbent texture.

[ 121 ]

AMPOULES

ANTUITRIN, see Gland Products, page 71.

BISMUTH SALICYLATE, 2 grs. (No. 154)

For intramuscular injection only

in boxes of one dozen 1-cc ampoules...................per box $2.50

Each cubic centimeter (cc) contains:

Bismuth Salicylate..................0.13 Gm. (2 grs.)

Chloretone (chlorbutanol)............3%

Oil base................................q.s.

Bismuth Salicylate is an antisyphilitic remedy. It is especially valuable in the treatment of cases in which there is intolerance or resistance to arsenicals and mercurials and for the control of the subjective symptoms of neurosyphilis.

The usual dose is 1 to 2 grains, once a week, until twelve to fifteen injections have been administered.

Injections should be made slowly and deeply into the muscles. This product should *never be administered intravenously*

CAFFEINE SODIO-BENZOATE, 7½ grs. (No. 3)

in boxes of one dozen 2-cc ampoules...................per box 2.00

Each 2 cc contains:

Caffeine Sodio-Benzoate............0.5 Gm. (7½ grs.)

Distilled water................................q.s.

In the use of this combination of Caffeine and Sodium Benzoate, the principal therapeutic action is due to the Caffeine, which is a heart stimulant having a sustaining effect upon the motor nerves and a stimulating effect upon the kidney function.

This solution is used in the treatment of neuralgias, heart failure, cardiac dropsy, chronic nephritis, collapse, and pneumonia of the aged.

The dose is 1 to 2 cc, to be repeated as the results may indicate. Administration may be subcutaneous, intramuscular or intravenous.

CALCIUM CHLORIDE, 15½ grs. (No 213)

For intravenous administration

in boxes of six 10-cc ampoules...................per box 2.00

in boxes of twenty-five 10-cc ampoules...................per box 6.40

Each 10 cc contains:

Calcium Chloride..................1 Gm. (15½ grs.)

This solution, administered intravenously, is used in the treatment of paralysis agitans, tetany, epilepsy and chorea. It is also used to

[ 122 ]

AMPOULES

promote calcification in tuberculosis; to supply the needed calcium in slow coagulation hemorrhages; and in conjunction with the administration of parathyroid extract in varicose ulcer and in chronic ulcerative toxemias.

Extreme care must be exercised in the administration of Calcium Chloride solutions to avoid any leakage into the perivascular tissue. When such leakage occurs, there is liability of serious sloughing.

Never inject this product subcutaneously or intramuscularly.

The usual dose is 10 cc at intervals of one to three days.

The rate of injection should not exceed 2 cc per minute.

CAMPHOR IN OIL

This solution, when administered intramuscularly, acts as a diffusible stimulant and probably also as a heart stimulant, and is used in cases of nervous depression, hysteria, convalescence from acute or chronic disease (such as typhoid), and in the crisis of lobar pneumonia.

Camphor is generally administered in doses of from 3 to 10 grains, repeating as required. In the failing heart of pneumonia, 36 grains may be given every 12 hours.

Ampoule No. 4—3 grs.

in boxes of one dozen 1-cc ampoules...................per box $1.80

Camphor, pure..................0.2 Gm. (3 grs.)

Vegetable oil...................q.s.

[ 123 ]

AMPOULES

### Ampoule No. 150—10 grs.

<table><tr><td>in boxes of six 5-cc ampoules</td><td>per box</td><td>$1.50</td></tr><tr><td colspan="3">Each 5 cc contains:</td></tr><tr><td>Camphor, pure</td><td>0.65 Gm. (10 grs.)</td><td></td></tr><tr><td>Vegetable oil</td><td>q.s.</td><td></td></tr></table>

### Ampoule No. 45—36 grs.

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>2.20</td></tr><tr><td colspan="3">Each 10 cc contains:</td></tr><tr><td>Camphor, pure</td><td>2.35 Gm. (36 grs.)</td><td></td></tr><tr><td>Vegetable oil</td><td>q.s.</td><td></td></tr></table>

CORPORA LUTEA, see Gland Products, page 63.

DIGITALONE, see page 21.

## EMETINE HYDROCHLORIDE

Emetine Hydrochloride, administered hypodermically, has been found to give beneficial results in the treatment of amebic dysentery, amebic hepatitis and other manifestations of invasion of the tissues by the Endameba hystolitica.

The usual dose is 1/3 to 1 grain two or three times daily until a total of not more than 8 grains has been given. Repetition of the treatment at intervals of two or three months has been recommended to forestall recurrence of the symptoms.

### Ampoule No. 40—1/3 gr.

<table><tr><td>in boxes of six 1/2-cc ampoules</td><td>per box</td><td>1.80</td></tr><tr><td colspan="3">Each 1/2 cc contains:</td></tr><tr><td>Emetine Hydrochloride</td><td>0.02 Gm. (1/3 gr.)</td><td></td></tr><tr><td>Physiologic salt solution</td><td>q.s.</td><td></td></tr></table>

### Ampoule No. 76—1/2 gr.

<table><tr><td>in boxes of six 1-cc ampoules</td><td>per box</td><td>2.00</td></tr></table>

### Ampoule No. 133—1 gr.

<table><tr><td>in boxes of six 1-cc ampoules</td><td>per box</td><td>3.20</td></tr></table>

EPHEDRINE SULPHATE, see page 21.

ERGOT ASEPTIC, see page 23.

ESTROGEN, see Gland Products, page 64.

[124]

AMPOULES

## GLUCOSE (Dextrose, U. S. P.) For intravenous administration

In the preparation of this solution we use crystallized Dextrose, U. S. P., which has been shown by thorough and exacting tests to be of exceptional purity.

Glucose in solution is indicated for intravenous administration in cases in which there is a pronounced disturbance of metabolism due to deficiency of carbohydrates, as frequently occurs in the toxemias of pregnancy, excessive muscular movement (as in chorea and eclampsia), postoperative shock and acidosis, hyperthyroidism, acute infections and other disease conditions attended with severe toxemia, as well as in hypoglycemia from insulin overdosage.

Before injection the solution should be diluted to twice its volume by the addition of sterile distilled water.

The solution, as marketed, contains a buffer salt which has been added to maintain the proper hydrogen-ion concentration and prevent excessive reaction.

### Ampoule No. 224—10 Gm. in 20 cc.

<table><tr><td>in boxes of 6</td><td>per box</td><td>$3.50</td></tr><tr><td>in boxes of 25</td><td>per box</td><td>12.25</td></tr></table>

### Ampoule No. 220—25 Gm. in 50 cc.

<table><tr><td>in boxes of 6</td><td>per box 6</td><td>8.70</td></tr><tr><td>in boxes of 25</td><td>per box of 25</td><td>30.00</td></tr><tr><td>single ampoules</td><td>each</td><td>1.50</td></tr></table>

[125]

AMPOULES

MEDCAMPAIGN
VERA

## GLYCEROPHOSPHATE COMPOUND (No. 35)

in boxes of one dozen 1-cc ampoules...per box $1.80

Sodium Glycerophosphate...0.1 Gm. (1½ grs.)

Strychnine cacydlate...0.0005 Gm. (1/125 gr.)

Iron cacydlate...0.01 Gm. (1/6 gr.)

Chloretone (chlorbutanol)...0.5%
Distilled water...q.s.

This combination of iron, arsenic and strychnine with sodium glycerophosphate is of particular value as a reconstructive tonic in anemia, neurasthenia, tardy convalescence, and general debility. It may be administered either subcutaneously or intramuscularly, the dose being 1 cc at intervals of one to three days.

Hexamethylenamine, see Uritone, page 145.

## IRON ARSENITE

Iron Arsenite is intended for use in cases in which combined iron and arsenic medication is indicated. It has been used with satisfactory results in the treatment of dry, scaly forms of cutaneous disease, especially in anemic subjects; in the anemia of chronic diarrhea or of malarial intoxication; chlorosis; pellagra; and chorea. Iron Arsenite should be injected deeply into the muscular tissues. The initial dose should be small and subsequent doses gradually increased as indicated by the tolerance of the patient. Too large doses are apt to cause excessive irritation and severe reactions. Injections may be given at intervals of two or three days.

[ 126 ]

AMPOULES

MEDCAMPAIGN
VERA

### Ampoule No. 87—1/6 gr.

in boxes of one dozen 1-cc ampoules...per box $1.50

Iron Arsenite...0.01 Gm. (1/6 gr.)

Quinine and Urea hydrochloride...0.5%

Distilled water...q.s.

### Ampoule No. 8—1 gr.

in boxes of one dozen 1-cc ampoules...per box 1.50

Iron Arsenite...0.065 Gm. (1 gr.)

Distilled water...q.s.

## IRON ARSENITE AND MANGANESE (No. 113)

in boxes of one dozen 1-cc ampoules...per box 1.60

Iron Arsenite...0.05 Gm. (3/4 gr.)

Manganese citrate...0.00065 Gm. (1/100 gr.)

Distilled water...q.s.

Manganese, besides its direct action, is believed to act also as a synergistic agent when associated with iron, greatly enhancing the therapeutic action of the latter.

[ 127 ]

AMPOULES

This combination has been found to have a beneficial action in the treatment of anemic conditions, especially when disturbance in the nutrition of the patient has resulted in skin lesions, such as eczema and psoriasis.

The same cautions as to dosage are to be heeded as are referred to under Iron Arsenite, page 126. Average dose, ½ to 1 cc.

## IRON ARSENITE AND STRYCHNINE

This combination is suggested for use in the treatment of atonic dyspepsia with anemia; chlorosis, malnutrition, convalescence, etc. It is of particular service in the treatment of dry or scaly eczema.

As in our other iron solutions, the quinine and urea hydrochloride is added in this case for the purpose of mitigating the discomfort that iron is so apt to cause when lodged under the skin. The intramuscular method of administration is recommended.

The injection should be made deeply into the muscle tissue; and the initial dose should be small, subsequent doses being increased in accordance with the tolerance of the patient.

### Ampoule No. 9

in boxes of one dozen 1-cc ampoules...................per box $1.60

<table><tr><td>Iron Arsenite</td><td>0.065 Gm. (1 gr.)</td></tr><tr><td>Strychnine nitrate</td><td>0.001 Gm. (1/65 gr.)</td></tr><tr><td>Quinine and Urea hydrochloride</td><td>0.5%</td></tr><tr><td>Distilled water</td><td>q.s.</td></tr></table>

### Ampoule No. 119 (R B)

in boxes of one dozen 1-cc ampoules...................per box 1.60

<table><tr><td>Iron Arsenite</td><td>0.05 Gm. (¾ gr.)</td></tr><tr><td>Strychnine nitrate</td><td>0.001 Gm. (1/65 gr.)</td></tr><tr><td>Quinine and Urea hydrochloride</td><td>0.5%</td></tr><tr><td>Distilled water</td><td>q.s.</td></tr></table>

### Ampoule No. 120 (R C)

<table><tr><td>Iron Arsenite</td><td>0.015 Gm. (¼ gr.)</td></tr><tr><td>Strychnine nitrate</td><td>0.00065 Gm. (1/100 gr.)</td></tr><tr><td>Quinine and Urea hydrochloride</td><td>0.5%</td></tr><tr><td>Distilled water</td><td>q.s.</td></tr></table>

[ 128 ]

AMPOULES

## IRON CACODYLATE

Iron Cacodylate is indicated for its combined tonic and alternative action in the treatment of anemic conditions and in dry skin affectedions. It has a somewhat different effect from that of Iron Arsenite, due to the larger proportion of arsenic present.

Our Iron Cacodylate is prepared by a special chemical process which yields a product unusually free from irritating effect and the tendency to cause excessive reaction. It can be given in comparatively large doses without toxic effects, since the liberation of arsenic in the body takes place slowly.

The usual dose is ½ grain, and intramuscular administration is recommended. The initial dose should be small, subsequent doses being increased in accordance with the tolerance of the patient.

### Ampoule No. 27—½ gr.

<table><tr><td>Iron Cacodylate</td><td>0.03 Gm. (½ gr.)</td></tr><tr><td>Distilled water</td><td>q.s.</td></tr></table>

For intravenous administration use Ampoule No. 207. It is advisable, because of the varying susceptibility of patients to arsenic, to begin with 1-cc doses, gradually increasing the successive injections, at intervals of two or three days, up to 5 cc, and then continue this dosage according to indications.

[ 129 ]

AMPOULES

### Ampoule No. 207—1 gr. For intravenous administration.

<table><tr><td>in boxes of six 5-cc ampoules</td><td>per box</td><td>$1.50</td></tr><tr><td>in boxes of twenty-five 5-cc ampoules</td><td>per box</td><td>4.80</td></tr></table>

Each 5 cc contains:

Iron Citrate..................0.065 Gm. (1 gr.)

Distilled water..................q.s.

## IRON CITRATE, GREEN

Iron and Ammonium Citrate has a beneficial action in the treatment of chlorosis and secondary anemias. It is freely soluble and is quickly absorbed without the constipating effect so evident when iron is administered orally. Although less irritating than most iron salts when administered hypodermically, it has been considered advisable to add a local anesthetic to minimize any irritation which might result.

Doses of ¼ to 1½ grains may be given daily or on alternate days. The size of dose must be determined by the tolerance of the patient. Intramuscular rather than subcutaneous administration is recommended.

### Ampoule No. 118—¼ gr.

Iron and Ammonium Citrate...........0.015 Gm. (¼ gr.)

Quinine and Urea hydrochloride...........0.5%

### Ampoule No. 25—¾ gr.

Iron and Ammonium Citrate...........0.05 Gm. (¾ gr.)

### Ampoule No. 7—1½ grs.

Iron and Ammonium Citrate...........0.1 Gm. (1½ grs.)

[130]

AMPOULES

## IRON CITRATE AND MANGANESE (No. 114)

Iron Citrate..................0.05 Gm. (¾ gr.)

Manganese citrate...........0.00065 Gm. (1/100 gr.)

The Manganese reinforces and enhances the hematinic action of the Iron Citrate. This combination is used in the treatment of chlorosis and secondary anemias.

Intramuscular injection is recommended as giving more decided results with less local irritation than subcutaneous injections.

One cubic centimeter is generally considered the proper dose.

## MAGNESIUM SULPHATE

Magnesium Sulphate, used with morphine, produces a pronounced synergistic effect, thereby greatly prolonging and intensifying the analgesic action of the morphine.

For hypodermic administration, if the morphine is dissolved in a 50% solution of Magnesium Sulphate as supplied in Ampoule No. 222, only about one-half the usual amount of Morphine is required, and the effect may be prolonged to five times its usual duration.

A preliminary injection of Morphine and Magnesium Sulphate facilitates inhalation anesthesia and reduces its risks.

### Ampoule No. 222—50%

in boxes of one dozen 2-cc ampoules...................per box 1.50

Each 2 cc contains:

Magnesium Sulphate..................1 Gm. (15½ grs.)

Magnesium Sulphate in 25% solution, as supplied in Ampoule No. 221, has been found decidedly effective in the treatment of cases in which there is need of a powerful depressant action on the central nervous system. The spasmodic symptoms caused by such diseases as eclampsia and tetanus can often be controlled by the intravenous administration of this solution.

The usual dose is 5 to 10 cc, repeated hourly if necessary.

### Ampoule No. 221—25%. For intravenous administration.

Each 10 cc contains:

Magnesium Sulphate..................2.5 Gm. (39 grs.)

[131]

AMPOULES

## MERCURIC IODIDE, RED

Mercuric Iodide is favored by many physicians for intramuscular administration as an antisyphilitic. The aqueous solution is for use where quick results are desired, but if slower absorption is indicated the solution in oil should be employed.

Intramuscular administration is recommended and the gluteus maximus is considered the most favorable site.

It is preferable to employ a syringe with glass barrel and piston, and platinum-irridium needle; otherwise there is danger of corrosion. The usual dose is 1 cc, repeated at two-day intervals.

### Ampoule No. 10—1/6 gr. (1% Aqueous Solution)

in boxes of one dozen 1-cc ampoules...................................per box $1.60

Mercuric Iodide, Red..................0.01 Gm. (1/6 gr.)

Sodium iodide..................0.01 Gm. (1/6 gr.)

Physiologic salt solution..................q.s.

### Ampoule No. 107—1/3 gr. (2% Aqueous Solution)

in boxes of one dozen 1-cc ampoules...................................per box 1.60

Mercuric Iodide, Red..................0.02 Gm. (1/3 gr.)

Sodium iodide..................0.02 Gm. (1/3 gr.)

### Ampoule No. 11—1/6 gr. (1% Solution in Oil)

Potassium iodide..................q.s.

Chloretone..................2%

Pure vegetable oil..................q.s.

### MERCUROSAL, see page 29.

## MERCURY CYANIDE, 1/6 gr. (No. 85)

Mercury Cyanide..................0.01 Gm. (1/6 gr.)

Apothesine..................0.5%

Mercury Cyanide is suggested for use in cases in which a soluble mercury salt is indicated, as in the treatment of syphilis.

[ 132 ]

AMPOULES

## MERCURY SALICYLATE

Mercury Salicylate is indicated for use in cases in which an insoluble mercury salt is desired, as in the treatment of syphilis. When administered intramuscularly it is slowly absorbed and therefore is not likely to produce salivation or toxic action.

The injections should be made slowly and deeply into the muscular tissues—*never administer intravenously*.

Our formula for this product has recently been so improved that very little shaking is required to obtain a complete suspension of the mercury salicylate in the oil. Apothesine is added for its anesthetic action. The usual dosage is 1 to 2 grains, at weekly intervals.

### Ampoule No. 108—1 gr.

in boxes of one dozen 1-cc ampoules...................................per box $2.00

Mercury Salicylate..................0.065 Gm. (1 gr.)

Basic Apothesine..................1%

Oil base..................q.s.

### Ampoule No. 109—2 grs.

in boxes of one dozen 1-cc ampoules...................................per box 2.20

Mercury Salicylate..................0.13 Gm. (2 grs.)

[ 133 ]

["AMPOULES", "## MERCURY SUCCINIMIDE, 1/6 gr. (No. 56)", "in boxes of one dozen 1-cc ampoules. . . . . . . . . . . . .

["AMPOULES", "### Ampoule No. 205—10 grs. For intravenous administration.", "in boxes of six 20-cc ampoules. . . . . . . . . . . . . .

["AMPOULES", "P\nC\nL\nA\nM\nO\nU\nL\nE\nS\n\nC\nD\nA\nM\nO\nU\nL\nE\nS", "SODIUM CACODYLATE", "Sodium Cacodylate is an organic arsenical which can be given hypodermically in comparatively large doses without toxic effect. This low toxicity is due to the fact that the liberation of arsenic in the body takes place slowly.", "Sodium Cacodylate is extensively employed in the treatment of malarial cachexia, neurasthenia, psoriasis, anemia, leukemia and pellagra.", "Injection of the contents of the 1-cc and 2-cc ampoules should be made slowly and deeply into the muscular tissues.", "For intravenous use—See Ampoules Nos. 201, 202 and 203. The solutions contained in these three ampoules are especially prepared for intravenous administration in cases in which the tonic or alterative action of arsenic is desired.", "The size of the initial dose and the rate of increase will be governed by the tolerance of the patient as well as the character of the disease under treatment.", "Dose: 0.05 Gm. (¾ gr.) to 1 Gm. (15½ grs.) for adults. Children require relatively smaller doses.", "Ampoule No. 20—¾ gr.", "in boxes of one dozen 1-cc ampoules . . . . . . . . . . . .

AMPOULES

Ampoule No. 126—15½ grs.

in boxes of one dozen 2-cc ampoules...................per box $3.00

Each 2 cc contains:

Sodium Cacodylate, chemically pure.. 1 Gm. (15½ grs.)

Distilled water....................................q.s.

Ampoule No. 203—15½ grs. For intravenous administration.

in boxes of six 10-cc ampoules...................per box 2.40

in boxes of twenty-five 10-cc ampoules...........per box 7.70

Each 10 cc contains:

SODIUM CITRATE, 2½% (No. 206)

For use in blood transfusion

in 50-cc ampoules...................single ampoules 1.00

per box of six ampoules 5.50

Each ampoule contains 50 cc of a 2.5% aqueous solution of chemically pure Sodium Citrate. For use in blood transfusion. The contents of one ampoule will prevent the coagulation of 500 cc of blood.

For service in any case in which it is impracticable to transfer
donated blood directly from donor to recipient without exposure to
the air, this Sodium Citrate solution is supplied. By adding the
citrate solution to the drawn blood, in the proportions advised,
coagulation is prevented until transfusion into the vein of the
patient can be effected.

For determining the compatibility of the two bloods—the giver's
and the receiver's—blood-typing serums, as described on page 212,
should be used.

SODIUM GLYCEROPHOSPHATE, 1½ grs. (No. 38)

in boxes of one dozen 1-cc ampoules...................per box 1.50

Sodium Glycerophosphate...........0.1 Gm. (1½ grs.)

Sodium Glycerophosphate is believed to supply phosphorus to the
cells and tissues of the body in an easily assimilable form.

It has been found of value in the treatment of muscular and nervous
debility, rachitis, osteomalacia, etc. It is claimed to accelerate
metabolism while retarding the elimination of organic phosphorus.

The dose of this product is 1 cc daily or on alternate days, as indicated by the response of the patient.

[140]

AMPOULES

SODIUM IODIDE

These solutions are specially prepared for intravenous injection in cases in which intensive iodide medication is desired.

Sodium Iodide gives very satisfactory results when employed intravenously, since it does not noticeably depress the heart and rarely produces iodism.

It is frequently used in the treatment of gonorrheal sequelæ and has also been found of decided value in the treatment of asthma and simple goiter. It is also employed in scrofula, syphilitic gummata, and arteriosclerosis.

The average dose is 10 to 20 cc daily or on alternate days. In the treatment of syphilitic lesions the dose must be rapidly increased to the limit of the patient's tolerance.

Ampoule No. 208—15½ grs. For intravenous administration.

in boxes of six 10-cc ampoules...................per box $2.50

in boxes of twenty-five 10-cc ampoules...........per box 8.00

Each 10 cc contains:

Sodium Iodide..................1 Gm. (15½ grs.)

Ampoule No. 211—31 grs. For intravenous administration.

in boxes of six 20-cc ampoules...................per box 3.50

in boxes of twenty-five 20-cc ampoules...........per box 11.20

[141]

AMPOULES

## SODIUM IODIDE AND SODIUM SALICYLATE, 31 grs.

(No. 216)

<table><tr><td>in boxes of six 20-cc ampoules</td><td>per box</td><td>$3.00</td></tr><tr><td>in boxes of twenty-five 20-cc ampoules</td><td>per box</td><td>9.60</td></tr></table>

Each 20 cc contains:

Sodium Salicylate..............1 Gm. (15½ grs.)

This combination is employed in the treatment of acute and chronic arthritis, particularly when a luetic factor is present. It is also frequently of service in bronchial asthma, and in lumbago, sciatica, etc.

The solution should be administered intravenously in doses of 10 to 20 cc at intervals of two to four days—depending upon the conditions to be treated.

## SODIUM SALICYLATE, 20 grs. (No. 217)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>1.70</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>5.50</td></tr></table>

Each 10 cc contains:

Sodium Salicylate..................1.3 Gm. (20 grs.)

Intravenous administration of Sodium Salicylate eliminates almost entirely the gastric disturbances so frequently evident when this salt is administered orally.

It is indicated especially in the treatment of rheumatism due to streptococci, and in streptococcic tonsillitis. Clinical evidence indicates that it also has decided value in the treatment of infectious diseases, as sepsis and pneumonia, in which a powerful antiseptic is indicated. It is sometimes employed because of its antipyretic and analgesic action, for the relief of pain in neuralgia and myalgia.

A dose of 20 grains is generally employed, administration being made daily for five days and subsequently on alternate days.

## SODIUM SALICYLATE COMPOUND (No. 223)

<table><tr><td>in boxes of six 20-cc ampoules</td><td>per box</td><td>3.00</td></tr><tr><td>in boxes of twenty-five 20-cc ampoules</td><td>per box</td><td>9.60</td></tr></table>

Each 20 cc contains:

Sodium Salicylate..................1 Gm. (15½ grs.)

Colchicine..................0.00065 Gm. (1/100 gr.)

[ 142 ]

AMPOULES

The formula for this combination differs from that of Ampoule No. 216 (Sodium Iodide and Sodium Salicylate) only in the addition of colchicine.

While this product may be employed for the same conditions as the other, it is specially indicated in the treatment of gout, since colchicine apparently has particular value in conditions of this type.

The usual dose is 10 to 20 cc, intravenously, at intervals of two to four days.

## SODIUM THIOSULPHATE, 7½ grs. (No. 219)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>$1.50</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>4.80</td></tr></table>

Each 10 cc contains:

Sodium Thiosulphate..................0.5 Gm. (7½ grs.)

Sodium Thiosulphate, administered intravenously, has been found of great service in cases of arsenical poisoning, as from the administration of arsphenamine or other arsenical compounds to patients who are hypersensitive to these drugs.

It is customary to begin the treatment with about 0.3 Gm. intravenously, following on successive days with doses of 0.45, 0.60 and 0.75 Gm., and then on alternate days with 0.9, 1.2 and 1.8 Gm. If by this time the symptoms have not entirely disappeared the last dose may be repeated on alternate days.

Sodium Thiosulphate has been used also in cases of bismuth and mercurial poisoning, but with inconclusive results.

[ 143 ]

AMPOULES

STRYCHNINE SULPHATE

Strychnine Sulphate is a prompt and powerful stimulant to the nervous system and indirectly to the circulatory system and the respiratory center.

When the solution is administered hypodermically it is of great value in the treatment of acute collapse and shock, faintness and other emergencies arising from a weakened circulation, and as an antidote in poisoning by chloroform or chloral hydrate.

Ampoule No. 63—$\frac{1}{64}$ gr.

in boxes of one dozen 1-cc ampoules...................per box $1.50

Strychnine Sulphate...................0.001 Gm. (1/64 gr.)

Physiologic salt solution...................q.s.

Ampoule No. 64—$\frac{1}{32}$ gr.

Strychnine Sulphate...................0.002 Gm. (1/32 gr.)

TARTAR EMETIC, 1% (No. 209) (Antimony and Potassium Tartrate) For intravenous administration

in boxes of six 5-cc ampoules...................per box 1.50

in boxes of twenty-five 5-cc ampoules...................per box 4.80

Each 5 cc contains:

Antimony and Potassium Tartrate...0.05 Gm. ($\frac{3}{4}$ gr.)

Distilled water...................q.s.

This 1% solution of Tartar Emetic is prepared for intravenous administration in the treatment of granuloma inguinale (tropical ulcer).

The usual dose is 5 cc intravenously, at intervals of three or four days, or the initial dose may be 2 cc, gradually increasing to a maximum of 10 cc.

This product has also been found of value in the treatment of Vincent's angina (trench mouth) and of chancroidal infections and complications.

THIO-BISMOL, see page 45.

THYROPROTEIN, see Gland Products, page 77.

[ 144 ]

AMPOULES

URITONE, 31 grs. (No. 212) (Hexamethylenamine)

in boxes of six 5-cc ampoules...................per box $1.50

Each 5 cc contains:

Uritone...................2 Gm. (31 grs.)

This 40% solution of Uritone is used for intravenous administration in the treatment of pyelitis, acute nephritis, spirochetosis, and especially for the relief of anuria and dysuria.

The dose, 5 cc, may be repeated daily for as long a period as may be necessary.

WATER, DOUBLE-DISTILLED

The water in these ampoules is especially distilled for use in preparing solutions for injection. It is sterilized and free from occluded gases, organic matter, and soluble salts.

Ampoule No. 210—5 cc

in boxes of six ampoules...................per box 1.00

in boxes of twenty-five ampoules...................per box 3.20

Ampoule No. 218—10 cc

in boxes of six ampoules...................per box 1.50

in boxes of twenty-five ampoules...................per box 4.80

Ampoule No. 214—20 cc

in boxes of six ampoules...................per box 2.50

in boxes of twenty-five ampoules...................per box 8.00

[ 145 ]

AMPOULES

## INTRAVENOUS AMPOULES

THE FOLLOWING is a complete list of ampoules designed especially for intravenous use. They are also included with the other ampoules in alphabetical order in the foregoing list, to which the reader is referred for additional information.

### CALCIUM CHLORIDE, 15½ grs. (No. 213)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>$ 2.00</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>6.40</td></tr></table>

A 10% aqueous solution of Calcium Chloride.

### GLUCOSE (Dextrose, U. S. P.), 10 Gm. (No. 224)

<table><tr><td>in boxes of six 20-cc ampoules</td><td>per box</td><td>3.50</td></tr><tr><td>in boxes of twenty-five 20-cc ampoules</td><td>per box</td><td>12.25</td></tr></table>

A 50% solution of pure Glucose, to be further diluted with distilled water before use.

### GLUCOSE (Dextrose, U. S. P.), 25 Gm. (No. 220)

<table><tr><td>in 50-cc ampoules</td><td>each</td><td>1.50</td></tr><tr><td>in boxes of six 50-cc ampoules</td><td>per box</td><td>8.70</td></tr><tr><td>in boxes of twenty-five 50-cc ampoules</td><td>per box</td><td>30.00</td></tr></table>

### IRON CACODYLATE, 1 gr. (No. 207)

<table><tr><td>in boxes of six 5-cc ampoules</td><td>per box</td><td>1.50</td></tr><tr><td>in boxes of twenty-five 5-cc ampoules</td><td>per box</td><td>4.80</td></tr></table>

An aqueous solution of Iron Cacodylate.

### MAGNESIUM SULPHATE, 25% (No. 221)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>2.00</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>6.40</td></tr></table>

A 25% aqueous solution of pure crystallized Magnesium Sulphate.

MERCUROSAL, see Specialties, page 29.

### QUININE DIHYDROCHLORIDE, 5 grs. (No. 204)

Each 10 cc contains 0.3 Gm. (5 grs.) of Quinine Dihydrochloride in physiologic salt solution.

[ 146 ]

AMPOULES

### QUININE DIHYDROCHLORIDE, 10 grs. (No. 205)

<table><tr><td>in boxes of six 20-cc ampoules</td><td>per box</td><td>$ 3.30</td></tr><tr><td>in boxes of twenty-five 20-cc ampoules</td><td>per box</td><td>10.50</td></tr></table>

Each 20 cc contains 0.65 Gm. (10 grs.) of Quinine Dihydrochloride in physiologic salt solution.

### SODIUM CACODYLATE, 3 grs. (No. 201)

An aqueous solution of Sodium Cacodylate, chemically pure.

### SODIUM CACODYLATE, 7 grs. (No. 202)

<table><tr><td>in boxes of six 5-cc ampoules</td><td>per box</td><td>1.70</td></tr><tr><td>in boxes of twenty-five 5-cc ampoules</td><td>per box</td><td>5.50</td></tr></table>

### SODIUM CACODYLATE, 15½ grs. (No. 203)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>2.40</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>7.70</td></tr></table>

### SODIUM CITRATE, 2½% solution (No. 206)

For use in blood transfusion

<table><tr><td>in 50-cc ampoules</td><td>each</td><td>1.00</td></tr><tr><td>in boxes of six 50-cc ampoules</td><td>per box</td><td>5.50</td></tr></table>

### SODIUM IODIDE, 15½ grs. (No. 208)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>2.50</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>8.00</td></tr></table>

A 10% aqueous solution of Sodium Iodide.

### SODIUM IODIDE, 31 grs. (No. 211)

<table><tr><td>in boxes of six 20-cc ampoules</td><td>per box</td><td>3.50</td></tr><tr><td>in boxes of twenty-five 20-cc ampoules</td><td>per box</td><td>11.20</td></tr></table>

### SODIUM IODIDE and SODIUM SALICYLATE, 31 grs. (No. 216)

Each 20 cc contains 1 Gm. (15½ grs.) Sodium Iodide and 1 Gm. (15½ grs.) Sodium Salicylate, in distilled water.

[ 147 ]

AMPOULES

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>$1.70</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>5.50</td></tr></table>

An aqueous solution of Sodium Salicylate.

Each 20 cc contains:

Sodium Iodide....................1 Gm. (15½ grs.)

Colchicine.........................0.00065 Gm. (1/100 gr.)

<table><tr><td>in boxes of six 10-cc ampoules</td><td>per box</td><td>1.50</td></tr><tr><td>in boxes of twenty-five 10-cc ampoules</td><td>per box</td><td>4.80</td></tr></table>

A 5% aqueous solution of Sodium Thiosulphate.

TARTAR EMETIC, 1% (Antimony and Potass. Tartrate) (No. 209)

A 1% aqueous solution of Tartar Emetic.

URITONE, 31 grs. (Hexamethylenamine) (No. 212)

A 40% aqueous solution of Uritone (hexamethylenamine).

WATER, DOUBLE-DISTILLED, 5 cc (No. 210)

<table><tr><td>in boxes of six ampoules</td><td>per box</td><td>1.00</td></tr><tr><td>in boxes of twenty-five ampoules</td><td>per box</td><td>3.20</td></tr></table>

WATER, DOUBLE-DISTILLED, 10 cc (No. 218)

<table><tr><td>in boxes of six ampoules</td><td>per box</td><td>1.50</td></tr><tr><td>in boxes of twenty-five ampoules</td><td>per box</td><td>4.80</td></tr></table>

WATER, DOUBLE-DISTILLED, 20 cc (No. 214)

<table><tr><td>in boxes of six ampoules</td><td>per box</td><td>2.50</td></tr><tr><td>in boxes of twenty-five ampoules</td><td>per box</td><td>8.00</td></tr></table>

[ 148 ]

HYPODERMIC TABLETS

HYPODERMIC TABLETS

The tablets fit closely in the tubes of 20 and are not apt to break or crumble when supplied in this package.

* ADRENALIN AND COCAINE, see page 4.

ADROCAINE, see page 6.

ANESTHETIC, see Adrocaine, Apothesine, Cocaine Hydrochloride, Quinine and Urea Hydrochloride; Codrenin, page 19; and Locosthetic, page 27.

* APOMORPHINE HYDROCHLORIDE, 1/10 gr. (No. 2)...................................

<table><tr><td>Per tube of 20</td><td>Per 100 in tubes of 20</td><td>Per bottle of 100</td></tr><tr><td>$ .78</td><td>$3.80</td><td>$3.30</td></tr></table>

Note.—The peculiarly perishable nature of apomorphine salts necessitates the very careful preservation of these tablets in closely corked dark containers. We cannot hold ourselves responsible for their deterioration.

APOTHESINE and combinations, see page 8.

<table><tr><td>ATROPINE SULPHATE, 1/200 gr. (No. 45)....</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/150 gr. (No. 32)....</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/100 gr. (No. 4).....</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/50 gr. (No. 3).....</td><td>.24</td><td>1.10</td><td>.60</td></tr></table>

CAFFEINE, 1/2 gr. (No. 46).......................... .24 1.10 .60

<table><tr><td>CAFFEINE SODIO-BENZOATE, 1/2 gr. (No. 90)</td><td>.24</td><td>1.10</td><td>.60</td></tr><tr><td>1 gr. (No. 201)</td><td>.28</td><td>1.30</td><td>.80</td></tr></table>

<table><tr><td>•COCAINE HYDROCHLORIDE, 1/4 gr. (No. 5)</td><td>.84</td><td>4.10</td><td>3.60</td></tr><tr><td>1/2 gr. (No. 47)</td><td>1.42</td><td>7.00</td><td>6.50</td></tr></table>

See also page 17.

* COCAINE AND ADRENALIN, see Adrenalin and Cocaine, page 4.

<table><tr><td>•CODEINE SULPHATE, 1/8 gr. (No. 98)........</td><td>.44</td><td>2.10</td><td>1.60</td></tr><tr><td>1/4 gr. (No. 99)........</td><td>.64</td><td>3.10</td><td>2.60</td></tr><tr><td>1/2 gr. (No. 141)........</td><td>1.08</td><td>5.30</td><td>4.80</td></tr></table>

[ 149 ]

HYPODERMIC TABLETS

<table><thead><tr><th></th><th>Per<br>tube<br>of 20</th><th>Per 100<br>in tubes<br>of 20</th><th>Per<br>bottle<br>of 100</th></tr></thead><tbody><tr><td>DIGITALIN, PURE, 1/100 gr. (No. 9)</td><td>$ .24</td><td>$1.10</td><td>$ .60</td></tr><tr><td>1/50 gr. (No. 147)</td><td>.27</td><td>1.25</td><td>.75</td></tr><tr><td>DIGITALONE, P. D. & Co., 1/4 gr. (No. 210)</td><td>.27</td><td>1.25</td><td>....</td></tr><tr><td colspan="4">Each tablet corresponds in physiologic activity to 0.5 cc (8 minims) Tincture Digitalis, U. S. P. Digitalis is a highly potent preparation of digitalis, almost wholly free from inert substance and particularly adapted to hypodermic use.</td></tr><tr><td>EMETINE HYDROCHLORIDE, 1/2 gr. (No. 207)</td><td>in tubes of 10</td><td>per tube</td><td>$1.50</td></tr><tr><td colspan="4">See also Ampoules Emetine Hydrochloride, page 124.</td></tr><tr><td>ERGOTIN. Owing to the extremely hygroscopic nature of ergotin, we do not manufacture hypodermic tablets containing it. Practitioners will find our Ergone (page 22) or Ergot Aseptic Ampoules (page 23) admirably adapted for hypodermic use.</td><td></td><td></td><td></td></tr><tr><td colspan="4">Eserine, see Physostigmine Sulphate.</td></tr><tr><td colspan="4">Glonion, see Nitroglycerin.</td></tr><tr><td colspan="4">Glyceryl Trinitrate, see Nitroglycerin.</td></tr><tr><td colspan="4">HYOSCINE HYDROBROMIDE (Scopolamine)</td></tr><tr><td>1/200 gr. (No. 153)</td><td>.26</td><td>1.20</td><td>.70</td></tr><tr><td>1/150 gr. (No. 148)</td><td>.29</td><td>1.35</td><td>.85</td></tr><tr><td>1/100 gr. (No. 11).</td><td>.32</td><td>1.50</td><td>1.00</td></tr><tr><td>1/50 gr. (No. 103).</td><td>.48</td><td>2.30</td><td>1.80</td></tr><tr><td>•HYOSCINE AND MORPHINE (No. 182)</td><td>.92</td><td>4.50</td><td>4.00</td></tr><tr><td colspan="4">Hyoscine hydrobromide</td></tr><tr><td colspan="4">Morphine hydrobromide</td></tr><tr><td>•MORPHINE SULPHATE, 1/12 gr. (No. 56)</td><td>.36</td><td>1.70</td><td>1.20</td></tr><tr><td>1/8 gr. (No. 14)</td><td>.40</td><td>1.90</td><td>1.40</td></tr><tr><td>1/6 gr. (No. 25)</td><td>.48</td><td>2.30</td><td>1.80</td></tr><tr><td>1/4 gr. (No. 13)</td><td>.60</td><td>2.90</td><td>2.40</td></tr><tr><td>1/2 gr. (No. 26)</td><td>1.00</td><td>4.90</td><td>4.40</td></tr></tbody></table>

[ 150 ]

HYPODERMIC TABLETS

<table><thead><tr><th></th><th>Per<br>tube<br>of 20</th><th>Per 100<br>in tubes<br>of 20</th><th>Per<br>bottle<br>of 100</th></tr></thead><tbody><tr><td>•MORPHINE AND ATROPINE, R<sub>3</sub> "C" (No. 58)</td><td>$ .43</td><td>$2.05</td><td>$1.55</td></tr><tr><td colspan="4">Morphine sulphate</td></tr><tr><td colspan="4">Atropine sulphate</td></tr><tr><td>•MORPHINE AND ATROPINE, R<sub>3</sub> "F" (No. 59)</td><td>.51</td><td>2.45</td><td>1.95</td></tr><tr><td colspan="4">Morphine sulphate</td></tr><tr><td colspan="4">Atropine sulphate</td></tr><tr><td>•MORPHINE AND ATROPINE, R<sub>3</sub> "H" (No. 16)</td><td>.63</td><td>3.05</td><td>2.55</td></tr><tr><td colspan="4">Morphine sulphate</td></tr><tr><td colspan="4">Atropine sulphate</td></tr><tr><td>•MORPHINE AND ATROPINE, R<sub>3</sub> "Q" (No. 119)</td><td>1.03</td><td>5.05</td><td>4.55</td></tr><tr><td colspan="4">Morphine sulphate</td></tr><tr><td colspan="4">Atropine sulphate</td></tr></tbody></table>

NITROGLYCERIN (Glyceryl Trinitrate)

<table><tbody><tr><td>1/150 gr. (No. 86)</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/100 gr. (No. 31)</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/50 gr. (No. 64).</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>.26</td><td>1.20</td><td>.70</td></tr><tr><td>Digitalin, pure</td><td></td><td></td><td></td></tr><tr><td>Strychnine nitrate</td><td></td><td></td><td></td></tr></tbody></table>

PHYSOSTIGMINE SULPHATE

<table><tbody><tr><td>1/100 gr. (No. 20)</td><td>.32</td><td>1.50</td><td>1.00</td></tr><tr><td>1/50 gr. (No. 173)</td><td>.42</td><td>2.00</td><td>1.50</td></tr></tbody></table>

QUININE AND UREA HYDROCHLORIDE

<table><tbody><tr><td>2 grs. (No. 139)</td><td>.64</td><td>3.10</td><td>2.60</td></tr><tr><td>5 grs. (No. 175)</td><td>1.32</td><td>6.50</td><td>6.00</td></tr><tr><td colspan="4">Readily soluble in water. Used in 0.25% to 1% solution for the induction of local anesthesia and in 5% solution for the injection treatment of uncomplicated internal hemorrhoids.</td></tr><tr><td colspan="4">See also Ampoules, page 137.</td></tr></tbody></table>

<table><tbody><tr><td>RINGER TABLETS (No. 220)</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td colspan="4">Sodium chloride, c. p.</td></tr><tr><td colspan="4">Potassium chloride, c. p.</td></tr><tr><td colspan="4">Calcium chloride, c. p.</td></tr><tr><td colspan="4">0.05 Gm.</td></tr><tr><td colspan="4">0.002 Gm.</td></tr><tr><td colspan="4">0.004 Gm.</td></tr></tbody></table>

Intended specifically for use in making up isotonic solutions of local anesthetics. One tablet makes an isotonic solution when dissolved in 10 cc (160 minims) of distilled water in conjunction with a sufficient amount of local anesthetic to produce a 2% solution of the latter.

[ 151 ]

HYPODERMIC-OPHTHALMIC TABLETS

PILLS AND TABLETS

<table><thead><tr><th></th><th>Per<br>tube<br>of 20</th><th>Per 100<br>in tubes<br>of 20</th><th>Per<br>bottle<br>of 100</th></tr></thead><tbody><tr><td>SCOPOLAMINE HYDROBROMIDE, 1/100 gr.<br>(No. 155) (Hyoscine)</td><td>$ .32</td><td>$1.50</td><td>$1.00</td></tr></tbody></table>

<table><thead><tr><th>•SCOPOLAMINE (Hyoscine) MORPHINE<br>COMPOUND (No. 206)</th><th>1.52</th><th>7.50</th><th>7.00</th></tr></thead><tbody><tr><td>Scopolamine hydrochloride</td><td>1/500 gr.</td><td></td><td></td></tr><tr><td>Dionin</td><td>1/3 gr.</td><td></td><td></td></tr><tr><td>Morphine hydrochloride</td><td>1/6 gr.</td><td></td><td></td></tr></tbody></table>

<table><tbody><tr><td>SPARTEINE SULPHATE, 1/4 gr. (No. 146)</td><td>.24</td><td>1.10</td><td>.60</td></tr><tr><td>1/2 gr. (No. 169)</td><td>.30</td><td>1.40</td><td>.90</td></tr></tbody></table>

<table><tbody><tr><td>STRYCHNINE SULPHATE, 1/100 gr. (No. 23)</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/60 gr. (No. 70)</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/40 gr. (No. 78)</td><td>.22</td><td>1.00</td><td>.50</td></tr><tr><td>1/30 gr. (No. 73)</td><td>.22</td><td>1.00</td><td>.50</td></tr></tbody></table>

OPHTHALMIC TABLETS

For the extemporaneous preparation of solutions suitable for the local treatment of the eye, either therapeutically or as a preliminary to surgical procedures. Chemically pure boric acid has been added as a diluent when such was required. The tablets dissolve readily in distilled water.

<table><thead><tr><th></th><th>Per<br>tube<br>of 20</th><th>Per<br>bottle<br>of 100</th><th>Per<br>bottle<br>of 1000</th></tr></thead><tbody><tr><td>ATROPINE SULPHATE, 1 gr. (No. 1)</td><td>$1.20</td><td>....</td><td>....</td></tr></tbody></table>

<table><tbody><tr><td>BORIC ACID, 5 grs. (No. 2)</td><td>....</td><td>$ .65</td><td>$2.50</td></tr></tbody></table>

COCAINE HYDROCHLORIDE, see page 149.

Eserine, see Physostigmine.

HOMATROPINE HYDROBROMIDE, 1/2 gr. (No. 4)
In tubes of 10 tablets...........per tube $1.50

<table><tbody><tr><td>PHYSOSTIGMINE BENZOATE, 1/8 gr. (No. 5)</td><td>1.60</td><td>....</td><td>....</td></tr></tbody></table>

<table><tbody><tr><td>ZINC SULPHATE, 1 gr. (No. 7)</td><td>....</td><td>.65</td><td>2.00</td></tr></tbody></table>

[ 152 ]

PILLS AND TABLETS

This list includes our gelatin-coated, sugar-coated, chocolate-coated and enteric-coated pills and our tablet triturates, compressed tablets and chocolate-coated tablets, specification being made in each instance following the title except in the case of oval, gelatin-coated pills; this being the usual form, no notation is made except when the pill is offered in some other form or coating.

<table><thead><tr><th>ABSORBENT DYSPEPTIC<br>(Compressed Tablet No. 315)</th><th>Per<br>100</th><th>Per<br>500</th><th>Per<br>1000</th></tr></thead><tbody><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>1 gr.</td><td>....</td><td>$3.00</td></tr><tr><td>Sodium bicarbonate</td><td>2 1/2 grs.</td><td>....</td><td>....</td></tr><tr><td>Charcoal</td><td>2 grs.</td><td>....</td><td>....</td></tr></tbody></table>

<table><tbody><tr><td>ACETANILID, 5 grs. (Compressed Tablet No. 4)</td><td>.42</td><td>....</td><td>2.70</td></tr></tbody></table>

<table><tbody><tr><td>ACETANILID COMPOUND (Auld-A), 5 grs.<br>(Compressed Tablet No. 430)<br>(Same formula as Acetanilid Compound Powder, N. F.)</td><td>.50</td><td>....</td><td>3.50</td></tr><tr><td>Acetanilid</td><td>3 1/2 grs.</td><td>....</td><td>....</td></tr><tr><td>Caffeine</td><td>1/2 gr.</td><td>....</td><td>....</td></tr><tr><td>Sodium bicarbonate</td><td>1 gr.</td><td>....</td><td>....</td></tr></tbody></table>

See also Migraine.

<table><tbody><tr><td>ACETANILID AND SODA COMPOUND No. 1<br>(Compressed Tablet No. 361, pink)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>(Compressed Tablet No. 106)</td><td>.45</td><td>....</td><td>3.00</td></tr></tbody></table>

<table><tbody><tr><td>Acetanilid</td><td>3 1/2 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>9/10 gr.</td></tr><tr><td>Caffeine</td><td>1/4 gr.</td></tr><tr><td>Sodium bromide</td><td>1/10 gr.</td></tr></tbody></table>

<table><tbody><tr><td>ACETANILID AND SODA COMPOUND No. 2<br>(Compressed Tablet No. 131)</td><td>.50</td><td>....</td><td>3.50</td></tr></tbody></table>

<table><tbody><tr><td>Acetanilid</td><td>2 1/2 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>2 1/2 grs.</td></tr><tr><td>Caffeine</td><td>1/2 gr.</td></tr><tr><td>Tinct. Gelsemium</td><td>4 1/2 mins.</td></tr></tbody></table>

[ 153 ]

PILLS AND TABLETS

## •ACETANILID AND SODA COMPOUND WITH CODEINE (Compressed Tablet No. 362)

<table><tr><td>Acetanilid</td><td>3½ grs.</td></tr><tr><td>Sodium bromide</td><td>1/10 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>9/10 gr.</td></tr><tr><td>Caffeine</td><td>1/4 gr.</td></tr><tr><td>Codeine</td><td>1/4 gr.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$4.00</td><td>....</td><td>....</td></tr></tbody></table>

Acetphenetidin, see Phenacetin.

## ACETYLSALICYLIC ACID, 5 grs.

<table><tr><td>(Compressed Tablet No. 529)</td><td>.50</td><td>....</td><td>$3.50</td></tr><tr><td>(Compressed Tablet No. 624, pink)</td><td>.50</td><td>....</td><td>3.50</td></tr></table>

## ACETYLSALICYLIC ACID COMPOUND

<table><tr><td>(Compressed Tablet No. 679)</td><td>.86</td><td>....</td><td>7.10</td></tr><tr><td>Acetylsalicylic acid</td><td>3 grs.</td></tr><tr><td>Phenacetin (Acetphenetidin)</td><td>2 grs.</td></tr><tr><td>Caffeine</td><td>½ gr.</td></tr></table>

Aiken, see Tonic, Aiken, page 198.

## ALKALINE AROMATIC

<table><tr><td>(Compressed Tablet No. 377, white)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>(Compressed Tablet No. 609, pink)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td colspan="4">Bottles of 50 (No. 377 or 609) per doz. $5.00</td></tr><tr><td>Sodium bicarbonate</td><td>5 grs.</td></tr><tr><td>Sodium borate</td><td>5 grs.</td></tr><tr><td>Sodium chloride</td><td>5 grs.</td></tr><tr><td>Sodium benzoate</td><td>7/24 gr.</td></tr><tr><td>Sodium salicylate</td><td>7/24 gr.</td></tr><tr><td>Thymol</td><td>7/240 gr.</td></tr><tr><td>Menthol</td><td>7/480 gr.</td></tr><tr><td>Oil Eucalyptus</td><td>7/240 min.</td></tr><tr><td>Oil Wintergreen (synthetic)</td><td>7/480 min.</td></tr></table>

For the making of extemporous solutions to be applied by spray or douche. Dissolve one tablet in 2 to 4 fluid ounces of warm water.

See also Nasal, and Plasma Nasal Tablets.

<table><tr><td>ALOE, U. S. P. (Pill No. 10)</td><td>.60</td><td>$2.25</td><td>....</td></tr><tr><td>Aloe</td><td>0.13 Gm. (about 2 grs.)</td></tr><tr><td>Powd. Soap</td><td>0.13 Gm. (about 2 grs.)</td></tr></table>

[ 154 ]

PILLS AND TABLETS

<table><tr><td>ALOE COMPOUND (Pill No. 271)</td><td>Per bottle of</td><td>Per bottle of</td></tr><tr><td></td><td>$ .70</td><td>$2.75</td><td>....</td></tr></table>

(Formerly known as Emmenagogue, Rigaud)

<table><tr><td>Aloe</td><td>1½ grs.</td></tr><tr><td>Powd. Rue</td><td>¾ gr.</td></tr><tr><td>Powd. American Saffron</td><td>¾ gr.</td></tr><tr><td>Powd. Savin</td><td>¾ gr.</td></tr></table>

## ALOE AND IRON, N. F. (Pill No. 13)

<table><tr><td>Aloe</td><td>0.07 Gm. (about 1 gr.)</td></tr><tr><td>Aromatic Powder</td><td>0.07 Gm. (about 1 gr.)</td></tr><tr><td>Ferrous sulphate, exsiccated</td><td>0.07 Gm. (about 1 gr.)</td></tr><tr><td>Confection Rose</td><td>q.s.</td></tr></table>

## ALOE AND MASTIC, N. F. (Pill No. 14)

<table><tr><td>Aloe</td><td>2 grs.</td></tr><tr><td>Powd. Red Rose</td><td>1/2 gr.</td></tr><tr><td>Mastic</td><td>3/5 gr.</td></tr></table>

## ALOE AND MYRRH, N. F. (Pill No. 15)

<table><tr><td>Aloe</td><td>0.13 Gm. (about 2 grs.)</td></tr><tr><td>Aromatic powder</td><td>0.04 Gm. (about 3/5 gr.)</td></tr><tr><td>Myrrh</td><td>0.06 Gm. (about 1 gr.)</td></tr></table>

Aloetic, see Aloe, U. S. P, page 154.

## ALOIN, ½ gr. (Pill No. 22)

.50 1.75 ....

Aloin and Belladonna Compound, see Aloin, Strychnine and Belladonna, No. 1, page 156.

## ALOIN, BELLADONNA, PODOPHYLLIN AND NUX VOMICA

<table><tr><td>(Chocolate-coated Tablet No. 12)</td><td>.40</td><td>....</td><td>$2.50</td></tr><tr><td>Aloin</td><td>1/10 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/10 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/10 gr.</td></tr><tr><td>Podophyllin</td><td>1/10 gr.</td></tr></table>

## ALOIN, BELLADONNA, STRYCHNINE AND CASCARA, No. 1 (Tablet Triturate No. 222)

<table><tr><td>(Chocolate-coated Tablet No. 13)</td><td>.35</td><td>....</td><td>1.80</td></tr><tr><td>Aloin</td><td>1/5 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr><tr><td>Strychnine</td><td>1/120 gr.</td></tr><tr><td>Ext. Cascara sagrada</td><td>1/2 gr.</td></tr></table>

.40 1.80 ....

[ 155 ]

PILLS AND TABLETS

ALOIN, BELLADONNA, STRYCHNINE AND
CASCARA, No. 2

(Chocolate-coated Tablet No. 14)

<table><tr><td>Aloin</td><td>1/2 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/16 gr.</td></tr><tr><td>Strychnine</td><td>1/120 gr.</td></tr><tr><td>Ext. Cascara sagrada</td><td>1/2 gr.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>....</td><td>....</td><td>$2.30</td></tr></tbody></table>

ALOIN, BELLADONNA, STRYCHNINE AND
IPECAC (Chocolate-coated Tablet No. 15).....

<table><tr><td>Aloin</td><td>1/5 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr><tr><td>Strychnine</td><td>1/60 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/16 gr.</td></tr></table>

.40 .... 2.30

ALOIN AND CASCARIN COMPOUND No. 1
(Dr. Duncan) (Chocolate-coated Tablet No. 16)

<table><tr><td>Aloin</td><td>1/5 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr><tr><td>Cascarin</td><td>1/4 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td></tr></table>

.40 .... 2.30

ALOIN AND CASCARIN COMPOUND No. 2
(Dr. Duncan) (Chocolate-coated Tablet No. 17)

<table><tr><td>Aloin</td><td>1/4 gr.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td>1/4 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr><tr><td>Podophyllin</td><td>1/4 gr.</td></tr></table>

.40 .... 2.50

ALOIN, STRYCHNINE AND BELLADONNA,
N. F. (Pill No. 755)..................

<table><tr><td>Aloin</td><td>1/5 gr.</td></tr><tr><td>Strychnine</td><td>1/130 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr></table>

.45 $1.50 ....

ALOIN, STRYCHNINE AND BELLADONNA,
No. 1 (Pill No. 27)..................

(Chocolate-coated Tablet No. 8)

<table><tr><td>Aloin</td><td>1/5 gr.</td></tr><tr><td>Strychnine</td><td>1/60 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr></table>

.45 1.50 ....

.40 .... 2.10

ALOIN, STRYCHNINE AND BELLADONNA
COMPOUND, N. F. (Pill No. 29)........

<table><tr><td>Aloin</td><td>1/5 gr.</td></tr><tr><td>Strychnine</td><td>1/130 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/8 gr.</td></tr><tr><td>Ext. Cascara sagrada</td><td>1/2 gr.</td></tr></table>

.45 1.50 ....

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PILLS AND TABLETS

Aloin, Strychnine, Belladonna and Ipecac, see Aloin, Belladonna, Strychnine and Ipecac, page 156; also Evacuant, page 179.

ALOPHEN (Pill No. 974, soft, chocolate-coated)

<table><tr><td>Aloin</td><td>1/4 gr.</td></tr><tr><td>Strychnine (powd.)</td><td>1/80 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/12 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/15 gr.</td></tr><tr><td>Phenolphthalein</td><td>1/2 gr.</td></tr></table>

An unusually effective laxative compound without depressing effect. Promotes peristalsis without griping, stimulates the liver, increases intestinal secretion and acts as a tonic to the mucous membrane of the digestive tract. Peculiarly efficient in softening the contents of the lower bowel.

Dose: 1 or 2 pills at night before retiring, or in obstinate chronic cases 1 after each meal.

AMMONIUM CHLORIDE, 5 grs.

(Compressed Tablet No. 213)

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$ .75</td><td>$3.00</td><td>....</td></tr></tbody></table>

.35 .... $2.00

Ammonium Sulphichthyolate, see Ichthyol Pills, page 181.

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<table><thead><tr><th>ANODYNE, INFANTS (Waugh), No. 2, Modified (Tablet Triturate No. 740)</th><th>Per bottle of</th><th></th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>Nickel bromide</td><td>$ .35</td><td>....</td><td>$1.50</td></tr><tr><td>Powd. Ipecac</td><td></td><td></td><td></td></tr><tr><td>Lithium carbonate</td><td></td><td></td><td></td></tr><tr><td>Oil Anise</td><td></td><td></td><td>q.s.</td></tr></tbody></table>

ANTI-ASTHMATIC (HARE)

<table><tbody><tr><td>(Compressed Tablet No. 55)</td><td>1.00</td><td>....</td><td>8.50</td></tr><tr><td>(Chocolate-coated Tablet No. 272)</td><td>1.05</td><td>....</td><td>9.00</td></tr><tr><td>Fl. ext. Euphorbia</td><td></td><td></td><td>3 mins.</td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td></td><td></td><td>1/200 gr.</td></tr><tr><td>Potassium iodide</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Sodium bromide</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Tinct. Lobelia</td><td></td><td></td><td>4 mins.</td></tr></tbody></table>

ANTI-CONSTIPATION

<table><tbody><tr><td>(Chocolate-coated Tablet No. 19)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Ext. Cascara sagrada</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Ext. Nux vomica</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Powd. Ipecac</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Podophyllin</td><td></td><td></td><td>1/8 gr.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-DYSPEPTIC (Pill No. 52)</td><td>.85</td><td>$3.50</td><td>....</td></tr><tr><td>Strychnine</td><td></td><td></td><td>1/40 gr.</td></tr><tr><td>Powd. Ipecac</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Mass of Mercury</td><td></td><td></td><td>2 grs.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-DYSPEPTIC No. 1<br/>(Compressed Tablet No. 134)</td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td>Powd. Ipecac</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Mass of Mercury</td><td></td><td></td><td>2 grs.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-DYSPEPTIC No. 2<br/>(Compressed Tablet No. 135)</td><td>.40</td><td>....</td><td>2.50</td></tr><tr><td>(Chocolate-coated Tablet No. 20)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Strychnine sulphate</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>Powd. Ipecac</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>Sodium bicarbonate</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Ext. Rhubarb</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Ext. Gentian</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Powd. Capsicum</td><td></td><td></td><td>1/4 gr.</td></tr></tbody></table>

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<table><thead><tr><th>ANTI-MALARIAL (Maddin), Milder (Pill 823)</th><th>Per bottle of</th><th></th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>Strychnine</td><td></td><td></td><td>1/40 gr.</td></tr><tr><td>Reduced Iron</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Aloe</td><td></td><td></td><td>1/6 gr.</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/24 gr.</td></tr><tr><td>Quinine sulphate</td><td></td><td></td><td>1 gr.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-MALARIAL (Maddin), Milder, without<br/>Aloe (Pill No. 850)</td><td>1.25</td><td>5.50</td><td>....</td></tr><tr><td>Strychnine</td><td></td><td></td><td>1/40 gr.</td></tr><tr><td>Reduced Iron</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/24 gr.</td></tr><tr><td>Quinine sulphate</td><td></td><td></td><td>1 gr.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-MALARIAL (Maddin), Stronger (Pill 824)</td><td>1.45</td><td>6.50</td><td>....</td></tr><tr><td>Strychnine</td><td></td><td></td><td>3/100 gr.</td></tr><tr><td>Reduced Iron</td><td></td><td></td><td>1 1/5 grs.</td></tr><tr><td>Quinine sulphate</td><td></td><td></td><td>1 1/5 grs.</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/20 gr.</td></tr><tr><td>Aloe</td><td></td><td></td><td>1/5 gr.</td></tr></tbody></table>

<table><tbody><tr><td>ANTIPYRINE, 5 grs. (Compressed Tablet 112)</td><td>1.05</td><td>....</td><td>$9.00</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-RHEUMATIC, P. D. & Co.<br/>(Compressed Tablet No. 232)</td><td>1.30</td><td>....</td><td>....</td></tr><tr><td>Colchicine</td><td></td><td></td><td>1/100 gr.</td></tr><tr><td>Potassium iodide</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Ext. Phytolacca root</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Guaiac</td><td></td><td></td><td>3 grs.</td></tr><tr><td>Digitalone, P. D. & Co.</td><td></td><td></td><td>1/10 gr.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-RHEUMATIC No. 2<br/>(Compressed Tablet No. 335)</td><td>.42</td><td>....</td><td>2.70</td></tr><tr><td>Salicylic acid</td><td></td><td></td><td>3 grs.</td></tr><tr><td>Sodium bicarbonate</td><td></td><td></td><td>2 1/2 grs.<br/>(Combined as Sodium salicylate)</td></tr><tr><td>Wine Colchicum seed</td><td></td><td></td><td>1 min.</td></tr></tbody></table>

<table><tbody><tr><td>ANTI-RHEUMATIC No. 3<br/>(Compressed Tablet No. 360)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Salicylic acid</td><td></td><td></td><td>3 grs.</td></tr><tr><td>Sodium bicarbonate</td><td></td><td></td><td>2 1/2 grs.</td></tr><tr><td>Wine Colchicum seed</td><td></td><td></td><td>1 min.</td></tr><tr><td>Guaiac</td><td></td><td></td><td>2 grs.</td></tr></tbody></table>

See also Rheumatic.

<table><tbody><tr><td>ARSENIC TRIOXIDE 1/30 gr.<br/>(Tablet Triturate No. 3)</td><td>.35</td><td>....</td><td>1.20</td></tr></tbody></table>

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>ARSENITIS (Chocolate-coated Tablet No. 441)</td><td>$ .43</td><td>....</td><td>$2.80</td></tr><tr><td>Strychnine arsenite</td><td></td><td></td><td>1/120 gr.</td></tr><tr><td>Quinine arsenite</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>Iron arsenite</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>Nucleinic acid</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>ASAFETIDA, 2 grs. (Pill No. 74)</td><td>.55</td><td>$2.00</td><td>....</td></tr><tr><td>(Chocolate-coated Tablet No. 182)</td><td>.43</td><td>....</td><td>2.80</td></tr><tr><td>3 grs. (Chocolate-coated Tablet No. 183)</td><td>.47</td><td>....</td><td>3.20</td></tr><tr><td>5 grs. (Pill No. 77)</td><td>.70</td><td>2.75</td><td>....</td></tr><tr><td>(Chocolate-coated Tablet No. 185)</td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td>ASAFETIDA, 3 grs., U. S. P. (Pill No. 75)</td><td>.60</td><td>2.25</td><td>....</td></tr><tr><td>Asafetida</td><td></td><td></td><td>0.2 Gm. (about 3 grs.)</td></tr><tr><td>Powd. Soap</td><td></td><td></td><td>0.06 Gm. (about 1 gr.)</td></tr><tr><td>ASAFETIDA AND IRON BROMIDE COMPOUND (Compressed Tablet No. 635, sugar-coated, pink)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Asafetida</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Iron bromide</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Ext. Hyoscyamus</td><td></td><td></td><td>1/16 gr.</td></tr><tr><td>Ext. Nux vomica</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Zinc phosphide</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>ASPIRIN—We do not supply Aspirin tablets or capsules, but do offer the same drug under its chemical name Acetylsalicylic Acid, and guarantee the purity and effectiveness of our product. On orders specifying Aspirin Tablets or Capsules we will supply Acetylsalicylic Acid Tablets, 5 grs. white (CT 529) or pink (CT 624), page 154.</td><td></td><td></td><td></td></tr><tr><td>ASIATIC (Strong) (Pill No. 832)</td><td>.50</td><td>....</td><td>....</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/9 gr.</td></tr><tr><td>Powd. Black Pepper</td><td></td><td></td><td>1 gr.</td></tr><tr><td colspan="4">Not listed in bottles of 500. To be used cautiously on account of large dose of arsenous acid.</td></tr><tr><td colspan="4">Asthma, see Anti-Asthmatic.</td></tr><tr><td colspan="4">ATROPINE SULPHATE</td></tr><tr><td>1/500 gr. (Tablet Triturate No. 17)</td><td>.35</td><td>....</td><td>1.40</td></tr><tr><td>1/200 gr. (Tablet Triturate No. 18)</td><td>.35</td><td>....</td><td>1.50</td></tr><tr><td>1/150 gr. (Tablet Triturate No. 767)</td><td>.35</td><td>....</td><td>1.50</td></tr><tr><td>1/100 gr. (Tablet Triturate No. 19)</td><td>.35</td><td>....</td><td>1.80</td></tr></tbody></table>

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>BELLADONNA LEAVES, EXTRACT, ¼ gr. (Tablet Triturate No. 233)</td><td>$ .35</td><td>....</td><td>$1.80</td></tr><tr><td>BILE SALTS AND CASCARIN (Chocolate-coated Tablet No. 476, enteric-coated)</td><td>.75</td><td>....</td><td>6.00</td></tr><tr><td>Cascarin (P. D. & Co.)</td><td></td><td>1 gr.</td><td></td></tr><tr><td>Bile salts, purified (P. D. & Co.)</td><td></td><td>1 gr.</td><td></td></tr><tr><td>BISMUTH AND MAGNESIA, No. 3 (Compressed Tablet No. 680)</td><td>2.10</td><td>....</td><td>....</td></tr><tr><td>Calcined Magnesia</td><td></td><td>10 grs.</td><td></td></tr><tr><td>Bismuth subnitrate</td><td></td><td>10 grs.</td><td></td></tr><tr><td>BISMUTH, MAGNESIA AND SODIUM BICARBONATE, No. 2 (Compressed Tablet No. 681)</td><td>2.15</td><td>....</td><td>....</td></tr><tr><td>Bismuth subnitrate</td><td></td><td>10 grs.</td><td></td></tr><tr><td>Calcined Magnesia</td><td></td><td>10 grs.</td><td></td></tr><tr><td>Sodium bicarbonate</td><td></td><td>10 grs.</td><td></td></tr><tr><td>BISMUTH SALICYLATE, AROMATIC (Compressed Tablet No. 253)</td><td>1.15</td><td>....</td><td>10.00</td></tr><tr><td>Bismuth salicylate, basic</td><td></td><td>3 grs.</td><td></td></tr><tr><td>Prepared Chalk</td><td></td><td>2 grs.</td><td></td></tr><tr><td>Aromatic powder</td><td></td><td>1 gr.</td><td></td></tr><tr><td>Zinc sulphocarbolate</td><td></td><td>1¼ grs.</td><td></td></tr><tr><td>BISMUTH SUBGALLATE, 5 grs. (Compressed Tablet No. 203)</td><td>1.15</td><td>....</td><td>10.00</td></tr><tr><td>BISMUTH SUBNITRATE, 5 grs. (Compressed Tablet No. 214)</td><td>1.05</td><td>....</td><td>9.00</td></tr><tr><td>BLAUD, 3 grs. (Pill No. 283)</td><td>.45</td><td>$1.50</td><td>....</td></tr><tr><td>(Pill No. 876, sugar-coated, pink)</td><td>.45</td><td>1.50</td><td>....</td></tr><tr><td>(Pill No. 976, soft, chocolate-coated)</td><td>.45</td><td>1.50</td><td>....</td></tr><tr><td>BLAUD, 5 grs., U. S. P. (Pill No. 284)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Pill No. 971, soft, chocolate-coated)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Pill No. 893, sugar-coated, pink)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Pill No. 892, soft, round, uncoated)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Compressed Tablet 364, sugar-coated, pink)</td><td>.40</td><td>....</td><td>2.50</td></tr><tr><td>(Chocolate-coated Tablet No. 359)</td><td>.40</td><td>....</td><td>2.50</td></tr></tbody></table>

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>BLAUD MODIFIED, (Pill No. 750)............</td><td>$ .50</td><td>$1.75</td><td>....</td></tr><tr><td>(Pill No. 977, soft, chocolate-coated)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Chocolate-coated Tablet No. 360)</td><td>.41</td><td>....</td><td>$2.60</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/40 gr.</td></tr><tr><td>BLAUD, ARSENIC AND NUX VOMICA, No. 1<br/>(Pill No. 860)............................</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>(Formerly known as Blaud Compound)</td><td></td><td></td><td></td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>BLAUD, ARSENIC AND NUX VOMICA, No. 2<br/>(Pill No. 981, soft, chocolate-coated)............</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>(Formerly known as Blaud Compound, R<sup>1</sup> "C")</td><td></td><td></td><td></td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/6 gr.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/40 gr.</td></tr><tr><td>Strychnine..................</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>BLAUD, ARSENIC AND STRYCHNINE<br/>(Pill No. 1031, soft, chocolate-coated)</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/40 gr.</td></tr><tr><td>Strychnine..................</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>BLAUD AND CASCARA COMPOUND<br/>(Pill No. 1002, soft, chocolate-coated)</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Cascarin, P. D. &amp; Co..................</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>BLAUD WITH CASCARIN<br/>(Pill No. 1008, soft, chocolate-coated)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Cascarin, P. D. &amp; Co..................</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>BLAUD AND MANGANESE COMPOUND No.<br/>2 (Chocolate-coated Tablet No. 217)............</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>3 grs.</td></tr><tr><td>Manganese dioxide..................</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Aloin..................</td><td></td><td></td><td>1/20 gr.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/100 gr.</td></tr><tr><td>Ext. Damiana..................</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Strychnine sulphate..................</td><td></td><td></td><td>1/120 gr.</td></tr><tr><td>Zinc phosphide..................</td><td></td><td></td><td>1/16 gr.</td></tr></tbody></table>

[ 162 ]

PILLS AND TABLETS

<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>BLAUD WITH NUX VOMICA<br/>(Pill No. 982, soft, chocolate-coated)</td><td>$ .55</td><td>$2.00</td><td>....</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/6 gr.</td></tr><tr><td>BLAUD, NUX VOMICA AND ARSENIC<br/>(Chocolate-coated Tablet No. 318)</td><td>.44</td><td>....</td><td>$2.90</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>BLAUD WITH NUX VOMICA AND CAS-<br/>CARA, No. 1 (Chocolate-coated Tablet No. 195)</td><td>.40</td><td>....</td><td>2.50</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>3 grs.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/10 gr.</td></tr><tr><td>Ext. Cascara sagrada..................</td><td></td><td></td><td>1 gr.</td></tr><tr><td>BLAUD, NUX VOMICA, CASCARA AND<br/>ARSENIC (Chocolate-coated Tablet No. 283)....</td><td>.47</td><td>....</td><td>3.20</td></tr><tr><td>(Blaud Compound Improved)</td><td></td><td></td><td></td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Ext. Nux vomica..................</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Ext. Cascara sagrada..................</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>BLAUD AND STRYCHNINE COMPOUND<br/>(Pill No. 983, soft, chocolate-coated)</td><td>.65</td><td>2.50</td><td>....</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Strychnine sulphate..................</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>Ext. Gentian..................</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Powd. Capsicum..................</td><td></td><td></td><td>1/64 gr.</td></tr><tr><td>Podophyllin, U. S. P..................</td><td></td><td></td><td>1/12 gr.</td></tr><tr><td>Mercuric chloride, corrosive............</td><td></td><td></td><td>1/80 gr.</td></tr><tr><td>BLAUD AND STRYCHNINE COMPOUND<br/>(Compressed Tablet No. 395, sugar-coated, red)</td><td>.43</td><td>....</td><td>2.80</td></tr><tr><td>(Chocolate-coated Tablet No. 381)</td><td>.43</td><td>....</td><td>2.80</td></tr><tr><td>Ferrous carbonate mass (Blaud)............</td><td></td><td></td><td>5 grs.</td></tr><tr><td>Arsenic trioxide..................</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Strychnine sulphate..................</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>Mercuric chloride, corrosive............</td><td></td><td></td><td>1/80 gr.</td></tr><tr><td>Powd. Capsicum..................</td><td></td><td></td><td>1/64 gr.</td></tr><tr><td>Ext. Gentian..................</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>BLUE MASS, 5 grs. (Pill No. 109)............</td><td>1.00</td><td>4.25</td><td>....</td></tr></tbody></table>

[ 163 ]

PILLS AND TABLETS

BLUE MASS COMPOUND (McGuire)

(Pill No. 868)

Per bottle of
100 500 1000
$ .70 $2.75 ....

<table><tr><td>Mass of Mercury</td><td>1 gr.</td></tr><tr><td>Powd. Rhubarb</td><td>1 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td>1 gr.</td></tr><tr><td>Purified Aloe</td><td>1 gr.</td></tr></table>

BORIC ACID, 5 grs. (Compressed Tablet No. 323)

.35 .... $2.00

BRONCHIAL (Compressed Tablet No. 325)

.42 .... 2.70

<table><tr><td>Ammonium chloride</td><td>1/3 gr.</td></tr><tr><td>Ext. Glycyrrhiza</td><td>1 gr.</td></tr><tr><td>Oleoresin Cubeb</td><td>1/6 gr.</td></tr><tr><td>Powd. Hyoscyamus</td><td>1/4 gr.</td></tr><tr><td>Powd. Senega</td><td>1/5 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/50 gr.</td></tr><tr><td>Balsam Tolu</td><td>1/5 gr.</td></tr></table>

BRONCHITIS, R "A" (Tablet Triturate No. 693)

.35 .... 1.50

<table><tr><td>Tinct. Aconite</td><td>7/10 min.</td></tr><tr><td>Tinct. Bryonia</td><td>1/10 min.</td></tr><tr><td>Tinct. Belladonna leaves</td><td>3/20 min.</td></tr><tr><td>Sulphurated Antimony</td><td>1/100 gr.</td></tr><tr><td>Potassium bichromate</td><td>1/100 gr.</td></tr></table>

BROWN MIXTURE, 60 minims, R "B" (without opium) (Tablet Triturate No. 999)

.35 .... 1.80

<table><tr><td>Fl. ext. Glycyrrhiza</td><td>7 1/8 mins.</td></tr><tr><td>Antimony and Potassium tartrate</td><td>3/200 gr.</td></tr><tr><td>Oil Anise</td><td>3/100 min.</td></tr><tr><td>Benzoic acid</td><td>3/100 gr.</td></tr><tr><td>Camphor</td><td>3/100 gr.</td></tr></table>

◆BROWN MIXTURE, 100 minims (Compressed Tablet No. 59)

.51 .... 3.60

Each tablet represents 100 minims of the compound mixture of Glycyrrhiza of the U. S. P. and contains:

<table><tr><td>Fl. ext. Glycyrrhiza</td><td>12 mins.</td></tr><tr><td>Powd. Opium</td><td>1/20 gr.</td></tr><tr><td>Antimony and Potassium tartrate</td><td>1/40 gr.</td></tr><tr><td>Benzoic acid</td><td>1/20 gr.</td></tr><tr><td>Oil Anise</td><td>q.s.</td></tr><tr><td>Camphor</td><td>q.s.</td></tr></table>

◆Narcotic registry number required.

[164]

PILLS AND TABLETS

BROWN MIXTURE COMPOUND, R "B" (without opium) (Compressed Tablet No. 646)

Per bottle of
100 500 1000
$ .35 .... $2.00

<table><tr><td>Ext. Glycyrrhiza</td><td>1 1/8 grs.</td></tr><tr><td>Benzoic acid</td><td>3/100 gr.</td></tr><tr><td>Camphor</td><td>q.s.</td></tr><tr><td>Oil Anise</td><td>q.s.</td></tr><tr><td>Antimony and Potassium tartrate</td><td>3/200 gr.</td></tr><tr><td>Ammonium chloride</td><td>1 gr.</td></tr></table>

Brown-Sequard, see Neuralgic, Brown-Sequard.

BUCHU COMPOUND (infusion)

(Compressed Tablet No. 324)

.75 .... 6.00

<table><tr><td>Infusion Buchu</td><td>120 mins.</td></tr><tr><td>Tinct. Hyoscyamus</td><td>30 mins.</td></tr><tr><td>Potassium bicarbonate</td><td>6 grs.</td></tr></table>

CACTUS COMPOUND, P. D. & Co. (Heart Tonic) (Pill No. 891, gelatin-coated, round)

(Tablet Triturate No. 807)

.60 $2.25 ....

.45 .... 3.00

<table><tr><td>Cactus grandiflorus</td><td>1/2 gr.</td></tr><tr><td>Sparteine sulphate</td><td>1/40 gr.</td></tr><tr><td>Digitalone powdered; P. D. & Co.</td><td>2/25 gr.</td></tr><tr><td>Strophanthin</td><td>1/5000 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/500 gr.</td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>1/500 gr.</td></tr></table>

CACTUS COMPOUND No. 1 (Heart Tonic) (Compressed Tablet No. 70)

.75 .... 6.00

<table><tr><td>Fl. ext. Cereus grandiflorus</td><td>5 mins.</td></tr><tr><td>Caffeine</td><td>1 gr.</td></tr><tr><td>Tinct. Digitalis</td><td>3 mins.</td></tr></table>

CAFFEINE CITRATED, 1 gr.

(Tablet Triturate No. 27)

CALCIUM CARBONATE, 10 grs.

(Compressed Tablet No. 692)

CALCIUM CARBONATE COMPOUND

(Compressed Tablet No. 8)

.35 .... 1.80

<table><tr><td>Formerly known as "Antacid (Sir Wm. Roberts, M. D.)"</td></tr><tr><td>Calcium carbonate, precipitated</td><td>3 1/2 grs.</td></tr><tr><td>Magnesium carbonate</td><td>2 1/2 grs.</td></tr><tr><td>Sodium chloride</td><td>1 gr.</td></tr></table>

CALCIUM LACTATE, 5 grs.

(Compressed Tablet No. 533)

.50 .... 3.50

[165]

PILLS AND TABLETS

CALCIUM SULPHIDE

<table><thead><tr><th></th><th colspan="3" style="text-align:center;">Per bottle of</th></tr><tr><th></th><th style="text-align:right;">100</th><th style="text-align:right;">500</th><th style="text-align:right;">1000</th></tr></thead><tbody><tr><td>¼ gr. (Pill No. 117)</td><td style="text-align:right;">$ .45</td><td style="text-align:right;">$1.50</td><td style="text-align:right;">$1.20</td></tr><tr><td style="padding-left: 20px;">(Tablet Triturate No. 29)</td><td style="text-align:right;">.35</td><td style="text-align:right;">....</td><td style="text-align:right;">....</td></tr><tr><td style="padding-left: 20px;">(Chocolate-coated Tablet No. 35)</td><td style="text-align:right;">.40</td><td style="text-align:right;">....</td><td style="text-align:right;">1.70</td></tr><tr><td>½ gr. (Pill No. 118)</td><td style="text-align:right;">.50</td><td style="text-align:right;">1.75</td><td style="text-align:right;">....</td></tr><tr><td style="padding-left: 20px;">(Tablet Triturate No. 30)</td><td style="text-align:right;">.35</td><td style="text-align:right;">....</td><td style="text-align:right;">1.30</td></tr><tr><td style="padding-left: 20px;">(Chocolate-coated Tablet No. 36)</td><td style="text-align:right;">.40</td><td style="text-align:right;">....</td><td style="text-align:right;">1.80</td></tr><tr><td>1 gr. (Pill No. 119)</td><td style="text-align:right;">.55</td><td style="text-align:right;">2.00</td><td style="text-align:right;">....</td></tr><tr><td style="padding-left: 20px;">(Tablet Triturate No. 305)</td><td style="text-align:right;">.35</td><td style="text-align:right;">....</td><td style="text-align:right;">1.40</td></tr><tr><td style="padding-left: 20px;">(Chocolate-coated Tablet No. 37)</td><td style="text-align:right;">.40</td><td style="text-align:right;">....</td><td style="text-align:right;">1.90</td></tr><tr><td>2 grs. (Chocolate-coated Tablet No. 394)</td><td style="text-align:right;">.40</td><td style="text-align:right;">....</td><td style="text-align:right;">2.10</td></tr></tbody></table>

CALOBARB (Compressed Tablet No. 627)

<table><tbody><tr><td>Calomel</td><td>1 gr.</td></tr><tr><td>Phenolphthalein</td><td>2 grs.</td></tr><tr><td>Powdered Rhubarb</td><td>2 grs.</td></tr></tbody></table>

.65 .... 5.00

CALOMEL, 1/10 gr. (Tablet Triturate No. 32)

<table><tbody><tr><td>with wintergreen (Tablet Triturate No. 730)</td><td>.35</td><td>....</td><td>1.30</td></tr><tr><td>with wintergreen (Tablet Triturate No. 752, pink)</td><td>.35</td><td>....</td><td>1.35</td></tr><tr><td>1/8 gr. (Tablet Triturate No. 307)</td><td>.35</td><td>....</td><td>1.30</td></tr><tr><td>1/4 gr. (Tablet Triturate No. 33)</td><td>.35</td><td>....</td><td>1.50</td></tr><tr><td>with wintergreen (Tablet Triturate No. 798, pink)</td><td>.35</td><td>....</td><td>1.55</td></tr><tr><td>1/2 gr. (Tablet Triturate No. 34)</td><td>.35</td><td>....</td><td>1.80</td></tr><tr><td>with wintergreen (Tablet Triturate No. 799, pink)</td><td>.35</td><td>....</td><td>1.85</td></tr><tr><td>1 gr. (Tablet Triturate No. 35)</td><td>.40</td><td>....</td><td>2.50</td></tr><tr><td>with wintergreen (Tablet Triturate No. 800, pink)</td><td>.41</td><td>....</td><td>2.55</td></tr><tr><td>2 grs. (Tablet Triturate No. 204)</td><td>.55</td><td>....</td><td>4.00</td></tr></tbody></table>

CALOMEL, IPECAC AND SODA, R "A"

(Tablet Triturate No. 195)

<table><tbody><tr><td>Calomel</td><td>1/5 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/10 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1 gr.</td></tr></tbody></table>

.35 .... 1.80

CALOMEL AND PHENOLPHTHALEIN, R "A"

(Palatable) (Tablet Triturate No. 978)

<table><tbody><tr><td>Calomel</td><td>1/10 gr.</td></tr><tr><td>Phenolphthalein</td><td>1/10 gr.</td></tr><tr><td>Wintergreen</td><td>q.s.</td></tr></tbody></table>

.35 .... 1.50

[ 166 ]

PILLS AND TABLETS

CALOMEL AND PHENOLPHTHALEIN, R "C"

(with wintergreen) (Tablet Triturate 985, pink)

<table><tbody><tr><td>Phenolphthalein</td><td>1/2 gr.</td></tr><tr><td>Calomel</td><td>1/2 gr.</td></tr><tr><td>Wintergreen</td><td>q.s.</td></tr></tbody></table>

Per bottle of
100 500 1000
$ .38 .... $2.30

CALOMEL, PODOPHYLLIN AND SODA, R

"B" (Tablet Triturate No. 313)

<table><tbody><tr><td>Calomel</td><td>1/2 gr.</td></tr><tr><td>Podophyllin</td><td>1/12 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1/2 gr.</td></tr></tbody></table>

.39 .... 2.40

"E" (Compressed Tablet No. 147)

<table><tbody><tr><td>Calomel</td><td>2 grs.</td></tr><tr><td>Podophyllin</td><td>1/3 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1/2 gr.</td></tr></tbody></table>

.65 .... 5.00

CALOMEL, RHUBARB AND COLOCYNTH
COMPOUND

(Compressed Tablet No. 649, sugar-coated)

<table><tbody><tr><td>Calomel</td><td>2 grs.</td></tr><tr><td>Pill Colocynth Compound</td><td>2 grs.</td></tr><tr><td>Pill Rhubarb Comp., N. F.</td><td>2 grs.</td></tr></tbody></table>

.80 .... 6.50

CALOMEL AND SODA, R "B"

(Tablet Triturate No. 216)

with wintergreen (Tablet Triturate 794, pink)

<table><tbody><tr><td>Calomel</td><td>1/10 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1 gr.</td></tr></tbody></table>

.35 .... 1.30

.35 .... 1.35

CALOMEL AND SODA, R "D"

(Tablet Triturate No. 779)

<table><tbody><tr><td>Calomel</td><td>1/8 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1 gr.</td></tr></tbody></table>

.35 .... 1.35

CALOMEL AND SODA, R "H"

(Tablet Triturate No. 311)

with wintergreen (Tablet Triturate 795, pink)

<table><tbody><tr><td>Calomel</td><td>1/4 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1 gr.</td></tr></tbody></table>

.35 .... 1.50

.35 .... 1.55

[ 167 ]

PILLS AND TABLETS

<table><thead><tr><th>CALOMEL AND SODA, R "K"</th><th colspan="3">Per bottle of</th></tr><tr><th>(Tablet Triturate No. 649)</th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>with wintergreen (Tablet Triturate 981, pink)</td><td>$ .35</td><td>....</td><td>$1.80</td></tr><tr><td>Calomel</td><td>.35</td><td>....</td><td>1.85</td></tr><tr><td>Sodium bicarbonate</td><td></td><td>....</td><td></td></tr></tbody></table>

<table><thead><tr><th>CALOMEL AND SODA, R "M"</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Tablet Triturate No. 312)</td><td>.40</td><td>....</td><td>2.50</td></tr><tr><td>with wintergreen (Tablet Triturate 796, pink)</td><td>.41</td><td>....</td><td>2.55</td></tr><tr><td>Calomel</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Sodium bicarbonate</td><td></td><td></td><td>1 gr.</td></tr></tbody></table>

<table><thead><tr><th>CALOMEL AND SODA, R "P"</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Compressed Tablet No. 350)</td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td>Calomel</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Sodium bicarbonate</td><td></td><td></td><td>2 grs.</td></tr></tbody></table>

<table><thead><tr><th>CAMPHOR, HYOSCYAMUS AND VALERIAN</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Chocolate-coated Tablet No. 51)</td><td>.60</td><td>....</td><td>4.50</td></tr><tr><td>Camphor</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Ext. Hyoscyamus</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Ext. Valerian</td><td></td><td></td><td>1/2 gr.</td></tr></tbody></table>

<table><thead><tr><th>CASCARA COMPOUND No. 2</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Chocolate-coated Tablet No. 483)</td><td>.53</td><td>....</td><td>3.80</td></tr><tr><td>Ext. Cascara sagrada</td><td></td><td></td><td>2 grs.</td></tr><tr><td>Podophyllin</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Powd. Ext. Belladonna leaves</td><td></td><td></td><td>1/16 gr.</td></tr></tbody></table>

<table><thead><tr><th>CASCARA COMPOUND No. 3 (Dr. Hinkle)</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Pill No. 886, sugar-coated, round, pink)</td><td>.45</td><td>$1.50</td><td>....</td></tr><tr><td>(Pill No. 970, soft, chocolate-coated)</td><td>.45</td><td>1.50</td><td>....</td></tr><tr><td>(Compressed Tablet 375, sugar-coated, pink)</td><td>.40</td><td>....</td><td>2.20</td></tr><tr><td>Aloin</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Oleoresin Ginger</td><td></td><td></td><td>1/16 gr.</td></tr><tr><td>Strychnine sulphate</td><td></td><td></td><td>1/60 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Podophyllin, U. S. P.</td><td></td><td></td><td>1/6 gr.</td></tr></tbody></table>

<table><thead><tr><th>CASCARA COMPOUND No. 3 (Dr. Hinkle),<br>Modified (Chocolate-coated Tablet No. 164)</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>Same as above except that it contains 1/120 grain<br>Strychnine sulphate instead of 1/60 grain.</td><td>.40</td><td>....</td><td>2.20</td></tr></tbody></table>

[ 168 ]

PILLS AND TABLETS

<table><thead><tr><th>CASCARA COMPOUND No. 3 (Dr. Hinkle),<br>Strong (Compressed Tablet No. 601, sugar-<br>coated, pink)</th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>Original Hinkle formula, as on page 168, except that<br>it contains 1/2 grain Aloin instead of 1/4 grain.</td><td>$ .40</td><td>....</td><td>$2.20</td></tr></tbody></table>

<table><thead><tr><th>CASCARA COMPOUND No. 3 (Dr. Hinkle),<br>without Strychnine (Compressed Tablet No.<br>694, sugar-coated, pink)</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>Aloin</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Oleoresin Ginger</td><td></td><td></td><td>1/16 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Podophyllin, U. S. P.</td><td></td><td></td><td>1/6 gr.</td></tr></tbody></table>

<table><thead><tr><th>CASCARA SAGRADA EXTRACT</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>1 gr. (Chocolate-coated Tablet No. 53)</td><td>.40</td><td>....</td><td>2.25</td></tr><tr><td>2 grs. (Compressed Tablet No. 261, sugar-coated)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>(Chocolate-coated Tablet No. 175)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>3 grs. (Compressed Tablet No. 306, sugar-coated)</td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td>(Chocolate-coated Tablet No. 54)</td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td>5 grs. (Pill No. 881)</td><td>.75</td><td>$3.00</td><td>....</td></tr><tr><td>(Compressed Tablet No. 207)</td><td>.60</td><td>....</td><td>4.50</td></tr><tr><td>(Compressed Tablet No. 522, sugar-coated)</td><td>.65</td><td>....</td><td>5.00</td></tr><tr><td>(Chocolate-coated Tablet No. 55)</td><td>.65</td><td>....</td><td>5.00</td></tr></tbody></table>

<table><thead><tr><th>CASCARIN, P. D. & Co., 3 grs.</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Compressed Tablet No. 504, sugar-coated, red)</td><td>.45</td><td>....</td><td>3.00</td></tr></tbody></table>

<table><thead><tr><th>CASCARIN, P. D. & Co., 5 grs.</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Compressed Tablet No. 505, sugar-coated, red)</td><td>.53</td><td>....</td><td>3.80</td></tr></tbody></table>

<table><thead><tr><th>CASCARIN COMPOUND No. 1</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Compressed Tablet No. 12)</td><td>.37</td><td>....</td><td>2.20</td></tr><tr><td>(Chocolate-coated Tablet No. 56)</td><td>.42</td><td>....</td><td>2.70</td></tr><tr><td>Cascarin</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Podophyllin</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Aloin</td><td></td><td></td><td>1/4 gr.</td></tr></tbody></table>

<table><thead><tr><th>CATHARTIC GRANULES, R "B"</th><th></th><th></th><th></th></tr></thead><tbody><tr><td>(Pill No. 712, pink granule)</td><td>.45</td><td>1.50</td><td>....</td></tr><tr><td>Aloin</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Podophyllin, U. S. P.</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Ext. Nux vomica</td><td></td><td></td><td>1/8 gr.</td></tr></tbody></table>

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<table><thead><tr><th></th><th colspan="3" style="text-align:center;">Per bottle of</th></tr><tr><th></th><th style="text-align:center;">100</th><th style="text-align:center;">500</th><th style="text-align:center;">1000</th></tr></thead><tbody><tr><td><strong>CATHARTIC, VEGETABLE, N. F. (Pill No. 808)</strong></td><td style="text-align:right;">$ .80</td><td style="text-align:right;">$3.25</td><td style="text-align:right;">....</td></tr><tr><td>Ext. Hyoscyamus</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Jalap resin</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Oil Peppermint</td><td></td><td></td><td>1/8 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Ext. Leptandra</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Podophyllin, U. S. P.</td><td></td><td></td><td>1/4 gr.</td></tr></tbody></table>

CATHARTIC COMPOUND, U. S. P.

<table><tbody><tr><td>(Pill No. 163, gelatin-coated or sugar-coated)</td><td>.80</td><td>3.25</td><td>....</td></tr><tr><td>(Pill No. 967, soft, chocolate-coated)</td><td>.80</td><td>3.25</td><td>....</td></tr></tbody></table>

<table><caption>(Compound Pills of Mild Mercurous Chloride, U.S.P.)</caption><tbody><tr><td>Ext. Colocynth Compound</td><td>1¼ grs.</td></tr><tr><td>Calomel</td><td>1 gr.</td></tr><tr><td>Resin of Jalap</td><td>¼ gr.</td></tr><tr><td>Powd. Gamboge</td><td>¼ gr.</td></tr></tbody></table>

<table><caption>In 1-lb. bottles</caption><tbody><tr><td>Sugar-coated (1200)</td><td>per lb.</td><td>$5.00</td></tr><tr><td>Chocolate-coated (1200)</td><td>per lb.</td><td>5.00</td></tr><tr><td>Gelatin-coated (1400)</td><td>per lb.</td><td>5.80</td></tr></tbody></table><table><caption>Bottles of 25</caption><tbody><tr><td>Gelatin-coated (oval, brown)</td><td>per doz.</td><td>3.00</td></tr><tr><td>½ gross lots, per gross</td><td></td><td>33.00</td></tr><tr><td>per gross</td><td></td><td>32.00</td></tr></tbody></table>

CATHARTIC COMPOUND, IMPROVED

<table><tbody><tr><td>(Pill No. 160, gelatin-coated or sugar-coated)</td><td>.60</td><td>2.25</td><td>....</td></tr><tr><td>(Pill No. 968, soft, chocolate-coated)</td><td>.60</td><td>2.25</td><td>....</td></tr></tbody></table>

<table><tbody><tr><td>Ext. Jalap</td><td>1/2 gr.</td></tr><tr><td>Leptandrin</td><td>1/4 gr.</td></tr><tr><td>Ext. Hyoscyamus</td><td>1/4 gr.</td></tr><tr><td>Ext. Gentian</td><td>1/2 gr.</td></tr><tr><td>Podophyllin, U. S. P.</td><td>1/4 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td>1 gr.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></tbody></table><table><caption>In 1-lb. bottles</caption><tbody><tr><td>Sugar-coated (1200)</td><td>per lb.</td><td>$3.70</td></tr><tr><td>Chocolate-coated (1200)</td><td>per lb.</td><td>3.70</td></tr><tr><td>Gelatin-coated (1700)</td><td>per lb.</td><td>5.15</td></tr></tbody></table><table><caption>Bottles of 25</caption><tbody><tr><td>Gelatin-coated (oval, black)</td><td>per doz.</td><td>2.35</td></tr><tr><td>½ gross lots, per gross</td><td></td><td>26.00</td></tr><tr><td>per gross</td><td></td><td>25.50</td></tr></tbody></table>

[170]

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<table><thead><tr><th></th><th colspan="3" style="text-align:center;">Per bottle of</th></tr><tr><th></th><th style="text-align:center;">100</th><th style="text-align:center;">500</th><th style="text-align:center;">1000</th></tr></thead><tbody><tr><td><strong>CATHARTIC COMPOUND, ACTIVE</strong><br>(Pill No. 819)</td><td style="text-align:right;">$ .50</td><td style="text-align:right;">$1.75</td><td style="text-align:right;">....</td></tr><tr><td>Aloe</td><td>1 1/8 grs.</td><td></td><td></td></tr><tr><td>Powd. Gamboge</td><td>3/16 gr.</td><td></td><td></td></tr><tr><td>Podophyllin, U. S. P.</td><td>1/8 gr.</td><td></td><td></td></tr><tr><td>Powd. Capsicum</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Croton oil</td><td>1/50 gr.</td><td></td><td></td></tr></tbody></table>

<table><caption>CATHARTIC COMPOUND, VEGETABLE, R "A"<br>(Pill No. 164, gelatin-coated or sugar-coated)</caption><tbody><tr><td>Ext. Colocynth</td><td>1/3 gr.</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>Powd. Cardamom</td><td>1/8 gr.</td><td></td><td></td><td></td></tr><tr><td>Podophyllin, U. S. P.</td><td>1/4 gr.</td><td></td><td></td><td></td></tr><tr><td>Scammony resin</td><td>1/3 gr.</td><td></td><td></td><td></td></tr><tr><td>Purified Aloe</td><td>1 1/4 grs.</td><td></td><td></td><td></td></tr><tr><td>Powd. Soap</td><td>1/8 gr.</td><td></td><td></td><td></td></tr></tbody></table>

<table><tbody><tr><td>CHARCOAL, 5 grs. (Compressed Tablet No. 63)</td><td>.35</td><td>....</td><td>$1.70</td></tr><tr><td>10 grs. (Compressed Tablet No. 64)</td><td>.45</td><td>....</td><td>3.00</td></tr></tbody></table>

<table><caption>CHARCOAL AND PEPSIN<br>(Compressed Tablet No. 115)</caption><tbody><tr><td>Charcoal</td><td>5 grs.</td><td>.35</td><td>....</td><td>2.00</td></tr><tr><td>Saccharated Pepsin</td><td>2 grs.</td><td></td><td></td><td></td></tr></tbody></table>

<table><caption>•CHLORODYNE (Compressed Tablet No. 14)</caption><tbody><tr><td>Morphine hydrochloride</td><td>1/6 gr.</td><td>2.70</td><td>....</td></tr><tr><td>Ext. Cannabis</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>1/300 gr.</td><td></td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Oleoresin Capsicum</td><td>1/10 min.</td><td></td><td></td></tr><tr><td>Oil Peppermint</td><td>q.s.</td><td></td><td></td></tr></tbody></table>

<table><caption>•CHLORODYNE No. 2 (half-strength)<br>(Chocolate-coated Tablet No. 186)</caption><tbody><tr><td>Ext. Cannabis</td><td>1/8 gr.</td><td>1.60</td><td>....</td></tr><tr><td>Morphine hydrochloride</td><td>1/12 gr.</td><td></td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Oleoresin Capsicum</td><td>1/20 min.</td><td></td><td></td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>1/600 gr.</td><td></td><td></td></tr><tr><td>Oil Peppermint</td><td>q.s.</td><td></td><td></td></tr></tbody></table>

<table><caption>CHOLERA INFANTUM, No. 1<br>(Chocolate-coated Tablet No. 492)</caption><tbody><tr><td>Zinc sulphocarbolate</td><td>1/20 gr.</td><td>.50</td><td>3.50</td></tr><tr><td>Bismuth subnitrate</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Calomel</td><td>1/60 gr.</td><td></td><td></td></tr><tr><td>Pancreatin</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Salol</td><td>1/10 gr.</td><td></td><td></td></tr></tbody></table>

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## CHOLELITH (Pilula Cholelithica)

(Pill No. 975, chocolate-coated, round)

<table><tr><td>Menthol</td><td>1/10 gr.</td></tr><tr><td>Phenolphthalein</td><td>1/3 gr.</td></tr><tr><td>Sodium salicylate (from salicylic acid, natural)</td><td>1 1/2 grs.</td></tr><tr><td>Acid Sodium oleate</td><td>1 1/2 grs.</td></tr></table>

For the treatment of cholelithiasis and allied conditions. Cholagogue and biliary stimulant.

Dose: 3 or 4 pills, followed by a copious draught of hot water, upon arising in the morning and upon retiring at night.

## CHOLELITH, R "B"

(Pill No. 1004, soft, chocolate-coated)

<table><tr><td>Menthol</td><td>1/10 gr.</td></tr><tr><td>Hexamethylene tetramine</td><td>2 1/2 grs.</td></tr><tr><td>Sodium salicylate (from salicylic acid, natural)</td><td>1 1/2 grs.</td></tr><tr><td>Acid sodium oleate</td><td>1 1/2 grs.</td></tr></table>

## CHROMIUM SULPHATE, 4 grs.

(Compressed Tablet No. 613)

1.30 5.75 ....

CINCHOPHEN, see page 16.

*COCAINE HYDROCHLORIDE, see page 17.

*CODEINE SULPHATE

<table><tr><td>1/8 gr. (Tablet Triturate No. 751)</td><td>1.60</td><td>....</td><td>....</td></tr><tr><td>1/4 gr. (Tablet Triturate No. 733)</td><td>2.60</td><td>....</td><td>....</td></tr><tr><td>1/2 gr. (Tablet Triturate No. 748)</td><td>4.80</td><td>....</td><td>....</td></tr><tr><td>1 gr. (Tablet Triturate No. 734)</td><td>9.40</td><td>....</td><td>....</td></tr></table>

## COLD (LAXATIVE), R "A" (Grip)

(Compressed Tablet No. 415, sugar-coated, red)

(Chocolate-coated Tablet No. 390)

<table><tr><td>Acetanilid</td><td>2 grs.</td></tr><tr><td>Quinine sulphate</td><td>1/2 gr.</td></tr><tr><td>Caffeine</td><td>1/4 gr.</td></tr><tr><td>Podophyllin</td><td>1/40 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/20 gr.</td></tr><tr><td>Aloin</td><td>1/40 gr.</td></tr><tr><td>Powd. Capsicum</td><td>1/10 gr.</td></tr></table>

[172]

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## COLD (LAXATIVE), R "B"

(Compressed Tablet No. 506, sugar-coated, red)

<table><tr><td>Quinine sulphate</td><td>2 grs.</td></tr><tr><td>Acetanilid</td><td>2 grs.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td>1/2 gr.</td></tr><tr><td>Powd. Capsicum</td><td>1/4 gr.</td></tr><tr><td>Aloin</td><td>1/4 gr.</td></tr><tr><td>Sodium bromide</td><td>1/8 gr.</td></tr></table>

## COLD (LAXATIVE), R "D"

(Chocolate-coated Tablet No. 345)

<table><tr><td>Quinine sulphate</td><td>1/2 gr.</td></tr><tr><td>Acetanilid</td><td>2 grs.</td></tr><tr><td>Tinct. Aconite</td><td>3 mins.</td></tr><tr><td>Podophyllin</td><td>1/20 gr.</td></tr><tr><td>Aloin</td><td>1/15 gr.</td></tr></table>

## COLD (LAXATIVE), R "E"

(Chocolate-coated Tablet No. 260)

<table><tr><td>Quinine sulphate</td><td>2 grs.</td></tr><tr><td>Acetanilid</td><td>2 grs.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td>1/4 gr.</td></tr><tr><td>Powd. Capsicum</td><td>1/4 gr.</td></tr><tr><td>Aloin</td><td>1/4 gr.</td></tr><tr><td>Sodium bromide</td><td>1/8 gr.</td></tr></table>

## COLD (LAXATIVE), R "F"

(Chocolate-coated Tablet No. 481)

<table><tr><td>Acetanilid</td><td>2 grs.</td></tr><tr><td>Quinine sulphate</td><td>1/4 gr.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td>1/2 gr.</td></tr><tr><td>Powd. Capsicum</td><td>1/4 gr.</td></tr><tr><td>Podophyllin</td><td>1/8 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/20 gr.</td></tr><tr><td>Ext. Hyoscyamus</td><td>1/20 gr.</td></tr></table>

## COLD AND FEVER (Dr. Evan F. Smith)

(Tablet Triturate No. 706)

<table><tr><td>Tinct. Eupatorium</td><td>1/4 min.</td></tr><tr><td>Camphor monobromated</td><td>1/10 gr.</td></tr><tr><td>Tinct. Aconite</td><td>1 min.</td></tr><tr><td>Tinct. Bryonia</td><td>1/4 min.</td></tr><tr><td>Tinct. Gelsemium</td><td>1/2 min.</td></tr></table>

## COLOR, for coloring liquids

Red (Tablet Triturate No. 805)

Green (Tablet Triturate No. 819)

Per bottle of
100 500 1000
$1.50 .... ....

60 $4.50

1.50 .... ....

59 4.40

35 1.50

45 3.00

45 3.00

Note—The colors are not certified for use in food products.

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Constipation, see Anti-Constipation, also Calomel, Cascara, Cathartic, etc.

CORPORA LUTEA, see Gland Products, page 64.

CORRECTIVE, INFANT, No. 2 (Ives)

(Tablet Triturate No. 738)

100 500 1000
$ .51 .... $3.60

<table><tr><td>Powd. Ipecac</td><td>1/50 gr.</td></tr><tr><td>Bismuth subnitrate</td><td>1 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1/2 gr.</td></tr><tr><td>Calomel</td><td>1/20 gr.</td></tr><tr><td>Saccharin</td><td>1/100 gr.</td></tr><tr><td>Oil Anise</td><td>1/20 min.</td></tr></table>

Corrosive Sublimate Tablets, U. S. P., see Anti-septic Tablets, page 7.

CORYZA, R "A" (Richards)

(Compressed Tablet No. 243)

(Chocolate-coated Tablet No. 65)

.60 .... 4.50

.65 .... 5.00

<table><tr><td>Quinine sulphate</td><td>1/2 gr.</td></tr><tr><td>Ammonium chloride</td><td>1/2 gr.</td></tr><tr><td>Ext. Belladonna leaves</td><td>1/20 gr.</td></tr><tr><td>Camphor</td><td>1/2 gr.</td></tr><tr><td>Ext. Aconite root</td><td>1/10 gr.</td></tr></table>

CORYZA, R "F" (Kenyon), without Morphine

(Tablet Triturate No. 722)

(Chocolate-coated Tablet No. 66)

.60 .... 4.50

.65 .... 5.00

<table><tr><td>Camphor</td><td>1/2 gr.</td></tr><tr><td>Quinine sulphate</td><td>1/2 gr.</td></tr><tr><td>Atropine sulphate</td><td>1/2000 gr.</td></tr></table>

CORYZA, R "H" (Smith), without Morphine

(Chocolate-coated Tablet No. 376)

.40 .... 2.40

<table><tr><td>Atropine sulphate</td><td>1/600 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/240 gr.</td></tr><tr><td>Arsenic trioxide</td><td>1/240 gr.</td></tr><tr><td>Quinine sulphate</td><td>1/10 gr.</td></tr><tr><td>Powd. Camphor</td><td>1/4 gr.</td></tr></table>

♦COUGH, No. 2 (Compressed Tablet No. 246).

.45 .... 3.00

<table><tr><td>Ammonium carbonate</td><td>1 gr.</td></tr><tr><td>Powd. Squill</td><td>3/4 gr.</td></tr><tr><td>Powd. Senega</td><td>3/4 gr.</td></tr><tr><td>Tinct. Opium camphorated</td><td>5 mins.</td></tr></table>

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COUGH, INFANT (Tablet Triturate No. 747)

100 500 1000
$ .35 .... $2.00

<table><tr><td>Ammonium chloride</td><td>1/4 gr.</td></tr><tr><td>Fl. ext. Ipecac</td><td>1/5 min.</td></tr><tr><td>Ext. Glycyrrhiza</td><td>1/4 gr.</td></tr><tr><td>Tinct. Belladonna leaves</td><td>1/5 min.</td></tr><tr><td>Oil Anise</td><td>1/40 min.</td></tr></table>

CREOSOTE, U. S. P.

1 gr. (Pill No. 783, enteric-coated) .60 $2.25 ....

2 grs. (Pill No. 790, enteric-coated) .70 2.75 ....

We use a specially designed coating for our Creosote pills, and every lot is tested for resistance to acid pepsin solutions and solubility in alkaline pancreatin solutions.

CREOSOTE, U. S. P., 1 minim

(Chocolate-coated Tablet No. 68) .45 .... 3.00

CUBEB COMPOUND No. 1

(Compressed Tablet No. 18) .45 .... 3.00

(Chocolate-coated Tablet No. 70) .50 .... 3.50

<table><tr><td>Powd. Cubeb</td><td>3/4 gr.</td></tr><tr><td>Copaiba mass</td><td>1/2 gr.</td></tr><tr><td>Venice Turpentine</td><td>1/4 gr.</td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td>1/10 min.</td></tr><tr><td>Ferrous sulphate, exsiccated</td><td>1/8 gr.</td></tr><tr><td>Oil Wintergreen (synthetic)</td><td>1/20 min.</td></tr></table>

CUBEB COMPOUND No. 4 (Pill No. 295)

(Chocolate-coated Tablet No. 320) .45 .... 3.00

(Formerly known as Gonorrhea)

<table><tr><td>Powd. Cubeb</td><td>1 1/4 grs.</td></tr><tr><td>Copaiba mass</td><td>1 1/4 grs.</td></tr><tr><td>Ferrous sulphate, exsiccated</td><td>1/4 gr.</td></tr><tr><td>Venice Turpentine</td><td>1/4 gr.</td></tr></table>

CYSTITIS, No. 1 (for Acid Urine)

(Compressed Tablet No. 19) .75 .... 6.00

(Chocolate-coated Tablet No. 71) .80 .... 6.50

<table><tr><td>Boric acid</td><td>2 grs.</td></tr><tr><td>Ext. Corn silk</td><td>1/2 gr.</td></tr><tr><td>Ext. Hydrangea</td><td>1/2 gr.</td></tr><tr><td>Potassium bicarbonate</td><td>2 grs.</td></tr><tr><td>Ext. Buchu</td><td>1 gr.</td></tr><tr><td>Ext. Triticum</td><td>1 gr.</td></tr><tr><td>Atropine sulphate</td><td>1/500 gr.</td></tr></table>

[175]

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CYSTITIS, No. 2 (for Alkaline Urine)

(Compressed Tablet No. 153)

(Chocolate-coated Tablet No. 72)

<table><tr><td>Benzoic acid</td><td>3 grs.</td></tr><tr><td>Ext. Corn silk</td><td>1/2 gr.</td></tr><tr><td>Sodium borate</td><td>2 grs.</td></tr><tr><td>Atropine sulphate</td><td>1/500 gr.</td></tr><tr><td>Ext. Hydrangea</td><td>1/2 gr.</td></tr><tr><td>Ext. Buchu</td><td>1 gr.</td></tr><tr><td>Ext. Triticum</td><td>1 gr.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$ .90</td><td>....</td><td>$7.50</td></tr><tr><td>.95</td><td>....</td><td>8.00</td></tr></tbody></table>

DAMIANA COMPOUND No. 1

(Compressed Tablet No. 516, sugar-coated, red)

(Chocolate-coated Tablet No. 73)

<table><tr><td>Ext. Damiana</td><td>2 grs.</td></tr><tr><td>Zinc phosphide</td><td>1/7 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/4 gr.</td></tr></table>

<table><tr><td>.70</td><td>....</td><td>5.50</td></tr><tr><td>.70</td><td>....</td><td>5.50</td></tr></table>

DAMIANA AND NUX VOMICA COM-

POUND (Chocolate-coated Tablet No. 253)

<table><tr><td>Ext. Nux vomica</td><td>1/10 gr.</td></tr><tr><td>Gold and Sodium chloride</td><td>1/50 gr.</td></tr><tr><td>Ext. Damiana</td><td>1/4 gr.</td></tr><tr><td>Zinc phosphide</td><td>1/25 gr.</td></tr></table>

<table><tr><td>.55</td><td>....</td><td>4.00</td></tr></table>

DAMIANA AND ZINC PHOSPHIDE COM-

POUND (Compressed Tablet No. 10)

<table><tr><td>Ext. Nux vomica</td><td>1/8 gr.</td></tr><tr><td>Ext. Damiana</td><td>2 grs.</td></tr><tr><td>Cantharides</td><td>1/25 gr.</td></tr><tr><td>Zinc phosphide</td><td>1/10 gr.</td></tr></table>

<table><tr><td>.65</td><td>....</td><td>5.00</td></tr><tr><td>.70</td><td>....</td><td>5.50</td></tr></table>

Davis, see Fever, Dr. T. G. Davis.

Dermatol, see Bismuth Subgallate, page 161.

DIARRHEA, β "A" (Compressed Tablet No. 21)

<table><tr><td>Bismuth subnitrate</td><td>3 grs.</td></tr><tr><td>Saccharated Pepsin</td><td>2 grs.</td></tr><tr><td>Aromatic Chalk powder</td><td>2 grs.</td></tr></table>

<table><tr><td>.95</td><td>....</td><td>8.00</td></tr></table>

DIGESTIVE, β "B"

(Compressed Tablet No. 22, sugar-coated)

<table><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>3 grs.</td></tr><tr><td>Diastase</td><td>1/4 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/8 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/12 gr.</td></tr></table>

<table><tr><td>.75</td><td>....</td><td>6.00</td></tr></table>

[176]

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DIGESTIVE, β "C" (Compressed Tablet No. 66)

<table><tr><td>Calcium lactophosphate</td><td>2 grs.</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>1 gr.</td></tr><tr><td>Pancreatin</td><td>1 gr.</td></tr><tr><td>Aromatics</td><td>q.s.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$ .65</td><td>....</td><td>$5.00</td></tr></tbody></table>

DIGESTIVE AROMATIC

(Compressed Tablet No. 363)

<table><tr><td>Saccharated Pepsin</td><td>4 grs.</td></tr><tr><td>Pancreatin</td><td>1 gr.</td></tr><tr><td>Diastase</td><td>1/4 gr.</td></tr><tr><td>Aromatic powder</td><td>1/4 gr.</td></tr></table>

See also Anti-Dyspeptic, Panteric, Pepsin, and Taka-Diastase.

DIGIFORTIS, see page 21.

DIGITALIN, PURE

1/100 gr. (Tablet Triturate No. 61)

1/50 gr. (Tablet Triturate No. 63). .55 .... 4.00

DIGITALIS TINCTURE, U.S.P., 5 minims

(Tablet Triturate No. 364) .37 .... 2.20

DIGITALIS, SQUILL AND MERCURY, N. F.,
see Triplex, Guy's Hospital.

DIGITALIS, STROPHANTHUS AND STRYCH-

<table><tr><td>NINE (Chocolate-coated Tablet No. 192)</td><td>1/100 gr.</td></tr><tr><td>Strychnine nitrate</td><td>1/5 gr.</td></tr><tr><td>Tinct. Digitalis</td><td>4½ mins.</td></tr><tr><td>Tinct. Strophanthus</td><td>1 min.</td></tr></table>

<table><tr><td>.43</td><td>....</td><td>2.75</td></tr></table>

DINNER (Lady Webster) (Pill No. 256)

<table><tr><td>Aloe</td><td>1 1/5 grs.</td></tr><tr><td>Mastic</td><td>3/5 gr.</td></tr><tr><td>Red Rose</td><td>2/5 gr.</td></tr></table>

<table><tr><td>.65</td><td>$2.50</td><td>....</td></tr></table>

DIURETIC No. 2 (Compressed Tablet No. 126)

<table><tr><td>Powd. Digitalis</td><td>1 gr.</td></tr><tr><td>Ext. Buchu</td><td>1 gr.</td></tr><tr><td>Potassium nitrate</td><td>1 gr.</td></tr><tr><td>Powd. Squill</td><td>1 gr.</td></tr></table>

DOBELL SOLUTION (Compressed Tablet 351)

<table><tr><td>Sodium borate</td><td>7 1/2 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>7 1/2 grs.</td></tr><tr><td>Carbolic acid</td><td>1 1/2 grs.</td></tr></table>

<table><tr><td>.75</td><td>....</td><td>....</td></tr></table>

[177]

PILLS AND TABLETS

*DOVER POWDER, 2½ grs.

(Tablet Triturate No. 202)

Ipecac and Opium Powder (powd. opium, ¼ gr.)

Per bottle of—
100 500 1000
$ .70 .... $5.50

*DOVER POWDER, 5 grs.

(Compressed Tablet No. 23)

Ipecac and Opium Powder (powd. opium, ½ gr.)

1.05

....

9.00

Dysmenorrhea, see Sedans, page 194.

Dyspeptic, see Anti-Dyspeptic, page 158.

Easton's Syrup, see Iron, Quinine and Strychnine
Phosphates, No. 1, page 183.

EDEMA (Chocolate-coated Tablet No. 386)

Ext. Sourwood leaves.................. 2 grs.

Ext. Elder flowers.................. 2 grs.

Ext. Squill.......................... 1/4 gr.

.73

....

5.75

ELATERIN, U. S. P., 1/10 gr.

(Tablet Triturate No. 71)

1.85

....

....

ENDOMETRITIS (Chocolate-coated Tablet 368)

Ext. Hamamelis.................. 1 gr.

Ext. Viburnum prunifolium........ 2 grs.

Ergotin (Bonjean)................ 1/2 gr.

Ext. Nux vomica.................. 1/12 gr.

Hydrastin.................. 1/10 gr.

1.10

....

9.50

ERGOTIN (BONJEAN), 1 gr. (Pill No. 273)

(C.C.T. No. 342)

2 grs. (Pill No. 274)....

3 grs. (Pill No. 275)....

(C.C.T. No. 306)

5 grs. (Pill No. 838)....

1.20 $5.25

1.10

....

9.50

1.90

8.75

2.50

11.75

2.45

....

4.00

19.25

....

....

ERGOTIN COMPOUND No. 1 (Pill No. 268)

(Formerly known as Emmenagogue, Improved)

Ergotin (Bonjean).................. 1 gr.

Aloe.................................. 1 gr.

Oil Savin.......................... q.s.

Ext. Black Hellebore.................. 1 gr.

Ferrous sulphate, exsiccated........ 1 gr.

1.40

6.25

....

[178]

PILLS AND TABLETS

ERGOTIN COMPOUND No. 4 (Pill No. 270)

(Formerly known as Emmenagogue No. 4)

Ext. Cotton-root bark.................. 1 gr.

ERGOTIN COMPOUND, IMPROVED

(Compressed Tablet No. 412, sugar-coated, red)

1.25 $11.00

(Compressed Tablet No. 156)

1.20 10.50

(Chocolate-coated Tablet No. 84)

1.25 11.00

Oil Savin.......................... 1/4 min.

EVACUANT (Pill No. 362)

.45 1.50

Aloin.................................. 1/4 gr.

Strychnine.......................... 1/60 gr.

Ext. Belladonna leaves.................. 1/8 gr.

Powd. Ipecac.......................... 1/16 gr.

FEBRILE (LAXATIVE)

(Chocolate-coated Tablet No. 297)

1.00 8.50

Quinine sulphate.................. 1 gr.

Acetanilid.......................... 2 grs.

Tinct. Gelsemium.................. 1½ mins.

Aloin.................................. 1/20 gr.

Podophyllin.......................... 1/40 gr.

Powd. Capsicum.................. 1/4 gr.

Fel Bovis, see Ox Gall, page 188.

Ferrous Carbonate (Blaud), see Blaud, page 161.

FERROUS IODIDE, N. F., 1 gr. (Pill No. 334)

.85 3.50

FEVER (Dr.T.G.Davis) (Tablet Triturate No. 630)

.35 1.50

Tinct. Aconite.................. 7/10 min.

Tinct. Bryonia.................. 1/10 min.

Tinct. Belladonna leaves........... 3/20 min.

[179]

PILLS AND TABLETS

FLATULENCE (Compressed Tablet No. 625, sugar-coated, yellow).

<table><tr><td>Ext. Nux vomica</td><td>1/4 gr.</td></tr><tr><td>Ext. Cascara sagrada</td><td>1 gr.</td></tr><tr><td>Ginger</td><td>3/4 gr.</td></tr><tr><td>Asafetida</td><td>1 gr.</td></tr><tr><td>Diastase</td><td>1/20 gr.</td></tr><tr><td>Powd. Capsicum</td><td>1/8 gr.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$ .45</td><td>....</td><td>$3.00</td></tr></tbody></table>

FOLLICULAR TONSILLITIS

(Tablet Triturate No. 728)

<table><tr><td>Tinct. Aconite</td><td>7/10 min.</td></tr><tr><td>Tinct. Bryonia</td><td>1/10 min.</td></tr><tr><td>Tinct. Belladonna leaves</td><td>3/20 min.</td></tr><tr><td>Mercuric iodide, red</td><td>1/100 gr.</td></tr><tr><td>Sodium salicylate</td><td>1 gr.</td></tr><tr><td>Oil Wintergreen (synthetic)</td><td>q.s.</td></tr></table>

<table><tr><td>.35</td><td>....</td><td>1.70</td></tr></table>

Glonoin, see Nitroglycerin, page 187.

GRIP (Dr. I. P. Klingensmith)

(Compressed Tablet No. 321)

<table><tr><td>Ammonium salicylate</td><td>2 1/2 grs.</td></tr><tr><td>Acetanilid</td><td>2 1/2 grs.</td></tr><tr><td>Caffeine</td><td>1/2 gr.</td></tr></table>

<table><tr><td>.70</td><td>....</td><td>5.50</td></tr></table>

See also Cold Laxative.

Heart Stimulant, see Nitroglycerin Compounds, page 187.

Heart Tonic, see Cactus Compounds, page 165.

HEPATIC (Dr. H. J. Kenyon)

(Chocolate-coated Tablet No. 91)

<table><tr><td>Euonymin, brown</td><td>1/8 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/8 gr.</td></tr><tr><td>Podophyllin</td><td>1/20 gr.</td></tr><tr><td>Aloin</td><td>1/12 gr.</td></tr><tr><td>Calomel</td><td>1/8 gr.</td></tr></table>

<table><tr><td>.44</td><td>....</td><td>2.90</td></tr></table>

Hinkle, see Cascara Compound No. 3, Dr. Hinkle.

HYOSCINE HYDROBROMIDE (Scopolamine)

1/200 gr. (Tablet Triturate No. 658)

1/100 gr. (Tablet Triturate No. 750)

<table><tr><td>.60</td><td>....</td><td>4.50</td></tr></table>

<table><tr><td>.85</td><td>....</td><td>7.00</td></tr></table>

[ 180 ]

PILLS AND TABLETS

HYPOTENSIVE (Compressed Tablet No. 578)..

Lithium hippurate 2 grs.

Nitroglycerin (Glyceryl trinitrate) 1/200 gr.

Sodium nitrite 1 gr.

These tablets are designed especially for the relief of vasoconstriction due to nervous imbalance — in other words, functional high blood pressure. Their effect is manifested promptly on ingestion of the dose, one or two tablets as occasion arises.

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$1.60</td><td>....</td><td>....</td></tr></tbody></table>

ICHTHYOL, 2 grs. (Pill No. 867, enteric-coated)

<table><tr><td>1.35</td><td>$6.00</td><td>....</td></tr></table>

INCONTINENCE, No. 2

(Chocolate-coated Tablet No. 362)

Tinct. Cubeb 2 mins.

Tinct. Cascarilla 2 mins.

Tinct. Belladonna leaves 3 mins.

Tinct. Rhubarb Aromatic 1 min.

Tinct. Nux vomica 1 min.

<table><tr><td>.40</td><td>....</td><td>$2.50</td></tr></table>

INTESTINAL (INFANT) (Tablet Triturate 792)

Powd. Ipecac 1/20 gr.

Salol 1/2 gr.

Zinc sulphocarbolate 1/8 gr.

Bismuth subgallate 1/2 gr.

Saccharin q.s.

Oil Anise q.s.

<table><tr><td>.45</td><td>....</td><td>3.00</td></tr></table>

[ 181 ]

PILLS AND TABLETS

## INTESTINAL No. 2
(Chocolate-coated Tablet No. 369)

<table><tr><td>Bismuth subgallate</td><td>2 grs.</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>1/2 gr.</td></tr><tr><td>Salol</td><td>2 grs.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$1.00</td><td>....</td><td>$8.50</td></tr></tbody></table>

## IRON, ARSENIC AND STRYCHNINE, No. 1
(Tablet Triturate No. 203)

(Chocolate-coated Tablet No. 92)

<table><tr><td>Reduced Iron</td><td>1 gr.</td></tr><tr><td>Arsenic trioxide</td><td>1/100 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td></tr></table>

<table><tr><td>.35</td><td>....</td><td>2.00</td></tr><tr><td>.40</td><td>....</td><td>2.50</td></tr></table>

## IRON, ARSENIC AND STRYCHNINE, No. 2
(Tablet Triturate No. 416)

(Chocolate-coated Tablet No. 93)

<table><tr><td>Reduced Iron</td><td>1 gr.</td></tr><tr><td>Arsenic trioxide</td><td>1/50 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td></tr></table>

Iron Iodide, see Ferrous Iodide, page 179.

## IRON OXIDE, SACCHARATED (Eisenzucker),
3 grs. (Compressed Tablet No. 316)

(Compressed Tablet No. 317)

<table><tr><td>.35</td><td>....</td><td>2.00</td></tr><tr><td>.43</td><td>....</td><td>2.80</td></tr></table>

## IRON, QUININE AND STRYCHNINE, No. 1
(Pill No. 552)

<table><tr><td>Ferrous carbonate mass (Vallet)</td><td>2 grs.</td></tr><tr><td>Quinine sulphate</td><td>1 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td></tr></table>

<table><tr><td>1.05</td><td>$4.50</td><td>....</td></tr></table>

## IRON, QUININE AND STRYCHNINE, No. 1
(Tablet Triturate No. 184)

(Chocolate-coated Tablet No. 94)

<table><tr><td>Reduced Iron</td><td>1/2 gr.</td></tr><tr><td>Quinine sulphate</td><td>1/2 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/120 gr.</td></tr></table>

<table><tr><td>.60</td><td>....</td><td>4.50</td></tr><tr><td>.65</td><td>....</td><td>5.00</td></tr></table>

## IRON, QUININE AND STRYCHNINE, No. 2
(Chocolate-coated Tablet No. 387)

<table><tr><td>Reduced Iron</td><td>1 gr.</td></tr><tr><td>Quinine sulphate</td><td>1 gr.</td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td></tr></table>

<table><tr><td>1.00</td><td>....</td><td>8.50</td></tr></table>

[ 182 ]

PILLS AND TABLETS

## IRON, QUININE AND STRYCHNINE CITRATE (Pill No. 348)

<table><tr><td>Iron and Quinine citrate</td><td>2 grs.</td></tr><tr><td>Strychnine citrate</td><td>1/50 gr.</td></tr></table>

<table><thead><tr><th colspan="3">Per bottle of</th></tr><tr><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>$1.05</td><td>$4.50</td><td>....</td></tr></tbody></table>

## IRON, QUININE AND STRYCHNINE PHOSPHATES, No. 1 (Pill No. 553)

<table><tr><td>Iron phosphate, precipitated</td><td>1 gr.</td></tr><tr><td>Quinine phosphate</td><td>1 gr.</td></tr><tr><td>Strychnine phosphate</td><td>1/60 gr.</td></tr></table>

<table><tr><td>1.35</td><td>6.00</td><td>....</td></tr></table>

## IRON, QUININE AND STRYCHNINE PHOSPHATES, No. 1 (Chocolate-coated Tablet 199)

<table><tr><td>Ferrous phosphate</td><td>1 gr.</td></tr><tr><td>Quinine phosphate</td><td>3/4 gr.</td></tr><tr><td>Strychnine phosphate</td><td>1/32 gr.</td></tr></table>

<table><tr><td>1.05</td><td>....</td><td>$9.00</td></tr></table>

Each tablet represents 1 fluid drachm of Easton's Syrup.

## KAMALA, 15½ grs. (Compressed Tablet No. 688)

<table><tr><td>1.25</td><td>....</td><td>11.00</td></tr></table>

## LAXATIVE (Barker) (Pill No. 365)

(Postpartum Laxative)

<table><tr><td>Aloe</td><td>5/6 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>5/12 gr.</td></tr><tr><td>Ext. Hyoscymus</td><td>1 1/4 grs.</td></tr><tr><td>Podophyllin, U. S. P.</td><td>1/12 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/12 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td>1 2/3 grs.</td></tr></table>

<table><tr><td>1.10</td><td>4.75</td><td>....</td></tr></table>

## LECITHIN, 0.1 Gm. (Pill No. 924, sugar-coated)

Lecithin is a natural phospho-glyceride containing a high percentage of phosphorus in organic combination. Indicated in all derangements due to lack of organic phosphorus. It has been recommended in anemia, chlorosis, rachitis, tuberculosis, and neu-roses due to lowered vitality. Dose: 1 pill three times a day.

<table><tr><td>4.30</td><td>....</td><td>....</td></tr></table>

## MAGNESIA AND SODA

(Compressed Tablet No. 682)

<table><tr><td>Calcined Magnesia</td><td>10 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>10 grs.</td></tr></table>

## MANGANESE DIOXIDE, 2 grs. (Pill No. 379)

<table><tr><td>.50</td><td>1.75</td><td>....</td></tr></table>

[ 183 ]

PILLS AND TABLETS

<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td><strong>MENORRHAGIC (Dr. Hirst)</strong><br>(Chocolate-coated Tablet No. 176)</td><td>$2.50</td><td>....</td><td>....</td></tr><tr><td>Gallic acid</td><td></td><td></td><td>3 grs.</td></tr><tr><td>Ergotin (Bonjean)</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Hydrastin</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td><strong>MERCURIC IODIDE, Red, 1/8 gr.</strong><br>(Pill No. 384, gelatin-coated, round)</td><td>.50</td><td>$1.75</td><td>....</td></tr><tr><td>(Mercury biniodide)</td><td></td><td></td><td></td></tr><tr><td><strong>MERCUROUS IODIDE, YELLOW</strong></td><td></td><td></td><td></td></tr><tr><td>1/8 gr. (Pill No. 388, gelatin-coated, round)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Tablet Triturate No. 107)</td><td>.35</td><td>....</td><td>$1.60</td></tr><tr><td>1/6 gr. (Pill No. 389, gelatin-coated, round)</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>(Tablet Triturate No. 108)</td><td>.35</td><td>....</td><td>1.80</td></tr><tr><td>1/4 gr. (Pill No. 391, gelatin-coated, round)</td><td>.55</td><td>2.00</td><td>....</td></tr><tr><td>(Tablet Triturate No. 109)</td><td>.35</td><td>....</td><td>1.90</td></tr><tr><td>(Chocolate-coated Tablet No. 98)</td><td>.40</td><td>....</td><td>2.40</td></tr><tr><td>1/2 gr. (Pill No. 393, gelatin-coated, round)</td><td>.65</td><td>2.50</td><td>....</td></tr><tr><td>(Tablet Triturate No. 110)</td><td>.43</td><td>....</td><td>2.80</td></tr><tr><td>(Mercury protoiodide)</td><td></td><td></td><td></td></tr><tr><td><strong>MERCURY WITH CHALK, 1 gr.</strong><br>(Tablet Triturate No. 100)</td><td>.35</td><td>....</td><td>2.00</td></tr><tr><td><strong>METHYLENE BLUE</strong></td><td></td><td></td><td></td></tr><tr><td>1 gr. (Pill No. 1060, chocolate-coated, round)</td><td>.65</td><td>2.50</td><td>....</td></tr><tr><td>2 grs. (Pill No. 1061, chocolate-coated, round)</td><td>.90</td><td>3.75</td><td>....</td></tr><tr><td><strong>METHYLENE BLUE COMPOUND</strong><br>(Pill No. 1055, sugar-coated, round, blue)</td><td>.90</td><td>3.75</td><td>....</td></tr><tr><td>Methylene Blue</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Powdered Cubeb</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Extract Kava</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Copaiba mass</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Oil Nutmeg</td><td>q.s.</td><td></td><td></td></tr><tr><td>Santal Oil, U. S. P. (East Indian)</td><td>1/10 gr.</td><td></td><td></td></tr><tr><td><strong>MIGRAINE, No. 1 (Compressed Tablet No. 5)</strong></td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Acetanilid</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Camphor monobromated</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Caffeine</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td><strong>MIGRAINE, No. 2 (Compressed Tablet No. 334)</strong></td><td>.75</td><td>....</td><td>6.00</td></tr><tr><td>Acetanilid</td><td>3 grs.</td><td></td><td></td></tr><tr><td>Camphor monobromated</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Caffeine</td><td>1/2 gr.</td><td></td><td></td></tr></tbody></table>

[ 184 ]

PILLS AND TABLETS

<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td><strong>MIGRAINE, IMPROVED</strong><br>(Compressed Tablet No. 355)</td><td>$ .47</td><td>....</td><td>$3.20</td></tr><tr><td>Acetanilid</td><td>2 1/2 grs.</td><td></td><td></td></tr><tr><td>Tinct. Gelsemium</td><td>3 mins.</td><td></td><td></td></tr><tr><td>Camphor monobromated</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Sodium salicylate</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>1/8 gr.</td><td></td><td></td></tr><tr><td><strong>MIXED TREATMENT, No. 1</strong><br>(Compressed Tablet No. 166)</td><td>1.00</td><td>....</td><td>8.50</td></tr><tr><td>(Chocolate-coated Tablet No. 100)</td><td>1.05</td><td>....</td><td>9.00</td></tr><tr><td>Potassium iodide</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Syrup Ferrous iodide</td><td>5 mins.</td><td></td><td></td></tr><tr><td>Mercuric chloride, corrosive</td><td>1/64 gr.</td><td></td><td></td></tr><tr><td>Solution Arsenous and Mercuric iodides</td><td>2 mins.</td><td></td><td></td></tr><tr><td>Tinct. Nux vomica</td><td>2 mins.</td><td></td><td></td></tr><tr><td><strong>MIXED TREATMENT, half-strength</strong><br>(Chocolate-coated Tablet No. 280)</td><td>.68</td><td>....</td><td>5.30</td></tr><tr><td>Potassium iodide</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Syrup Ferrous iodide</td><td>2 1/2 mins.</td><td></td><td></td></tr><tr><td>Mercuric chloride, corrosive</td><td>1/128 gr.</td><td></td><td></td></tr><tr><td>Solution Arsenous and Mercuric iodides</td><td>1 min.</td><td></td><td></td></tr><tr><td>Tinct. Nux vomica</td><td>1 min.</td><td></td><td></td></tr><tr><td><strong>MORPHINE SULPHATE</strong></td><td></td><td></td><td></td></tr><tr><td>1/8 gr. (Tablet Triturate No. 118)</td><td>1.40</td><td>....</td><td>....</td></tr><tr><td>1/6 gr. (Tablet Triturate No. 119)</td><td>1.80</td><td>....</td><td>....</td></tr><tr><td>1/4 gr. (Tablet Triturate No. 120)</td><td>2.40</td><td>....</td><td>....</td></tr><tr><td>(Pill No. 406)</td><td>2.40</td><td>$11.25</td><td>....</td></tr><tr><td>1/2 gr. (Tablet Triturate No. 121)</td><td>4.40</td><td>....</td><td>....</td></tr><tr><td><strong>NASAL (Compressed Tablet No. 34)</strong></td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>Screw-cap bottles of 50</td><td>per doz.</td><td>$5.00</td><td></td></tr><tr><td>Sodium bicarbonate</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Sodium borate</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Sodium chloride</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Sodium benzoate</td><td>7/24 gr.</td><td></td><td></td></tr><tr><td>Oil Eucalyptus</td><td>7/48 min.</td><td></td><td></td></tr><tr><td>Thymol</td><td>7/48 gr.</td><td></td><td></td></tr><tr><td>Menthol</td><td>7/96 gr.</td><td></td><td></td></tr><tr><td>Oil Wintergreen (synthetic)</td><td>7/96 min.</td><td></td><td></td></tr><tr><td>Sodium salicylate</td><td>7/24 gr.</td><td></td><td></td></tr></tbody></table>

Dissolve 1 tablet in 2 to 4 ounces of warm water for douche or spray.

See also Alkaline Aromatic and Plasma Nasal.

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>NAUSEA, IMPROVED (Compressed Tablet 652)</td><td>$1.50</td><td>....</td><td>....</td></tr><tr><td>Bismuth subnitrate</td><td></td><td>2 grs.</td><td></td></tr><tr><td>Apothesine</td><td></td><td>1/4 gr.</td><td></td></tr><tr><td>Cerium oxalate</td><td></td><td>2 grs.</td><td></td></tr><tr><td colspan="4">This tablet contains Apothesine for its local anesthetic effect, in place of the cocaine formerly used.</td></tr><tr><td>Nerve Tonic No. 1, see Zinc Phosphide Compound, Dr. Westbrook, page 200.</td><td></td><td></td><td></td></tr><tr><td>Nerve and Brain Sedative, see Asafetida and Iron Bromide Compound, page 160.</td><td></td><td></td><td></td></tr><tr><td>NEURALGIC (Brown-Sequard) (Pill No. 414)</td><td>2.55</td><td>$12.00</td><td>....</td></tr><tr><td>(Neuralgic Idiopathic)</td><td></td><td></td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>2/3 gr.</td><td></td><td></td></tr><tr><td>Ext. Ignatia</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Ext. Opium</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Ext. Cannabis</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Ext. Conium fruit</td><td>2/3 gr.</td><td></td><td></td></tr><tr><td>Ext. Stramonium</td><td>1/5 gr.</td><td></td><td></td></tr><tr><td>Ext. Aconite root</td><td>1/15 gr.</td><td></td><td></td></tr><tr><td>Ext. Belladonna leaves</td><td>1/6 gr.</td><td></td><td></td></tr><tr><td>NEURALGIC (Brown-Sequard), half-strength (Pill No. 415)</td><td>1.45</td><td>6.50</td><td>....</td></tr><tr><td>(Neuralgic Idiopathic, half-strength)</td><td></td><td></td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>1/3 gr.</td><td></td><td></td></tr><tr><td>Ext. Ignatia</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Ext. Opium</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Ext. Cannabis</td><td>1/8 gr.</td><td></td><td></td></tr><tr><td>Ext. Conium fruit</td><td>1/3 gr.</td><td></td><td></td></tr><tr><td>Ext. Stramonium</td><td>1/10 gr.</td><td></td><td></td></tr><tr><td>Ext. Aconite root</td><td>1/30 gr.</td><td></td><td></td></tr><tr><td>Ext. Belladonna leaves</td><td>1/12 gr.</td><td></td><td></td></tr><tr><td>NEURALGIC (Dr. Gross) without Morphine (Pill No. 417)</td><td>1.95</td><td>9.00</td><td>....</td></tr><tr><td>Quinine sulphate</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Arsenic trioxide</td><td>1/20 gr.</td><td></td><td></td></tr><tr><td>Ext. Aconite root</td><td>1/10 gr.</td><td></td><td></td></tr><tr><td>Strychnine</td><td>1/30 gr.</td><td></td><td></td></tr></tbody></table>

[186]

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>NEURALGIC (Dr. H. J. Kenyon) (Tablet Triturate No. 454)</td><td>$ .42</td><td>....</td><td>$2.70</td></tr><tr><td>Ext. Cannabis</td><td>1/8 gr.</td><td></td><td></td></tr><tr><td>Sodium arsenate</td><td>1/20 gr.</td><td></td><td></td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td><td></td><td></td></tr><tr><td>Aconitine</td><td>1/400 gr.</td><td></td><td></td></tr><tr><td>Zinc phosphide</td><td>1/16 gr.</td><td></td><td></td></tr><tr><td>NEURALGIC, IMPROVED (Compressed Tablet No. 169)</td><td>1.45</td><td>....</td><td>....</td></tr><tr><td>Quinine sulphate</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Acetanilid</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Ext. Hyoscyamus</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Arsenic trioxide</td><td>1/100 gr.</td><td></td><td></td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td><td></td><td></td></tr><tr><td>Ext. Cannabis</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>NITROGLYCERIN (Glyceryl Trinitrate)</td><td></td><td></td><td></td></tr><tr><td>1/200 gr. (Tablet Triturate No. 455)</td><td>.35</td><td>....</td><td>1.40</td></tr><tr><td>1/150 gr. (Tablet Triturate No. 456)</td><td>.35</td><td>....</td><td>1.45</td></tr><tr><td>1/100 gr. (Pill No. 421, round)</td><td>.45</td><td>$1.50</td><td>....</td></tr><tr><td>(Tablet Triturate No. 122)</td><td>.35</td><td>....</td><td>1.50</td></tr><tr><td>1/50 gr. (Tablet Triturate No. 123)</td><td>.35</td><td>....</td><td>1.60</td></tr><tr><td>NITROGLYCERIN COMPOUND, R "A" (Costa (Tablet Triturate No. 618))</td><td>.35</td><td>....</td><td>1.80</td></tr><tr><td>(Chocolate-coated Tablet No. 109)</td><td>.40</td><td>....</td><td>2.30</td></tr><tr><td>Tinct. Digitalis</td><td>3 mins.</td><td></td><td></td></tr><tr><td>Tinct. Strophanthus</td><td>1 min.</td><td></td><td></td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>1/100 gr.</td><td></td><td></td></tr><tr><td>Tinct. Belladonna leaves</td><td>1/4 min.</td><td></td><td></td></tr><tr><td>NITROGLYCERIN COMPOUND, R "B" (Gardiner) (Tablet Triturate No. 619)</td><td>.37</td><td>....</td><td>2.20</td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td><td></td><td></td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>1/200 gr.</td><td></td><td></td></tr><tr><td>Fl. ext. Digitalis</td><td>1 min.</td><td></td><td></td></tr><tr><td>Tinct. Strophanthus</td><td>1 1/2 mins.</td><td></td><td></td></tr><tr><td>Reduced Iron</td><td>1 gr.</td><td></td><td></td></tr><tr><td>NITROGLYCERIN COMPOUND, R "C" (Tablet Triturate No. 777)</td><td>.35</td><td>....</td><td>2.00</td></tr><tr><td>Nitroglycerin (Glyceryl trinitrate)</td><td>1/100 gr.</td><td></td><td></td></tr><tr><td>Tinct. Strophanthus</td><td>1 min.</td><td></td><td></td></tr><tr><td>Strychnine sulphate</td><td>1/60 gr.</td><td></td><td></td></tr><tr><td>Tinct. Digitalis</td><td>3 mins.</td><td></td><td></td></tr><tr><td>Tinct. Belladonna leaves</td><td>1/4 min.</td><td></td><td></td></tr></tbody></table>

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<table><tr><td>NUX VOMICA EXTRACT, ¼ gr.<br>(Tablet Triturate No. 461)</td><td>Per bottle of<br>100 500 1000<br>$ .35 .... $1.80</td></tr><tr><td>(Chocolate-coated Tablet No. 112)</td><td>.40 .... 2.30</td></tr></table>

<table><tr><td>ORCHIC SUBSTANCE<br>OVARIAN SUBSTANCE<br>OVARIAN RESIDUE</td><td>See Gland Products, pages 66-67.</td></tr><tr><td>OX GALL EXTRACT, 2 grs.<br>(Pill No. 834, enteric-coated)</td><td>.65 $2.50 ....</td></tr></table>

<table><tr><td>OX GALL COMPOUND<br>(Chocolate-coated Tablet No. 118)</td><td>.90 .... 7.50</td></tr><tr><td>Pancreatin</td><td>1 gr.</td></tr><tr><td>Ox Gall, powd. ext.</td><td>1 gr.</td></tr><tr><td>Ext. Colocynth Compound</td><td>1/4 gr.</td></tr><tr><td>Quinine hydrochloride</td><td>1/2 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/8 gr.</td></tr><tr><td>Ext. Taraxacum</td><td>1 gr.</td></tr></table>

<table><tr><td>OX GALL, PEPSIN AND PANCREATIN<br>(Chocolate-coated Tablet No. 119)</td><td>.85 .... 7.00</td></tr><tr><td>Ox Gall, powd. ext.</td><td>2 grs.</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>2 grs.</td></tr><tr><td>Pancreatin</td><td>2 grs.</td></tr></table>

PANCREATIN, TRIPLE STRENGTH, see Pan-
teric Tablets and Capsules, page 36.

PANTERIC, see page 36.

<table><tr><td>PAPAIN COMPOUND (Compressed Tablet 535)</td><td>.60 .... 4.50</td></tr><tr><td>Papain</td><td>3/4 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>1/2 gr.</td></tr><tr><td>Charcoal</td><td>1/3 gr.</td></tr><tr><td>Wintergreen</td><td>q.s.</td></tr></table>

PARATHYROID, see Gland Products, page 68.

<table><tr><td>PEPSIN, P. D. & Co. (1:3000)</td><td></td></tr><tr><td>1 gr. (Compressed Tablet No. 73)</td><td>3.50</td></tr><tr><td>2 grs. (Compressed Tablet No. 238, sugar-coated)</td><td>.65 5.00</td></tr><tr><td>3 grs. (Compressed Tablet No. 239, sugar-coated)</td><td>.81 6.60</td></tr><tr><td>5 grs. (Compressed Tablet No. 254, sugar-coated)</td><td>1.10 9.50</td></tr></table>

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<table><tr><td>PEPSIN, BISMUTH AND CHARCOAL<br>(Compressed Tablet No. 72)</td><td>Per bottle of<br>100 500 1000<br>$ .95 .... $8.00</td></tr><tr><td>Charcoal</td><td>2 grs.</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>2 grs.</td></tr><tr><td>Bismuth subnitrate</td><td>2 grs.</td></tr></table>

<table><tr><td>PEPSIN, BISMUTH AND NUX VOMICA<br>(Chocolate-coated Tablet No. 178)</td><td>1.20 .... 10.50</td></tr><tr><td>Bismuth subnitrate</td><td>3 grs.</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>1 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/10 gr.</td></tr></table>

<table><tr><td>PEPSIN AND PANCREATIN, No. 2<br>(Compressed Tablet No. 308, sugar-coated)</td><td>.80 .... 6.50</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>2 grs.</td></tr><tr><td>Pancreatin</td><td>3 grs.</td></tr></table>

<table><tr><td>PEPSIN AND PANCREATIN COMPOUND<br>(Compressed Tablet No. 244)</td><td>.65 .... 5.00</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>1 gr.</td></tr><tr><td>Pancreatin</td><td>1 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/4 gr.</td></tr><tr><td>Oleoresin Ginger</td><td>1/16 gr.</td></tr></table>

<table><tr><td>PEPSIN AND PANCREATIN COMPOUND<br>No. 2 (Compressed Tablet No. 339)</td><td>.75 .... 6.00</td></tr><tr><td>Pancreatin</td><td>3/4 gr.</td></tr><tr><td>Bismuth subnitrate</td><td>1 gr.</td></tr><tr><td>Powd. Ginger</td><td>1/2 gr.</td></tr><tr><td>Pepsin, P. D. & Co. (1:3000)</td><td>3/4 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>2 grs.</td></tr><tr><td>Ext. Nux vomica</td><td>1/10 gr.</td></tr></table>

<table><tr><td>PHENACETIN, 2 grs. (Compressed Tablet 108)</td><td>.55 .... 4.00</td></tr><tr><td>3 grs. (Compressed Tablet No. 109)</td><td>.73 .... 5.80</td></tr><tr><td>5 grs. (Compressed Tablet No. 201)</td><td>.95 .... 8.00</td></tr></table>

<table><tr><td>PHENACETIN AND QUININE<br>(Chocolate-coated Tablet No. 284)</td><td>1.80 .... ....</td></tr><tr><td>Phenacetin</td><td>2½ grs.</td></tr><tr><td>Quinine sulphate</td><td>2½ grs.</td></tr></table>

<table><tr><td>PHENACETIN AND SALOL<br>(Compressed Tablet No. 114)</td><td>.77 .... 6.20</td></tr><tr><td>Phenacetin</td><td>2½ grs.</td></tr><tr><td>Salol</td><td>2½ grs.</td></tr></table>

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PHENOLPHTHALEIN

<table><thead><tr><th></th><th colspan="3" style="text-align:center;">Per bottle of</th></tr><tr><th></th><th style="text-align:center;">100</th><th style="text-align:center;">500</th><th style="text-align:center;">1000</th></tr></thead><tbody><tr><td>1 gr. (Compressed Tablet No. 508, pink)</td><td style="text-align:right;">$ .37</td><td style="text-align:center;">....</td><td style="text-align:right;">$2.20</td></tr><tr><td>Palatable (Compressed Tablet No. 531, pink)</td><td style="text-align:right;">.41</td><td style="text-align:center;">....</td><td style="text-align:right;">2.60</td></tr><tr><td>2 grs. (Compressed Tablet No. 527, sugar-coated)</td><td style="text-align:right;">.55</td><td style="text-align:center;">....</td><td style="text-align:right;">4.00</td></tr><tr><td>Palatable (Compressed Tablet No. 536, pink)</td><td style="text-align:right;">.52</td><td style="text-align:center;">....</td><td style="text-align:right;">3.70</td></tr><tr><td>3 grs. (Compressed Tablet No. 528, sugar-coated)</td><td style="text-align:right;">.65</td><td style="text-align:center;">....</td><td style="text-align:right;">5.00</td></tr><tr><td>5 grs. (Compressed Tablet No. 538, sugar-coated)</td><td style="text-align:right;">.90</td><td style="text-align:center;">....</td><td style="text-align:right;">7.50</td></tr></tbody></table>

PHOSPHORUS, U. S. P., 1/100 gr. (Pill No. 446) .45 $1.50 ....

PHOSPHORUS, NUX VOMICA AND DAMIANA (Aphrodisiac) (Pill No. 447)

<table><tr><td></td><td>1.20</td><td>5.25</td><td>....</td></tr><tr><td>(Pill No. 894, sugar-coated, pink)</td><td>1.20</td><td>5.25</td><td>....</td></tr></table>

<table><tr><td>Phosphorus</td><td>1/100 gr.</td></tr><tr><td>Ext. Damiana</td><td>2 grs.</td></tr><tr><td>Ext. Nux vomica</td><td>1/8 gr.</td></tr></table>

PICHI COMPOUND

(Pill No. 1048, soft, chocolate-coated) .60 2.25 ....

<table><tr><td>Ext. Pichi</td><td>1½ grs.</td></tr><tr><td>Ext. Buchu</td><td>1/4 gr.</td></tr><tr><td>Ext. Uva Ursi</td><td>1/2 gr.</td></tr><tr><td>Oil Juniper berries</td><td>1/16 gr.</td></tr><tr><td>Ext. Digitalis</td><td>1/15 gr.</td></tr></table>

PLASMA NASAL (Dr. Murray McFarlane)

(Compressed Tablet No. 307) .45 .... 3.00

<table><tr><td>Sodium chloride</td><td>5 1/2 grs.</td></tr><tr><td>Sodium sulphate</td><td>1 1/2 grs.</td></tr><tr><td>Sodium phosphate</td><td>1/4 gr.</td></tr><tr><td>Potassium chloride</td><td>2/5 gr.</td></tr><tr><td>Potassium sulphate</td><td>1/4 gr.</td></tr><tr><td>Potassium phosphate</td><td>1/3 gr.</td></tr><tr><td>Menthol</td><td>1/30 gr.</td></tr></table>

For the preparation of solutions to be applied by spray or douche. One tablet in 2 ounces of luke-warm water makes a solution about isotonic with blood serum. See also Alkaline Aromatic, and Nasal.

PODOPHYLLIN (Podophyllum resin)

<table><tr><td>¼ gr. (Pill No. 505, gelatin-coated, round)</td><td>.50</td><td>1.75</td><td>....</td></tr><tr><td>(Tablet Triturate No. 144)</td><td>.35</td><td>....</td><td>2.00</td></tr><tr><td>½ gr. (Pill No. 506, gelatin-coated, round)</td><td>.60</td><td>2.25</td><td>....</td></tr></table>

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POTASSIUM BICARBONATE, 40 grs.

(Compressed Tablet No. 408) $ .75 .... .... ....

For adding to solutions of Magnesium citrate just before the bottle is corked.

<table><tr><td>In 1-lb. bottles</td><td>per lb.</td><td>$1.35</td></tr><tr><td>In 5-lb. tins</td><td>per lb.</td><td>1.15</td></tr></table>

POTASSIUM BROMIDE, 5 grs.

(Compressed Tablet No. 78) .43 .... $2.80

POTASSIUM CHLORATE, 5 grs.

(Compressed Tablet No. 79) .35 .... 1.50

<table><tr><td>In 1-lb. bottles</td><td>per lb.</td><td>$1.75</td></tr><tr><td>In 1-lb. boxes</td><td>per lb.</td><td>1.60</td></tr><tr><td>In 5-lb. boxes</td><td>per lb.</td><td>1.50</td></tr></table>

POTASSIUM IODIDE

<table><tr><td>2 grs. (Compressed Tablet No. 382)</td><td>.85</td><td>....</td><td>7.00</td></tr><tr><td>5 grs. (Compressed Tablet No. 119)</td><td>1.70</td><td>....</td><td>....</td></tr></table>

POTASSIUM PERMANGANATE

<table><tr><td>½ gr. (Compressed Tablet No. 177)</td><td>.35</td><td>....</td><td>1.20</td></tr><tr><td>1 gr. (Compressed Tablet No. 178)</td><td>.35</td><td>....</td><td>1.40</td></tr><tr><td>2 grs. (Compressed Tablet No. 120)</td><td>.35</td><td>....</td><td>1.60</td></tr><tr><td>3 grs. (Compressed Tablet No. 386)</td><td>.35</td><td>....</td><td>1.80</td></tr><tr><td>5 grs. (Compressed Tablet No. 179)</td><td>.35</td><td>....</td><td>2.00</td></tr></table>

QUININE HYDROBROMIDE, NEUTRAL, 5 grs. (Chocolate-coated Tablet No. 484) 3.40 .... ....

QUININE SULPHATE; 1, 2, 3 and 5 grs., see page 38.

QUININE, IRON AND ZINC VALERATES

(Three Valerates) (Pill No. 555) 2.35 $11.00 ....

<table><tr><td>Quinine valerate</td><td>1 gr.</td></tr><tr><td>Iron valerate</td><td>1 gr.</td></tr><tr><td>Zinc valerate</td><td>1 gr.</td></tr></table>

QUININE AND SALOL

(Chocolate-coated Tablet No. 285) 1.90 .... ....

<table><tr><td>Quinine sulphate</td><td>2½ grs.</td></tr><tr><td>Salol</td><td>2½ grs.</td></tr></table>

RENNIN, 1 gr. (Tablet Triturate No. 482) .55 .... 4.00

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>RHEUMATIC, R "B"<br>(Chocolate-coated Tablet No. 210)</td><td>$1.10</td><td>....</td><td>$9.50</td></tr></tbody></table>

<table><tbody><tr><td>Lithium salicylate</td><td>5 grs.</td></tr><tr><td>Colchicine</td><td>1/150 gr.</td></tr><tr><td>Cimicifugin</td><td>1/4 gr.</td></tr><tr><td>Phytolaccin</td><td>1/8 gr.</td></tr></tbody></table>

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>RHEUMATIC THROAT (Dr. Quinlan)<br>(Compressed Tablet No. 259)</td><td>.65</td><td>.... 5.00</td></tr></tbody></table>

<table><tbody><tr><td>Sodium salicylate</td><td>7½ grs.</td></tr><tr><td>Wine Colchicum seed</td><td>5 mins.</td></tr><tr><td>Sodium bicarbonate</td><td>2½ grs.</td></tr><tr><td>Oil Wintergreen (synthetic)</td><td>q.s.</td></tr></tbody></table>

See also Anti-Rheumatic.

<table><tbody><tr><td>RHINITIS (full strength) (Tablet Triturate 713)<br>(Chocolate-coated Tablet No. 132)</td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td></td><td>.60</td><td>....</td><td>4.50</td></tr></tbody></table>

<table><tbody><tr><td>Powd. Camphor</td><td>1/2 gr.</td></tr><tr><td>Fl. ext. Belladonna root</td><td>1/4 min.</td></tr><tr><td>Quinine sulphate</td><td>1/2 gr.</td></tr></tbody></table>

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>RHINITIS (half-strength, Dr. Lincoln)<br>(Tablet Triturate No. 644)<br>(Chocolate-coated Tablet No. 133)</td><td>.41</td><td>.... 2.60</td></tr><tr><td></td><td>.46</td><td>.... 3.10</td></tr></tbody></table>

<table><tbody><tr><td>Powd. Camphor</td><td>1/4 gr.</td></tr><tr><td>Fl. ext. Belladonna root</td><td>1/8 min.</td></tr><tr><td>Quinine sulphate</td><td>1/4 gr.</td></tr></tbody></table>

<table><tbody><tr><td>RHUBARB, N. F. (Pill No. 567)</td><td>.70</td><td>$2.75</td><td>....</td></tr><tr><td>Powd. Rhubarb</td><td>3 grs.</td></tr><tr><td>Powd. Soap</td><td>1 gr.</td></tr></tbody></table>

<table><tbody><tr><td>RHUBARB POWDERED, 5 grs.<br>(Compressed Tablet No. 383)</td><td>.45</td><td>....</td><td>3.00</td></tr></tbody></table>

<table><tbody><tr><td>RHUBARB COMPOUND (Pill No. 570)<br>(Chocolate-coated Tablet No. 300)</td><td>.70</td><td>2.75</td><td>....</td></tr><tr><td>(National Formulary Pill Formula)</td><td>.55</td><td>....</td><td>4.00</td></tr></tbody></table>

<table><tbody><tr><td>Powd. Rhubarb</td><td>0.13 Gm. (about 2 grs.)</td></tr><tr><td>Powd. Myrrh</td><td>0.06 Gm. (about 1 gr.)</td></tr><tr><td>Aloe</td><td>0.10 Gm. (about 1½ grs.)</td></tr><tr><td>Oil Peppermint</td><td>0.005 Gm. (about 1/13 gr.)</td></tr></tbody></table>

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>RHUBARB AND IPECAC COMPOUND, R "A"<br>(Dr. M. L. Goodkind) (Compressed Tablet 343)</td><td>$ .55</td><td>....</td><td>$4.00</td></tr></tbody></table>

<table><tbody><tr><td>Powd. Rhubarb</td><td>1 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>5 grs.</td></tr><tr><td>Powd. Ipecac</td><td>1/8 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/4 gr.</td></tr><tr><td>Fl. ext. Cascara sagrada</td><td>5 mins.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></tbody></table>

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>RHUBARB AND IPECAC COMPOUND, R "C"<br>(Roosevelt Hospital) (Compressed Tablet 257)</td><td>.43</td><td>.... 2.80</td></tr><tr><td>Powd. Rhubarb</td><td>1 gr.</td></tr><tr><td>Sodium bicarbonate</td><td>5 grs.</td></tr><tr><td>Powd. Ipecac</td><td>1/8 gr.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></tbody></table>

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>RHUBARB AND IPECAC COMPOUND, R "E"<br>(Roosevelt Hospital) (Compressed Tablet 342)</td><td>.50</td><td>.... 3.50</td></tr><tr><td>Powd. Rhubarb</td><td>2 grs.</td></tr><tr><td>Sodium bicarbonate</td><td>5 grs.</td></tr><tr><td>Powd. Ipecac</td><td>1/4 gr.</td></tr><tr><td>Tinct. Nux vomica</td><td>5 mins.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></tbody></table>

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>RHUBARB AND SODA, R "B"<br>(Compressed Tablet No. 98)</td><td>.35</td><td>.... 2.00</td></tr><tr><td>Powd. Rhubarb</td><td>1½ grs.</td></tr><tr><td>Sodium bicarbonate</td><td>1½ grs.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></tbody></table>

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>RHUBARB AND SODA MIXTURE<br>(Compressed Tablet No. 425)</td><td>.40</td><td>.... 2.50</td></tr><tr><td>Sodium bicarbonate</td><td>2½ grs.</td></tr><tr><td>Powd. Rhubarb</td><td>9/10 gr.</td></tr><tr><td>Powd. Ipecac</td><td>9/50 gr.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></tbody></table>

One tablet represents a teaspoonful of Compound Mixture Rhubarb, National Formulary.

<table><thead><tr><th></th><th></th><th></th></tr></thead><tbody><tr><td>SACCHARIN (soluble), 25 milligrams<br>(Tablet Triturate No. 488)</td><td>.35</td><td>.... 1.60</td></tr><tr><td>¼ gr. (Tablet Triturate No. 991)</td><td>.35</td><td>.... 1.50</td></tr><tr><td>½ gr. (Tablet Triturate No. 651)</td><td>.35</td><td>.... 1.80</td></tr><tr><td>1 gr. (Tablet Triturate No. 489)</td><td>.42</td><td>.... 2.70</td></tr></tbody></table>

Saccharin has about 500 times the sweetening power of sugar; 25 milligrams of it, therefore, equals 12,500 milligrams or 12.5 Gm. (in other words, about two small teaspoonsfuls) of sugar. It has no nutritive value.

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>SALICIN, 5 grs. (Compressed Tablet No. 39)</td><td>$2.00</td><td>....</td><td>....</td></tr><tr><td>SALOL, 2½ grs. (Compressed Tablet No. 40)</td><td>.48</td><td>....</td><td>$3.30</td></tr><tr><td>5 grs. (Compressed Tablet No. 41)</td><td>.65</td><td>....</td><td>$5.00</td></tr><tr><td colspan="4">SALOL AND PHENACETIN, see Phenacetin and Salol.</td></tr><tr><td colspan="4">SALOL AND QUININE, see Quinine and Salol.</td></tr><tr><td>SANTONIN, ½ gr. (Tablet Triturate No. 154)</td><td>5.50</td><td>....</td><td>....</td></tr><tr><td>SANTONIN AND CALOMEL, R "B" (Tablet Triturate No. 761)</td><td>3.10</td><td>....</td><td>....</td></tr><tr><td>Santonin</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Calomel</td><td>1/8 gr.</td><td></td><td></td></tr><tr><td>SANTONIN AND CALOMEL, R "C" (Tablet Triturate No. 840)</td><td>3.10</td><td>....</td><td>....</td></tr><tr><td>Santonin</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Calomel</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>SANTONIN AND CALOMEL, R "D" (Tablet Triturate No. 156)</td><td>5.55</td><td>....</td><td>....</td></tr><tr><td>Santonin</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>Calomel</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>SEDANS (Compressed Tablet No. 226)</td><td>2.70</td><td>....</td><td>....</td></tr><tr><td>Black Haw</td><td>7½ grs.</td><td></td><td></td></tr><tr><td>Jamaica Dogwood</td><td>3¾ grs.</td><td></td><td></td></tr><tr><td>Hydrastis</td><td>7½ grs.</td><td></td><td></td></tr><tr><td>SEDATIVE (Dr. B. F. Baer) (Chocolate-coated Tablet No. 160)</td><td>.75</td><td>....</td><td>6.00</td></tr><tr><td>Ext. Valerian</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Ext. Sumbul</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Asafetida</td><td>1 gr.</td><td></td><td></td></tr><tr><td>SEDATIVE (Dr. Brown) (Compressed Tablet No. 322)</td><td>.60</td><td>....</td><td>4.50</td></tr><tr><td>Sodium bromide</td><td>2½ grs.</td><td></td><td></td></tr><tr><td>Potassium bromide</td><td>2½ grs.</td><td></td><td></td></tr><tr><td>Ammonium bromide</td><td>2½ grs.</td><td></td><td></td></tr><tr><td>Tinct. Hyoscyamus</td><td>8 mins.</td><td></td><td></td></tr><tr><td>Tinct. Cannabis</td><td>5 mins.</td><td></td><td></td></tr><tr><td>SILVER NITRATE, ¼ gr. (Pill 803, compressed)</td><td>.55</td><td>$2.00</td><td>....</td></tr></tbody></table>

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>SODA MINT (Compressed Tablet No. 99)</td><td></td><td></td><td></td></tr><tr><td>In 1-lb. bottles</td><td>per lb.</td><td>$1.65</td><td></td></tr><tr><td>In 5-lb. tins</td><td>per lb.</td><td>1.30</td><td></td></tr><tr><td>SODA MINT, R "B" (Compressed Tablet 413)</td><td></td><td></td><td></td></tr><tr><td>Sodium bicarbonate</td><td>4¾ grs.</td><td></td><td></td></tr><tr><td>Ammonium carbonate</td><td>q.s.</td><td></td><td></td></tr><tr><td>Oil Peppermint</td><td>q.s.</td><td></td><td></td></tr><tr><td>In 1-lb. bottles</td><td>per lb.</td><td>$1.65</td><td></td></tr><tr><td>In 5-lb. tins</td><td>per lb.</td><td>1.30</td><td></td></tr><tr><td>SODA MINT AND CHARCOAL (Compressed Tablet No. 402)</td><td></td><td></td><td></td></tr><tr><td>Soda Mint</td><td>4 grs.</td><td></td><td></td></tr><tr><td>Charcoal</td><td>1 gr.</td><td></td><td></td></tr><tr><td>SODA MINT AND PEPSIN (Compressed Tablet No. 357)</td><td></td><td></td><td></td></tr><tr><td>Pepsin, P.D. & Co. (1:3000), Igr., with "Soda Mint."</td><td></td><td></td><td></td></tr><tr><td>In 1-lb. bottles</td><td>per lb.</td><td>$4.25</td><td></td></tr><tr><td>SODIUM BENZOATE, 5 grs. (Chocolate-coated Tablet No. 168)</td><td></td><td></td><td></td></tr><tr><td>SODIUM BICARBONATE</td><td></td><td></td><td></td></tr><tr><td>5 grs. (Compressed Tablet No. 100)</td><td>.35</td><td>....</td><td>1.20</td></tr><tr><td>10 grs. (Compressed Tablet No. 217)</td><td>.35</td><td>....</td><td>1.50</td></tr><tr><td>32.5 grs. (Compressed Tablet No. 634)</td><td>.50</td><td>....</td><td>....</td></tr><tr><td>No. 634 in 1-lb. bottles</td><td>per lb.</td><td>$0.70</td><td></td></tr><tr><td colspan="4">Compressed Tablet No. 634 is intended for use in making solutions of Magnesium Citrate, one tablet being added just before corking the bottle.</td></tr><tr><td>SODIUM BROMIDE</td><td></td><td></td><td></td></tr><tr><td>5 grs. (Compressed Tablet No. 43)</td><td>.42</td><td>....</td><td>2.70</td></tr><tr><td>10 grs. (Compressed Tablet No. 44)</td><td>.60</td><td>....</td><td>4.50</td></tr><tr><td>SODIUM CHLORIDE (Normal Salt) (Compressed Tablet No. 365)</td><td></td><td></td><td></td></tr><tr><td>Sodium chloride, pure</td><td>15½ grs.</td><td></td><td></td></tr></tbody></table>

One tablet dissolved in 4 ounces of distilled water will form a physiologic salt solution (normal saline solution). See also Ringer Tablets, page 151.

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td>SODIUM NITRITE, 1/2 gr. (Tablet Triturate 980)</td><td>$ .35</td><td>....</td><td>$1.60</td></tr><tr><td>1 gr. (Tablet Triturate No. 961)</td><td>.35</td><td>....</td><td>1.80</td></tr><tr><td>SODIUM SALICYLATE, 5 grs.<br>(Compressed Tablet No. 101)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>(Chocolate-coated Tablet No. 139)</td><td>.50</td><td>....</td><td>3.50</td></tr><tr><td>with wintergreen (Compressed Tablet No. 532)</td><td>.45</td><td>....</td><td>3.00</td></tr><tr><td>SODIUM SALICYLATE FROM SALICYLIC<br>ACID NATURAL, 5 grs.<br>(Compressed Tablet No. 390)</td><td>2.00</td><td>....</td><td>....</td></tr><tr><td>SODIUM SALICYLATE COMPOUND<br>(Compressed Tablet No. 191)</td><td>.47</td><td>....</td><td>3.20</td></tr><tr><td>Sodium salicylate</td><td>3 grs.</td><td></td><td></td></tr><tr><td>Tinct. Digitalis</td><td>1 1/2 mins.</td><td></td><td></td></tr><tr><td>Ext. Colchicum corm</td><td>1/2 gr.</td><td></td><td></td></tr><tr><td>STRONTIUM SALICYLATE, 5 grs.<br>(Compressed Tablet No. 401)</td><td>.65</td><td>....</td><td>5.00</td></tr><tr><td>STRYCHNINE NITRATE, 1/30 gr.<br>(Tablet Triturate No. 726)</td><td>.35</td><td>....</td><td>1.65</td></tr><tr><td>STRYCHNINE SULPHATE</td><td></td><td></td><td></td></tr><tr><td>1/100 gr. (Tablet Triturate No. 160)</td><td>.35</td><td>....</td><td>1.25</td></tr><tr><td>1/60 gr. (Pill No. 758, gelatin-coated, round)</td><td>.45</td><td>$1.50</td><td>....</td></tr><tr><td>(Tablet Triturate No. 161)</td><td>.35</td><td>....</td><td>1.30</td></tr><tr><td>(C.T. No. 371, sugar-coated, red)</td><td>.40</td><td>....</td><td>1.80</td></tr><tr><td>(Chocolate-coated Tablet No. 143)</td><td>.40</td><td>....</td><td>1.80</td></tr><tr><td>1/50 gr. (Tablet Triturate No. 162)</td><td>.35</td><td>....</td><td>1.40</td></tr><tr><td>1/40 gr. (Pill No. 829, gelatin-coated, round)</td><td>.45</td><td>1.50</td><td>....</td></tr><tr><td>(Tablet Triturate No. 163)</td><td>.35</td><td>....</td><td>1.50</td></tr><tr><td>(C.T. No. 373, sugar-coated, red)</td><td>.40</td><td>....</td><td>2.00</td></tr><tr><td>(Chocolate-coated Tablet No. 145)</td><td>.40</td><td>....</td><td>2.00</td></tr><tr><td>1/30 gr. (Pill No. 830, gelatin-coated, round)</td><td>.45</td><td>1.50</td><td>....</td></tr><tr><td>(Tablet Triturate No. 164)</td><td>.35</td><td>....</td><td>1.60</td></tr><tr><td>(C.T. No. 374, sugar-coated, red)</td><td>.40</td><td>....</td><td>2.10</td></tr><tr><td>(Chocolate-coated Tablet No. 146)</td><td>.40</td><td>....</td><td>2.10</td></tr><tr><td>1/20 gr. (Tablet Triturate No. 165)</td><td>.35</td><td>....</td><td>1.70</td></tr></tbody></table>

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SULPHOCARBOLATES COMBINED

(Compressed Tablet No. 349)

<table><tr><td>Zinc sulphocarbolate</td><td>1 gr.</td></tr><tr><td>Sodium sulphocarbolate</td><td>2 grs.</td></tr><tr><td>Calcium sulphocarbolate</td><td>2 grs.</td></tr></table>

<table><tr><td>Per bottle of</td></tr><tr><td>100</td><td>500</td><td>1000</td></tr><tr><td>$ .45</td><td>....</td><td>$3.00</td></tr></table>

SULPHON ETHYL METHANE, see Trional.

SULPHONAL (Sulphon Methane), 5 grs.

(Compressed Tablet No. 267)

SULPHUR AND CREAM OF TARTAR

(Compressed Tablet No. 103)

<table><tr><td>Sulphur, sublimed</td><td>4 grs.</td></tr><tr><td>Potassium bitartrate</td><td>2 grs.</td></tr></table>

SUMBUL COMPOUND (Goodell) (Pill No. 760)

(Compressed Tablet No. 194, sugar-coated)

(Chocolate-coated Tablet No. 148)

<table><tr><td>Ext. Sumbul</td><td>1 gr.</td></tr><tr><td>Arsenic trioxide</td><td>1/40 gr.</td></tr><tr><td>Ferrous sulphate, exsiccated</td><td>1 gr.</td></tr><tr><td>Asafetida</td><td>2 grs.</td></tr></table>

•SUN CHOLERA (Chocolate-coated Tablet 149)

<table><tr><td>Spirit Camphor</td><td>3 mins.</td></tr><tr><td>Tinct. Opium</td><td>3 mins.</td></tr><tr><td>Tinct. Rhubarb</td><td>1 1/2 mins.</td></tr><tr><td>Tinct. Capsicum</td><td>1 1/2 mins.</td></tr><tr><td>Oil Peppermint</td><td>q.s.</td></tr></table>

TARTAR EMETIC AND IPECAC

(Tablet Triturate No. 606)

<table><tr><td>Antimony and Potassium tartrate</td><td>1/100 gr.</td></tr><tr><td>Powd. Ipecac</td><td>1/100 gr.</td></tr></table>

THREE IODIDES (Chocolate-coated Tablet 153)

<table><tr><td>Mercuric iodide, red</td><td>1/30 gr.</td></tr><tr><td>Arsenous iodide</td><td>1/40 gr.</td></tr><tr><td>Ferrous iodide</td><td>1/12 gr.</td></tr></table>

.35 1.50

.40 2.50

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<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td><strong>THREE VALERATES AND SUMBUL (Dr. Manton) (Pill No. 294)</strong></td><td>$2.50</td><td>$11.75</td><td>....</td></tr><tr><td>Zinc valerate</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Quinine valerate</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Iron valerate</td><td></td><td></td><td>1/2 gr.</td></tr><tr><td>Ext. Sumbul</td><td></td><td></td><td>2 grs.</td></tr><tr><td><strong>THROAT, MENTHOLATED (P. D. & Co.) (Compressed Tablet No. 330)</strong></td><td>.37</td><td>....</td><td>$2.20</td></tr><tr><td>Menthol</td><td></td><td></td><td>1/35 gr.</td></tr><tr><td>Oil Anise</td><td></td><td></td><td>1/80 min.</td></tr><tr><td>Benzoic acid</td><td></td><td></td><td>1/12 gr.</td></tr><tr><td>Eucalyptol</td><td></td><td></td><td>1/16 min.</td></tr><tr><td>Chloretone</td><td></td><td></td><td>1/100 gr.</td></tr><tr><td><strong>THROAT, MENTHOLATED (Modified) (Compressed Tablet No. 427)</strong></td><td>.35</td><td>....</td><td>2.00</td></tr><tr><td>Menthol</td><td></td><td></td><td>1/35 gr.</td></tr><tr><td>Oil Anise</td><td></td><td></td><td>1/80 min.</td></tr><tr><td>Benzoic acid</td><td></td><td></td><td>1/12 gr.</td></tr><tr><td>Eucalyptol</td><td></td><td></td><td>1/16 min.</td></tr><tr><td><strong>TONIC (Aiken) (Pill No. 629)</strong></td><td>1.20</td><td>5.25</td><td>....</td></tr><tr><td>Quinine sulphate</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Reduced Iron</td><td></td><td></td><td>2/3 gr.</td></tr><tr><td>Strychnine</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td><strong>TONIC (Aiken) (Compressed Tablet No. 196)</strong></td><td>.85</td><td>....</td><td>7.00</td></tr><tr><td><strong>(Chocolate-coated Tablet No. 150)</strong></td><td>.90</td><td>....</td><td>7.50</td></tr><tr><td>Quinine sulphate</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Reduced Iron</td><td></td><td></td><td>2/3 gr.</td></tr><tr><td>Strychnine sulphate</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Ext. Gentian</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td colspan="4">It will be noted that this formula differs slightly from the preceding, the only material difference, however, being that it contains ¼ grain of gentian extract.</td></tr><tr><td><strong>TONIC (Aiken) LAXATIVE (Chocolate-coated Tablet No. 437)</strong></td><td>.90</td><td>....</td><td>7.50</td></tr><tr><td>Arsenic trioxide</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Quinine sulphate</td><td></td><td></td><td>1 gr.</td></tr><tr><td>Strychnine sulphate</td><td></td><td></td><td>1/50 gr.</td></tr><tr><td>Ext. Gentian</td><td></td><td></td><td>1/4 gr.</td></tr><tr><td>Reduced Iron</td><td></td><td></td><td>2/3 gr.</td></tr><tr><td>Cascarin, P. D. & Co.</td><td></td><td></td><td>1/2 gr.</td></tr></tbody></table>

[ 198 ]

PILLS AND TABLETS

<table><thead><tr><th></th><th colspan="3">Per bottle of</th></tr><tr><th></th><th>100</th><th>500</th><th>1000</th></tr></thead><tbody><tr><td><strong>TONSILLITIS (Tablet Triturate No. 645)</strong></td><td>$ .35</td><td>....</td><td>$1.40</td></tr><tr><td>Mercuric iodide, red</td><td>1/100 gr.</td><td></td><td></td></tr><tr><td>Tinct. Aconite</td><td>7/10 min.</td><td></td><td></td></tr><tr><td>Tinct. Belladonna leaves</td><td>3/20 min.</td><td></td><td></td></tr><tr><td>Tinct. Bryonia</td><td>1/10 min.</td><td></td><td></td></tr><tr><td colspan="4">See also Follicular Tonsillitis.</td></tr><tr><td><strong>TRIONAL (Sulphon Ethyl Methane), 5 grs. (Compressed Tablet No. 280)</strong></td><td>2.00</td><td>....</td><td>....</td></tr><tr><td><strong>TRIPLE BROMIDES, No. 1 (Compressed Tablet No. 49)</strong></td><td>.55</td><td>....</td><td>4.00</td></tr><tr><td>Sodium bromide</td><td>2½ grs.</td><td></td><td></td></tr><tr><td>Potassium bromide</td><td>2½ grs.</td><td></td><td></td></tr><tr><td>Ammonium bromide</td><td>2½ grs.</td><td></td><td></td></tr><tr><td><strong>TRIPLE BROMIDES, No. 2 (Compressed Tablet No. 331)</strong></td><td>.85</td><td>....</td><td>7.00</td></tr><tr><td>Sodium bromide</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Potassium bromide</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Ammonium bromide</td><td>5 grs.</td><td></td><td></td></tr><tr><td colspan="4">Triple Valerates, see Quinine, Iron and Zinc Valerates, page 191.</td></tr><tr><td><strong>TRIPLEX (Pill No. 634)</strong></td><td>.75</td><td>$3.00</td><td>....</td></tr><tr><td colspan="4">(Aloe, Mercury and Podophyllum, N. F.)</td></tr><tr><td>Aloe</td><td>2 grs.</td><td></td><td></td></tr><tr><td>Podophyllin</td><td>1/4 gr.</td><td></td><td></td></tr><tr><td>Mass of Mercury</td><td>1 gr.</td><td></td><td></td></tr><tr><td><strong>TRIPLEX (Guy's Hospital) (Pill No. 862)</strong></td><td>.80</td><td>3.25</td><td>....</td></tr><tr><td colspan="4">(Digitalis, Squill and Mercury, N. F.)</td></tr><tr><td>Mass of Mercury</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Powd. Squill</td><td>1 gr.</td><td></td><td></td></tr><tr><td>Powd. Digitalis</td><td>1 gr.</td><td></td><td></td></tr><tr><td><strong>URITONE, 5 grs. (Compressed Tablet No. 525)</strong></td><td>.50</td><td>....</td><td>3.50</td></tr><tr><td><strong>7½ grs. (Compressed Tablet No. 423)</strong></td><td>.65</td><td>....</td><td>5.00</td></tr><tr><td colspan="4">(Hexamethylene tetramine)</td></tr><tr><td><strong>URITONE AND SODIUM ACID PHOSPHATE (Compressed Tablet No. 685)</strong></td><td>.70</td><td>....</td><td>5.50</td></tr><tr><td>Uritone (Hexamethylene tetramine)</td><td>5 grs.</td><td></td><td></td></tr><tr><td>Sodium acid phosphate</td><td>5 grs.</td><td></td><td></td></tr></tbody></table>

[ 199 ]

PILLS AND TABLETS

## UTERINE ASTRINGENT

(Compressed Tablet No. 628)

<table><tr><td>Tannic acid</td><td>2 grs.</td></tr><tr><td>Alum</td><td>3 grs.</td></tr><tr><td>Zinc sulphate</td><td>2 grs.</td></tr><tr><td>Boric acid</td><td>6 grs.</td></tr><tr><td>Fluid Golden-seal (colorless)</td><td>1½ mins.</td></tr></table>

Dissolve one tablet in 1 to 4 fluid ounces of water, for vaginal douche or injection.

Per bottle of-

<table><tr><td>100</td><td>500</td><td>1000</td></tr><tr><td>$ .65</td><td>....</td><td>$5.00</td></tr></table>

## VIBURNUM COMPOUND

(Compressed Tablet No. 50)

(Chocolate-coated Tablet No. 154)

<table><tr><td>Ext. Star-grass</td><td>1/2 gr.</td></tr><tr><td>Ext. Helonias</td><td>1/2 gr.</td></tr><tr><td>Ext. Cramp-bark (Viburnum Opulus)</td><td>1 gr.</td></tr><tr><td>Ext. Viburnum prunifolium</td><td>1 gr.</td></tr><tr><td>Ext. Squaw Vine</td><td>1/2 gr.</td></tr><tr><td>Caulophyllin</td><td>1/4 gr.</td></tr></table>

## WARBURG TINCTURE, N. F., representing 1 fluid drachm (Pill No. 643)

(Chocolate-coated Tablet No. 170)

## WARBURG TINCTURE WITHOUT ALOE, N. F., representing 1 fluid drachm (Pill No. 644)

(Chocolate-coated Tablet No. 282)

## ZINC PHOSPHIDE COMPOUND (Dr. Westbrook) (Chocolate-coated Tablet No. 106)

<table><tr><td>Zinc phosphide</td><td>1/10 gr.</td></tr><tr><td>Reduced Iron</td><td>1 gr.</td></tr><tr><td>Ext. Nux vomica</td><td>1/4 gr.</td></tr></table>

<table><tr><td>.90</td><td>....</td><td>7.50</td></tr></table>

<table><tr><td>1.95</td><td>$9.00</td><td>....</td></tr></table>

<table><tr><td>1.60</td><td>....</td><td>....</td></tr></table>

<table><tr><td>1.95</td><td>9.00</td><td>....</td></tr></table>

<table><tr><td>.40</td><td>....</td><td>2.50</td></tr></table>

Of all these Pills and Tablets it can be said:

1. They are true to formula.

2. They disintegrate promptly in the alimentary tract.

3. They represent single average doses.

In ordering or prescribing Pills or Tablets, specify P. D. & Co.

[ 200 ]

BIOLOGICAL PRODUCTS

# BIOLOGICAL PRODUCTS

## ANTI-ANTHRAX SERUM

Bio. 45. 50 cc in syringe, with needle and gravity tube. per package $6.50 Used in the treatment of anthrax (malignant carbuncle) in the human. Dose, 50 to 100 cc intravenously.

Antidiphtheric Serum, see Diphtheria Antitoxin, page 206.

## ANTIDYSENTERIC SERUM

Bio. 122. 20 cc in rubber-capped vial. per bottle 4.25

This serum is obtained from the blood of horses which have been immunized to polyvalent suspensions of *Bacterium dysenteriae*, including several strains of the Shiga, Flexner and Hiss Y types. It is intended for the treatment of bacillary dysentery only, not amebic dysentery. The cases in which its use is indicated include epidemic, jail and asylum dysentery, and infantile summer diarrhea due to infection with one or another of the dysentery bacteria.

A prophylactic dose of 10 cc confers temporary immunity, probably not exceeding 10 to 12 days. Curative dose, 60 to 100 cc, preferably intravenously.

## ANTIGONOCOCCIC SERUM

Bio. 95. 2 cc in glass bulb, 3 bulbs in box. per box 3.00

Bio. 96. 12 cc in rubber-diaphragm-capped bulb. per bulb 2.00

This serum is obtained from the blood of horses that have been inoculated with gradually increasing quantities of cultures of the most virulent strains of gonococci obtainable. It is of special service in the sequelæ and complications of gonococcic infection—as orchitis, epididymitis, tendo-synovitis, and in particular gonorrheal arthritis (in which last-mentioned condition it has achieved therapeutic distinction). Dose, 2 to 12 cc hypodermically, repeated at intervals of a few days according to the judgment of the practitioner. Best results are obtained with the larger doses.

## ANTIMENINGOCOCCIC SERUM

Bio. 170. Two syringes, each containing 15 cc; also flexible gravity tube and two needles (intraspinous and intravenous), with stylet. 6.00

Bio. 172. 50 cc in syringe, with needle and gravity tube. 7.00

This serum contains bacteriolysins, agglutinins and antiendotoxins, developed as a result of injecting sound horses with live cultures of the four Gordon groups of *Diplococcus intracellularis meningitidis* (Weichselbaum). For intraspinal or intravenous injection. Complete directions for use accompany each package.

IMPORTANT.—This serum is carried in stock in the Detroit Laboratory and in our various branches. It should be ordered by wire direct from the home office or the nearest branch.

[ 201 ]

BIOLOGICAL PRODUCTS

ANTIPNEUMOCOCCIC SERUM (Type 1).

Bio. 40. 50 cc in syringe container, with gravity tube...package $6.50

This serum represents the reaction of healthy horses to consecutive injections of *Diplococcus pneumoniae*, type 1, and is used in the treatment of pneumonia due to this particular strain.

ANTISTREPTOCOCCIC SERUM (Polyvalent)

Bio. 110. 10 cc in syringe with sterile double-pointed needle.... 2.50

Bio. 114. 10 cc in rubber-diaphragm capped vial.................. 2.00

Bio. 112. 20 cc in syringe with sterile double-pointed needle.... 4.00

Streptococcus cultures from a great variety of pathologic conditions, such as endocarditis, mastoiditis, acute peritonitis, puerperal septicemia, and streptococcic spinal meningitis, are used for injecting the horses that are to yield this serum.

ANTISTREPTOCOCCIC SERUM (Polyvalent), Refined and
Concentrated

Bio. 2005. 10 cc in syringe with sterile double-pointed needle.... 6.50

This product is similar to the Antistreptococcic Serum above de-
scribed, but is superior to it in being a hyper-refined and concen-
trated product, 1 cc being equivalent to from 5 to 10 cc of the un-
concentrated product. It is obtained from the serum of horses that
have been hyperimmunized against highly virulent and toxicogenic
strains of both hemolytic and non-hemolytic streptococci.

The dose is 10 to 20 cc, injected intramuscularly.

[202]

BIOLOGICAL PRODUCTS

The official name for a bacterial vaccine adopted by the United States Public Health Service is "Bacterial Vaccine made from," followed by the name or names of the organism or organisms entering into its composition. For instance, Acne Combined Vaccine would be entitled: "Bacterial Vaccine made from Acne bacillus, Acne diplococcus, Staphylococcus albus, and Staphylococcus aureus."

Bacterial vaccines supplied by Parke, Davis & Co. are labeled in accordance with this regulation, but the trade names are used on the label as supplementary titles.

The numbers following the titles in the following list indicate the bacterial content of 1 cc. The 1-cc and 2.5-cc. bulbs are rubber-capped. The 5-cc and 20-cc vials are closed with rubber caps having a thin rubber diaphragm in the center, through which the needle is to be thrust for withdrawal of the dose; the puncture closes automatically.

Special Bacterial Vaccines (Bacterins).—We are prepared to make up Bacterial Vaccines on special order at the price given for the listed Vaccines, each cubic centimeter to contain not more than 1000 million bacteria, or if a mixed vaccine not more than 5000 million and not to exceed five species of bacteria. Minimum quantities for which orders can be accepted are: 1-cc bulbs, 10; 5-cc vials, 6; 20-cc vials, 5.

On orders calling for more than five species of bacteria or for a higher bacterial count than mentioned above, an extra charge will be made to cover additional costs.

Acne Combined, 2000 million.

<table>
  <tr>
    <td>Acne bacillus, 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Acne diplococcus, 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Staphylococcus albus, 1200 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Staphylococcus aureus, 600 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Bio. 186. Four 1-cc bulbs in package</td>
    <td>$2.00</td>
  </tr>
  <tr>
    <td>Bio. 185. 5-cc vial</td>
    <td>1.25</td>
  </tr>
  <tr>
    <td>Bio. 189. 20-cc vial</td>
    <td>3.00</td>
  </tr>
</table>

Catarrhal (Respiratory) Com-
bined, 1200 million.

<table>
  <tr>
    <td>Friedlander bacillus, 50 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Pneumococcus (4 types), 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Micrococcus catarrhalis, 50 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Streptococcus, hemolytic and non-hemo- lytic, 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Staphylococcus albus, 350 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Staphylococcus aureus, 350 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Pseudo-diphtheria bacillus, 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Influenza bacillus (Pfeiffer), 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Bio. 610. Four 1-cc bulbs in package</td>
    <td>$2.00</td>
  </tr>
  <tr>
    <td>Bio. 612. Four 1-cc syringes in pkg.</td>
    <td>4.00</td>
  </tr>
  <tr>
    <td>Bio. 614. 5-cc vial</td>
    <td>1.25</td>
  </tr>
  <tr>
    <td>Bio. 615. 20-cc vial</td>
    <td>3.00</td>
  </tr>
</table>

Coley's Mixture, see page 205.

Combined (Van Cott), 1500 mil-
lion.

<table>
  <tr>
    <td>Colon bacillus, 200 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Pneumococcus (4 types), 200 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Streptococcus, hemolytic and non-hemo- lytic, 100 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Staphylococcus albus, 500 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Staphylococcus aureus, 500 million.</td>
    <td></td>
  </tr>
  <tr>
    <td>Bio. 225. Four 1-cc bulbs in package</td>
    <td>$2.00</td>
  </tr>
  <tr>
    <td>Bio. 229. 5-cc vial</td>
    <td>1.25</td>
  </tr>
  <tr>
    <td>Bio. 230. 20-cc vial</td>
    <td>3.00</td>
  </tr>
</table>

Furunculosis, 2000 million.

<table>
  <tr>
    <td>Staph. aureus from furunculosis cases.</td>
    <td></td>
  </tr>
  <tr>
    <td>Bio. 255. Four 1-cc bulbs in package</td>
    <td>$2.00</td>
  </tr>
  <tr>
    <td>Bio. 258. 5-cc vial</td>
    <td>1.25</td>
  </tr>
  <tr>
    <td>Bio. 259. 20-cc vial</td>
    <td>3.00</td>
  </tr>
</table>

[203]

BIOLOGICAL PRODUCTS

BACTERIAL VACCINES—Continued

Gonorrheal Combined, 4000 million. (Urethritis Combined)

Gonococcus, 1000 million.
Staphylococcus albus, 1200 million.
Staphylococcus aureus, 800 million.
Micrococcus catarrhalis, 100 million.
Streptococcus, 200 million.
Colon bacillus, 500 million.
Pseudo-diphtheria bacillus, 200 million.

<table><tr><td>Bio. 285. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 289. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 290. 20-cc vial.</td><td>3.00</td></tr></table>

Influenza Combined, 1200 million

Influenza bacillus (Pfeiffer), 400 million.
Micrococcus catarrhalic, 100 million.
Pneumococcus (4 types) 400 million.
Streptococcus, hemolytic and non-hemolytic, 300 million.

<table><tr><td>Bio. 670. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 672. Four 1-cc syringes in pkg.</td><td>4.00</td></tr><tr><td>Bio. 674. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 675. 20-cc vial.</td><td>3.00</td></tr></table>

Influenza-Pneumonia Prophylactic, 5000 million.

Pneumococcus, 3000 million (60%) (type 1, 10%; type 2, 15%; type 3, 10%; type 4, 25%).

Streptococcus hemolyticus, 1000 million.
Influenza bacillus (Pfeiffer), 500 million.
Staphylococcus aureus, 500 million.

<table><tr><td>Bio. 632. Three bulbs in package</td><td>$1.25</td></tr><tr><td>(One complete course)</td><td></td></tr><tr><td>Bio. 635. 20-cc vial.</td><td>3.00</td></tr></table>

Pertussis, 4000 million.

Pertussis bacillus.

<table><tr><td>Bio. 198. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 201. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 202. 20-cc vial.</td><td>3.00</td></tr></table>

Pertussis Combined, 5000 million.

Pertussis bacillus, 4000 million.
Staphylococcus aureus, 500 million.
Streptococcus, hemolytic and non-hemolytic, 100 million.

Micrococcus catarrhalis, 40 million.
Influenza bacillus (Pfeiffer), 160 million.
Pneumococcus (4 types), 200 million.

<table><tr><td>Bio. 620. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 622. Four 1-cc syringes in pkg.</td><td>4.00</td></tr><tr><td>Bio. 624. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 625. 20-cc vial.</td><td>3.00</td></tr></table>

Pneumococcus (4 types), 3000 million.

<table><tr><td>Bio. 465. 5-cc vial.</td><td>$1.25</td></tr></table>

Pneumonia Combined, 3000 million.

Pneumococcus (4 types), 2000 million.
Friedlander bacillus, 500 million.
Streptococcus, hemolytic and non-hemolytic, 500 million.

<table><tr><td>Bio. 467. 5-cc vial.</td><td>$1.25</td></tr></table>

Staphylococcus Combined, 2000 million.

Staphylococcus albus, 1000 million
Staphylococcus aureus, 1000 million.

<table><tr><td>Bio. 376. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 390. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 391. 20-cc vial.</td><td>3.00</td></tr></table>

Streptococcus, 500 million.

(hemolytic and non-hemolytic)

<table><tr><td>Bio. 411. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 458. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 459. 20-cc vial.</td><td>3.00</td></tr></table>

Streptococcus and Staphylococcus Combined, 1250 million.

Streptococcus, hemolytic and non-hemolytic, 250 million.

Staphylococcus albus, 500 million.
Staphylococcus aureus, 500 million.

<table><tr><td>Bio. 650. Four 1-cc bulbs in package</td><td>$2.00</td></tr><tr><td>Bio. 654. 5-cc vial.</td><td>1.25</td></tr><tr><td>Bio. 655. 20-cc vial.</td><td>3.00</td></tr></table>

Typhoid, 1000 million.

Typhoid bacillus.

<table><tr><td>Bio. 427. Three bulbs (1 course)</td><td>$0.75</td></tr><tr><td>Bio. 426. Three syringes (1 course)</td><td>2.25</td></tr><tr><td>Bio. 429. Ten 2.5-cc bulbs (hospital package)</td><td>5.00</td></tr><tr><td>Bio. 431. 20-cc vial.</td><td>3.00</td></tr></table>

Typhoid-Paratyphoid, 2500 million.

Typhoid bacillus, 1000 million.
Paratyphoid bacillus A, 750 million.
Paratyphoid bacillus B, 750 million.

<table><tr><td>Bio. 441. Three bulbs (1 course)</td><td>$0.75</td></tr><tr><td>Bio. 443. Three syringes (1 course)</td><td>2.25</td></tr><tr><td>Bio. 444. Ten 2.5-cc bulbs (hospital package)</td><td>5.00</td></tr><tr><td>Bio. 446. 20-cc vial</td><td>3.00</td></tr></table>

Urethritis Combined, see Gonorrheal Combined.

[204]

BIOLOGICAL PRODUCTS

Catarrhalis Immunogen, see page 210.

Unfiltered toxins of *Streptococcus erysipelatis* and *Bacillus prodigiosus*, prepared according to the formula and directions of Dr. Wm. B. Coley, of the New York Cancer Hospital. For the treatment of inoperable sarcoma by injection into or near the tumor. The initial dose is ¼ to ½ minim, but as tolerance is established the dose is increased, the object being to produce a decided reaction but not an intolerable one. General directions for use accompany the material, which is not carried in stock by druggists, owing to its fragility, but ordered from the laboratory as required. Within three weeks it can usually be told whether or not improvement is to be expected from the treatment.

This mixture has been employed as a non-specific protein in arthritis and general paresis with apparently good effect.

For packages and prices see page 61.

CULTURE MEDIA (For prices, see page 61)

In "breakable" glass-sealed tubes, each tube in an individual carton accompanied by a sterilized vial containing cotton plug.

<table><tr><td>No. 1</td><td>Nutrient Gelatin.</td><td>No. 11</td><td>Plain Bouillon.</td></tr><tr><td>No. 4</td><td>Nutrient Agar.</td><td>No. 16</td><td>Glucose Bouillon.</td></tr><tr><td>No. 5</td><td>Glycerin Agar.</td><td>No. 18</td><td>Serum Agar.</td></tr><tr><td>No. 6</td><td>Glucose Agar.</td><td>No. 20</td><td>Lactose Bile Medium.</td></tr><tr><td>No. 8</td><td>Blood Serum (Loeffler's mixture for growing Bact. diphtheriae), with swab for obtaining culture material from throat.</td><td>No. 21</td><td>Endo's Medium.</td></tr><tr><td>No. 8</td><td>Blood Agar.</td><td>No. 22</td><td>Litmus Lactose Agar.</td></tr><tr><td>No. 8</td><td>Blood Agar.</td><td>No. 23</td><td>Ascites Agar.</td></tr><tr><td>No. 8</td><td>Blood Agar.</td><td>No. 25</td><td>Blood Agar.</td></tr></table>

No. 8 can also be obtained in a cotton-plugged, rubber-capped tube.

Other Culture Media will be made up on order in lots of not less than 50 tubes. Please specify kind of tubes desired (rubber-capped or glass-sealed).

DIPHTHERIA ANTITOXIN, see page 206.

DIPHTHERIA TOXIN FOR THE SCHICK TEST

Bio. 78. Two 5-cc vials, to make 50 tests...........per package $1.50

Vial No. 1 contains sufficient undiluted Diphtheria Toxin for fifty tests. Vial No. 2 contains 5 cc of diluent.

For use, the toxin is diluted by injecting the 5 cc of diluent through the rubber diaphragm of the red labeled vial (there is only one M. L. D. of toxin in the vial). The test is made by placing 0.1 cc of the dilution just under the outer layer of the skin. The diluted toxin cannot be preserved for future use.

DIPHTHERIA TOXIN HEATED, for Schick Control

Bio. 79. 5-cc rubber-capped vial (for 50 tests)...........per package 1.50

[205]

BIOLOGICAL PRODUCTS

PARKER
DAVIS
& COMPANY
Vيرا

DIPHOTHERIA ANTITOXIN

<table><tr><td>Bio. 16. 1000 units in syringe (average prophylactic dose) per package</td><td>$1.00</td></tr><tr><td>Bio. 18. 3000 units in syringe</td><td>per package 2.00</td></tr><tr><td>Bio. 20. 5000 units in syringe</td><td>per package 3.00</td></tr><tr><td>Bio. 22. 10,000 units in syringe (average therapeutic dose) per package</td><td>per package 5.00</td></tr><tr><td>Bio. 23. 20,000 units in syringe</td><td>per package 9.00</td></tr></table>

The pseudo-globulins of antidiphtheric serum, precipitated and purified by the elimination of non-essential serum constituents, such as serum albumin and euglobulins. By concentration of the product we are enabled to offer a large dose in a small volume. Prophylactic dose, 1000 units. Therapeutic dose, 5000 to 20,000 units intramuscularly. In severe or late cases large doses are indicated—50,000 to 100,000 units. Repeat the injections at intervals of six to twelve hours if necessary. Literature supplied on request.

DIPHOTHERIA TOXIN FOR THE SCHICK TEST, see page 205.

DIPHOTHERIA TOXIN-ANTITOXIN MIXTURE (Diphtheria Prophylactic) 1/10 L+ dose of toxin in each cubic centimeter

<table><tr><td>Bio. 67. Case of three 1-cc bulbs</td><td>per package 1.00</td></tr><tr><td>Bio. 69. 30 cc in rubber-diaphragm-capped vial</td><td>per vial 2.50</td></tr><tr><td>Bio. 68. Thirty 1-cc bulbs (hospital package)</td><td>per package 8.00</td></tr></table>

The antitoxin is from the blood of immunized goats. The mixture is prepared according to standards established by the U. S. Public Health Service. A prophylactic course consists of three hypodermic injections of 1 cc each, at intervals of five days. Immunity develops gradually—in the course of two to six months.

Diphtheria Prophylactic is intended for general immunization against diphtheria in schools and communities, excluding immedi-

[ 206 ]

PARKER
DAVIS
& COMPANY
Vيرا

BIOLOGICAL PRODUCTS

ate contacts, and is applicable of course for the protection of individuals anywhere who have not been recently exposed.

When antitoxin is given as a prophylactic or in treatment the Diphtheria Prophylactic should not be used until the passive immunity conferred by the antitoxin has exhausted itself—a matter of about two weeks.

DIPHOTHERIA TOXOID

Bio. 2100. One bulb (0.5 cc) of dilute Toxoid for the reaction test, and two bulbs (1 cc) of prophylactic Toxoid for one immunization................................................... $1.00

Bio. 2102. Ten bulbs of dilute Toxoid and 20 bulbs of prophylactic Toxoid (hospital package), for ten immunizations 8.00

Intended, like Diphtheria Toxin-Antitoxin Mixture, for producing active immunity to diphtheria. The prophylactic course consists of two injections a week apart.

Erysipelas Phylacogen, see page 213.

ERYSIPELAS STREPTOCOCCUS ANTITOXIN, Refined and
Concentrated

Bio. 2010. 5,000 units (approximately 10 cc) in syringe with sterile double-pointed needle...................per package 9.00

Of special value in the treatment of facial erysipelas. The dose is 10 to 20 cc or more.

The usual dose of the unconcentrated product is about 100 cc. The advantage of the concentrated product, therefore, is quite obvious.

[ 207 ]

BIOLOGICAL PRODUCTS

MERCANTILE
P
CO.
VERA

Erysipelas Streptococcus Immunogen, see page 210.

Gonococcus Antigen, see page 212.

Gonococcus Immunogen, see page 210.

Gonorrhea Phylacogen, see page 213.

## HEMOSTATIC SERUM (LaPenta) (Hemoplastin)

For the control of hemorrhage, by stimulating the coagulating mechanism of the patient's blood. Contains thrombokinase and prothrombin in balanced solution, and very little protein. Suitable for intravenous, intramuscular or subcutaneous injection in any case in which excessive bleeding is feared from operation, or for the prompt control of otherwise uncontrollable hemorrhage. The dose varies from 2 cc to 5 cc, but the larger dose is usually to be preferred.

The injections may be repeated at intervals of four to six hours until the bleeding is controlled, though a single dose is often sufficient for this purpose. For packages and prices see page 61. Literature supplied on request.

## HEMOSTATIC SERUM (LaPenta), Oral

Hemostatic Serum when given orally will shorten the coagulation time of the blood in the same way as when given hypodermically.

Full directions accompany each package. For prices see page 61.

[208]

BIOLOGICAL PRODUCTS

MERCANTILE
P
CO.
VERA

## IMMUNOGENS

Immunogens are antigenic agents of the same general order as bacterial vaccines, being obtained from fresh bacterial cultures, but the method of preparation is different and the protein content decidedly less. They contain no bacterial bodies, but only the washings of the fresh cultures—ectoantigens.

On being taken from the culture medium on which they have grown, the live bacteria are subjected to a saline bath of short duration, and the bacteria promptly thrown out of the suspension by centrifugation, so the finished product contains no bacterial bodies at all, but only what has been extracted from them, or rather from the surface of their bodies, by the salt solution. Immunogens not only contain no bacterial bodies; they contain not more than one-tenth as much protein as bacterial vaccines.

By agglutination and complement-fixation tests Immunogens have been proved to be superior to bacterial vaccines in the development of specific antibodies, and this superiority has been confirmed by clinical observation, notably with respect to Pneumococcus and Streptococcus Immunogens.

All the Immunogens are supplied in 10-cc rubber-diaphragm-capped vials to facilitate withdrawal of the desired dose without exposing the remainder to contamination, and one price applies to all (see page 61).

[209]

BIOLOGICAL PRODUCTS

## Catarrhalis Immunogen Combined (Bio. 340)

Ectoantigens of *Micrococcus catarrhalis*, *Bacterium influenzae*, *Staphylococcus aureus*, streptococci (hemolytic and non-hemolytic), and pneumococci (types 1, 2 and 3), for the prevention and treatment of catarrhal infections of the upper respiratory tract, such as acute coryza, rhinitis, pharyngitis, laryngitis, tonsillitis, and sinusitis.

## Erysipelas Streptococcus Immunogen (Bio. 355)

Ectoantigens of hemolytic streptococci from erysipelas, for the treatment of erysipelas.

## Gonococcus Immunogen (Bio. 295)

Ectoantigens of gonococci, for the treatment of acute or subacute gonorrhea,

## Gonococcus Immunogen Combined (Bio. 300)

Ectoantigens of *Micrococcus gonorrhoeae*, *Staphylococcus aureus* and *Staphylococcus albus*, for the treatment of subacute and chronic gonococcus infections, especially when complicated by a secondary invasion with staphylococci.

## Pertussis Immunogen (Bio. 315)

Ectoantigens of *Bacterium pertussis*, for the prevention of whooping cough.

## Pertussis Immunogen Combined (Bio. 320)

Ectoantigens of *Bacterium pertussis*, *Staphylococcus aureus* and *Staphylococcus albus*, for the treatment of whooping cough, especially when complications are present or suspected.

## Pneumococcus Immunogen (Bio. 305)

Ectoantigens of types 1, 2 and 3 of *Diplococcus pneumoniae*, for the treatment of pneumonia and pneumococcus infections in general.

## Pneumococcus Immunogen Combined (Bio. 310)

Ectoantigens of types 1, 2 and 3 of *Diplococcus pneumoniae*, and hemolytic and non-hemolytic streptococci. The indications are the same, in general, as for Pneumococcus Immunogen, but streptococcic infections are taken care of also.

## Staphylococcus Immunogen (Bio. 335)

Ectoantigens of *Staphylococcus albus* and *Staphylococcus aureus*. Intended especially for the treatment of boils, carbuncles, abscesses, or any pathological condition due to invasion by staphylococci.

## Streptococcus Immunogen (Bio. 325)

Ectoantigens of hemolytic and non-hemolytic streptococci, for the treatment of streptococcus infections in general—including generalized infections following injuries, and puerperal sepsis.

[210]

BIOLOGICAL PRODUCTS

## Streptococcus Immunogen Combined (Bio. 330)

Ectoantigens of hemolytic and non-hemolytic streptococci, *Staphylococcus albus* and *Staphylococcus aureus*. The indications are the same as for Streptococcus Immunogen, but in addition, as in the case of Gonococcus Immunogen Combined, this product counteracts the effect of staphylococcic invasion as well.

Laboratory diagnostic agents are attaining extensive use and are now an important part in the armamentarium of every busy physician. Directions for the use of the following are supplied with the materials as ordered.

Items preceded by an asterisk (*) are not carried in Depot or Branch House stocks, as it is necessary to check their activity at regular intervals; they must be ordered direct from Detroit.

For packages and prices of Laboratory Diagnostic Agents see pages 61-62.

*Acetone Insoluble Antigen (Noguchi Beef-Heart Antigen). For use in the complement fixation test in the diagnosis of suspected syphilitic sera.

*Antidysenteric Serum, Agglutinating. "Shiga," "Hiss Y" and "Flexner" (polyvalent) strains. For use in the agglutination test in the diagnosis of bacillary dysentery and the typing of cultures.

*Antihuman Amboceptor (Hemolysin). Rabbit Serum. For use in the Noguchi modification of the complement fixation test in the diagnosis of suspected syphilitic sera.

*Antihuman Precipitin Serum. For identifying human blood in bloodstains.

*Antimeningococcic Serum, Agglutinating (Gordon Groups). Groups 1, 2, 3 and 4, for use in the agglutination test for classifying meningococci.

*Antimeningococcic Serum, Agglutinating, Polyvalent. Used in the agglutination test, for the diagnosis of epidemic meningitis and as a control for serologic diagnosis.

*Antiparatyphoid Serum, Agglutinating. Paratyphoid bacillus "A" and Paratyphoid bacillus "B," for the identification of *B. paratyphosus* "A" and "B" and as a control in serologic diagnosis.

*Antipneumococcic Serum, Agglutinating. Types 1, 2, and 3, for the diagnosis of lobar pneumonia and as a control in serologic diagnosis.

*Antisheep Amboceptor (Hemolysin). Rabbit Serum. Titration 1:5000 to 1:8000 (new Kolmer technic). For use in the complement fixation test in the diagnosis of suspected syphilitic sera, and other complement fixation tests (tuberculosis, gonorrhea).

*Antityphoid Serum, Agglutinating. For control in the agglutination test for diagnosis of typhoid fever.

[211]

BIOLOGICAL PRODUCTS

**Cholesterinized Antigen** (Beef Heart, fortified). For use in the complement fixation test in the diagnosis of suspected syphilitic sera.

*Dick Test, see page 216.*

*Diphtheria Toxin for the Schick Test, see page 205.*

*Gonococcus Antigen (Polyvalent).* The water-soluble portion of polyvalent suspensions of the gonococcus, used for the complement fixation test in the diagnosis of obscure cases of gonorrheal infection. The auxiliary reagents (amboceptor, etc.) are the same as those employed in the fixation test for syphilis. Each vial contains sufficient Antigen for about 80 single complement fixation tests.

*Human Blood-typing Serums.* Bedside test package containing two capillary tubes (in colorless glass) of test serum A and two capillary tubes (in amber glass) of test serum B, with rubber bulbs, sufficient for typing the blood of both patient and donor. Also, for use in laboratories and hospitals, 1-cc bulbs of each test serum, "A" and "B," The League of Nations Health Organization has officially classified Type 2 and Type 3, Jansky and Moss, as Test serum A and Test serum B, respectively.

*Kahn Standard Antigen.* For use in the precipitation test for syphilis.

*Kolmer Antigen.* For use in the complement fixation test in the diagnosis of suspected syphilitic sera.

*Paratyphoid Bacillus "A" Suspension (Concentrated).* For diagnosis, by agglutination test, of paratyphoid fever due to *B. paratyphosus* A.

*Paratyphoid Bacillus "B" Suspension (Concentrated).* For diagnosis, by agglutination test, of paratyphoid fever due to *B. paratyphosus* B.

*Plain Alcoholic Antigen* (Beef Heart). For use in the complement fixation test in the diagnosis of suspected syphilitic sera.

*Scarlet Fever Toxin for the Dick Test, see page 216.*

*Schick Test, see page 205.*

*Tubercle Antigen* (Craig Modification). For use in the complement fixation test in the diagnosis of tuberculosis. The auxiliary reagents (amboceptor, etc.) are the same as those employed in the fixation test for syphilis. Each vial contains sufficient Antigen for about 80 single complement fixation tests.

*Tuberculin, see page 221.*

*Typhoid Bacillus Suspension (Concentrated).* For diagnosis, by agglutination test, of typhoid infection.

*Microscopical Slides, see page 32.*

*Mixed Infection Phylacogen, see page 213.*

[212]

BIOLOGICAL PRODUCTS

## NORMAL HORSE SERUM

<table><tr><td>Bio. 52. 10-cc rubber-capped vial</td><td>per package</td><td>$1.25</td></tr><tr><td>Bio. 53. 30-cc rubber-diaphragm-capped bottle</td><td>per package</td><td>2.50</td></tr></table>

## PERTUSSIS IMMUNOGEN, see page 210.

## PHYLACOGENS

The term "Phylacogen" distinguishes the modified bacterial derivatives manufactured by Parke, Davis & Co. Phylacogens are filtrates of pathogenic bacterial cultures representing many strains of a number of individual species related to the particular infectious condition for which the product is recommended. Dose: subcutaneous, 1 cc and upwards; intravenous, not more than ¼ cc to begin with, to be gradually increased according to the indications, one injection being given every day or according to special indications. All the Phylacogens are supplied in 10-cc rubber-diaphragm-capped vials only. For prices see page 62.

### Erysipelas Phylacogen (Bio. 585)

Culture filtrates of streptococci (hemolytic and non-hemolytic), *Staphylococcus aureus* and *Staph. albus* from erysipelas cases.

### Gonorrhea Phylacogen (Bio. 590)

Culture filtrates of *Micrococcus gonorrhoeae*, *Staphylococcus aureus* and *albus*, *Streptococcus* (hemolytic and non-hemolytic), and *Micrococcus catarrhalis*.

### Mixed Infection Phylacogen (Bio. 595)

The organisms represented in this product are *Staphylococcus albus* and *aureus*, *Streptococcus* (hemolytic and non-hemolytic), the colon bacillus, and four types of pneumococci (*Diplococcus pneumoniae*).

Mixed Infection Phylacogen is used in the treatment of septic conditions of uncertain etiology, abscess formation, surgical infections, puerperal septicemia, otitis media, mastoiditis, appendicitis, empyema, carbuncle, mastitis, osteomyelitis, gangrene, septic phlebitis, tonsillitis, asthma and hay fever.

### Pneumonia Phylacogen (Bio. 605)

Prepared from various strains of each of the four types of *Diplococcus pneumoniae* isolated from typical pneumococcus infections.

It may be advisable to give ¼ cc every four hours during the day for the first two days, and larger daily injections thereafter.

### Rheumatism Phylacogen (Bio. 580)

Culture filtrates of streptococci from cases of acute arthritis, and of *Staphylococcus albus* and *aureus*. Treatment should be continued until the symptoms disappear.

[213]

BIOLOGICAL PRODUCTS

## Typhoid Phylacogen (Bio. 600)

Typhoid Phylacogen represents *Bacillus typhosus* and *Bacillus paratyphosus* A and B.

The early use of the Phylacogen usually shortens the course of the disease, renders the symptoms milder, and reduces the incidence of disturbing and dangerous complications.

## Pneumococcus Immunogen, see page 210.

## POLIOMYELITIS ANTISTREPTOCOCCIC SERUM, Refined and Concentrated

Bio. 2015. 10-cc in syringe container...................per package $10.00

The serum, obtained from the blood of horses which have been immunized against the toxins and highly virulent cultures of streptococci isolated from cases of poliomyelitis, is refined so as to retain the agglutinating and antibacterial properties in concentrated solution, free from most of the inactive serum constituents.

Poliomyelitis Antistreptococcic Serum, refined and concentrated, is offered for use in poliomyelitis with the recognition that the etiology of this disease and the value of serum in its treatment are still unsettled.

The dose ranges from 10 to 50 cc, injected intramuscularly or intravenously. Should be used at the earliest possible moment.

## POLLEN EXTRACTS FOR HAY FEVER

There are three 4-cc rubber-diaphragm-capped vials in each package. Vial No. 1 contains 20 units per cc; No. 2, 200 units per cc; and No. 3, 2000 units per cc. The first dose is 0.1 cc, or 2 units, and from this point the doses increase at each injection in the absence of contraindications. The prophylactic course should begin two months in advance of the date of the annual attack of hay fever.

Complete directions for the use of the extracts accompany each package. Literature supplied on request.

### Gramineæ (Timothy and related grasses)

Bio. 360. Three vials for one course, ready for use..per package 9.00

### Chenopodiaceæ (Russian Thistle group)

Bio. 362. Three vials for one course, ready for use..per package 9.00

### Ambrosiaceæ (Ragweed and related genera)

Bio. 364. Three vials for one course, ready for use..per package 9.00

### Artemisiæ (Wormwood and related species)

Bio. 366. Three vials for one course, ready for use..per package 9.00

For Pollen Extracts for Diagnosis, see pages 55 and 57.

[214]

BIOLOGICAL PRODUCTS

## PRECIPITATED HORSE SERUM (Coagulose)

A sterile anhydrous powder, obtained by precipitation and desiccation of normal horse serum; used for the control of hemorrhage of the new-born and other hemorrhagic conditions due to defective coagulability of the blood. The contents of one vial, dissolved in 8 to 10 cc of water, constitute one hypodermic dose. The powder itself is sometimes applied locally, to stanch the flow of blood in persistent oozing after surgical operations. For price see page 62.

See also Hemostatic Serum, page 208.

## PUERPERAL SEPTICEMIA ANTISTREPTOCOCCIC SERUM, Refined and Concentrated

Bio. 2020. 500,000 units (approximately 10 cc), in syringe with sterile double-pointed needle...................per package $9.00

Indicated in the prophylaxis and treatment of puerperal septicemia. The serum is obtained from horses which have been hyperimmunized against the toxin and highly virulent cultures of streptococci isolated in pure culture from the blood of patients suffering from typical severe cases of puerperal septicemia.

The potency of the serum is determined by the number of skin test doses of toxin neutralized by a given quantity of it.

## RABIES VACCINE (Cumming)

Bio. 440. 21-dose treatment in 3 installments............complete 40.00

Bio. 440. 14-dose treatment in 2 installments............complete 27.00

This product is finished in packages of seven 2-cc syringe containers, each syringe completely equipped with needle, etc. A full adult treatment consists of twenty-one doses of 2 cc each, or three packages as described. For children under 4 years of age 1-cc doses are recommended. In cases where the exposure is slight, a superficial bite or abrasion on the lower extremities or through the clothing remote from the brain, a 14-dose treatment may suffice. On receipt of an order we will supply one package of seven syringes immediately, and the remaining one or two packages at intervals of four days.

Carried in stock in Detroit and in our various branches. Order by wire from the home office or the nearest branch.

Literature furnished on request.

Ragweed Pollen Extract, see page 214.

Rheumatism Phylacogen, see page 213.

Russian Thistle Pollen Extract, see page 214.

[215]

BIOLOGICAL PRODUCTS

## SCARLET FEVER STREPTOCOCCUS ANTITOXIN, Refined and Concentrated

Bio. 115. Therapeutic dose, 6000 units (300,000 original neutralizing units) in syringe...................per package $8.00

Bio. 116. Prophylactic dose, 2000 units (100,000 original neutralizing units) in syringe...................per package 4.50

Scarlet Fever Streptococcus Antitoxin, as manufactured by us, is both antitoxic and antibacterial, representing the serological reac- tion of the horse to living cultures of the scarlet fever strepto- coccus as well as to the toxins derived from this organism. The unit value has been increased fifty-fold so that what was formerly 50 units is now designated 1 unit. This accounts for the equivalence noted above—(6000 units = 300,000 original units).

Given in time, one therapeutic dose is usually sufficient. It should be repeated, however, in 12 to 24 hours, if necessary. One pro- phylactic dose protects contacts for about 10 days.

## SCARLET FEVER STREPTOCOCCUS ANTITOXIN FOR THE SCHULTZ-CHARLTON TEST

Bio. 151. In 1-cc bulbs (5 tests)...................per package 1.00

Directions for use accompany the material.

## SCARLET FEVER STREPTOCOCCUS TOXIN FOR PREVENTIVE IMMUNIZATION

Bio. 157. Five vials, containing respectively 500, 2000, 8000, 25,000 and 80,000 skin test doses...........per package 2.25

Bio. 158. Hospital package, ten vials of each of the five strengths (50 vials in all), sufficient for ten immunizations...... 15.00

Beginning with the smallest dose, five injections are required for immunization, the injections being given at intervals of about five days.

## SCARLET FEVER STREPTOCOCCUS TOXIN FOR THE DICK TEST

Bio. 154. 1-cc vial of diluted Toxin (10 tests)...........per package 1.00

All our scarlet fever products are licensed and approved by the Scarlet Fever Committee. Literature will be supplied to any physician on request.

Schick Control, see Diphtheria Toxin, Heated, page 205.

Smallpox Vaccine, see Vaccine Virus. page 221.

[216]

BIOLOGICAL PRODUCTS

## TETANUS ANTITOXIN

The pseudo-globulins of Antitetanic Serum, precipitated and purified by the elimination of non-essential serum constituents (serum albumin and euglobulins).

The antitetanic units given below are in standard American units.

The international standard unit was fixed by the League of Nations Committee at exactly one-half the American standard.

<table><tr><td>Bio. 147.</td><td>1500 units in bulb (average prophylactic dose)..................</td><td>$ 2.00</td></tr><tr><td>Bio. 141.</td><td>1500 units in syringe....................................</td><td>2.50</td></tr><tr><td>Bio. 143.</td><td>5000 units in syringe....................................</td><td>6.00</td></tr><tr><td>Bio. 146.</td><td>10,000 units in syringe (average therapeutic dose)........</td><td>12.00</td></tr><tr><td>Bio. 149.</td><td>20,000 units in syringe....................................</td><td>22.00</td></tr></table>

Tetanus antitoxin possesses a distinct prophylactic value, but to be effective after the symptoms of tetanus have made their appearance it must be given early and in large doses. Dose, as a prophylactic, immediately after receipt of suspicious injury, 1500 units; to combat symptoms, an initial intravenous dose of 10,000 to 20,000 units, followed by 5000 to 10,000 units intramuscularly or intravenously every six to twelve hours or oftener, depending upon the clinical response. In developed cases 5000 units may be given intramuscularly by the gravity method after the withdrawal of a proper amount of spinal fluid, and this dose may be repeated in twenty-four hours if necessary. To control the muscular spasms, Chlore- tone (chlorbutanol) 30 to 60 grains in hot olive oil enema is highly recommended.

[217]

BIOLOGICAL PRODUCTS

TUBERCULIN B. F., HUMAN

Bio. 480. Package of six 1-cc rubber-capped bulbs...per package $4.50

The bouillon in which virulent human tubercle bacilli have grown is filtered through paper and through a porcelain filter, and preserved by the addition of cresols. For purity it is tested both bacteriologically and on animals. Employed as an immunizing and curative agent in tuberculosis. Dose, 1/10,000 milligram (1/10,000, 000 cc) and upwards. Dilution tables accompany each package.

TUBERCULIN B. F., BOVINE

Bio. 485. Package of six 1-cc rubber-capped bulbs...per package 4.50

For the treatment of human tuberculosis. It is sometimes preferred to tuberculin of human origin. The dose, like that of the other tuberculins, must be small to begin with, and regulated by the observed effect.

TUBERCULIN T. R., Concentrated

Bio. 510. Glass bulb, rubber-capped, containing 1 milligram of total dry tubercle solids in 1 cc of liquid...per bulb 2.00

Dry tubercle bacilli are thoroughly ground, then extracted with water and centrifugalized, the supernatant fluid discarded, and the sediment dried, reground, and brought into solution in a mixture of glycerin and water. Dilution tables accompany each package.

TUBERCULIN T. R., Dilute

Bio. 500. Package of six 1-cc rubber-capped bulbs...per package 4.50

Each cubic centimeter contains 1/1000 milligram of dry tubercle solids. Cresol is added as a preservative.

Sir A. E. Wright, of London, advises and employs 1/4000 to 1/500 of a milligram (dry solids) at a dose (one-fourth the contents of a single bulb, up to 2 bulbs). Others advise much smaller initial doses, even to 1/1,000,000 milligram of the dry solids (1/1000 cc of the Dilute Tuberculin). In gradually increasing the dose, the utmost caution must be observed to avoid a reaction.

TUBERCULIN OLD

(Made according to Koch's original process)

Bio. 491. 1-cc bulb, rubber-diaphragm cap...per bulb 2.00

This product is prepared by evaporating the bouillon culture of the tubercle bacillus to one-tenth the original volume, after which the organisms are removed by filtration and the product tested. It is used for both diagnostic and curative purposes. Dilution tables accompany each package.

[220]

BIOLOGICAL PRODUCTS

TUBERCULIN FOR THE VON PIRQUET TEST

Bio. 530. Package containing 3 sealed glass tubes of Tuberculin and 3 tubes of control material...per package $1.50

Each tube contains sufficient Tuberculin Old for one diagnostic test by the von Pirquet method. Full directions for making the test are given in the circular accompanying each package.

Typhoid Bacillus Suspension, see page 212.

Typhoid Phylacogen, see page 214.

VACCINE VIRUS (Smallpox Vaccine)

Bio. 560. Package of five capillary glass tubes (five vaccinations), with five needles for scarifying and rubber bulb for ejecting...per package 1.00

Bio. 651. Package containing one capillary glass tube (one vaccination), with rubber bulb for ejecting and needle for scarifying...per package .25

"Vaccination must become an aseptic surgical operation." The features which have given reputation to our Glycerinated Vaccine are: (1) Purity; (2) Potency; (3) Security from contamination in transit or storage; (4) Exchangeability.

Directions for use by three different methods—scarification, intradermic, and multiple pressure—accompany each package.

Vaccine Virus rapidly loses its potency if not kept cold; freezing will not injure it.

Wormwood Pollen Extract, see page 214.

[221]

MATERIA MEDICA INDEX—Continued

ANTACIDS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Alkaline Aromatic Tablets</td><td>154</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Calcium Carbonate Compound Tablets</td><td>165</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Soda Mint Tablets</td><td>195</td></tr></tbody></table>

ANTHELMINTICS

<table><tbody><tr><td>Carbon Tetrachloride Capsules</td><td>108</td></tr><tr><td>Chenopodium Oil Capsules</td><td>110</td></tr><tr><td>Male Fern and Kamala Capsules</td><td>111</td></tr><tr><td>Santonin and Calomel Tablets</td><td>194</td></tr></tbody></table>

ANTIARTHRITICS

<table><tbody><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Cinchophen</td><td>16</td></tr><tr><td>Colchicine and Methyl Salicylate Capsules</td><td>110</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Methylene Blue Compound Capsules</td><td>111-112</td></tr><tr><td>Methylene Blue Compound Tablets</td><td>184</td></tr><tr><td>Rheumatism Phylacogen</td><td>213</td></tr><tr><td>Sal-Ethyl Capsules</td><td>113</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Sodium Iodide and Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Sodium Salicylate Compound Ampoules</td><td>142</td></tr><tr><td>Wintergreen Oil Capsules</td><td>114</td></tr></tbody></table>

ANTIBACTERIAL SERUMS

<table><tbody><tr><td>Anti-anthrax</td><td>201</td></tr><tr><td>Antidysenteric</td><td>201</td></tr><tr><td>Antigonococcic</td><td>201</td></tr></tbody></table>

[ix]

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Antimeningococcic</td><td>201</td></tr><tr><td>Antipneumococcic, Type 1</td><td>202</td></tr><tr><td>Antistreptococcic</td><td>202</td></tr><tr><td>Erysipelas Streptococcus Antitoxin</td><td>207</td></tr><tr><td>Poliomyelitis Antistreptococcic</td><td>214</td></tr><tr><td>Puerperal Septicemia Antistreptococcic</td><td>215</td></tr><tr><td>Scarlet Fever Streptococcus Antitoxin</td><td>216</td></tr></tbody></table>

ANTIMALARIALS

<table><tbody><tr><td>Calisaya Alkaloids</td><td>98</td></tr><tr><td>Calisaya Bark</td><td>98</td></tr><tr><td>Cinchona Alkaloids</td><td>90-91</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Quinine Dihydrochloride Ampoules</td><td>135</td></tr><tr><td>Quinine Hydrobromide, Neutral</td><td>112, 191</td></tr><tr><td>Quinine Pills and Tablets</td><td>38</td></tr><tr><td>Quinine and Urea Hydrochloride Ampoules</td><td>137</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr></tbody></table>

ANTINAUSEANTS

<table><tbody><tr><td>Apothesine Tablets, Oral</td><td>8</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Glucose Solution in Ampoules</td><td>125</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Nausea Tablets</td><td>186</td></tr></tbody></table>

ANTIPHLOGISTICS

<table><tbody><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Adrenalin and Chloretone Ointment</td><td>48</td></tr><tr><td>Adrenalin Suppositories</td><td>4</td></tr><tr><td>Adrenalin and Chloretone Suppositories</td><td>4</td></tr><tr><td>Adrenalin Compound Suppositories</td><td>4</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Chloretone Compound Suppositories, Vaginal</td><td>14</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Inhalone</td><td>50</td></tr><tr><td>Menthum (camphor and menthol ointment)</td><td>50</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Phenichthol (ichthyol, alum and lead ointment)</td><td>51</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Silvol Ointment</td><td>52</td></tr><tr><td>Silvol Suppositories, Vaginal</td><td>40</td></tr><tr><td>Storaxol</td><td>52</td></tr><tr><td>Thermofuge</td><td>46</td></tr><tr><td>Thiodine</td><td>46</td></tr><tr><td>Thiodine Suppositories, Vaginal</td><td>46</td></tr><tr><td>Yellow Oxide of Mercury Ointment</td><td>53</td></tr></tbody></table>

ANTIPRURITICS

<table><tbody><tr><td>Adrenalin and Chloretone Suppositories</td><td>4</td></tr><tr><td>Adrenalin Compound Suppositories</td><td>4</td></tr><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Neko</td><td>32</td></tr><tr><td>Storaxol</td><td>52</td></tr><tr><td>Sulphur Ointment</td><td>53</td></tr></tbody></table>

ANTISEPTICS

<table><tbody><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Creosote Carbonate Capsules</td><td>111</td></tr><tr><td>Euthymol</td><td>24</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Formidine</td><td>24</td></tr><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Neko</td><td>32</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Potassium Permanganate Tablets</td><td>191</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Thiodine</td><td>46</td></tr><tr><td>Uritone</td><td>47, 145, 199</td></tr></tbody></table>

ANTISPASMODICS

<table><tbody><tr><td>Adrenalin (in asthma)</td><td>2</td></tr><tr><td>Antidysenteric Serum</td><td>201</td></tr><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Clnor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Cholera Infantum Mixture</td><td>15</td></tr><tr><td>Diarrhea Cordial</td><td>19</td></tr><tr><td>Ephedrine (in asthma)</td><td>21</td></tr><tr><td>Ephedrine Inhalant</td><td>22</td></tr><tr><td>Diarrhea Cordial</td><td>19</td></tr><tr><td>Liquor Sedans</td><td>26</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Sedans Tablets</td><td>194</td></tr></tbody></table>

ANTISYPHILITICS

<table><tbody><tr><td>Bismuth Salicylate Ampoules</td><td>122</td></tr><tr><td>Bismuth Salicylate in Oil</td><td>9</td></tr><tr><td>Calomelettes</td><td>10</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Mercurettes</td><td>28</td></tr><tr><td>Mercuric Iodide (Red) Ampoules</td><td>132</td></tr><tr><td>Mercurosal</td><td>28, 29</td></tr><tr><td>Mercury Cyanide Ampoules</td><td>32</td></tr><tr><td>Mercury Salicylate Ampoules</td><td>133</td></tr><tr><td>Mercury Salicylate Cream</td><td>30</td></tr></tbody></table>

[x]

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Mercury Succinimide Ampoules</td><td>34</td></tr><tr><td>Sodium Cocodylate Ampoules</td><td>138</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Syrup Trifolium Compound</td><td>94</td></tr><tr><td>Thio-Bismol</td><td>45</td></tr></tbody></table>

ANTITOXINS

(See also Antibacterial Serums)

<table><tbody><tr><td>Diphtheria Antitoxin</td><td>206</td></tr><tr><td>Erysipelas Streptococcus Antitoxin</td><td>207</td></tr><tr><td>Poliomyelitis Antistreptococcic Serum</td><td>214</td></tr><tr><td>Puerperal Septicemia Antistreptococcic Serum</td><td>215</td></tr><tr><td>Scarlet Fever Streptococcus Antitoxin</td><td>216</td></tr><tr><td>Tetanus Antitoxin</td><td>217</td></tr><tr><td>Tetanus-Perfringens Antitoxin</td><td>218</td></tr></tbody></table>

ASTRINGENTS

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Adrenalin and Chloretone Ointment</td><td>48</td></tr><tr><td>Adrenalin Suppositories</td><td>4</td></tr><tr><td>Adrenalin and Chloretone Suppositories</td><td>4</td></tr><tr><td>Adrenalin Compound Suppositories</td><td>4</td></tr><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Astringent Suppositories, Vaginal</td><td>9</td></tr><tr><td>Chloretone Compound Suppositories, Vaginal</td><td>14</td></tr><tr><td>Diarrhea Cordial</td><td>19</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Phenichthol Ointment</td><td>51</td></tr><tr><td>Resorco Ointment</td><td>51</td></tr></tbody></table>

CATHARTICS

(See also Laxatives)

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Alophen Pills</td><td>157</td></tr><tr><td>Calobarb Tablets</td><td>166</td></tr><tr><td>Calomel Pills and Tablets</td><td>166-168</td></tr><tr><td>Castor Oil in Capsules</td><td>108-109</td></tr><tr><td>Cathartic Granules and Pills</td><td>169-171</td></tr><tr><td>Phenolphthalein Tablets</td><td>190</td></tr><tr><td>Senna, Fluid Extract</td><td>89</td></tr><tr><td>Sodium Phosphate Effervescent</td><td>118</td></tr></tbody></table>

CIRCULATORY SEDATIVES

<table><tbody><tr><td>Aconite</td><td>81</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Hypotensive Tablets</td><td>181</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134</td></tr><tr><td>Nitroglycerine Tablets</td><td>151, 187</td></tr><tr><td>Quinine Hydrobromide, Neutral</td><td>112-191</td></tr><tr><td>Sodium Nitrite Tablets</td><td>196</td></tr></tbody></table>

CIRCULATORY STIMULANTS

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Camphor in Oil, Ampoules</td><td>123</td></tr><tr><td>Camphor Spirit</td><td>116</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21</td></tr><tr><td>Ephedrine</td><td>21</td></tr><tr><td>Pitressin</td><td>70</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Spirits of Ammonia</td><td>116</td></tr><tr><td>Strophanthone</td><td>41</td></tr><tr><td>Strychnine Sulphate Ampoules</td><td>144</td></tr><tr><td>Thyroid Glands, Desiccated</td><td>74</td></tr></tbody></table>

[ xi ]

COUNTERIRRITANTS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr></tbody></table>

DIGESTANTS

<table><tbody><tr><td>Elixir Lactated Pepsin</td><td>104</td></tr><tr><td>Ox-gall Tablets</td><td>188</td></tr><tr><td>Panteric Capsules</td><td>36</td></tr><tr><td>Panteric Tablets</td><td>36</td></tr><tr><td>Papain Compound Tablets</td><td>188</td></tr><tr><td>Pepsin Tablets</td><td>188-189</td></tr><tr><td>Taka-Diastase</td><td>43</td></tr></tbody></table>

DISINFECTANTS

<table><tbody><tr><td>Cresylone</td><td>19</td></tr><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Neko</td><td>32</td></tr></tbody></table>

DIURETICS

<table><tbody><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21</td></tr><tr><td>Santal Oil Capsules</td><td>114</td></tr><tr><td>Strophanthone</td><td>41</td></tr><tr><td>Uritone (Hexamethylene tetramine) Ampoules</td><td>145</td></tr></tbody></table>

EMMENAGOGUES

<table><tbody><tr><td>Aloe Compound Pill</td><td>155</td></tr><tr><td>Aloe and Rue Compound Elixir</td><td>96</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Estrogen</td><td>64</td></tr><tr><td>Ovarian Residue</td><td>66</td></tr><tr><td>Thyroid</td><td>74</td></tr></tbody></table>

EPITHELIAL STIMULANTS

<table><tbody><tr><td>Bismuth Paste</td><td>49</td></tr><tr><td>Scarlet Red Emulsion</td><td>39</td></tr><tr><td>Scarlet Red Ointment</td><td>51-52</td></tr></tbody></table>

EXPECTORANTS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Citronin</td><td>16</td></tr><tr><td>Codeine Cough Sedative</td><td>17</td></tr><tr><td>Creosote Carbonate Capsules</td><td>111</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Ipecac Syrup</td><td>92</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr><tr><td>Palatol</td><td>35</td></tr><tr><td>Palatol Compound</td><td>36</td></tr><tr><td>Proposote Capsules</td><td>112</td></tr><tr><td>Santal Oil Capsules</td><td>114</td></tr><tr><td>Syrup Cocillana Compound</td><td>42</td></tr></tbody></table>

GLAND PRODUCTS

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Antuitrin Ampoules</td><td>71</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Estrogen Ampoules</td><td>64</td></tr><tr><td>Lipo-Lutin Ampoules</td><td>65</td></tr><tr><td>Mammary Gland</td><td>65</td></tr><tr><td>Orchic Substance</td><td>66</td></tr><tr><td>Ovarian Residue (Ovarian Substance without Corpora Lutea)</td><td>66</td></tr><tr><td>Ovarian Substance (Whole Ovary)</td><td>67</td></tr><tr><td>Parathyroid Gland</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Pineal Gland</td><td>69</td></tr><tr><td>Pitocin Ampoules</td><td>69</td></tr><tr><td>Pitressin Ampoules</td><td>70</td></tr><tr><td>Pituitary Anterior Lobe</td><td>71</td></tr><tr><td>Pituitary Whole Gland</td><td>71</td></tr><tr><td>Pituitary Posterior Lobe</td><td>72</td></tr><tr><td>Pituitrin Ampoules</td><td>72</td></tr><tr><td>Placenta</td><td>73</td></tr><tr><td>Suprarenal Gland</td><td>74</td></tr><tr><td>Testicular Substance (Orchic Substance)</td><td>66</td></tr><tr><td>Thymus Gland</td><td>74</td></tr><tr><td>Thyroid Gland</td><td>74</td></tr><tr><td>Thyroprotein</td><td>77</td></tr></tbody></table>

[ xii ]

GONOCOCCIDES

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Argentide</td><td>9</td></tr><tr><td>Methylene Blue Compound Capsules</td><td>111-112</td></tr><tr><td>Methylene Blue Compound Tablets</td><td>184</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Neo-Silvol Suppositories, Vaginal</td><td>34</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Silvol Suppositories, Vaginal</td><td>40</td></tr></tbody></table>

HEMATINICS

<table><tbody><tr><td>Blaud Pills and Tablets</td><td>161-163</td></tr><tr><td>Combined Hypophosphites</td><td>91</td></tr><tr><td>Emulsion Metagen and Cod-liver Oil</td><td>30</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrocascarin</td><td>116</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Ferrosenicum</td><td>117</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Glycerophosphates Compound Elixir</td><td>102</td></tr><tr><td>Hematacol</td><td>25</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Arsenite and Manganese Ampoules</td><td>127</td></tr><tr><td>Iron Arsenite and Strychnine Ampoules</td><td>128</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Iron Citrate (Green) Ampoules</td><td>130</td></tr><tr><td>Iron Citrate and Manganese Ampoules</td><td>131</td></tr><tr><td>Iron and Manganese Solution</td><td>117</td></tr><tr><td>Iron Peptonate and Manganese Solution</td><td>117</td></tr><tr><td>Liver Extract</td><td>27</td></tr><tr><td>Metagen</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr></tbody></table>

HEMOSTATICS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Adrenalin and Chloretone Ointment</td><td>48</td></tr><tr><td>Adrenalin Suppositories (Rectal)</td><td>4</td></tr><tr><td>Adrenalin and Chloretone Suppositories (Rectal)</td><td>4</td></tr><tr><td>Adrenalin Compound Suppositories (Rectal)</td><td>4</td></tr><tr><td>Ergone</td><td>21</td></tr><tr><td>Ergot Aseptic Ampoules</td><td>23</td></tr><tr><td>Hemostatic Serum (LaPenta)</td><td>208</td></tr><tr><td>Pituitrin Ampoules</td><td>72</td></tr><tr><td>Pitocin Ampoules</td><td>69</td></tr></tbody></table>

HYPNOTICS

<table><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134</td></tr><tr><td>Trional Tablets</td><td>199</td></tr></tbody></table>

LAXATIVES

<table><tbody><tr><td>Alophen Pills</td><td>157</td></tr><tr><td>Cascara Evacuant</td><td>11</td></tr><tr><td>Cascara Compound Pills</td><td>168-169</td></tr><tr><td>Cascarin Tablets</td><td>169</td></tr><tr><td>Cholelith Pills</td><td>172</td></tr><tr><td>Fluid Extract Cascara Sagrada, P. D. & Co.</td><td>83</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Olgar</td><td>35</td></tr><tr><td>Olgar Compound</td><td>35</td></tr></tbody></table>

NERVE SEDATIVES

<table><tbody><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Asafetida Pills and Tablets</td><td>160</td></tr><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Brometone</td><td>10</td></tr></tbody></table>

[ xiii ]

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Cannabis</td><td>82-83</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Guarana</td><td>86</td></tr><tr><td>Neuralgic Tablets</td><td>186-187</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Quinine Hydrobromide, Neutral</td><td>112, 191</td></tr><tr><td>Sedative Tablets</td><td>194</td></tr></tbody></table>

NERVE STIMULANTS

<table><tbody><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Camphor in Oil, Ampoules</td><td>123</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Glycerophosphates Compound Elixir</td><td>102</td></tr><tr><td>Iron Arsenite and Strychnine Ampoules</td><td>128</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Nux Vomica</td><td>87</td></tr><tr><td>Strychnine Sulphate Ampoules</td><td>144</td></tr></tbody></table>

NUTRITIVES

<table><tbody><tr><td>Cod-liver Oil</td><td>18, 19, 109</td></tr><tr><td>Emulsion Metagen and Cod-liver Oil</td><td>30</td></tr><tr><td>Glucose Ampoules</td><td>125</td></tr><tr><td>Nutritive Liquid Peptone</td><td>33</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr></tbody></table>

OXYTOCICS

<table><tbody><tr><td>Ergone</td><td>22</td></tr><tr><td>Ergot Aseptic Ampoules</td><td>23</td></tr><tr><td>Fluid Extract Ergot</td><td>85</td></tr><tr><td>Pitocin Ampoules</td><td>69</td></tr><tr><td>Pituitrin Ampoules</td><td>72</td></tr><tr><td>Quinine Dihydrochloride Ampoules</td><td>135</td></tr></tbody></table>

TONICS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Blaud Pills and Tablets</td><td>161-163</td></tr><tr><td>Cod-liver Oil in Capsules</td><td>109</td></tr><tr><td>Cod-liver Oil Phosphorized</td><td>19</td></tr><tr><td>Cod-liver Oil Standardized</td><td>18</td></tr><tr><td>Creosote Tonic Compound in Capsules</td><td>111</td></tr><tr><td>Emulsion Metagen and Cod-liver Oil</td><td>30</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrocascarin</td><td>116</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Ferrosenicum</td><td>117</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Glycerophosphates Compound Elixir</td><td>102</td></tr><tr><td>Hematacol</td><td>25</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Iron Arsenic and Strychnine Tablets</td><td>182</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Arsenite and Manganese Ampoules</td><td>127</td></tr><tr><td>Iron Arsenite and Strychnine Ampoules</td><td>128</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Iron Citrate (Green) Ampoules</td><td>130</td></tr><tr><td>Iron Citrate and Manganese Ampoules</td><td>131</td></tr><tr><td>Iron and Manganese Solution</td><td>117</td></tr><tr><td>Iron Peptonate and Manganese Solution</td><td>117</td></tr><tr><td>Metagen</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Nuclein Ampoules</td><td>134</td></tr><tr><td>Palatol</td><td>35</td></tr><tr><td>Palatol Compound</td><td>36</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr><tr><td>Sodium Glycerophosphate Ampoules</td><td>140</td></tr><tr><td>Syrup Trifolium Compound</td><td>94</td></tr><tr><td>Thyroid</td><td>74</td></tr></tbody></table>

[ xiv ]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Estrogen Ampoules</td><td>64</td></tr><tr><td>Iron Citrate Ampoules</td><td>130</td></tr><tr><td>Lipo-Lutin Ampoules</td><td>65</td></tr><tr><td>Thyroid</td><td>74-77</td></tr></tbody></table>

ANAL FISSURE

<table><tbody><tr><td>Belladonna Ointment</td><td>49</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Olgar</td><td>35</td></tr></tbody></table>

ANEMIA

<table><tbody><tr><td>Blaud Pills and Tablets</td><td>161-163</td></tr><tr><td>Calisaya Alkaloids, P. D. & Co.</td><td>98</td></tr><tr><td>Calisaya and Iron combinations</td><td>98-99</td></tr><tr><td>Cod-liver Oil</td><td>18</td></tr><tr><td>Elixir Chlorides of Iron, Arsenic and Mercury, with Calisaya</td><td>99</td></tr><tr><td>Elixir Glycerophosphate Compound with Iron, Quinine and Strychnine</td><td>102</td></tr><tr><td>Elixir Phosphates Compound with Calisaya</td><td>105</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrocascarin</td><td>116</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Iron, Arsenic and Strychnine Elixir</td><td>103</td></tr><tr><td>Iron, Arsenic and Strychnine Tablets</td><td>182</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Arsenite and Manganese Ampoules</td><td>127</td></tr><tr><td>Iron Arsenite and Strychnine Ampoules</td><td>128</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Iron Citrate Ampoules</td><td>130</td></tr><tr><td>Iron Citrate and Manganese Ampoules</td><td>131</td></tr><tr><td>Iron, Quinine and Strychnine Elixirs</td><td>103</td></tr><tr><td>Iron, Quinine and Strychnine Pills and Tablets</td><td>182, 183</td></tr><tr><td>Liver Extract</td><td>27</td></tr><tr><td>Metagen</td><td>30</td></tr><tr><td>Metagen and Cod-liver Oil Emulsion</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr><tr><td>Sodium Glycerophosphate Ampoules</td><td>140</td></tr><tr><td>Tonic Pills and Tablets</td><td>198</td></tr></tbody></table>

ANGINA PECTORIS

<table><tbody><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>20, 150</td></tr><tr><td>Hypotensive Tablets</td><td>181</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Strophanthone</td><td>41</td></tr></tbody></table>

ANOREXIA

<table><tbody><tr><td>Alkavena Elixir</td><td>96</td></tr><tr><td>Gentian Elixirs</td><td>101</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Tonic (Aiken) Tablets</td><td>198</td></tr></tbody></table>

ARTERIAL HYPERTENSION

<table><tbody><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Hypotensive Tablets</td><td>181</td></tr><tr><td>Nitroglycerin Tablets</td><td>187</td></tr><tr><td>Sodium Nitrite Tablets</td><td>196</td></tr></tbody></table>

[xvii]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>ARTHRITIS</td><td></td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Colchicine and Methyl Salicylate Capsules</td><td>110</td></tr><tr><td>Rheumatism Phylacogen</td><td>213</td></tr><tr><td>Sal-Ethyl Capsules</td><td>113</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr></tbody></table>

ASCITES

<table><tbody><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Strophanthone</td><td>41</td></tr><tr><td>Uritone</td><td>47</td></tr></tbody></table>

ASTHMA

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Adrephine</td><td>5</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Anti-Asthmatic Elixir (Hare)</td><td>97</td></tr><tr><td>Anti-Asthmatic Tablets (Hare)</td><td>158</td></tr><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Catarrhalis Immunogen Combined</td><td>210</td></tr><tr><td>Diagnostic Protein Extracts (for diagnosis)</td><td>54</td></tr><tr><td>Ephedrine</td><td>21</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr></tbody></table>

AURICULAR FIBRILLATION

<table><tbody><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalin Tablets</td><td>177</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Digitalis Tincture</td><td>84, 177</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr></tbody></table>

AUTO-INTOXICATION

<table><tbody><tr><td>Alophen Pills</td><td>157</td></tr><tr><td>Cascara Evacuant</td><td>11</td></tr><tr><td>Creosote Capsules</td><td>111</td></tr><tr><td>Creosote Carbonate Capsules</td><td>112</td></tr><tr><td>Creosote Pills and Tablets</td><td>175</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Olgar</td><td>35</td></tr><tr><td>Olgar Compound</td><td>35</td></tr><tr><td>Salol and Castor Oil Capsules</td><td>113</td></tr><tr><td>Salol Compound Capsules</td><td>113</td></tr><tr><td>Sulphocarbolates Combined Tablets</td><td>197</td></tr><tr><td>Thyroid</td><td>74-77</td></tr></tbody></table>

BILIARY COLIC

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chlorodyne Tablets</td><td>171</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr></tbody></table>

BLEPHARITIS

<table><tbody><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Neo-Silvol Ointment</td><td>51</td></tr><tr><td>Silvol Ointment</td><td>52</td></tr><tr><td>Yellow Oxide of Mercury Ointment</td><td>53</td></tr></tbody></table>

BOILS (see Furunculosis)

BRONCHITIS

<table><tbody><tr><td>Aconite Tincture or Fluid Extract</td><td>81</td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Anodyne Pine Syrups</td><td>90</td></tr><tr><td>Bronchial Tablets</td><td>164</td></tr><tr><td>Brown Mixture Tablets</td><td>164, 165</td></tr></tbody></table>

[xviii]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Catarrhalis Immunogen Combined</td><td>210</td></tr><tr><td>Catarrhal Vaccine, Respiratory</td><td>203</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Citronin</td><td>16</td></tr><tr><td>Codeine Cough Sedative</td><td>17</td></tr><tr><td>Codeine Sulphate Tablets (for cough)</td><td>172</td></tr><tr><td>Cod-liver Oil</td><td>18</td></tr><tr><td>Cough Tablets (expectorant)</td><td>174</td></tr><tr><td>Creosote and Terpin Hydrate Elixir</td><td>100</td></tr><tr><td>Fluid Extract Squill</td><td>89</td></tr><tr><td>Menthol Expectorant Syrup</td><td>92</td></tr><tr><td>Mentholated Cough Balsam</td><td>93</td></tr><tr><td>Nutritive Liquid Peptone</td><td>33</td></tr><tr><td>Propionate Capsules</td><td>112</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Syrup Cocillana Compound</td><td>42</td></tr><tr><td>Throat Mentholated Tablets</td><td>198</td></tr><tr><td>White Pine Compound Syrups</td><td>94, 95</td></tr></tbody></table>

BURNS AND SCALDS

<table><tbody><tr><td>Adrenalin</td><td>2, 3</td></tr><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr><tr><td>Scarlet Red Emulsion</td><td>39</td></tr><tr><td>Scarlet Red Ointment</td><td>51, 52</td></tr></tbody></table>

CARBUNCLE

<table><tbody><tr><td>Cod-liver Oil</td><td>18</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrosenicum</td><td>117</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Furunculosis Vaccine</td><td>203</td></tr><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr></tbody></table>

CHANCROID

<table><tbody><tr><td>Neo-Silvol granules</td><td>34</td></tr><tr><td>Tartar Emetic Ampoules</td><td>144</td></tr></tbody></table>

CHILBLAINS

<table><tbody><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Thiodine</td><td>46</td></tr></tbody></table>

CHOLELITHIASIS

<table><tbody><tr><td>Bile Salts and Cascarin Tablets</td><td>161</td></tr><tr><td>Pill Cholelith</td><td>172</td></tr></tbody></table>

CHOLERA INFANTUM

<table><tbody><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Cholera Infantum Mixture</td><td>15</td></tr><tr><td>Cholera Infantum Tablets</td><td>171</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Nutritive Liquid Peptone</td><td>33</td></tr></tbody></table>

CHOREA

<table><tbody><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Parathyroid</td><td>68</td></tr></tbody></table>

[xix]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Paroidin</td><td>68</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Thyroid</td><td>74-77</td></tr></tbody></table>

COLIC

<table><tbody><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Diarrhea Cordial</td><td>19</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr></tbody></table>

COLLAPSE

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122, 149</td></tr><tr><td>Camphor in Oil Ampoules</td><td>123, 124</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Strophanthone</td><td>41</td></tr></tbody></table>

CONJUNCTIVITIS

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Adrephine</td><td>5</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Silver Nitrate in Wax Capsules</td><td>39</td></tr><tr><td>Yellow Oxide of Mercury Ointment</td><td>53</td></tr></tbody></table>

CONSTIPATION

<table><tbody><tr><td>Aloin and combinations in Pill and Tablet</td><td>155-157</td></tr><tr><td>Alophen Pills</td><td>157</td></tr><tr><td>Calobarb Tablets</td><td>166</td></tr><tr><td>Calomel Tablets</td><td>166, 167, 168</td></tr><tr><td>Cascara Compound Pills and Tablets</td><td>168, 169</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Cascara Evacuant</td><td>11</td></tr><tr><td>Cascara Sagrada Extract Pills and Tablets</td><td>169</td></tr><tr><td>Cascara Sagrada Fluid Extract</td><td>83</td></tr><tr><td>Cascarin Compound Tablets</td><td>169</td></tr><tr><td>Castor Oil Capsules</td><td>108</td></tr><tr><td>Cathartic Compound Elixir</td><td>99</td></tr><tr><td>Cathartic Compound Pills</td><td>170, 171</td></tr><tr><td>Corrective Laxative Syrup</td><td>91</td></tr><tr><td>Dinner Tablets (Lady Webster)</td><td>177</td></tr><tr><td>Evacuant Pills</td><td>179</td></tr><tr><td>Laxative Pills</td><td>183</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Olgar</td><td>35</td></tr><tr><td>Olgar Compound</td><td>35</td></tr><tr><td>Phenolphthalein Tablets</td><td>190</td></tr><tr><td>Podophyllin Pills and Tablets</td><td>190</td></tr><tr><td>Rhubarb combinations in Tablet form</td><td>193</td></tr><tr><td>Sodium Phosphate, Effervescent</td><td>118</td></tr></tbody></table>

CORNEAL ULCER

(see Keratitis)

CORYZA

<table><tbody><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrephine</td><td>5</td></tr><tr><td>Catarrhal Vaccine Respiratory</td><td>203</td></tr><tr><td>Catarrhalis Immunogen Combined</td><td>210</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>"Cold" Tablets</td><td>172, 173</td></tr><tr><td>Coryza Tablets</td><td>174</td></tr><tr><td>Glaseptic Nebulizer</td><td>58</td></tr><tr><td>Inhalone</td><td>50</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Rhinitis Tablets</td><td>192</td></tr><tr><td>Silvol</td><td>40</td></tr></tbody></table>

[xx]

THERAPEUTIC INDEX—Continued

CRETINISM

PAGE

<table><tr><td>Thyroid</td><td>74</td></tr><tr><td>Thyroprotein</td><td>77</td></tr></table>

CYSTITIS

<table><tr><td>Copaiba Capsules</td><td>110</td></tr><tr><td>Cystitis Tablets</td><td>175, 176</td></tr><tr><td>Gonococcus Immunogen</td><td>210</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Pichi Compound Pills</td><td>190</td></tr><tr><td>Santal Oil Capsules</td><td>114</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Uritone</td><td>47</td></tr></table>

DERMATITIS

<table><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr><tr><td>Sodium Thiosulphate Ampoules</td><td>143</td></tr><tr><td>Storaxol</td><td>52</td></tr><tr><td>Thyroid</td><td>74-77</td></tr></table>

DIABETES INSIPIDUS

<table><tr><td>Ergone</td><td>22</td></tr><tr><td>Ergot Aseptic</td><td>23</td></tr><tr><td>Ferrosenicum</td><td>117</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Pitressin</td><td>70</td></tr><tr><td>Pituitrin</td><td>72</td></tr></table>

DIARRHEA

<table><tr><td>Castor Oil Capsules</td><td>108</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Diarrhea Cordial</td><td>19</td></tr><tr><td>Diarrhea Tablets</td><td>176</td></tr></table>

[xxi]

<table><tr><td>Ergone</td><td>22</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Panteric Tablets</td><td>36</td></tr><tr><td>Sun Cholera Tablets</td><td>197</td></tr></table>

DIPHTHERIA

<table><tr><td>Diphtheria Antitoxin</td><td>206</td></tr><tr><td>Diphtheria Prophylactic</td><td>206</td></tr><tr><td>Diphtheria Toxin for Schick Test</td><td>205</td></tr></table>

DROPSY

<table><tr><td>Digifortis</td><td>20</td></tr><tr><td>Diuretic Improved Elixir</td><td>101</td></tr><tr><td>Diuretic Tablets</td><td>177</td></tr><tr><td>Fluid Extract Squill</td><td>89</td></tr></table>

DYSMENORRHEA

<table><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Dioscorea Compound Elixir</td><td>100</td></tr><tr><td>Estrogen</td><td>64</td></tr><tr><td>Hydrastis and Cramp-bark Compound Elixir</td><td>103</td></tr><tr><td>Lipo-Lutin</td><td>65</td></tr><tr><td>Liquor Sedans</td><td>26</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr><tr><td>Sedans Tablets</td><td>194</td></tr><tr><td>Viburnum Compound Tablets</td><td>200</td></tr></table>

DYSPEPSIA

<table><tr><td>Absorbent Dyspeptic Tablets</td><td>153</td></tr><tr><td>Antidyspeptic Tablets</td><td>158</td></tr><tr><td>Digestive Tablets</td><td>176, 177</td></tr><tr><td>Gentian Elixir</td><td>101</td></tr><tr><td>Lactated Pepsin Elixirs</td><td>104</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Panteric Capsules or Tablets</td><td>36</td></tr><tr><td>Papain Compound Tablets</td><td>188</td></tr><tr><td>Pepsin and Bismuth Elixirs</td><td>105</td></tr></table>

THERAPEUTIC INDEX—Continued

<table><tr><td>Pepsin Tablets</td><td>188</td></tr><tr><td>Taka-Diastase</td><td>43-45</td></tr></table>

ECLAMPSIA

<table><tr><td>Brometone</td><td>10</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Hypotensive Tablets</td><td>181</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Veratrone</td><td>47</td></tr></table>

ECZEMA

<table><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Iron Arsenite Ampoules (in dry eczema)</td><td>126</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Resorco Ointment</td><td>51</td></tr><tr><td>Storaxol Ointment</td><td>52</td></tr><tr><td>Syrup Trifolium Compound</td><td>94</td></tr><tr><td>Thiodine</td><td>46</td></tr><tr><td>Tincture Green Soap</td><td>86</td></tr><tr><td>Zinc Oxide Ointment (early stage)</td><td>53</td></tr></table>

EDEMA

<table><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Diuretic Tablets</td><td>177</td></tr><tr><td>Edema Tablets</td><td>178</td></tr></table>

EMPYEMA

<table><tr><td>Ferrosenicum</td><td>117</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Palatol Compound</td><td>36</td></tr><tr><td>Proposote Capsules</td><td>112</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr></table>

ENDOCARDITIS

<table><tr><td>Aconite Tincture</td><td>81</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr></table>

<table><tr><td>Antistreptococcic Serum</td><td>202</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr><tr><td>Syrup Iron Chloride (Weld)</td><td>92</td></tr><tr><td>Veratrone</td><td>47</td></tr></table>

ENDOMETRITIS

<table><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Endometritis Tablets</td><td>178</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Gonococcus Immunogen Combined</td><td>210</td></tr><tr><td>Liquor Sedans</td><td>26</td></tr><tr><td>Neo-Silvol Suppositories, Vaginal</td><td>34</td></tr><tr><td>Silvol Suppositories, Vaginal</td><td>40</td></tr><tr><td>Streptococcus Immunogen, Combined</td><td>211</td></tr><tr><td>Thiodine Suppositories, Vaginal</td><td>46</td></tr></table>

ENURESIS

<table><tr><td>Ergone</td><td>22</td></tr><tr><td>Incontinence Tablets</td><td>181</td></tr><tr><td>Pitressin</td><td>70</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Thyroid</td><td>74-77</td></tr></table>

EPIDIDYMITIS

<table><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Gonococcus Immunogen</td><td>210</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Thermofuge</td><td>46</td></tr><tr><td>Thiodine</td><td>46</td></tr></table>

EPILEPSY

<table><tr><td>Acetanilid Compound Elixir</td><td>96</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Chloretone</td><td>12</td></tr></table>

[xxii]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Sodium Bromide Elixir</td><td>106</td></tr><tr><td>Three Bromides Elixir</td><td>106</td></tr><tr><td>Triple Bromides Tablets</td><td>199</td></tr></tbody></table>

ERYSIPELAS

<table><tbody><tr><td>Aconite Tincture or Fluid Ext.</td><td>81</td></tr><tr><td>Erysipelas Immunogen</td><td>210</td></tr><tr><td>Erysipelas Phylacogen</td><td>213</td></tr><tr><td>Erysipelas Streptococcus Antitoxin</td><td>207</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Neko</td><td>32, 33</td></tr></tbody></table>

EXOPHTHALMIC GOITER

<table><tbody><tr><td>Glycerophosphates Compound Elixir</td><td>102</td></tr><tr><td>Quinine Hydrobromide, Neutral</td><td>112</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Stearodine Tablets</td><td>40</td></tr><tr><td>Thyroid (cautiously)</td><td>74</td></tr></tbody></table>

FELONS (see Abscess)

FISSURE IN ANO

<table><tbody><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Adrenalin Suppositories</td><td>4</td></tr><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Scarlet Red Ointment</td><td>51, 52</td></tr></tbody></table>

FISSURED NIPPLES

<table><tbody><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Scarlet Red Ointment</td><td>51, 52</td></tr></tbody></table>

FISTULA

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Bismuth Paste</td><td>49</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Scarlet Red Ointment</td><td>51, 52</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr></tbody></table>

FLATULENCE

<table><tbody><tr><td>Asafetida Pills and Tablets</td><td>160</td></tr><tr><td>Creosote Capsules</td><td>111</td></tr><tr><td>Flatulence Tablets</td><td>180</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr><tr><td>Palatol Compound</td><td>36</td></tr><tr><td>Panteric Capsules or Tablets</td><td>36</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Potassium Permanganate Tablets</td><td>191</td></tr><tr><td>Proposote Capsules</td><td>112</td></tr></tbody></table>

FOOD SENSITIZATION

Protein Extracts (for diagnosis) 54

FURUNCULOSIS

<table><tbody><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrosericum</td><td>117</td></tr><tr><td>Furunculosis Vaccine</td><td>203</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Metagen and Cod-liver Oil</td><td>50</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Nuclein Ampoules</td><td>130</td></tr><tr><td>Staphylococcus Immunogen</td><td>214</td></tr><tr><td>Syrup Trifolium Compound</td><td>94</td></tr></tbody></table>

GASTRALGIA

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Cannabis Americana</td><td>82</td></tr><tr><td>Chloretone</td><td>12</td></tr></tbody></table>

[xxiii]

THERAPEUTIC INDEX—Continued

GASTRIC ULCER

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Apothesine Tablets, Oral</td><td>8</td></tr><tr><td>Bismuth Subnitrate Tablets</td><td>161</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Taka-Diastase</td><td>43, 44, 45</td></tr></tbody></table>

GASTRITIS

<table><tbody><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Taka-Diastase</td><td>43, 44, 45</td></tr></tbody></table>

GASTRO-ENTERITIS

<table><tbody><tr><td>Castor Oil Capsules</td><td>108</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr><tr><td>Palatol Compound</td><td>36</td></tr></tbody></table>

GOITER

(see also Exophthalmic Goiter)

<table><tbody><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Stearodine Tablets</td><td>40</td></tr><tr><td>Syrup Trifolium Compound</td><td>94</td></tr><tr><td>Thyroid</td><td>74-77</td></tr></tbody></table>

GONORRHEA

<table><tbody><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Copaiba Capsules (in late stage)</td><td>110</td></tr><tr><td>Copaiba, Cubeb and Santal Capsules</td><td>110</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Cubeb and Santal Capsules (in late stage)</td><td>110, 111</td></tr><tr><td>Cubeb Compound Pills and Tablets</td><td>175</td></tr><tr><td>Gonococcus Immunogen</td><td>210</td></tr><tr><td>Gonorrhea Phylacogen</td><td>213</td></tr><tr><td>Gonorrheal Vaccine Combined</td><td>204</td></tr><tr><td>Lafayette Mixture</td><td>117</td></tr><tr><td>Methylene Blue Compound Capsules and Pills</td><td>111, 112, 184</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Salol and Methylene Blue Capsules</td><td>114</td></tr><tr><td>Salol and Santal Compound Capsules</td><td>114</td></tr><tr><td>Santal Oil Capsules</td><td>114</td></tr><tr><td>Santal and Methylene Blue Compound Capsules</td><td>114</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Thiodine Suppositories, Vaginal</td><td>46</td></tr></tbody></table>

GOUT

<table><tbody><tr><td>Cod-Liver Oil</td><td>18</td></tr><tr><td>Colchicine and Methyl Salicylate Capsules</td><td>110</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr><tr><td>Potassium Permanganate Tablets</td><td>191</td></tr><tr><td>Sal-Ethyl Capsules</td><td>113</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr></tbody></table>

GRANULOMA INGUINALE

(Tropical Ulcer)

<table><tbody><tr><td>Tartar Emetic Ampoules</td><td>144</td></tr></tbody></table>

HAY FEVER

<table><tbody><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrephine</td><td>5</td></tr></tbody></table>

[xxiv]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Neo-Silvol (topically)</td><td>34</td></tr><tr><td>Pollen Extracts (for prophy-laxis)</td><td>55, 57</td></tr><tr><td>Resorco Ointment</td><td>51</td></tr></tbody></table>

HEART DISEASE

<table><tbody><tr><td>Aconite Tincture (in palpitation and hypertrophy)</td><td>81</td></tr><tr><td>Adrenalin (in heart-block)</td><td>2</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Iron Citrate Ampoules (in anemic cases)</td><td>130</td></tr><tr><td>Pituitrin (in tachycardia)</td><td>72</td></tr><tr><td>Strophanthone</td><td>41</td></tr></tbody></table>

HEART FAILURE

<table><tbody><tr><td>Cactus Compound Pills and Tablets</td><td>165</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Nitroglycerin Compound Tablets</td><td>187</td></tr></tbody></table>

HEMATEMESIS

<table><tbody><tr><td>Adrenalin, internally</td><td>1</td></tr><tr><td>Hemostatic Serum</td><td>208</td></tr></tbody></table>

HEMOPHILIA

<table><tbody><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Hemostatic Serum</td><td>208</td></tr><tr><td>Paroidin</td><td>68</td></tr></tbody></table>

HEMOPTYSIS

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Emetine Hydrochloride Ampoules</td><td>124</td></tr><tr><td>Hemostatic Serum</td><td>208</td></tr><tr><td>Hypotensive Tablets</td><td>181</td></tr><tr><td>Ipecac Syrup (small doses)</td><td>92</td></tr><tr><td>Nitroglycerin Tablets</td><td>187</td></tr></tbody></table>

HEMORRHAGE

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Coagulose</td><td>215</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Ergot Aseptic Ampoules</td><td>23</td></tr><tr><td>Ergotin Pills and Tablets</td><td>178</td></tr><tr><td>Hemostatic Serum</td><td>208</td></tr><tr><td>Normal Horse Serum</td><td>213</td></tr><tr><td>Pituitrin</td><td>72</td></tr></tbody></table>

HEMORRHOIDS

<table><tbody><tr><td>Adrenalin and Chloretone Ointment</td><td>48</td></tr><tr><td>Adrenalin and Chloretone Suppositories</td><td>4</td></tr><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Ergone (in bleeding piles)</td><td>22</td></tr><tr><td>Quinine and Urea Hydrochloride (5% solution)</td><td>137, 151</td></tr><tr><td>Storaxol</td><td>52</td></tr></tbody></table>

HEPATIC ABSCESS

<table><tbody><tr><td>Emetine Hydrochloride Ampoules</td><td>124</td></tr></tbody></table>

HEPATIC TORPOR

<table><tbody><tr><td>Calomel Tablets</td><td>166</td></tr><tr><td>Calomel and Soda Tablets</td><td>167, 168</td></tr><tr><td>Elixir Glycerophosphates Compound</td><td>102</td></tr><tr><td>Hepatic Tablets</td><td>180</td></tr><tr><td>Pill Alophen</td><td>157</td></tr><tr><td>Pill Cholelith</td><td>172</td></tr></tbody></table>

[xxv]

THERAPEUTIC INDEX—Continued

HICCOUGH

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Adrenalin by mouth</td><td>1</td></tr><tr><td>Belladonna Fluid Extract or Tincture</td><td>81</td></tr><tr><td>Belladonna Fluid Extract</td><td>81</td></tr><tr><td>Belladonna Tincture</td><td>81</td></tr><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Ipecac Syrup (to empty stomach)</td><td>92</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr></tbody></table>

HOOKWORM

<table><tbody><tr><td>Carbon Tetrachloride Capsules</td><td>108</td></tr><tr><td>Chenopodium Oil Capsules</td><td>110</td></tr></tbody></table>

HYPERCHLORHYDRIA

<table><tbody><tr><td>Bismuth and Magnesia Tablets</td><td>161</td></tr><tr><td>Magnesia and Soda Tablets</td><td>183</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Pepsin Tablets</td><td>188</td></tr></tbody></table>

HYPEREMESIS GRAVIDARUM

<table><tbody><tr><td>Adrenalin, internally</td><td>1</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Estrogen Ampoules</td><td>64</td></tr><tr><td>Glucose Ampoules</td><td>125</td></tr><tr><td>Lipo-Lutin Ampoules</td><td>65</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr></tbody></table>

HYPERTHYROIDISM

<table><tbody><tr><td>Adrenalin (in diagnosis)</td><td>1</td></tr><tr><td>Thyroidectin</td><td>47</td></tr></tbody></table>

HYSTERIA

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Camphor in Oil Ampoules</td><td>123, 124</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Elixir Glycerophosphates Compound</td><td>102</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Pill Three Valerates and Sumbul</td><td>198</td></tr><tr><td>Utrovol Elixir</td><td>107</td></tr></tbody></table>

INCONTINENCE OF URINE

(see Enuresis)

INDIGESTION, INTESTINAL

(see also Dypepsia)

<table><tbody><tr><td>Bile Salts and Cascarin Tablets</td><td>161</td></tr><tr><td>Milk of Bismuth</td><td>32</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr><tr><td>Ox-gall Pills (enteric-coated)</td><td>188</td></tr><tr><td>Ox-gall Compound Tablets</td><td>188</td></tr><tr><td>Panjeric Tablets or Capsules</td><td>36</td></tr></tbody></table>

INFECTED WOUNDS

<table><tbody><tr><td>Antistreptococcic Serum</td><td>202</td></tr><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Cresylone</td><td>19</td></tr><tr><td>Formidine</td><td>24</td></tr><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Mixed Infection Phylacogen</td><td>213</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr><tr><td>Tetanus Antitoxin</td><td>217</td></tr><tr><td>Tetanus-Perfringens Antitoxin</td><td>218</td></tr></tbody></table>

[xxvi]

THERAPEUTIC INDEX—Continued

INFLUENZA

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Acetylsalicylic Acid Tablets</td><td>154</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Citronin</td><td>16</td></tr><tr><td>Codeine Cough Sedative</td><td>17</td></tr><tr><td>Influenza Vaccine Combined</td><td>204</td></tr><tr><td>Pneumococcus Immunogen</td><td>210</td></tr><tr><td>Syrup Cocillana Compound</td><td>42</td></tr></tbody></table>

INSECT BITES

<table><tbody><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Storaxol</td><td>52</td></tr></tbody></table>

INSOMNIA

<table><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Bromide and Chloral Compound Elixir</td><td>97</td></tr><tr><td>Bromides Compound Elixir</td><td>97</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Sulphonal Tablets</td><td>197</td></tr><tr><td>Three Bromides Elixir</td><td>106</td></tr></tbody></table>

INTERTRIGO

<table><tbody><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Milk of Bismuth, externally</td><td>32</td></tr></tbody></table>

IVY POISONING

<table><tbody><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Ethereal Antiseptic Soap</td><td>6</td></tr><tr><td>Thiodine</td><td>46</td></tr></tbody></table>

KERATITIS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Metagen</td><td>30</td></tr><tr><td>Metagen and Cod-liver Oil</td><td>30</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Silvol Ointment</td><td>52</td></tr><tr><td>Tuberculin (in tuberculous cases)</td><td>219-221</td></tr><tr><td>Yellow Oxide of Mercury Ointment</td><td>53</td></tr></tbody></table>

LARYNGITIS

<table><tbody><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrephine</td><td>5</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Catarrhalis Immunogen</td><td>210</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Silvol</td><td>40</td></tr></tbody></table>

LEUCORRHEA

<table><tbody><tr><td>Astringent Suppositories, Vaginal</td><td>9</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Chloretone Compound Suppositories, Vaginal</td><td>14</td></tr><tr><td>Cresylone</td><td>19</td></tr><tr><td>Estrogen Ampoules</td><td>64</td></tr><tr><td>Germicidal Discs (1:20,000 solution mercuric iodide)</td><td>24</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Neo-Silvol Suppositories, Vaginal</td><td>34</td></tr><tr><td>Silvol Suppositories, Vaginal</td><td>40</td></tr><tr><td>Thiodine Suppositories, Vaginal</td><td>46</td></tr></tbody></table>

LEUKEMIA

<table><tbody><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrosernicum</td><td>117</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr></tbody></table>

[xxvii]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr></tbody></table>

LOCOMOTOR ATAXIA

(see also Syphilis)

<table><tbody><tr><td>Acetanilid Compound Elixir</td><td>96</td></tr><tr><td>Acetylsalicylic Acid Tablets</td><td>154</td></tr><tr><td>Adrenalin (for gastric crises)</td><td>1</td></tr><tr><td>Brometone (for laryngeal crises)</td><td>10</td></tr></tbody></table>

LUMBAGO

<table><tbody><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Colchicine and Methyl Salicylate</td><td>110</td></tr><tr><td>Elixir Glycerophosphates Compound</td><td>102</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Rheumatism Phylacogen</td><td>213</td></tr><tr><td>Sal-Ethyl Capsules</td><td>113</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr></tbody></table>

MALARIA

<table><tbody><tr><td>Antimalarial Elixir</td><td>97</td></tr><tr><td>Antimalarial Tablets</td><td>159</td></tr><tr><td>Elixir Cinchona Detannated</td><td>100</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Quinine</td><td>38, 191</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr><tr><td>Warburg Tincture Pills and Tablets</td><td>200</td></tr></tbody></table>

MALNUTRITION

<table><tbody><tr><td>Cod-liver Oil</td><td>18, 19, 109</td></tr><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrochonine</td><td>116</td></tr><tr><td>Ferrosernicum</td><td>117</td></tr><tr><td>Iodalbin</td><td>26</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Metagen</td><td>30</td></tr><tr><td>Metagen and Cod-liver Oil Emulsion</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr><tr><td>Palatol Compound</td><td>36</td></tr></tbody></table>

MENINGITIS

<table><tbody><tr><td>Antimeningococcic Serum</td><td>201</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Chloretone</td><td>12</td></tr></tbody></table>

MENOPAUSE

<table><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Estrogen</td><td>64</td></tr><tr><td>Liquor Sedans</td><td>26</td></tr><tr><td>Ovarian Substance (whole ovary)</td><td>67</td></tr></tbody></table>

MENORRHAGIA AND METORRHAGIA

<table><tbody><tr><td>Digifortis</td><td>20</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Hemostatic Serum</td><td>208</td></tr><tr><td>Liquor Sedans</td><td>26</td></tr><tr><td>Mammary Substance</td><td>65</td></tr><tr><td>Menorrhagic Tablets</td><td>184</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Placenta</td><td>73</td></tr><tr><td>Rhus Aromatica (in menorrhagia)</td><td>88</td></tr></tbody></table>

MYXEDEMA

<table><tbody><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Thyroid</td><td>74</td></tr><tr><td>Thyroprotein</td><td>77</td></tr></tbody></table>

NAUSEA

(see also Hyperemesis)

<table><tbody><tr><td>Apothesine Tablets, Oral</td><td>8</td></tr></tbody></table>

[xxviii]

THERAPEUTIC INDEX—Continued

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Chloretone</td><td>12</td></tr><tr><td>Nausea Tablets</td><td>186</td></tr></tbody></table>

NEPHRITIS

<table><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Caffeine Sodio-Benzoate</td><td>122, 129</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr></tbody></table>

NERVOUSNESS

<table><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Bromides Compound Elixir</td><td>97</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Sedative Tablets</td><td>194</td></tr><tr><td>Sodium Bromide Tablets</td><td>195</td></tr><tr><td>Three Bromides Elixir</td><td>106</td></tr></tbody></table>

NEURALGIA

<table><tbody><tr><td>Acetylasalicylic Acid Tablets</td><td>154</td></tr><tr><td>Aconite Tincture or Fluid Extract</td><td>81</td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Belladonna Ointment</td><td>49</td></tr><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Camphor Liniment</td><td>118</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Cod-liver Oil, Standardized</td><td>18</td></tr><tr><td>Elixir Glycerophosphates Compound</td><td>102</td></tr><tr><td>Magnesium Sulphate Ampoules</td><td>131</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr><tr><td>Neuralgia Tablets</td><td>186, 187</td></tr><tr><td>Potassium Bromide Tablets</td><td>191</td></tr><tr><td>Sal-Ethyl Capsules</td><td>113</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Sodium Salicylate Compound Ampoules</td><td>142</td></tr><tr><td>Three Valerates and Sumbul Pills</td><td>198</td></tr></tbody></table>

NEURASTHENIA

<table><tbody><tr><td>Cod-liver Oil, Phosphorized</td><td>19</td></tr><tr><td>Elixir Glycerophosphates</td><td>102</td></tr><tr><td>Glycerophosphate Compound Ampoules</td><td>126</td></tr><tr><td>Hematic Hypophosphites</td><td>25</td></tr><tr><td>Hypophosphites Syrups</td><td>91, 92</td></tr><tr><td>Lecithin Pills</td><td>183</td></tr><tr><td>Metagen</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Nuclein Ampoules</td><td>134</td></tr><tr><td>Sodium Glycerophosphate Ampoules</td><td>140</td></tr></tbody></table>

NEURITIS

<table><tbody><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr><tr><td>Pitressin Ampoules</td><td>70</td></tr><tr><td>Sal-Ethyl Capsules</td><td>113</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr></tbody></table>

NIPPLES, SORE

(see also Fissured Nipples)

<table><tbody><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Tincture Benzoin</td><td>81</td></tr></tbody></table>

[xxix]

THERAPEUTIC INDEX—Continued

NYMPHOMANIA

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Potassium Bromide Elixir</td><td>105</td></tr></tbody></table>

OBESITY

<table><tbody><tr><td>Pituitary Emplets (whole gland) in girdle obesity</td><td>71</td></tr><tr><td>Saccharin Tablets, as a substitute for sugar</td><td>93</td></tr><tr><td>Thryoid (when due to hypothyroidism)</td><td>75</td></tr></tbody></table>

OPHTHALMIA

<table><tbody><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr></tbody></table>

OPHTHALMIA NEONATORUM

<table><tbody><tr><td>Silver Nitrate in wax capsules</td><td>39</td></tr></tbody></table>

ORCHITIS

<table><tbody><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Gonococcus Immunogen Combined</td><td>210</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Thermofuge</td><td>46</td></tr><tr><td>Thiodine</td><td>46</td></tr></tbody></table>

OSTEO-ARTHRITIS

<table><tbody><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Thymus</td><td>74</td></tr></tbody></table>

OSTEOMALACIA

<table><tbody><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Elixir Glycerophosphates Compound</td><td>102</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Parathyroid</td><td>68</td></tr></tbody></table>

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Paroidin</td><td>68</td></tr><tr><td>Phosphorized Cod-liver Oil</td><td>19</td></tr><tr><td>Sodium Glycerophosphate Ampoules</td><td>140</td></tr></tbody></table>

OSTEOMYELITIS

<table><tbody><tr><td>Antistreptococcic Serum</td><td>210</td></tr><tr><td>Mixed Infection Phylacogen</td><td>213</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr></tbody></table>

OTITIS MEDIA

<table><tbody><tr><td>Catarrhalis Immunogen</td><td>210</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Formidine</td><td>24</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr><tr><td>Thiodine</td><td>46</td></tr></tbody></table>

PARASITIC SKIN DISEASES

<table><tbody><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Storaxol</td><td>52</td></tr></tbody></table>

PEDICULOSIS

<table><tbody><tr><td>Neko</td><td>32, 33</td></tr></tbody></table>

PELLAGRA

<table><tbody><tr><td>Metagen</td><td>30</td></tr><tr><td>Metagen and Cod-liver Oil Emulsion</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr></tbody></table>

PEMPHIGUS

<table><tbody><tr><td>Ferroarsine</td><td>116</td></tr><tr><td>Ferrosenicum</td><td>117</td></tr><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr></tbody></table>

[xxx]

THERAPEUTIC INDEX—Continued

PERICARDITIS

PAGE

<table><tr><td>Aconite Tincture</td><td>81</td></tr><tr><td>Caffeine Sodio-Benzoate Ampoules</td><td>122</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr></table>

PERITONITIS

<table><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>210</td></tr></table>

PERNICIOUS ANEMIA

(see also Anemia)

<table><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Cacodylate Ampoules</td><td>129</td></tr><tr><td>Liver Extract</td><td>27</td></tr></table>

PERTUSSIS

<table><tr><td>Adrenalin on tongue</td><td>1</td></tr><tr><td>Brometone</td><td>10</td></tr><tr><td>Codeine Cough Sedative</td><td>17</td></tr><tr><td>Pertussis Immunogen</td><td>210</td></tr><tr><td>Pertussis Vaccine</td><td>204</td></tr></table>

PHARYNGITIS

<table><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Ephedrine</td><td>21</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Thiodine, externally</td><td>46</td></tr></table>

PLEURISY

<table><tr><td>Aconite Tincture or Fluid Ext.</td><td>81</td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Iodalbin</td><td>26</td></tr></table>

<table><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr></table>

PNEUMONIA

<table><tr><td>Aconite Tincture</td><td>81</td></tr><tr><td>Antipneumococcic Serum</td><td>202</td></tr><tr><td>Caffeine Sodio-Benzoate</td><td>122</td></tr><tr><td>Camphor Ampoules</td><td>123, 124</td></tr><tr><td>Chlor-Anodyne (for pain)</td><td>12</td></tr><tr><td>Codeine Sulphate Tablets (for cough)</td><td>172</td></tr><tr><td>Cold sponging (for fever)</td><td></td></tr><tr><td>Creosote Carbonate Capsules</td><td>111</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Nutritive Liquid Peptone with Creosote</td><td>33</td></tr><tr><td>Pneumococcus Immunogen</td><td>210</td></tr><tr><td>Pneumonia Phylacogen</td><td>213</td></tr><tr><td>Proposote</td><td>112</td></tr><tr><td>Strophanthone Ampoules</td><td>21</td></tr><tr><td>Strychnine Sulphate Ampoules</td><td>144</td></tr><tr><td>Uritone Ampoules</td><td>145</td></tr></table>

POLIOMYELITIS

<table><tr><td>Poliomyelitis Antistreptococcic Serum</td><td>214</td></tr><tr><td>Uritone, as a prophylactic</td><td>148, 199</td></tr></table>

POSTPARTUM HEMORRHAGE

(see also Hemorrhage)

<table><tr><td>Ergot Fluid Extract</td><td>85</td></tr><tr><td>Ergot Aseptic Ampoules</td><td>23</td></tr><tr><td>Pituitrin Ampoules</td><td>72</td></tr></table>

PROCTITIS

<table><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Adrenalin and Chloretone Ointment</td><td>48</td></tr></table>

[xxxi]

THERAPEUTIC INDEX—Continued

PULMONARY EDEMA

PAGE

<table><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Atropine Sulphate Tablets</td><td>160</td></tr></table>

PURPURA HEMORRHAGICA

<table><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Hemostatic Serum</td><td>208</td></tr><tr><td>Normal Horse Serum</td><td>213</td></tr><tr><td>Precipitated Horse Serum</td><td>215</td></tr></table>

PYELITIS

<table><tr><td>Neo-Silvol, by ureteral instillation</td><td>34</td></tr><tr><td>Santal Oil Capsules</td><td>114</td></tr><tr><td>Uritone</td><td>47, 199</td></tr></table>

RHEUMATISM

<table><tr><td>Acetylsalicylic Acid (for pain)</td><td>154</td></tr><tr><td>Aconite Tincture, locally</td><td>81</td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Anti-Rheumatic Elixir</td><td>97</td></tr><tr><td>Anti-Rheumatic Tablets</td><td>159</td></tr><tr><td>Capsolin</td><td>50</td></tr><tr><td>Colchicine and Methyl Salicylate Capsules</td><td>110</td></tr><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Manaca and Salicylates Elixir</td><td>104</td></tr><tr><td>"Rheumatic" Tablets</td><td>192</td></tr><tr><td>Rheumatism Phylacogen</td><td>213</td></tr><tr><td>Sal-Ethyl</td><td>113</td></tr><tr><td>Salicylic Acid Compound Elixir</td><td>106</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Sodium Salicylate Elixir</td><td>106</td></tr><tr><td>Sodium Salicylate Tablets</td><td>196</td></tr><tr><td>Sodium Salicylate Compound Ampoules</td><td>142</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr><tr><td>Wintergreen Oil Capsules</td><td>114</td></tr></table>

<table><tr><td>Adrenalin Suppositories</td><td>4</td></tr><tr><td>Adrenalin and Chloretone Suppositories</td><td>4</td></tr><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Mineral Oil, Heavy</td><td>32</td></tr></table>

PROSTATITIS

<table><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Morphine and Atropine Ampoules</td><td>134, 151</td></tr><tr><td>Uritone</td><td>47</td></tr></table>

PROTEIN SENSITIZATION

<table><tr><td>Diagnostic Protein Extracts</td><td>54</td></tr></table>

PRURITUS

<table><tr><td>Adrenalin and Chloretone Ointment</td><td>48</td></tr><tr><td>Cod-liver Oil</td><td>18, 19, 30, 109</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Panteric Capsules or Tablets</td><td>36</td></tr><tr><td>Storaxol</td><td>52</td></tr><tr><td>Thiodine</td><td>46</td></tr></table>

PSORIASIS

<table><tr><td>Iron Arsenite Ampoules</td><td>126</td></tr><tr><td>Iron Arsenite and Manganese Ampoules</td><td>127</td></tr><tr><td>Metagen</td><td>30</td></tr><tr><td>Metatone</td><td>31</td></tr><tr><td>Panteric Capsules or Tablets</td><td>36</td></tr><tr><td>Sodium Cacodylate Ampoules</td><td>138</td></tr><tr><td>Storaxol</td><td>52</td></tr><tr><td>Thyroid</td><td>74</td></tr></table>

PUERPERAL SEPSIS

<table><tr><td>Puerperal Septicemia Streptococcus Antitoxin</td><td>215</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>211</td></tr></table>

[xxxi]

THERAPEUTIC INDEX—Continued

RHEUMATISM, GONOR-
RHEAL

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Gonococcus Immunogen</td><td>210</td></tr><tr><td>Gonorrheal Vaccine</td><td>204</td></tr></tbody></table>

RHEUMATOID ARTHRITIS

<table><tbody><tr><td>Ichthyol Ointment</td><td>50</td></tr><tr><td>Rheumatism Phylacogen</td><td>213</td></tr><tr><td>Streptococcus Immunogen<br>Combined</td><td>211</td></tr></tbody></table>

RHINITIS

<table><tbody><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Adrephine</td><td>5</td></tr><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Catarrhal Vaccine Respiratory</td><td>203</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Inhalone</td><td>50</td></tr><tr><td>Nasal Tablets</td><td>185</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Pituitrin, diluted, for local application</td><td>72</td></tr><tr><td>Rhinitis Tablets</td><td>192</td></tr><tr><td>Silvol Ointment</td><td>52</td></tr></tbody></table>

RICKETS

<table><tbody><tr><td>Cod-liver Oil, Standardized</td><td>18</td></tr><tr><td>Cod-liver Oil, Standardized<br>in Capsules</td><td>109</td></tr><tr><td>Cod-liver Oil, Phosphorized</td><td>19</td></tr><tr><td>Elixir Glycerophosphates Com<br>pound</td><td>102</td></tr><tr><td>Metagen</td><td>30</td></tr><tr><td>Metagen and Cod-liver Oil<br>Emulsion</td><td>30</td></tr><tr><td>Sodium Glycerophosphate<br>Ampoules</td><td>140</td></tr></tbody></table>

RINGWORM

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Ethereal Antiseptic Soap</td><td>6</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Thiodine</td><td>46</td></tr></tbody></table>

SALPINGITIS

<table><tbody><tr><td>Antigonococcic Serum</td><td>201</td></tr><tr><td>Combined Bacterial Vaccine<br>(Van Cott)</td><td>203</td></tr><tr><td>Gonococcus Immunogen Com<br>bined</td><td>210</td></tr><tr><td>Thiodine</td><td>46</td></tr><tr><td>Thiodine Suppositories, Vaginal</td><td>46</td></tr></tbody></table>

SARCOMA

<table><tbody><tr><td>Chlor-Anodyne</td><td>12</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Coley's Mixed Toxins</td><td>205</td></tr><tr><td>Morphine and Atropine</td><td>134, 151</td></tr></tbody></table>

SCABIES

<table><tbody><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Storaxol</td><td>52</td></tr><tr><td>Sulphur Ointment</td><td>53</td></tr></tbody></table>

SCARLET FEVER

<table><tbody><tr><td>Scarlet Fever Streptococcus<br>Antitoxin</td><td>216</td></tr><tr><td>Scarlet Fever Toxin (for immunization)</td><td>216</td></tr></tbody></table>

SCIATICA

<table><tbody><tr><td>Acetylsalicylic Acid Tablets</td><td>154</td></tr><tr><td>Adrenalin Ointment</td><td>48</td></tr><tr><td>Cod-liver Oil, Standardized</td><td>18</td></tr><tr><td>Elixir Glycerophosphates Com<br>pound</td><td>102</td></tr><tr><td>Sodium Glycerophosphate</td><td>140</td></tr><tr><td>Sodium Salicylate Ampoules</td><td>142</td></tr><tr><td>Streptococcus Immunogen<br>Combined</td><td>211</td></tr></tbody></table>

[xxxiii]

THERAPEUTIC INDEX—Continued

SEASICKNESS

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Amyl Nitrite Ampoules</td><td>121</td></tr><tr><td>Brometone (prophylactic)</td><td>10</td></tr><tr><td>Chloretone</td><td>12</td></tr></tbody></table>

SHOCK

<table><tbody><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr><tr><td>Ergone</td><td>22</td></tr><tr><td>Pitressin</td><td>70</td></tr><tr><td>Pituitrin</td><td>72</td></tr><tr><td>Strophanthone Ampoules</td><td>41</td></tr></tbody></table>

SMALLPOX

<table><tbody><tr><td>Neko (to modify or prevent<br>pitting)</td><td>32, 33</td></tr><tr><td>Smallpox Vaccine (prophylactic)</td><td>221</td></tr></tbody></table>

SORES

(see also Ulcers)

<table><tbody><tr><td>Anesthone Cream</td><td>48</td></tr><tr><td>Emollientine</td><td>50</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Phenichthol Ointment</td><td>51</td></tr><tr><td>Potassium Permanganate Tablets<br>(for solution)</td><td>191</td></tr><tr><td>Resorco Ointment</td><td>51</td></tr><tr><td>Scarlet Red Ointment</td><td>51, 52</td></tr><tr><td>Zinc Oxide Ointment</td><td>53</td></tr></tbody></table>

SPASMS

<table><tbody><tr><td>Benzyl Benzoate Capsules</td><td>108</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Paroidin</td><td>68</td></tr></tbody></table>

STERILITY

<table><tbody><tr><td>Estrogen Ampoules</td><td>64</td></tr><tr><td>Thyroid</td><td>74</td></tr></tbody></table>

STINGS AND BITES

<table><thead><tr><th></th><th>PAGE</th></tr></thead><tbody><tr><td>Chloretone Emollient</td><td>14</td></tr><tr><td>Chloretone Inhalant</td><td>14</td></tr><tr><td>Ethereal Antiseptic Soap</td><td>6</td></tr><tr><td>Potassium Permanganate Tablets<br>(pulverized and applied in<br>snake bite)</td><td>191</td></tr></tbody></table>

SYPHILIS

<table><tbody><tr><td>Bismuth Salicylate in Oil</td><td>9, 122</td></tr><tr><td>Calomelettes</td><td>10</td></tr><tr><td>Elixir Six Iodides</td><td>106</td></tr><tr><td>Iodalbin</td><td>26</td></tr><tr><td>Iodalbin and Merzurol Tablets</td><td>26</td></tr><tr><td>Mercurettes</td><td>28</td></tr><tr><td>Mercuric Iodide Ampoules</td><td>132</td></tr><tr><td>Mercuric Iodide Pills and Tablets</td><td>184</td></tr><tr><td>Meruusal</td><td>28</td></tr><tr><td>Mercury Cyanide Ampoules</td><td>132</td></tr><tr><td>Mercurv Salicylate Ampoules</td><td>133</td></tr><tr><td>Mercury Succinimide Ampoules</td><td>134</td></tr><tr><td>Mixed Treatment Tablets</td><td>185</td></tr><tr><td>Sodium Camodylate Ampoules</td><td>138</td></tr><tr><td>Sodium Iodide Ampoules</td><td>141</td></tr><tr><td>Syrup Trifolium Compound</td><td>94</td></tr><tr><td>Thio-Bismol Ampoules</td><td>45</td></tr><tr><td>Three Iodides Tablets</td><td>197</td></tr></tbody></table>

TACHYCARDIA

<table><tbody><tr><td>Brometone</td><td>10</td></tr><tr><td>Chloretone</td><td>12</td></tr><tr><td>Corpora Lutea</td><td>63</td></tr><tr><td>Digifortis</td><td>20</td></tr><tr><td>Digitalone</td><td>21, 150</td></tr></tbody></table>

TAPEWORM

<table><tbody><tr><td>Male Fern and Kamala Capsules</td><td>111</td></tr><tr><td>Oleoresin Aspidium</td><td>35</td></tr></tbody></table>

[xxxiv]

THERAPEUTIC INDEX—Continued

TETANUS PAGE

<table><tr><td>Chloretone (to control spasms)</td><td>12</td></tr><tr><td>Tetanus Antitoxin</td><td>217</td></tr></table>

TETANY

<table><tr><td>Parathyroid Emplets</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr></table>

TONSILLITIS

<table><tr><td>Aconite Tincture or Fluid Extract</td><td>81</td></tr><tr><td>Adrenalin Inhalant</td><td>3</td></tr><tr><td>Adrephine</td><td>5</td></tr><tr><td>Analgesic Balm</td><td>49</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Follicular Tonsillitis Tablets</td><td>180</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr><tr><td>Nuclein Ampoules</td><td>134</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Tonsillitis Tablets</td><td>198</td></tr></table>

TUBERCULOSIS

<table><tr><td>Antistreptococcic Serum</td><td>202</td></tr><tr><td>Bismuth Paste</td><td>49</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Citronin</td><td>16</td></tr><tr><td>Codeine Tablets (to control cough)</td><td>172</td></tr><tr><td>Cod-liver Oil</td><td>18, 19, 30, 109</td></tr><tr><td>Creosote Carbonate Capsules</td><td>111</td></tr><tr><td>Elixir Glycerophosphates Compound</td><td>102</td></tr><tr><td>Iron Arsenite and Manganese Ampoules</td><td>127</td></tr><tr><td>Panteric Capsules or Tablets</td><td>36</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Streptococcus Immunogen Combined</td><td>210</td></tr><tr><td>Syrup Cocillana Compound (to control cough)</td><td>42</td></tr></table>

[xxv]

TYPHOID FEVER

<table><tr><td>Sponging (for fever).</td><td></td></tr><tr><td>Typhoid Phylacogen</td><td>214</td></tr><tr><td>Typhoid Vaccine (prophylactic)</td><td>204</td></tr><tr><td>Typhoid-Paratyphoid Vaccine (prophylactic)</td><td>204</td></tr><tr><td>Uritone Ampoules</td><td>145</td></tr></table>

ULCERS

<table><tr><td>Boro-Chloretone</td><td>10</td></tr><tr><td>Boroseptic Ointment</td><td>49</td></tr><tr><td>Cresylone</td><td>19</td></tr><tr><td>Calcium Chloride Ampoules</td><td>122</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Milk of Magnesia</td><td>32</td></tr><tr><td>Parathyroid</td><td>68</td></tr><tr><td>Paroidin</td><td>68</td></tr><tr><td>Quinine and Urethane Ampoules (in varicose ulcers)</td><td>136</td></tr><tr><td>Scarlet Red Emulsion</td><td>39</td></tr><tr><td>Scarlet Red Ointment</td><td>51, 52</td></tr><tr><td>Silvol</td><td>40</td></tr><tr><td>Silvol Ointment</td><td>52</td></tr><tr><td>Tartar Emetic (in tropical ulcer)</td><td>144</td></tr></table>

UNCINARIASIS

(see Hookworm)

URTICARIA

<table><tr><td>Adrenalin</td><td>1</td></tr><tr><td>Panteric Capsules or Tablets</td><td>36</td></tr></table>

UTERINE INERTIA

<table><tr><td>Ergone</td><td>22</td></tr><tr><td>Ergot Aseptic Ampoules</td><td>23</td></tr><tr><td>Pitocin</td><td>69</td></tr><tr><td>Pituitrin</td><td>72</td></tr></table>

THERAPEUTIC INDEX—Continued

VAGINITIS

(see also Leucorrhea) PAGE

<table><tr><td>Astringent Suppositories, Vaginal</td><td>9</td></tr><tr><td>Borol</td><td>10</td></tr><tr><td>Chloretone Compound Suppositories, Vaginal</td><td>14</td></tr><tr><td>Germicidal Discs</td><td>24</td></tr><tr><td>Golden-seal, Fluid Extract</td><td>86</td></tr><tr><td>Neko</td><td>32, 33</td></tr><tr><td>Neo-Silvol</td><td>34</td></tr></table>

PAGE

<table><tr><td>Neo-Silvol Suppositories, Vaginal</td><td>34</td></tr><tr><td>Silvol Suppositories, Vaginal</td><td>40</td></tr><tr><td>Thiodine Suppositories, Vaginal</td><td>46</td></tr></table>

VINCENT'S ANGINA

<table><tr><td>Tarta Emetic Ampoules</td><td>144</td></tr></table>

WORMS

<table><tr><td>Santonin and Calomel Tablets</td><td>194</td></tr><tr><td>See also Hookworm and Tapeworm</td><td></td></tr></table>

[xxxvi]

## THYREOIDECTIN

For a number of years a serious effort has been made to test the theory that Graves' disease, or exophthalmic goitre, being due to the presence of an excess of thyroid secretion in the blood, might be combated by administering to the patient the more or less toxic material which it is the natural function of the thyroid secretion to neutralize. The excess of thyroid secretion in the blood, it was thought, might be "taken up" by the medicament, since the mutual cancellation of both is constantly taking place in the healthy organism. Normally the thyroid secretion is believed to act as an antidote to certain unknown substances—presumably waste products of bodily metabolism—circulating in the blood. But quantity counts as well as quality, even in the human laboratory. If the unknown substances, supposed to be waste products, cannot be properly dealt with by the thyroid secretion, owing to its scarcity—due to diminished function of the thyroid gland—the result is the intoxication of myxedema. On the other hand, if there are not enough of these unknown substances to combine with all of the thyroid secretion liberated in the blood stream, the result is intoxication with that secretion—"thyroidism," proceeding to exophthalmic goitre. This consideration, or assumption, has led to the clinical experiments which alone could verify or discredit it.

Assuming that the quality of the blood is communicated to the milk in animals like the cow and the goat, Lanz in 1894 treated two exophthalmic-goitre patients with milk from thyroidectomized goats. The results were so favorable that the treatment was applied to

2

four other patients, all of whom as a consequence showed marked improvement and gain in weight.

In 1894 Drs. Ballet and Enriquez took the blood of thyroidectomized dogs—dogs that had undergone the surgical operation of removal of the thyroid gland, and had lived long enough thereafter to experience the blood-changes which loss of thyroid function is sure to entail—and injected that blood into patients suffering from exophthalmic goitre. The results were so encouraging that other practitioners soon adopted the method, or a modification of it. The *Deutsche Medizinische Wochenschrift*, No. 38, 1899, contained a report of three cases of exophthalmic goitre, in the practice of Dr. Burghart, that improved under the treatment, two of them decidedly. Dr. Burghart did not confine himself to the use of injections, but administered a dried alcoholic extract of the blood.

Later, a Darmstadt chemical house prepared a serum from the blood of thyroidectomized sheep, which, administered to patients who had exophthalmic goitre, produced a good effect; it was given both per os and subcutaneously.

A patient of Schultes (Münch. Med. Woch., No. 20, 1902) in whom the symptoms of exophthalmic goitre had been in evidence for four years, with pronounced psychic disturbance at times, is said to have been completely cured in two months by the use of gradually increasing doses of the serum (from the blood of thyroidectomized sheep).

THYREOIDECTIN, a reddish-brown powder prepared from the blood of thyroidectomized animals, is marketed in capsules containing 5 grains each, in bottles of 50 capsules. It is generally well borne, being readily soluble and rapidly absorbed from the stomach. The dose is one to two capsules three times a day, the amount being varied according to the requirements of the individual case. In the hands of a number of careful observers this preparation has proven of much

3

therapeutic value in the treatment of Graves' disease, or exophthalmic goitre. Almost invariably a marked improvement is observed in the subjective and objective symptoms characteristic of the disease—an improvement which is some instances eventuates in apparent cure, though the remedy is purely symptomatic. The dose should be diminished gradually, as the condition of the patient permits.

## THE THERAPEUTIC DISTINCTION BETWEEN THYREOIDECTIN, THYROPROTEIN, AND DESICCATED THYROIDS.

In order to make the subject perfectly clear, it may be stated in a general way that Thyroprotein and Desiccated Thyroids are indicated in conditions in which there is a deficiency of thyroid activity, and Thyreoidectin in cases in which there is a hypersecretion of the thyroid gland.

The disturbances of the thyroid function due to disease may be divided into two classes: (1) diseases dependent upon suppression or diminution of thyroid secretion; (2) diseases dependent upon hyperactivity of the thyroid glands. The three typical forms of disease due to decreased thyroid secretion are, cretinism, cachexia strumipriva, and myxedema. In addition to these three characteristic conditions, an attempt has been made by certain investigators to correlate with diminution of thyroid secretion some cases of obesity, delayed union of fracture, chronic rheumatism, arthritis deformans, hemophilia, certain forms of migraine, amenorrhea, dysmenorrhea, menorrhagia, incontinence of urine, rickets, and skin diseases. That obesity is frequently found in conjunction with those forms of goitre which are ascribed to decreased thyroid activity is very evident, and in such cases the administration of thyroid preparations will bring about rapid loss in weight. The indiscriminate use of thyroid

4

for this purpose is to be condemned. If given at all it
should be only in the most conservative manner, and
combined with proper hygienic and dietetic measures.
Regarding the relationship of the other conditions
mentioned to thyroid activity, we must conclude that
neither clinical nor laboratory experience has yet de-
cided the question, and that, from a practical stand-
point, the field of thyroid therapy is limited to the con-
ditions first named (cretinism, cachexia strumipriva,
and myxedema) and one other, namely, the later stages
of exophthalmic goitre when the gland tissue becomes
largely replaced with fibrous growth and hypersecre-
tion has been followed by hyposecretion.

The clinical indications for Thyroprotein and Desiccated Thyroids are the same, but the former represents a more scientific method of treatment. In Thyroprotein the physician has a product that is standardized according to nucleoprotein content and that is free from certain substances found in the desiccated glands which appear to be not only useless but in certain cases actually harmful.

Thyreoidectin is of value chiefly in the treatment of
exophthalmic goitre, but it must be remembered that
in many cases of this type enlargement of the thyroid
and exophthalmos develop late in the disease. For
that reason Thyreoidectin is useful in many cases of
thyroid hypersecretion in which there is no evidence of
a goitre, but only pronounced circulatory or nervous
symptoms. In individuals who show a pronounced
tachycardia, extreme nervousness, tremors, digestive
disturbances, insomnia, and marked loss in weight, an
oversecretion of the thyroid is to be suspected and the
advisability of administering Thyreoidectin carefully
considered. The Thyreoidectin treatment is not ex-
pected to supplant surgical methods, but is to be re-
garded as an adjunct to operative treatment and an aid
in dealing with cases of thyroidism in which, for any
reason, surgical intervention is deemed inadvisable.

A DISCUSSION OF THE NEW THERAPY OF
GRAVES' DISEASE.

We reproduce the following report from the *Journal of the American Medical Association* for the benefit of those who find the ordinary methods of treating exophthalmic goitre unsatisfactory, and who may be mentally speculating as to the promise contained in what may be called the toxic-antitoxic therapy of the disease—the administration of the excess of one product of functional activity to neutralize another. THYREOIDECTIN, representing the blood of thyroidectomized animals, is procurable in the very convenient form of capsules, and will enable any practitioner to add his individual quota to the solution of the question at issue, namely, the successful treatment of Graves' disease.—PARKE, DAVIS & Co.

SYMPTOMS AND TREATMENT OF EXOPHTHALMIC GOITRE.

(From The Journal of the American Medical Association, April 22, 1905.)

At a joint meeting of the Chicago Neurological and
Chicago Medical Societies, held March 29, 1905; Dr.
Harold N. Moyer, President of the Chicago Neuro-
logical Society, in the chair:

L. F. Barker said that, while the nature of Graves'
disease is not yet wholly clear, great strides have been
made toward an understanding of it. The theory that
a disturbance of the thyroid gland is responsible for
the symptoms of the disease is now the dominant one,
and there are some points difficult to reconcile with
any of the theories yet propounded. As regards the
etiology, it is known that the disease occurs nearly five
times as frequently in the female as in the male; that it

ξ

6

is commonest in early life, and especially in the third
decade; that it has a tendency to appear in the so-called
neuropathic families; that many cases of the disease
may occur in one family; that it often develops after
emotional shock or prolonged emotional disturbance;
that occasionally it appears as a sequel of some infec-
tious process; and, finally, that climatic and terrestrial
conditions play no important role in its causation,
though it would appear that it is rather more common
in districts where ordinary goitre is prevalent.

As the cardinal symptoms of the disease are usually
described, we have the tetrad—tachycardia, goitre,
exophthalmos, and tremor. In well-marked cases all
these symptoms may be present, but in undoubted in-
stances of the disease one, two, or even three of them
may be absent. Aside from the thyroid gland, it is the
circulatory system, the nervous system, the eyes and
the skin, the functions of which are especially disor-
dered, though there are also evidences of disturbed
activity in still other parts of the body. (These circu-
latory disturbances were pointed out and discussed at
considerable length.) Perhaps the most important ner-
vous symptom is tremor. It has been carefully studied
by Marie and is now regarded as a very constant phe-
nomenon, though it undergoes marked variation in de-
gree and continuousness. The eye symptoms of the
disease are among the most characteristic. On the
part of the skin, increased sweating is the most im-
portant symptom. Diarrhea is not infrequently a
troublesome symptom.

Four principal theories of the disease have been ad-
vanced: 1, that it is due to disease of the sympathetic
nervous system; 2, that the seat of the malady is in the
medulla oblongata; 3, that it is primarily a disease of
the thyroid gland; and 4, that it is a neurosis.

Modern therapeutic measures have been largely
based on the "thyroid" theory. The results of partial
strumectomy indicate that the successful removal of a

7

portion of the thyroid gland can lead to cure or to
definite amelioration of the condition. On the theory
that the thyroid secretion normally neutralizes certain
general metabolic poisons in the body, Moebius and
others conceived of treating cases of exophthalmic
goitre, in which there is presumably an excess of thy-
roid secretion in the body, by introducing subcutane-
ously or by the mouth the serum of thyroidectomized
animals. It was hoped that the non-neutralized gen-
eral metabolic poisons of such animals would nullify
the toxic effect of the excessive thyroid secretion. As
to treatment, experience has shown the great import-
ance of general measures: complete rest for a time,
fresh air, careful diet, mild balneotherapy, etc.

The speaker personally favors rest, isolation and sys-
tematic psychotherapy as a routine treatment. In cases
which do not respond to this or to antithyroid therapy,
operation may be considered, but if it is to be done it
should be undertaken before marked cachexia de-
velops and before the heart is too seriously diseased.

THE LARVATED FORMS OF EXOPHTHALMIC GOITRE.

Dr. L. Harrison Mettler said that a typical case must
reveal tachycardia, struma, and exophthalmos. When
combined or single, these symptoms will answer for
the making of the diagnosis if they are sufficiently pro-
nounced, for their characteristics are such that they are
not likely to be mistaken for similar phenomena in
other diseases. The same may be said of tremor, but
with less positiveness. There is a large class of cases
in which tachycardia, with general nervousness, trem-
or, and possibly slight evanescent struma or exoph-
thalmos, occurs. The heart irregularity comes on sud-
denly after a severe strain or sudden shock, mostly in
a woman with hysterical tendencies or with a neuro-
pathic ancestry. It exhibits the typical traits of the
Basedow tachycardia, such as the persistent elevation
of the pulse beat, the peculiar thrill. With it is a gen-

8

eral nervousness and possibly a number of symptoms, such as a mild psychosis, hyperidrosis, vertigo, aboulia, weakness, and even some general emaciation. These cases are not infrequently mistaken for simple neu- rasthenia, tuberculosis, and other affections. They are undoubtedly instances of the disease, but are masked and ill defined. If they get well, with or without treat- ment, they remain as examples of the larvated forms; if they go on and in months or years ultimately develop all of the cardinal signs, they enter the class of typical but delayed cases. Their etiology is obscure; their symptomatology includes any of the more or less in- definite manifestations commonly recognized in neu- rasthenic and hysterical states, plus one of the cardinal symptoms of the disease, which cardinal symptom is usually the characteristic tachycardia. Their prognosis is uncertain, though generally it is good. Their course is brief and intermittent, and their treatment is simple and highly satisfactory. Caution is necessary in regard to hastily attributing the recovery of these cases to any specific mode of treatment, for, as they so often re- cover with no other treatment than physical rest and mental quietude, any hasty conclusion as to the efficacy of this or that medicament may be the result of a mere *post hoc* reasoning.

## OCULAR SYMPTOMS OF EXOPHTHALMIC GOITRE.

Dr. Henry Gradle stated that in well-marked cases the patient had a wild, staring look, amounting even to an expression of terror. This is caused by the pro- trusion of the eyeballs, together with a retraction of the upper eyelid, whereby some of the sclera is exposed to view above the cornea. The widening of the lid aperture is peculiar to this disease. The exophthalmos varies in degree. (These variations were pointed out.) One-sided exophthalmos is not very rare. The diag- nosis is occasionally certain without exophthalmos, or the latter may develop after the other cardinal symp-

9

toms have existed for a while. Conversely, protrusion of the eyes or even of one eye only, when accompanied by the characteristic retraction of the upper lid, justi- fies the diagnosis of incipient or incomplete exoph- thalmic goitre, even though goitre and heart symptoms be absent. The retraction of the upper lid exposing the sclera to an abnormal extent is, perhaps, more char- acteristic of the disease than mere protrusion of the eye. Pigmentation of the skin, resembling the bronze color of Addison's disease, has been noted on various areas of the body and also around the eyes. Jellinek referred to the diffuse brown coloring of the skin of the eyelid, the upper more than the lower, as an early, though not constant and sometimes evanescent, symp- tom in exophthalmic goitre. Moebius has observed in- sufficiency of the converging power of the eyes as a fairly frequent occurrence. Pulsation of the arteries of the retina has been described by Becker as common. The protrusion of the eyeball is partly due to increased vascularity of the organ; it always diminishes after death. In some autopsies the eyeballs, prominent in life, were even found receded to normal position, and no anomalies were observed in the orbit. In other *post mortem* records the exophthalmos was explained by the increased amount of fat found within the orbit; the ocular muscles were infiltrated with fat, and the optic nerves were elongated. When recovery occurs, either spontaneously or under treatment, the eye symp- toms can disappear completely. There is a single case on record of the occurrence of conical cornea. The causative relation of the latter to the stretching and de- formity of the cornea was suggested to Dor by the un- usual improvement of the keratoconus in both eyes, only one of which had been operated on, when the pa- tient recovered from the goitre under the administra- tion of thymus. (Gradle recently saw a similar coin- cidence of these two obscure conditions—exophthalmic goitre and conical cornea.)

10

## THE SERUM TREATMENT OF EXOPHTHALMIC GOITRE.

Dr. Harold N. Moyer said that if the disease is the result of a too abundant or an excessively toxic secretion of the thyroid gland, the only rational form of therapy consists either in checking the secretion or else in neutralizing the toxic products thrown into the blood stream. The first of these alternatives was beyond our control, but, as the thyroid secretion is normally neutralized by certain anti-bodies present in the blood, the serum or blood of animals from which the thyroid gland had been removed and in which these anti-bodies had been allowed to accumulate for some time should prove capable of neutralizing the excessive or perverted secretions causing the disease. The first experiments along these lines were undertaken independently of each other by Ballet and Enriquez in Paris, and Lanz in Amsterdam. The former used serum, the latter the milk of thyroidectomized animals. The results obtained by either method were very encouraging. Further experiments were conducted by Burghardt, Schultes, Goebel, Moebius, and others. The same properties which were found in the blood and serum proved to be present also, although in not as great concentration, in the milk of these animals. The latter was preferred by some experimenters because it proved less expensive than the pure serum.

Thyreoidectin is derived from the blood of thyroidectomized animals. In the preparation of the capsules, not only the serum but the entire blood has been utilized. It forms a reddish-brown powder, readily soluble, non-toxic, unirritating to and rapidly absorbed from the stomach. It is put up in 5-grain capsules, of which one or two are administered three times a day, according to the needs of the individual case.

11

## PERSONAL EXPERIENCE WITH THE SERUM TREATMENT OF EXOPHTHALMIC GOITRE.

Dr. Sydney Kuh reported eleven cases of exophthalmic goitre treated with the serum of a thyroidectomized animal. He believes he is justified in saying that it is an excellent palliative. Among the eleven cases there was only one in which the effect of the treatment was temporary only, and another one in which there was no effect at all. One thing was very striking, and that was the marked and rapid improvement in the subjective condition of most of the patients. Within a few days after taking the first dose of the serum they would report a change for the better. The remedy influences the pulse as much as anything that is employed in the treatment of tachycardia in exophthalmic goitre. It increases the appetite and decreases nervousness. It has a pronounced tendency to increase the weight. Theoretically, it seems hardly probable that the results from the serum should be permanent. One may expect that after some time a smaller dose may suffice, and that an intermittent treatment only may be required. In the first case reported the patient has been without serum for quite a long period—two and a half years— and has remained in excellent health all that time, but the author thinks it is doubtful whether she will remain in that condition unless she occasionally takes a few doses of the serum.

## TWO SEVERE CASES OF EXOPHTHALMIC GOITRE.

Dr. Charles L. Mix reported two severe cases of exophthalmic goitre treated by the serum. In one, the patient's pulse ranged from 120 to 140. Since taking the serum she has gained forty pounds in weight, and her pulse ranges in the nineties at present. She is able to work for her living. In addition to the improvement

12

doing away of myasthenia, there is a very pronounced effect in the condition of the thyroid gland—the neck has diminished materially in size, and the heart also has decreased in size materially.

The second case was a much more pronounced one. The patient had been seen by four eminent Chicago physicians, who gave her no hope. Her heart was giving way; edema was rapidly appearing; there was marked ascites; girth at the navel was 37 inches; pulse ranged between 140 and 150; neck measured 14½ inches in circumference. She was twenty pounds under weight, but after the disappearance of the ascites she gained twenty pounds. The patient took serum in doses of 2 cubic centimeters three times a day, which was afterwards reduced to 1 Cc. three times a day, and then the serum was abandoned altogether and dry serum given. The serum from a thyroidectomized horse was then injected, and patient grew worse. She took goat-serum, and after taking it during the winter she gained twenty pounds in weight. Pulse at present is about 111.

He believes there is a neutralization point in these cases. He noticed that if he gave too large doses hypodermatically the patient would have marked symptoms of cardiac failure, resembling those of angina pectoris, associated with pain in the arm. The danger of collapse was so great on one occasion that stimulants had to be given. After the dose had been decreased the patient was getting along better. On the other hand, he thinks that one can give too little serum. In the case with ascites he reduced the dose to ten grains a day, but this was too little, as the patient began to get worse again. She was able to take fifteen grains daily without any particular difficulty, and he presumes in the course of time it will be possible to reduce that still further. It seems to him that the serum treatment affords very great possibilities. In tachycardia, the gain in weight and strength, the

13

(Excerpted from *The American Practitioner and News*, August, 1907.)

## REPORT OF THIRTEEN CASES OF EXOPHTHALMIC GOITRE TREATED WITH THYREOIDECTIN.

BY HARRIET C. B. ALEXANDER, M.D.,

Attending Physician, Mary Thompson Hospital, Chicago, Ill.

**Case 1.** Miss K. R., aged 25 years, by occupation a packer in a warehouse. Father died of tuberculosis at 45. Mother living and healthy. Menstruation established at 14, regular, scanty, painful first day. Has had scarlet fever and measles. Pulse 122. Fine, regular tremor. Thyroid enlarged, mostly on the right side.

The tremor improved and the goitre diminished somewhat after a few weeks' treatment, when she failed to return. She is now under treatment again, the symptoms having recurred after she stopped the treatment.

**Case 2.** Miss A. H., aged 38 years, typesetter. Father living. Mother died at 62 of rheumatism. Menstruation established at 15, regular now, but at first very irregular and painful. Is nervous, with slight convulsive movements. Thyroid enlarged on the right side. Fine, regular tremor. Pulse 98.

Patient was placed on Thyreoidectin August 1st. On September 6th there was some improvement. At this time galvanization of the sympathetic was also employed. Patient continued on Thyreoidectin until October 20th. Galvanization was also employed twice a week. Less nervous, and convulsive movements occur less frequently. Gland diminished.

**Case 3.** Miss E. B., aged 24. Housemaid. Vomits after eating. Lost six pounds in two weeks. Pulse 108. Fine, regular tremor. Dizzy and ringing in ears. Thyreoidectin treatment began on August 25th. Sep-

14

tember 1st, vomiting less. Improvement marked. Size of tumor reduced greatly. Nervous symptoms diminished. Appetite improved and vomiting ceased after two weeks of treatment.

Case 4. Mrs. W., aged 36 years, housewife. Father died at 86 of heart failure. Mother living, aged 89. German parentage. Father's family six children, five living. One died, operation, 1903, vaginal hysterectomy. Patient has pain in left side. Dyspnea, tremor. Thyroid enlarged slightly on right side. Patellar reflex diminished on left side, exaggerated on right. Excitable; cries frequently.

Thyreoidectin treatment began July 25th, continued until September 8th. Some improvement in nervous symptoms, but gland not diminished apparently. Patient failed to return.

Case 5. Mrs. J. M., aged 47 years, housewife. Menopause. Thyroid enlarged equally on both sides. Patient has nocturnal convulsive attacks and short periods of unconsciousness in the day time. Epileptic. Excitable, cries easily. Has explosive attacks. Statements unreliable, vary considerably. Memory deficient. Patient has anxious appearance. Appetite capricious. Sleep broken. Constipation. Pulse 100 to 122.

Treatment.—Nitrite of amyl. Thyreoidectin. The patient said she had more frequent attacks after beginning the Thyreoidectin. Pulse and tremor improved, but owing to the patient's feeling about the remedy it was discontinued.

Case 6. Miss S. F., aged 38 years, stenographer. Sister of preceding patient. Thyroid enlarged at fourteenth year. Depressed, unable to work. Thyroid very large. Tremor. Pulse 105.

Thyreoidectin and galvanization continued for three months. Improvement in subjective and objective symptoms. Only slight reduction of gland. Patient

15

irregular about taking remedy. Pulse reduced to 86. Depression less.

Case 7. Miss L. L. V., aged 16 years, operates an auditing machine. Parents living. Six brothers and two sisters, all living. Menstruation established at 13, regular, profuse. Diphtheria at two years. Urine negative. Easily frightened. Depressed only at times. Tremor. Pulse 92. Right lobe of thyroid enlarged. Poor appetite.

Thyreoidectin treatment began October 6th and continued until December 1st. Pulse normal. Patient in better spirits. Gland reduced. Has continued work during treatment except for taking an extra half day off to come to the clinic. Increase in weight. Subjective symptoms improved. Appetite good.

Case 8. Miss E. L., aged 15 years. Mother living. Father died of typhoid at 39. Menstruation established at 13, regular, painful, scanty. Has had four attacks of chorea. Scarlet fever a year ago. Complains of general nervousness. Tremor. Pulse 102. Thyroid enlarged, both lobes equally. Has noticed enlargement for a year.

Thyreoidectin treatment began on September 20th and continued for three months. Reduction of gland to nearly normal. Lessened nervous symptoms. Pulse 85. Patient was seen in February, and says she is nervous again and pulse is more rapid. She is again taking the remedy.

Case 9. Mrs. S. S., aged 38 years, married, waitress. Father died of typhoid, mother of pneumonia. A sister died of tuberculosis. Patient has had five children, four living, and two miscarriages. She is extremely irritable, cries often for nothing at all. Sleeps badly. Can only work occasionally. Pulse 95. Tremor fine. Thyroid enlarged, more on right side.

Thyreoidectin treatment and a certain amount of rest. After being on the remedy for two and a half

16

months patient is again able to work all the time. En-
largement reduced. Pulse 80. No more irritable than
was normal. Appetite improved and weight increased
six pounds.

*Case 10.* Miss M. B., aged 18 years, telephone operator. Father died of pneumonia. Mother is living. Menstruation established at 14, irregular, profuse and painless. Has had no serious illness. No history of cancer, tuberculosis or insanity in the family. Urine negative, except indican abundant. Nervous. Sleep broken. Dreams horrible things. Dizzy. Often faints. Thyroid enlarged about equally on the two sides. Tremor. Frequent and painful urination. Appetite very poor.

Began treatment on October 4th. Thyreoidectin and cascara. The treatment was continued until December 1st. She expressed herself as being much better. Subjective symptoms improved. Apparently no diminution in size of tumor. Appetite improved. Sleeps better.

*Case 11.* Mrs. A. S., aged 40 years, married, housewife. Father died at 66, cause unknown. Mother died at 66, cancer of bowel; had three children, all living. Patient established menstruation at 15, scanty, painful, regular. Three children, all living. She gets frightened easily. Faints. Dizzy. Nervous. Excitable. Face symmetrical. Fine tremor. Pulse 144. Temperature 100.4° F. Thyroid enlarged on both sides. Urine negative.

Thyreoidectin. Arsenauro gtt. iij, dose to be increased until gtt. viij are taken. Treatment began August 22d and continued until December 30th. Symptoms improved. Size of gland reduced. Has not fainted since October. Pulse 108. Temperature normal.

*Case 12.* Miss M. K., aged 16 years, employed in warehouse. Father and mother living. Father a hard

17

drinker; had three children, all living and well except patient. Menstruation established at 13, irregular and painful, amount normal. Has had scarlet fever, pneumonia and tonsillitis. Emotional, cries often, and is easily angered. Thyroid enlarged. Pulse 62. Temperature 97.4° F. Tremor fine, regular. Urine contains indican.

Thyreoidectin. Galvanization twice a week. Size of gland reduced and improvement in subjective symptoms. Menstruation less painful.

*Case 13.* Miss J. L., aged 16, clerk. Father and mother both living and well; had ten children, eight living. Menstruation established at 14, regular, normal in amount and painless. Had no children's diseases. Urine negative. Nervous at menstrual period only. Thyroid enlarged. Tremor slight. Pulse 90. Temperature 99° F.

Thyreoidectin. Patient says she can work longer without getting tired. Gland greatly reduced. Pulse 85. Temperature normal. Still nervous at periods.

BIBLIOGRAPHY.

1. Jour. Amer. Med. Ass'n, April 22, 1905, p. 1810.

2. Moebius, Muench. Med. Woch., January 27, 1903, p. 149.

3. Goebel, Muench. Med. Woch., May 20, 1902, p. 435.

4. Schultes, Muench. Med. Woch., May 20, 1902, p. 834.

5. Lanz, Muench. Med. Woch., January 27, 1903.

6. Lademann, American Medicine, November 19, 1904, p. 886.

7. Jour. Amer. Med. Ass'n, November 5, 1904.

8. Med. and Surg. Monitor, April, 1905, p. 107.

9. Murray, London Lancet, August 27, 1904.

10. Foerma, Aerzt. Rundsch., 1905, No. 1.

11. Indemans, Deut. Med. Zeit., 1905, No. 1.

12. Christians, Hospitalsidende, Copenhagen, No. 51.

13. Von Leyden, Medicinische Klinik, No. 1.

14. Burghart, Deut. Med. Woch., 1899, No. 38.

15. Jour. Amer. Med. Ass'n, April 29, 1905, p. 1410.

16. Peters, Muench. Med. Woch., No. 11.

17. American Medicine, July, 1904, p. 128.

18. Alexander, Muench. Med. Woch., 1905, No. 29.

18

# TREATMENT OF EXOPHTHALMIC GOITRE WITH SERUM OF THYROIDECTOMIZED ANIMALS.

BY S. KRUMHOLZ, M.D., CHICAGO.

[From the Illinois Medical Journal, March, 1910.]

My experience in the treatment of exophthalmic goitre with serum was in the capacity of associate to Sidney Kuh at the West Side Free Dispensary of the Jewish Aid Society. Through his instrumentality the serum of a thyroidectomized horse was furnished by Parke, Davis & Co. for experimental purposes. I desire to express my appreciation to Dr. Kuh for the privilege and commend Parke, Davis & Co. for their coöoperation. My observation extends over a period of more than four years, consists of fourteen cases, and in addition cites thirteen cases of Dr. Kuh.

My cases were all ambulatory, and the patients followed their usual occupations, with the exception of No. 2; and none received other medicines, except No. 8, who, in addition to the serum, was given iron, quinine and strychnine at times, and No. 2, for whom I prescribed on several occasions for bladder complaint. They were required to appear twice weekly, when pulse-rate, temperature and weight were recorded, as great stress has been laid upon these physical signs on account of their accuracy. The other signs and subjective symptoms were inquired into at longer intervals. Interruptions in treatment were frequent, which tended to delay the approximation of dosage upon which favorable results chiefly depend. The accelerated pulse of some patients at certain periods of presentation, as indicated on charts, is due to the overcrowded condition of the waiting-room at our dispensary, which acted powerfully to excite the nervous systems and emotions of these patients.

The serum employed was obtained from horses, by

19

drawing the blood from the jugular vein two weeks after the removal of the thyroid gland and allowing the clot to separate under favorable temperature. The method of administration was by mouth, and the dose ranged from 30 to 120 drops of the liquid or 15 to 60 grains of the desiccated serum daily.

Theoretically the action of the serum is not to inhibit directly the hyper- or perverted secretion of the thyroid gland, and therefore it would be illogical to attribute to it unqualified remedial value. I believe it does not possess the superior quality which is credited to thyroid extract in myxedema. My opinion is, however, that this serum is the most valuable drug as yet offered. In most cases the usual mode of life need not be discontinued, which is an important factor among poor patients.

In most cases nearly the whole symptom-complex is ameliorated. The subjective symptoms subside. The tremor and nervousness diminish, and the nutritional disturbance is markedly lessened. In some cases the thyroid gland is reduced in size and occasionally the exophthalmos recedes. The tachycardia, which, according to Moebius, is the fatal symptom, is reduced more promptly and effectively with the serum than with any other therapeutic agent.

Taking the fourteen cases under my observation as a basis for computation, the ailment did not recur in Cases 5 and 14 after a lapse of several years, equaling 14.3 per cent. Marked improvement resulted in 42.8 per cent., slight improvement in 35.6 per cent. In one case, or 7.1 per cent., there was no response to treatment. After treatment had ceased relapses occurred in Cases 1, 2, 3, 4, and 13, after periods of nine, eight and in the last three six months, respectively. These figures seem to indicate that the serum has an accumulative action like iodothyrin, and in order to secure permanent relief should [continue to] be administered at intervals.

20

## THE TREATMENT OF EXOPHTHALMIC GOITRE.

BY W. S. YATES, M.D., CAPRON, OKLA.

[*Denver Medical Times*, September, 1909.]

My satisfactory experience with Thyroids induced me to test the value of Thyreoidectin in the treatment of that formidable malady known as exophthalmic goitre. This product is derived from the blood of animals which have been deprived of the thyroid gland; it comes from the laboratories of Parke, Davis & Co. I administered it in 5-grain capsules. The happy results I have had lead me to believe that a report of my experience would be interesting to the profession at large.

[The writer cites in detail three cases of exophthalmic goitre in which he gave 5-grain doses of Thyreoidectin three times a day. The first case received in all four hundred doses of the drug. In five weeks she had gained eighteen pounds and to all appearances is now perfectly well. As the writer says: "The Thyreoidectin may not have cured in the strictest sense of the word, but it certainly controlled the symptoms and is now holding the disease in abeyance; without it I am sure she would not have lived many months from the day of the first visit."]

## THE SERUM TREATMENT IN EXOPHTHALMIC GOITRE.

John B. Hawes, M. D., of Boston (*American Medicine*, October, 1906), says: "Recently in America a new preparation, Thyreoidectin, has been put on the market. This is in capsule form and is obtained from the dried blood of thyroidectomized animals and not from the serum alone. It is described as a non-toxic, non-irritating, soluble red powder. G. Christian has treated 18 patients with this, all considerably benefited."

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## THYREOIDECTIN AND IODALBIN IN EXOPHTHALMIC GOITRE.

BY HUGO H. MILLER, M.D., MINNEAPOLIS, MINN.

[*Medical Index-Lancet*, December, 1908.]

I was consulted recently by a prominent singer; on examination I made a diagnosis of exophthalmic goitre. Treatment was commenced on 5-grain capsules of Thyreoidectin and Iodalbin three times a day for one week—which dosage was increased to 10 grains a day for three weeks, and again reduced to 5 grains three times a day. After the first week she was not so nervous; at the end of three weeks there were unmistakable signs of the tumor getting smaller and the eyes losing their prominence; at the end of eight weeks the pulse was normal and the tumor not noticeable. Thyreoidectin was given without any bad effects at any time. The patient resumed her singing engagements and has had no return of the tumor. The results in this case are very encouraging, and I will give Thyreoidectin and Iodalbin first place in the medical treatment of exophthalmic goitre.

BY A. J. COX, M.D., TYLER, MINN.

[*Northwestern Lancet*, June, 1908.]

It has been my good fortune to treat some of these cases, and they were cured by the use of medicine. I will mention two of them. The worst case was a man, 40 years of age. He had an exhausting diarrhea, severe vomiting, and a heart-action of 140 to 160 and tremulous. I had tried several remedies to relieve this patient, but failed, until I heard of Thyreoidectin, prepared by Parke, Davis & Co. I had reached the limit

22

in medicine I thought, but I determined to try this new remedy. I have no desire to advertise any company's medicine, but I am convinced that this has therapeutic value in this disease. In three cases in which I have used it I have had signal success.

Another case was a woman, who was greatly benefited; the nervous symptoms were removed; the prostration of the eyeballs was reduced; the thyroid gland is a great deal smaller; and she is now bright and well. A third case I saw in consultation; a recent letter from the physician in this case states that his patient is greatly improved after two weeks' treatment.

## REPORT OF TWO CASES OF EXOPHTHALMIC GOITRE IN MEN.

BY D. A. VENDERHOOF, M.D., BYRON, ILL.

[Journal of the American Medical Association, November 10, 1906.]

Case 1.—C. M., aged 47, came under my observation during January, 1905. At the end of three weeks his condition was only slightly improved, so I stopped the use of strychnine and put him on Thyreoidectin, 5-grain capsules, one capsule three times a day. I also continued the use of a solution of ammonio-citrate of iron and sodium bromide three times a day, and used an ointment of red mercuric iodide and iodide of potassium over the goitre itself. An ice-bag was also used over the pericardium night and day. At the end of the week slight changes were noticeable. The tachycardia began slowly to disappear, and in two months the pulse ranged from 95 to 110. The tremor became less noticeable, and the forcible throbbing of the arteries of the neck disappeared to a great extent. The enlarged gland has slowly decreased in size till it no longer can be seen. The Thyreoidectin was then discontinued

23

and the patient put on general tonics. At present he feels very well so long as he does not work, but as soon as he tries to work he becomes tired and nervous.

Case 2.—M., aged 36. I put him on Thyreoidectin, gr. 15 a day, with strychnine sulphate, gr. 1-30 three times a day. His improvement was very rapid, and in two months he was able to work as hard as ever. The pulse at present is only slightly above normal. The thyroid gland is almost normal in size and the man feels very well indeed.

## THE ANTITHYROID TREATMENT OF GOITRE.

BY A. GORDON GULLAN, M.D., LIVERPOOL, ENG.

Senior Physician Stanley Hospital; Lecturer on Clinical Medicine, University of Liverpool, Eng.

[Medico-Chirurgical Journal, July, 1908.]

Since 1905 I have used Thyreoidectin in five cases—all were greatly improved. I consider the results of such treatment eminently satisfactory and such as to encourage its more extended use. I will summarize my cases briefly:

Case 1.—Elizabeth C., aged 42. Gave rodagen every twenty-four hours with but little improvement. Thyreoidectin, in 5-grain doses, was substituted with marked benefit.

Case 2.—Nurse M., aged 27. All the symptoms well developed. Was greatly improved by Thyreoidectin thrice daily. Her pulse-rate has fallen from 130 to about 90 per minute; the circumference of her neck has decreased 1½ inches; and the nervous tremors and exophthalmos are much less marked.

24

*Case 3.*—Miss B., aged 25. Improved so much under the administration of Thyreoidectin that we gave her permission to marry, though twelve months previously that had been quite out of the question, owing to the grave symptoms present. She has gained in weight and lost much of her nervousness. I have recently heard that she is now in good health.

*Case 4.*—Jane S., aged 17. Has always had a large thyroid, but at puberty the goitre increased and marked symptoms of thyroidism developed. Under treatment for some months with Thyreoidectin she has greatly improved.

*Case 5.*—Male, aged 25. Showed well-marked symptoms. Has improved on Thyreoidectin, so much so as to enable him to return to work.

[The author concludes with the statement that he used Thyreoidectin instead of similar preparations on account of its superior results. He believes that when benefit is not obtained the doses are too small.]

## THE ORGANOTHERAPY OF EXOPHTHALMIC GOITRE.

BY HUGO ERICHSEN, M.D., L.R.C.P. & S.

*[Therapeutic Gazette, October, 1908.]*

An interesting report of a case of exophthalmic goitre treated with thyroidectomized goat serum, prepared by Parke, Davis & Co., was published in the *Boston Medical and Surgical Journal* (vol. 152, p. 492) in 1905 by James M. Jackson. The goitre involved both lobes and the isthmus, and the exophthalmos was marked. Four months after the beginning of treatment the patient was practically well, the goitre and exophthalmos had nearly disappeared, the tremor

25

and perspiration were very slight, and the pulse-rate had been reduced to 100 or a little under. The patient was able to return to work and expressed the greatest satisfaction at the result of her treatment.

A report by Dr. Emil Ries, of Chicago, of an aggravated case of exophthalmic goitre successfully treated with Thyreoidectin (a reddish-brown powder prepared from the blood of thyroidectomized animals) appeared in the *Illinois Medical Journal* for March, 1906. In January, 1905, the patient was unable to walk any distance. She was greatly emaciated. She had exophthalmos and Graefe's sign, a pulse of 112 to 120, and a goitre. She was salivated; she vomited; she looked sallow; and she was sent to Dr. Ries for operation. The patient weighed at that time seventy-three pounds. She was put on Thyreoidectin, taking as much as she could. She was put to bed, and during the first month gained twelve pounds. Her pulse went down to about 96. The salivation disappeared completely and her color improved somewhat, although the goitre did not shrink very much. Exophthalmos was slightly less, but the general condition improved considerably.

The writer says: "The patient continued to take Thyreoidectin off and on until September of last year, but since then she has not had any. She now weighs 141 pounds, a gain of almost 70 pounds. She has received no other medication except this. Her pulse, when I examined it two days ago, was 120. The goitre has shrunk considerably, and the exophthalmos is not at all marked now. She can eat, as you may gather from the fact that she gained seventy pounds. She does not vomit any more. She is not salivated. Menstruation had been absent for a considerable time before she came to me, and she did not menstruate until some time in the summer of 1905. But for the last three months she has menstruated regularly without any local treatment. The most important feature is the remarkable improvement in the patient's general

26

condition. I simply show this case as an example of
what Thyreoidectin may do."

Thyreoidectin is readily soluble in water, non-toxic, does not produce gastric irritation, and is rapidly absorbed from the stomach. It is put up in 5-grain capsules, which are given by the mouth, the dose being gradually increased from 15 to 60 grains a day, the 60-grain daily portion being divided into three doses.

## PARKE, DAVIS & COMPANY.

### LABORATORIES:

### BRANCH HOUSES:

70658

Bacillus tetani with spores. x 1000.
Drawing from cover-slip preparation.

# FACTS OF GENERAL INTEREST.

## What Is the Difference Between Bacterial Vaccines (Bacterins), Serums, and Toxins?

Bacterial Vaccines or Bacterins are suspensions, in physiologic salt solution, of pathogenic bacteria whose vitality has been destroyed by heat.

Serums are the liquid portion or serum of the blood of animals, usually horses, that have been treated with gradually increased doses of bacterial toxins or attenuated or killed cultures of the organisms themselves.

Toxins are the products of bacterial (pathogenic) growth.

## How Are Bacterial Vaccines Prepared?

Bacterial Vaccines are prepared in the laboratory by growing pathogenic bacteria in the usual way. The cultures are carefully killed by the application of heat, and suspended in physiologic salt solution. A preservative is added and the various "strengths" are adjusted by a count of the number of bacteria in each cubic centimeter of fluid.

## How Are Serums Prepared?

Serums are made by a process that may be divided into three steps.

**First Step:** Preparation of the toxin or attenuated culture.

2

**Second Step:** Injection of the horse (with toxin in the preparation of antidiphtheric and antitetanic sera, and with killed cultures in the case of antistreptococcic and antigonococcic sera).

**Third Step:** Bleeding of the horse and preparation of the serum or antitoxin for use.

*The First Step in the Production of Antidiphtheric Serum.*—Pure cultures of pathogenic bacteria are grown on bouillon. As the germs grow, a “toxin” is produced which is taken up by the bouillon: i.e., the bouillon becomes eventually an aqueous solution of toxin. The bouillon is carefully filtered to remove all bacteria, and the clear filtrate which contains only the toxin is used to “treat” the horses.

*The Second Step.*—Every precaution is employed to determine that the horses chosen are free from disease. Subcutaneous injections of toxin are given, beginning with very small doses. At intervals of a few days gradually increased doses are given, the effect of which is to make the animals immune to the disease toxin. The treatment is continued until enormous doses, a half liter or more, can be administered without ill effect. The horse is then known to be thoroughly immunized, and his blood is highly charged with anti-toxin, the protective substance which neutralizes the toxin and which is wanted for use in the treatment of disease in human patients.

*The Third Step.*—The horse, being now thoroughly immune, is ready for bleeding. Under strict aseptic precautions several liters of blood is taken from the jugular vein. The blood is collected in sterilized glass tubes, which are closed with plugs of sterile cotton and set aside until the clot separates. The clear

3

straw-colored serum is decanted off, a preservative is added, and in the case of Antidiphtheric Serum and Antitetanic Serum the material is standardized in antitoxic units. It is then put into glass bulbs or syringe containers for use.

*Antitetanic Serum.* The process of manufacture of Antitetanic Serum resembles that described in the preceding sections on Antidiphtheric Serum. Antitetanic Serum is very generally recognized as a valuable prophylactic and is used also in the treatment of tetanus.

*Antistreptococcic and Antigonococcic Serums.* These antisera are produced by injecting killed cultures of the specific bacteria into the horses, whereas in the case of Antidiphtheric and Antitetanic sera the toxins are injected. The reason why killed cultures are used instead of toxins is that the streptococcus and the gonococcus do not form extracellular toxins. The second and third steps in the process are precisely the same as those described under Antidiphtheric Serum.

## What Is the Antitoxic Unit?

Let us take Antidiphtheric Serum as an example.

Here we are dealing with the intangible as well as the invisible. An antitoxic unit is to be apprehended by its effect only. It is capable of neutralizing an amount of toxin, or bacterial poison, that is in turn measurable by its fatal effect on guinea-pigs in the presence of a standard immunity unit as furnished by the United States Government. Now let us state the case more definitely: The immunity unit is mixed with the toxin and administered to a guinea-pig weighing 250 grammes; sufficient toxin must be used

4

to kill the guinea-pig, notwithstanding the protection
afforded by the immunity unit. This amount of toxin
(that is to say, just enough to kill the protected ani-
mal) is called the L+ dose. Here we have the second
definite quantity, the first being the immunity unit.
The *antitoxic unit* is to be measured by the L+ dose of
toxin, as the L+ dose of toxin was measured by the
immunity unit. So much antitoxic serum as will just
save the life of a 250-gramme guinea-pig injected
with the L+ dose of toxin constitutes an antitoxic unit.
The toxin and the antitoxin are mixed and injected at
one dose. As a matter of fact the L+ dose of toxin is
approximately equivalent to one hundred minimum
fatal doses of toxin; so an antitoxic unit will save the
life of one guinea-pig exposed to the action of one hun-
dred times the minimum fatal dose of toxin (or one
L+ dose), or the lives of one hundred guinea-pigs, each
exposed to one minimum fatal dose. Hence 3000 anti-
toxic units, a usual therapeutic dose, will protect three
hundred thousand guinea-pigs from death by *toxin*.
This affords a forceful illustration of the potency of
Antidiphtheric Serum or diphtheria antitoxin.

Therapeutic Action of Serums.

Infectious diseases are caused by *toxins* resulting
from the growth of pathogenic bacteria. The pa-
tient's economy endeavors to combat the disease by
developing *antitoxins*. When that process is success-
ful the patient recovers without treatment, or he may
not become acutely ill. That is, he is immune to the
disease. This is *active immunity*. When the pa-
tient's body cannot produce sufficient antitoxin to
nullify the effect of the toxin, he is treated by means
of antitoxins or antibodies that have been developed in
the blood of the horse.

Streptococcus pyogenes—plate culture. x 1000.
From drawing.

5

Serums contain these antibodies. When a serum is injected the physician supplies antibodies to his patient—he produces *passive immunity*.

## Therapeutic Action of Bacterial Vaccines.

When Bacterial Vaccines are injected into human beings they have an effect similar to that produced on the horse by the injection of toxins or attenuated cultures; they produce *active immunity*. In other words, the injection of a dose of a Bacterial Vaccine stimulates the patient's body to manufacture an extraordinary supply of antibodies and thus enables him to resist the disease.

In the use of Serums the antibodies are supplied to the patient: in the use of Bacterial Vaccines he supplies his own antibodies. Serums confer *passive immunity*, Vaccines *active immunity*.

## How Do Serums and Vaccines Prevent Disease?

They act precisely as they do when used for their therapeutic effect—they render the patient for a time immune to the disease. The injection of 1500 units of Antitetanic Serum supplies sufficient antitoxin to prevent the development of tetanus after infection. It confers *passive immunity*. The injection should be made immediately after receipt of the injury, or as soon thereafter as possible. Its efficiency as a prophylactic has been demonstrated many times. So also the injection of a dose of Typhoid Vaccine stimulates the elaboration in the patient's body of sufficient antitoxin to prevent the development of typhoid fever. It confers *active immunity*.

6

## Confusion of Terms.

Some confusion as to the use of the names of these various products appears to exist in the minds of students and others. This is very readily cleared up by remembering that the serums contain *anti* bodies; they are therefore classed as *antidiphtheric serum, anti-tetanic serum, antigenococcic serum, antistreptococcic serum, etc*. The bacterial vaccines do not contain antibodies. They are classed as streptococcus vaccine, gonococcus vaccine, staphylococcus vaccine, colon vaccine, etc.

## When Should Serums Be Used, and When Bacterial Vaccines?

When the condition of the patient is such that he cannot produce his own antibodies it is necessary to supply them by an injection of serum. Thus serums give the best results in acute general infections.

At the very outset infectious processes are generally localized, and in such cases the prompt use of a suitable Bacterial Vaccine is indicated. Thus it will be observed that the extent of the infection is a guide to the proper selection of the serum or vaccine to be employed. Stated in another way, Bacterial Vaccines are most useful in localized and semi-localized infections, and Serums are indicated in general infections.

Example.—Dr. Geo. F. Seaborn (New York State Journal of Medicine, April, 1911) illustrates this point very aptly as follows: “In the early stage of puerperal sepsis, before general infection has taken place, we may expect beneficial results from a Bacterial Vaccine; but when the infection has been allowed to run its course unchecked until it becomes more or less

7

general, Antistreptococcic Serum, if the infection is due to the streptococcus, should prove of greater value than Streptococcus Vaccine.”

## Useful and Experimental Vaccines.

Some of the Bacterial Vaccines have a recognized place in modern therapeutics; others must still be regarded as in the experimental stage of progress. Parke, Davis & Co. now supply Gonococcus, Staphylococcus, Gonococcus and Staphylococcus Combined, Streptococcus, Furunculosis, Typhoid (prophylactic), Colon, and the Van Cott Combined Bacterial Vaccine consisting of the streptococcus, pneumococcus, bacillus coli communis, and three varieties of staphylococcus. Others may be supplied should continued study warrant their adoption as therapeutic agents. Among the more or less promising experimental vaccines may be mentioned neoformans, pyocyaneus, pneumococcus, micrococcus catarrhalis, influenza, and acne.

The vaccines are not infallible; they have their limitations; and while they yield brilliant results in selected cases they should still be regarded as an auxiliary means of treating the infectious diseases and as supplementary to the other resources of up-to-date surgery and medicine.

# BACTERIAL VACCINES OR BACTERINS.

## What They Are, How They Are Prepared, and
How They Are Used in the Treatment
of Infectious Diseases.

We are indebted to Metchnikoff for the discovery that certain leucocytes (the phagocytes) resist infection by destroying pathogenic bacteria in the blood stream. They are enabled to do this by the opsonins which, in some way, combine with the bacteria and "prepare" them for destruction by the phagocytes. Sir A. E. Wright, of London, demonstrated that fact and invented the term "opsonins." Wright also discovered that the opsonins may be increased by injecting bacterins or bacterial vaccines, and thus an entirely new method of treating infectious disease was brought to light.

**What are Bacterial Vaccines or Bacterins?** They are suspensions, in physiologic salt solution, of killed bacteria. The suspensions are sterilized and standardized accurately to ensure exact therapeutic effects. The effect of their administration is to raise the destructive power of the patient's leucocytes against the specific living bacterial invaders.

**"Stock" Vaccines or Bacterins.** Stock vaccines are prepared in laboratories equipped with every facility for bacteriologic work. They are produced from strains of virulent bacteria obtained from reliable sources, and are kept on hand for immediate use in the treatment of infectious diseases.

Autogenous Vaccines are especially prepared for

Bacillus coli communis. x 1000.
Drawing from cover-slip preparation.

8

9

use in a given case from cultures of bacteria obtained
from the patient himself. They are administered to
the patient from whom the original culture is obtained.

**Which Should be Preferred?** Clinical evidence
is constantly accumulating to the effect that "stock"
vaccines from a reliable laboratory are in every re-
spect as satisfactory and vastly more convenient and
economical than "autogenous" vaccines. The prepar-
ation of the latter is expensive and often attended with
unavoidable delay. Furthermore, many practitioners
have not the facilities for making autogenous vaccines
and prefer to depend upon a reliable source of supply
of stock vaccines.

**The Opsonic Index.** The opsonic index indi-
cates the patient's capacity to resist disease as com-
pared with that of a normal individual. In other
words, it is the measure of the efficiency of his blood-
serum to "prepare" invading bacteria for destruction
by the leucocytes (phagocytes).

**How the Opsonic Index is Determined.** Dr. E.
C. L. Miller,* of the Research Laboratories of Parke,
Davis & Co., describes the method as follows: Pre-
liminary to making a determination of the opsonic in-
dex it is necessary to prepare (1) an emulsion of the
bacteria in question, (2) a quantity of washed blood
corpuscles, (3) a drop or two of the blood serum of
the patient, and (4) a little normal pool serum. With
these constituents in hand the actual test is made as
follows:

**The Actual Test.** Equal portions of the emul-
sion of bacteria, the washed blood corpuscles and the

*A reprint of Dr. Miller's paper, which appeared in the *Therapeutic Gazette* for March, 1907, will be mailed, on request, to any physician.—
PARKE, DAVIS & CO.

10

patient's serum are mixed and incubated. During this incubation some of the bacteria are taken up by the phagocytes. Then smears of this mixture are stained and examined with the microscope in order to determine to what extent the bacteria have been taken up. The number of bacteria in the phagocytes is systematically noted as they come into view, and when 50 or 100 leucocytes have been thus counted the average is determined. This average is the phagocytic count when using the patient's serum.

An exactly similar test, carried through by using blood corpuscles, bacterial suspension and pool serum in equal quantities, gives the phagocytic count when using pool serum. The opsonic index is found by dividing the phagocytic count of the patient's serum by the phagocytic count of the pool serum.

**Example.** Suppose 100 leucocytes take up 500 bacteria mixed with pool serum. Now when the bacteria are mixed with the patient's serum and counted, suppose it is found that but 400 bacteria are taken up or ingested by the leucocytes. The opsonic index of that patient would be 4/1000 or 1/5, or, expressed in decimals, .8; the index of normal blood being 1.

**What a Low Index Indicates.** An opsonic index much below normal usually indicates inadequate power of resistance on the part of the patient toward the organism in question, and this power can be increased by the administration of homologous bacterial vaccines; a bacterial vaccine in this sense being 'simply a suspension of the bacteria in physiologic salt solution, sterilized properly and standardized. A bacterial vaccine may be made from a pure culture obtained from the patient himself (in which case it is spoken

11

of as an autogenous or personal vaccine) or it may be made from corresponding bacteria obtained from similar cases (stock vaccines).

**Is the Opsonic Index Essential in Practice?** The judicious use of bacterial vaccines appears to be devoid of harmful effect. When it is considered that the opsonic index is not within reach of many practitioners and that its use may involve unnecessary delay except in well-equipped institutions, it may be considered as not indispensable to success in this new department of therapeutics. The practitioner may safely rely upon the symptoms as a guide in determining the number and frequency of the doses. These should be small at first, and at sufficient intervals to avoid the effects indicative of the "negative phase."

**The Positive and Negative Phases.** In a paper by E. M. Houghton, Ph.C., M.D. (Therapeutic Gazette, January, 1907), this subject is discussed as follows: "A short time after the inoculation is made the opsonic index falls lower than it was previous to the injection. This Wright has named the 'negative phase.' Sooner or later, from a few hours to several days, the opsonic index rises above the starting-point. This is called the 'positive phase.' The amount of the opsonins in the blood remains stationary for a variable length of time, and then diminishes. As soon as their diminution is noted, a second injection of the vaccine is given, which is followed by a negative phase, but less pronounced than before. Soon the positive phase comes on, reaching a higher level than previously. Thus the injections are repeated from time to time according to the opsonic index of the patient's blood, and the positive phase gradually attains

12

a higher and higher level, until it may be as high as or considerably higher than that of a normal person. In other words, if the vaccinations are properly given, 'never during a negative phase,' and as a result the patient's tissues are stimulated to an increased production of the opsonins, phagocytosis is increased, the invading bacteria are disposed of, and the patient recovers from his infection."

**Directions for Use.** Bacterial Vaccines are administered subcutaneously by means of the syringe container or the ordinary hypodermatic syringe, in the usual manner. If the hypodermatic syringe be employed it is necessary to see that the instrument is properly sterilized. (A ready means of sterilizing the syringe is to wash it out repeatedly with a warm 5-percent. solution of carbolic acid; the needle should also be cleansed internally and externally by the same means; finally rinse out the instrument with recently boiled water.)

The skin at the point of injection should be scrubbed with soap and water and then rubbed with a 5-percent. carbolic solution, this disinfectant acting at the same time as a local anesthetic, diminishing the pain of injection.

## GONOCOCCUS VACCINE.

This is supplied in three dilutions—containing respectively 20 million, 100 million and 500 million bacteria to each cubic centimeter of fluid.

Micrococcus gonorrhoeae from pus. x 700.
Drawing from cover-slip preparation.

13

*Preparation.* Cultures of Micrococcus gonorrhœæ on ascites-agar are washed off with physiologic salt solution and shaken to separate the germs thoroughtfully from one another. The suspension is then sterilized with heat and diluted until each Cc. contains 20 million, 100 million or 500 million bacteria, as desired. The physiologic salt solution used in this work contains 0.2% trikresol as a preservative.

*Therapeutics.* Gonococcus Vaccine is used in the treatment of gonorrheal arthritis, gleet, prostatitis, orchitis, epididymitis, seminal vesiculitis, vulvovaginitis, and as a preventive and curative agent in pyosalpinx. In acute specific urethritis the results thus far reported are uncertain.

*Dose.* An initial dose of five to twenty millions may be used. It is usually found that much larger doses are ultimately necessary to effect a cure. As much as 1000 millions has been given at one time. In general it may be said that the dose can be gradually increased until one is found which produces the maximum of positive phase with the minimum of negative phase. This is frequently about 20 million, though it may reach 100 million or even 500 million. A second injection should be administered when the positive phase is beginning to wane. As it is usually impracticable to take the opsonic index regularly the general clinical condition will serve as the guide, both for size of dose and for frequency of administration. A slight local reaction may follow the first dose. General constitutional disturbances are not frequent. The number of doses required varies from one to eight; they are given at intervals of five to ten days.

For list of packages supplied by Parke, Davis & Co., see page 20.

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## STAPHYLOCOCCUS VACCINE.

Staphylococcus Vaccines are four in number:

- Staphylococcus Albus.

- Staphylococcus Aureus.

- Staphylococcus Citreus.

Staphylococcus Combined (Albus, Aureus, and Citreus).

These vaccines are supplied in dilutions of 400 millions and 1000 millions.

**Preparation.** Cultures of Staphylococcus pyogenes on plain agar are washed off with physiologic salt solution and shaken to separate the germs thoroughly from one another. The suspension is then sterilized with heat and diluted until each Cc. contains the desired number of bacteria. The physiologic salt solution used in this work contains 0.2% trikresol as a preservative.

**Therapeutics.** Staphylococcus Vaccines are used in the treatment of acne, sycosis, osteomyelitis, psoriasis, abscess, infected fistulæ, boils, carbuncles, abscesses, otitis media, suppurating glands, eczema, septic infections, cystitis, ulcerative endocarditis, and mixed infections.

**Dose.** It has been shown that initial doses of 50 to 200 million staphylococci are advisable. The first dose should be small, and increases should be made if the negative phase (see page 11) does not appear. If a negative phase follows the injection the dose should not be increased. A good plan is to inject 100 to 125 millions and at the expiration of four or five days when the positive phase is beginning to wane administer double that amount. Proceed in the same manner, gradually increasing the dose at intervals of five days.

15

## STREPTOCOCCUS VACCINE.

Streptococcus Vaccine is supplied in dilutions of 40 millions and 200 millions.

**Preparation.** Cultures of Streptococcus pyogenes on plain agar are washed off with physiologic salt solution and shaken to separate the germs thoroughly from one another. The suspension is then sterilized with heat and diluted (with physiologic salt solution containing 0.2% trikresol) until each Cc. contains the desired number of bacteria.

**Therapeutics.** It is used in the treatment of erysipelas, scarlatina, puerperal sepsis, cellulitis, phlegmon, septic endocarditis, lymphangitis, certain mixed infections, and in streptococcic secondary infections especially of tuberculous sinuses and lupus vulgaris.

**Dose.** The initial dose may be two to five millions, to be gradually increased.

A list of the packages supplied by Parke, Davis & Co. will be found on page 20.

## COLON VACCINE.

Colon Vaccine is supplied in dilutions of 200 millions and 500 millions. It is prepared in the same manner as streptococcus vaccine.

**Therapeutics.** It is employed in the treatment of colon infections of the genito-urinary and biliary tracts: e.g., cystitis, pyelitis, cholecystitis, rectal abscess, ischiorectal abscess, renal abscess, prostatitis, pyosalpinx, ulceration of the colon, acute jaundice.

16

**Dose.** The initial dose is 50 millions. This may be increased in accordance with the usual rule.

## TYPHOID VACCINE (Prophylactic).

Typhoid Vaccine (Prophylactic) is supplied in dilutions of 500 and 1000 millions.

*Preparation.* Cultures of the Bacillus typhosus on plain agar are washed off with physiologic salt solution and shaken to separate the germs thoroughly from one another. The suspension is then sterilized with heat and diluted until each Cc. contains the desired number of bacteria. The physiologic salt solution used in this work contains 0.2% triresol as a preservative.

*Therapeutics.* Typhoid Vaccine (Prophylactic) is an immunizing agent, the value of which in protecting vaccinated subjects against typhoid infection has been established through extensive trials in the armies of the United States, Great Britain, and other countries, as well as in civil practice. It is not recommended for therapeutic purposes.

**Dose.** The first dose is 500 million bacteria, to be followed ten days later by a full dose of 1000 million, and, for better protection, by a third dose of the same quantity after another interval of ten days. Headache, malaise, etc., sometimes occur a few hours after the administration of a dose of Typhoid Vaccine, hence it is advisable to give the injection in the late afternoon if possible. A space three or four inches in diameter at the site of injection shows more or less redness and may possibly be tender to the touch, but

Staphylococcus pyogenes aureus. x 1000.
Drawing from cover-slip preparation.

17

all symptoms pass off in forty-eight to seventy-two hours. Fever is a contraindication to the use of the vaccine, and in women the presence or near approach of the menstrual period.

## COMBINED BACTERIAL VACCINE (VAN COTT).

Each cubic centimeter contains, of the Streptococcus pyogenes, 50 million; Staphylococcus aureus, albus, and citreus, 500 million; Bacillus coli communis, 100 million; and Pneumococcus, 100 million; total, 750,000,000 bacteria, sterile and ready for use.

**Preparation.** Cultures of the various bacteria above specified are prepared separately by the method outlined under "Typhoid Vaccine," sterilized with heat and diluted with physiologic salt solution containing 0.2% trikresol, so that when mixed with all the constituent dilutions of the Combined Vaccine the streptococcus will be present in the proportion of 50 million, each of the staphylococci mentioned in the proportion of 167 million (making a total of 500 million for the three varieties), the Bacillus coli communis in the proportion of 100 million, and the pneumococcus in the proportion of 100 million, in all 750 million bacteria in eachCc.

**Therapeutics.** Combined Bacterial Vaccine (Van Cott) has been used with marked success in erysipelas, puerperal sepsis, phlegmon, mastoiditis, malignant endocarditis, acute tonsillitis, and a variety of suppurative infections the exact bacterial nature of which could not be diagnosticated.

18

**Dose.** The dose ranges from 0.5 Cc. to as much as 5 Cc.—the latter in severe puerperal sepsis; the contents of one bulb or syringe-container may be regarded as an average dose, to be repeated at four-day intervals if necessary. In cases of profound toxemia, 치θarsis by enema or otherwise is distinctly indicated. The so-called "Murphy drip," by means of which enemata are slowly introduced into the rectum and lower intestine, has been employed with satisfaction in many cases.

## FURUNCULOSIS VACCINE.

Furunculosis Vaccine is supplied in dilutions of 400 millions.

*Preparation.* Strains of staphylococci of the different varieties, and obtained from the furuncular lesions (boils or other circumscribed abscesses) of a considerable number of cases, are cultivated on agar, then washed off and thoroughly separated, and diluted (with pure water) until each cubic centimeter contains 400 million bacteria.

*Therapeutics.* Furunculosis Vaccine is used in the treatment of boils, carbuncles, pustular acne, impetigo contagiosa, and sycosis staphylogenes—in fact, in that entire class of staphylococcus infections that manifest themselves by subcutaneous abscess or cutaneous erup- tion.

**Dose.** The initial dose should not exceed 100 to 150 millions; the second dose, within six days, is 200 to 250 millions; should a third dose be necessary, 300

19

to 400 millions may be administered six days after the second dose. Succeeding doses must be governed, both as regards intervals and amounts, by the clinical indications.

## GONORRHEAL VACCINE COMBINED.

Gonorrheal Vaccine Combined is supplied in dilutions containing 500 million gonococci and 400 million staphylococci (albus, aureus, and citreus combined).

*Preparation.* Cultures of the Micrococcus gonorrhœæ are grown on a suitable culture medium, washed off with physiologic salt solution, shaken to separate the germs, sterilized with heat, and diluted so that each ½ Cc. contains 500 million bacteria. To this dilution is added a dilution of the combined staphylococci (albus, aureus, and citreus), grown on plain agar and washed, separated, and sterilized as in the case of Staphylococcus Vaccine Combined, so that each ½ Cc. contains 400 million bacteria. The diluting fluid is physiologic salt solution containing 0.2% trikresol.

*Therapeutics.* Gonorrheal Vaccine Combined is used in the treatment of gonorrheal infections in which the presence of staphylococci prevents a completely curative effect from Gonococcus Vaccine alone. These cases include chronic posterior urethritis, prostatitis, epididymitis, and other complications and sequelæ of gonorrhea.

**Dose.** As a general thing 0.2 to 0.5 Cc. is regarded as a safe initial dose, to be followed if necessary at intervals of five or six days by gradually increasing

20

doses, the quantity to be governed by the reaction or
lack of reaction following the previous dose, as head-
ache, malaise, etc.

PACKAGES.

The Bacterial Vaccines marketed by Parke, Davis &
Co. are supplied in two styles of package—(1) a
plain glass bulb, from which the quantity required for
a single dose must be withdrawn into a hypodermic
syringe; and (2) a combined bulb and syringe from
which injection may be made directly into the patient.
There is just one exception to this rule, namely Gono-
coccus Vaccine 20 million, which is offered in bulbs
only. The bulbs are provided with rubber stoppers
which may be reparaffined in place if it is desired to
preserve the unused vaccine; in this way one bulb
may serve for three or four doses. The syringe pack-
ages are graduated into fourths, so that fractional
quantities may be injected; they are also provided
with rubber caps, which, like the stoppers of the plain
bulbs, may be reparaffined in place for the preserva-
tion of the vaccine residue. As a rule, however, one
bulb or syringe represents one dose.

The plain bulbs are marketed in packages of four,
the syringe containers in packages of one and four.
Typhoid Vaccine (Prophylactic) is an exception; three
doses being sufficient for immunization, the first dif-
fering from the second and third in quantity, this vac-
cine is marketed in packages containing one bulb of 500
millions, and two bulbs of 1000 millions each; also in
syringe containers of the same number and contents;
in single syringes containing 2500 millions, which can
be administered in three successive doses; and in pack-
ages of 30 bulbs, 10 of which contain 500 million bac-
teria each, and 20 1000 million bacteria each.

Bacillus diphtheriae. x 1000.

THE TUBERCULINS.

What They Are: How They Are Prepared: Their
Diagnostic and Therapeutic Use.

List of Tuberculins. The following Tuberculins are manufactured by Parke, Davis & Co.: Tuberculin B. F. (Bouillon Filtrate); Tuberculin T. R. (Concentrated); Tuberculin T. R. (Dilute); Tuberculin B. E. (Bazillen Emulsion); Tuberculin Old; Tuberculin Ointment for Moro Test; Tuberculin for von Pirquet Test; Purified Tuberculin Discs, for the ophthalmic test.

TUBERCULIN B. F. (BOUILLON FILTRATE).

This consists of the bouillon in which virulent human tubercle bacilli have grown, filtered through porcelain. In addition to 5 per cent. of glycerin it contains all the soluble products formed by the bacteria during their period of growth. It is not concentrated or subjected to the action of heat, and is preserved by the addition of 0.4 per cent. trikresol. It is tested for purity on animals and bacteriologically. This is the Tuberculin with which Spengler made his investigations in 1893, and which he and other observers have used ever since in the treatment of tuberculosis. Denys did so much to obtain recognition for this product that it is sometimes called by his name (Denys' Tuberculin).

21

22

**Use.**—Tuberculin B. F. is used in the treatment of tuberculosis, being administered subcutaneously. Some of those most experienced in tuberculin administration give but a very small fraction of a cubic centimeter of Tuberculin B. F., even as little as one ten-millionth (one ten-thousandth of a milligram) serving in some cases as an initial dose. The usual dose ranges from 1-10,000 to 1-1000 milligram. The dose is repeated at suitable intervals and cautiously increased, the patient being watched very carefully to avoid a reaction.

**Reaction to be Avoided.** The purpose of these injections is to immunize the patient to tuberculin in particular and to tuberculosis in general, and the dose is increased as the patient's powers of resistance increase. A reaction (heightened temperature, etc.) means that the dose has been so large as to break down and disorganize the patient's resisting power. If, in spite of precautions, a reaction does occur, the injections when again begun must be in a much smaller dose than that which caused the reaction.

From the above considerations it becomes evident that it is impossible to recommend definite doses of Tuberculin B. F., the safest way being to begin with a very small dose (see table of dilutions), and gradually increase the dose as the patient's condition will permit.

**References to Authorities.** The following publications will give more detailed information relative to the use and dosage of Tuberculin B. F.:

Prof. Denys' book, Le Bouillon Filtre, published by O. Doin, Paris.

Prof. Sahli's book, Le Traitement de la Tuberculose par la Tuberculine, published by Kündig, Geneva.

23

Tru-
deau: Therapeutic Use of Tuberculin. Amer-
ican Journal of the Medical Sciences, Philadelphia,
June, 1907.

**Packages.** This preparation is supplied in glass bulbs of 1 Cc. capacity, six bulbs in a box.

TUBERCULIN OLD.

This is known as concentrated Tuberculin. It is
made after Koch's formula from pure cultures of the
tubercle bacillus, and differs from Tuberculin B. F.
only in the fact that it is concentrated by evaporation
to one-tenth its original form. It contains 50 per cent.
of glycerin, which acts as a preservative. All germs
are removed by thorough filtration, and the prepara-
tion is rigidly tested for purity.

**Use.** Tuberculin Old is used chiefly as a diagnostic agent, and occasionally therapeutically. In diagnosis it is employed in the form of the Ointment (Moro's test), the fluid (von Pirquet's test) and the Purified Tuberculin Discs (ophthalmic test). The technic of these tests is described under their respective names in succeeding sections. The therapeutic dose of Tuberculin Old is 0.0001 mg. to 0.001 mg. (1-10,000 to 1-1000 milligram).

*Directions for Obtaining the Systemic Reaction* as given by Koch, are as follows:

"In the first place the patient's temperature is observed for at least one day, or better, two, in order to ascertain whether the temperature is below 37° C. (98.6° F.) Patients whose temperature is above 37° C. are unsuited for the diagnostic application of Tuberculin, and ought not under any circumstances to be subjected to the Tuberculin test. If a patient is

24

found suitable, he receives an injection of Tuberculin under the skin of the back, in the forenoon. With weak patients one begins with one-tenth of a milligram; with robust persons whose tubercular alterations are probably very slight, one may begin with 1 milligram. If there is no rise of temperature at all, one gives a dose double as large as the first, not on the next day, but on the day after the next. But if there is a slight rise of temperature, only a quarter of a degree for instance, the dose is not raised, but repeated as soon as the temperature has gone down to its normal level. It very often happens that, though the same dose has been given, the second reaction is stronger than the first. This is quite specially characteristic of the effect of Tuberculin, and may be regarded as a quite infallible sign of the presence of tuberculosis. But if the first small doses produce no reaction, one gives 5 and finally even 10 milligrams. For certainty's sake I am accustomed to give this latter dose twice, and only when no reaction occurs even then do I feel justified in assuming that the case is not one of fresh or progressive tuberculosis demanding specific treatment.

"If one adopt this method, one will never expose a patient to danger, nor even cause him any serious discomfort, for, as I have already said, slight rises of temperature, up to 38° C., which give most patients hardly any disagreeable sensation whatever, suffice."

**The Therapeutic Use of Old Tuberculin.** Old Tuberculin may be used for treating cases of tuberculosis in the same way and with much the same results as the newer products, Tuberculin B. F., T. R., and B. E.

For this purpose minute doses are employed which require accurate and high dilution.

Bacillus tuberculosis from sputum. x 1200.
Drawing from cover-slip preparation.

26

We have used the word "milligram" in the above table instead of the longer and less familiar term "cubic millimeter," but it should be understood that a milligram of Old Tuberculin or Bouillon Filtrate is entirely different from a milligram of Tuberculin T. R. or B. E. In the case of Tuberculin T. R. or B. E. there is actually in the liquid a definite amount of tubercle solids, and one milligram of T. R. or of B. E. means one milligram of these tubercle solids (weighed after drying) without regard to the amount of liquid in which it is contained. On the other hand, Old Tuberculin or Bouillon Filtrate does not contain any definite amount of tubercle solids; as the name implies, it is simply the bouillon in which the germs have grown. One milligram really means one cubic millimeter of this bouillon. In short, the dose of T. R. and B. E. is expressed in terms of weight, the dose of Old Tuberculin and B. F. as liquid measure.

By using the method outlined above, various dilutions can be prepared with accuracy as well as facility, and by reference to Tables I and II the physician can readily determine the amount of tuberculin actually present in different doses of such dilutions.

## TUBERCULIN T. R. (CONCENTRATED).

This is also known as "new tuberculin." Koch himself directed attention to the fact that Tuberculin Old is a toxin, and it produces immunity to the toxin of the bacillus, but not to the bacillus itself. Tuberculin T. R. was prepared to afford a means of producing immunity to the germs of tuberculosis. It is in fact a bacterial vaccine.

27

### How Tuberculin T. R. Differs from Old Tuberculin.
Tuberculin T. R. is the best known and most widely used of the various tuberculins. The untoward results following the use of large doses of Old Tuberculin in the beginning of tuberculin therapy induced Koch to attempt to produce a product free from harmful characteristics. To this end he separated the water-soluble constituents of the tubercle germ from the insoluble or strictly cellular constituents and then brought these latter into solution by prolonged grinding. This solution, or perhaps more correctly colloidal suspension, of the insoluble constituents of the tubercle germs, he called T. R., and he believed that the rejected water-soluble portions were toxic and noxious, while the T. R. represented the immunizing constituents.

Subsequent experience has shown that T. R. does contain immunizing and remedial substances, but that it is by no means innocuous and must be used in small and very carefully regulated doses to avoid injury to the patient.

### Preparation.
The bacilli are ground, mixed with physiologic salt solution, and centrifugated; the residue only is kept and dried, ground and again centrifugated, a portion of solid matter being held in the solution which is preserved. This process is performed again and again with the gradually diminishing residues until all is taken up. The clear solutions resulting from the several centrifugations (except the first) are mixed together and standardized.

### Standard of Strength.
Each cubic centimeter of Tuberculin T. R. contains one milligram (0.001 Gm.) of total tubercle solids (dry).

28

**Dosage.** In the therapeutic use of T. R. the question of dosage is probably the most important point to receive attention. In fact, many clinicians consider the manner of administering Tuberculin (size of dose and interval between doses) more important than the variety of Tuberculin used. Sir A. E. Wright aims to give such a dose of T. R., usually from 1-16000 to 1-4000 milligram, as will keep the opsonic index of his patients at or above normal.*

Truodeat lays out a systematic course of immunization for a patient: beginning with a dose so small as to have no discernible effect, he very gradually increases it as the resistance of the patient increases until, at the end, the patient can withstand a large dose. (His doses of B. E. run from 1-10000 milligram to 1 milligram.)

Sahli,§ like Trudeau, begins with small doses and increases even more slowly, but instead of coming up to a *dosis maxima* he prefers to stop at what he considers for that particular patient to be a *dosis optima*. This *dosis optima* must from time to time be increased, not in accordance with any fixed schedule, but only as the needs of the patient indicate.

In general the initial dose of T. R. may be stated as .0001 to .0002 mg. (10⁻⁶ to 10⁻⁵ milligram).

**Confusion as to Dose.** There has been some misunderstanding regarding the strength of the T. R. manufactured in Germany, due to the fact that it has been universally understood to contain 10 milligrams of tubercle solids per cubic centimeter, whereas now the manufacturers state that 1 Cc. *represents the mate-

*Lancet, Dec. 2, 1905, page 1600.

821. †American Journal of the Medical Sciences, vol. cxxxiii, 1907, p.

§"Traitement de la Tuberculose."

Bacillus typhosus. x 1000.

29

rial extracted from 10 milligrams of dry tubercle germs, but in fact contains only 2 milligrams of total tubercle solids. The New Tuberculin Bazillen Emulsion as manufactured in Germany is understood to contain 5 milligrams of tubercle solids per cubic centimeter.

Each Cc. Contains 1 Milligram of Total Tubercle Solids. In order to eliminate this confusion from our products, to make them uniform in strength and to facilitate the necessary dilutions, we have decided to put up both T. R. and B. E. of a strength of one milligram per cubic centimeter; that is to say, each cubic centimeter contains one milligram of total tubercle solids (dry). As the dose of these products is never expressed in liquid measure, but always in weight of total dry tubercle solids, we do not think this change will cause confusion or misunderstanding. On the contrary, it certainly will simplify the problem of making the dilutions, which for some is rather difficult. In order to make the dilutions by measure satisfactorily, one should have accurately calibrated 0.1-Cc. and 1-Cc. pipettes, and 10-Cc., 100-Cc. and 1000-Cc. flasks graduated on the neck.

DIRECTIONS FOR MAKING DILUTIONS OF TUBERCULIN
T. R.

Make up the dilutions as required. They will not keep.

Remove the rubber stopper and withdraw as much Tuberculin as required. Replace rubber stopper and dip neck of bulb and plug in melted paraffin.

The following table may be helpful to those not accustomed to making the dilutions specified. The dilutions are best made with sterile physiologic salt

30

solution containing 0.5% carbolic acid, which may be made as follows: Salt, 8.5; carbolic acid, 5; water, to make 1000.

1 Cc. Tuberculin represents 1 milligram of solid material............Sol. 0.

$$1 \text{ Cc. Sol. } 0 + 9 \text{ Cc. of diluent} = 1:10$$

DILUTION.

0.1 Mg. Sol. I.

$$1 \text{ Cc. Sol. I} + 9 \text{ Cc. of diluent} = 1:100$$

0.01 Mg. Sol. II.

$$1 \text{ Cc. Sol. II} + 9 \text{ Cc. of diluent} = 1:1000$$

0.001 Mg. Sol. III.

$$1 \text{ Cc. Sol. III} + 9 \text{ Cc. of diluent} = 1:10000$$

0.0001 Mg. Sol. IV.

$$1 \text{ Cc. Sol. IV} + 9 \text{ Cc. of diluent} = 1:100000$$

0.00001 Mg. Sol. V.

**Packages.** Tuberculin T. R. (Concentrated) is supplied in rubber-stoppered glass bulbs of 1 Cc. capacity, each containing 1 milligram of dry tubercle solids. Price, $2.00 a bulb.

## TUBERCULIN T. R. (DILUTE).

This differs in strength from Tuberculin T. R. (Concentrated). One cubic centimeter contains 1-1000 of a milligram of dry tubercle solids. In its preparation the refined residue is brought into solution in a mixture of glycerin and water and diluted with physiologic salt solution containing 0.2 per cent. trikresol.

**Dosage.** Tuberculin, as a therapeutic agent, had a very checkered career until Sir A. E. Wright, of London, showed, by means of the opsonic index, the necessity of using small doses in order to avoid producing marked and undesirable negative phases. Wright and his followers generally use doses varying from 1-4000 to 1-500 of a milligram. This range of dosage can easily be measured from Tuberculin T. R. (Dilute), provided one has a syringe graduated in tenths of a cubic centimeter, as the following table shows:

31

<table><thead><tr><th></th><th>Approximately</th><th>Exactly</th></tr></thead><tbody><tr><td>1 minim contains..................</td><td>1-16200 Mg.</td><td>1-16230 Mg.</td></tr><tr><td>2 minimms " ..........................</td><td>1-8100 "</td><td>1-8115 "</td></tr><tr><td>3 " " ..............................</td><td>1-5400 "</td><td>1-5410 "</td></tr><tr><td>4 " " ..............................</td><td>1-4050 "</td><td>1-4058 "</td></tr><tr><td>5 " " ..............................</td><td>1-3250 "</td><td>1-3246 "</td></tr><tr><td>6 " " ..............................</td><td>1-2700 "</td><td>1-2705 "</td></tr><tr><td>7 " " ..............................</td><td>1-2320 "</td><td>1-2319 "</td></tr><tr><td>8 " " ..............................</td><td>1-2030 "</td><td>1-2029 "</td></tr><tr><td>9 " " ..............................</td><td>1-1800 "</td><td>1-1803 "</td></tr><tr><td>10 " " ............................</td><td>1-1625 "</td><td>1-1623 "</td></tr><tr><td>11 " " ............................</td><td>1-1475 "</td><td>1-1476 "</td></tr><tr><td>12 " " ............................</td><td>1-1350 "</td><td>1-1353 "</td></tr><tr><td>13 " " ............................</td><td>1-1250 "</td><td>1-1248 "</td></tr><tr><td>14 " " ............................</td><td>1-1160 "</td><td>1-1159 "</td></tr><tr><td>15 " " ............................</td><td>1-1080 "</td><td>1-1082 "</td></tr><tr><td>16 " " ............................</td><td>1-1015 "</td><td>1-1014 "</td></tr><tr><td>17 " " ............................</td><td>1-950 "</td><td>1-955 "</td></tr><tr><td>18 " " ............................</td><td>1-900 "</td><td>1-902 "</td></tr><tr><td>19 " " ............................</td><td>1-850 "</td><td>1-852 "</td></tr><tr><td>20 " " ............................</td><td>1-810 "</td><td>1-812 "</td></tr><tr><td>21 " " ............................</td><td>1-775 "</td><td>1-773 "</td></tr><tr><td>22 " " ............................</td><td>1-740 "</td><td>1-738 "</td></tr><tr><td>23 " " ............................</td><td>1-700 "</td><td>1-706 "</td></tr><tr><td>24 " " ............................</td><td>1-675 "</td><td>1-676 "</td></tr><tr><td>25 " " ............................</td><td>1-650 "</td><td>1-649 "</td></tr><tr><td>26 " " ............................</td><td>1-625 "</td><td>1-624 "</td></tr><tr><td>27 " " ............................</td><td>1-600 "</td><td>1-601 "</td></tr><tr><td>28 " " ............................</td><td>1-580 "</td><td>1-580 "</td></tr><tr><td>29 " " ............................</td><td>1-560 "</td><td>1-560 "</td></tr><tr><td>30 " " ............................</td><td>1-540 "</td><td>1-540 "</td></tr><tr><td>31 " " ............................</td><td>1-525 "</td><td>1-525 "</td></tr><tr><td>32 " " ............................</td><td>1-500 "</td><td>1-500 "</td></tr></tbody></table>

The intervals and size of dose conducive to best results vary with different patients, the guiding factors being the general condition of the patient and the opsonic index. Undoubtedly the opsonic index forms the most accurate and reliable guide and should be

32

utilized whenever possible, although by some it is not
considered indispensable. In either case it is wise to
begin with a small dose and work up—the ideal dose
being the one that produces the maximum of positive
phase with the minimum of negative phase. If the
opsonic index is taken regularly, a second injection
should be given when the effect of the first is begin-
ning to wear off. If the opsonic index is not taken,
the doses are usually given at intervals of seven or
ten days.

**Packages.** Tuberculin T. R. (Dilute) is supplied in sealed glass bulbs of 1 Cc. capacity. Price, $2.00 per case of six bulbs. The dose is 1-16 to 1 Cc.

TUBERCULIN B. E.

This is another form of new tuberculin and was
devised by Koch. From his studies of this product
Koch considered it superior to the T. R. It certainly
represents more completely the entire tubercle germ
than does T. R. It seems to be growing in favor with
clinicians; but, in order to avoid reactions, it must be
used with even greater care than T. R.

**Preparation.** It also is made from the germ bodies—pulverized and suspended in glycerin solution. Like Tuberculin T. R. it is a bacterial vaccine. The well washed, live, virulent tubercle bacilli are thorougly dried and then ground in a porcelain ball mill for several weeks. At the end of this time they are taken up in water and set aside in order that any in completely ground particles may settle to the bottom.

**Standard of Strength.** The supernatant fluid is assayed for total tubercle solids and diluted so that

Bacillus typhosus showing flagella. x 1000.

33

the resulting product shall contain 50 per cent. of glycerin and one milligram of tubercle solids per cubic centimeter. It is tested bacteriologically with great care, both on suitable culture media and on animals. Dilutions are made precisely as in the case of Tuberculin T. R. (See page 30.)

Use. Tuberculin B. E. is used in the treatment of tuberculosis, in doses of 1-16000 to 1 milligram. Directions for diluting accompany each bulb.

Packages. This preparation is supplied in rubber-stoppered glass bulbs of 1 Cc. capacity.

TABLE II.—SHOWING THE AMOUNT OF TUBERCLE SOLID SUBSTANCE (DRY) IN VARYING AMOUNTS OF THE DIFFERENT DILUTIONS OF T. R. AND B. E.

<table><thead><tr><th rowspan="2">SIZE OF DOSE.</th><th colspan="5">DILUTIONS (see page 30).</th><th rowspan="2">Sol. I.<br>1:10</th><th rowspan="2">Sol. O.<br>0 1 Mg.<br>0.2 "</th></tr><tr><th>Sol. IV.<br>1:10000</th><th>Sol. III.<br>1:1000</th><th>Sol. II.<br>1:100</th><th>Sol. I.<br>1:10</th><th>Sol. O.</th></tr></thead><tbody><tr><td>0.1 Cc. contains...</td><td>.00001 Mg.</td><td>.0001 Mg.</td><td>.001 Mg.</td><td>.01 Mg.</td><td></td><td></td><td></td></tr><tr><td>.2 " " "</td><td>.00002 " "</td><td>.0002 " "</td><td>.002 " "</td><td>.02 " "</td><td></td><td></td><td></td></tr><tr><td>.3 " " "</td><td>.00003 " "</td><td>.0003 " "</td><td>.003 " "</td><td>.03 " "</td><td></td><td></td><td></td></tr><tr><td>.4 " " "</td><td>.00004 " "</td><td>.0004 " "</td><td>.004 " "</td><td>.04 " "</td><td></td><td></td><td></td></tr><tr><td>.5 " " "</td><td>.00005 " "</td><td>.0005 " "</td><td>.005 " "</td><td>.05 " "</td><td></td><td></td><td></td></tr><tr><td>.6 " " "</td><td>.00006 " "</td><td>.0006 " "</td><td>.006 " "</td><td>.06 " "</td><td></td><td></td><td></td></tr><tr><td>.7 " " "</td><td>.00007 " "</td><td>.0007 " "</td><td>.007 " "</td><td>.07 " "</td><td></td><td></td><td></td></tr><tr><td>.8 " " "</td><td>.00008 " "</td><td>.0008 " "</td><td>.009 " "</td><td>.09 " "</td><td></td><td></td><td></td></tr><tr><td>.9 " " "</td><td>.00009 " "</td><td>.0009 " "</td><td>.010 " "</td><td>.10 " "</td><td></td><td></td><td></td></tr><tr><td>1.0 " " "</td><td>.00010 " "</td><td>.0010 " "</td><td></td><td></td><td></td><td></td><td></td></tr><tr><td>1 minims contains</td><td>.000006 " "</td><td>.00006 " "</td><td>.0006 " "</td><td>.006 " "</td><td></td><td></td><td></td></tr><tr><td>2 minims " "</td><td>.000012 " "</td><td>.00012 " "</td><td>.0012 " "</td><td>.012 " "</td><td></td><td></td><td></td></tr><tr><td>3 " " "</td><td>.000018 " "</td><td>.00018 " "</td><td>.0018 " "</td><td>.018 " "</td><td></td><td></td><td></td></tr><tr><td>4 " " "</td><td>.000025 " "</td><td>.00025 " "</td><td>.0025 " "</td><td>.025 " "</td><td></td><td></td><td></td></tr><tr><td>5 " " "</td><td>.000031 " "</td><td>.00031 " "</td><td>.0031 " "</td><td>.031 " "</td><td></td><td></td><td></td></tr><tr><td>6 " " "</td><td>.000037 " "</td><td>.00037 " "</td><td>.0037 " "</td><td>.037 " "</td><td></td><td></td><td></td></tr><tr><td>7 " " "</td><td>.000043 " "</td><td>.00043 " "</td><td>.0043 " "</td><td>.043 " "</td><td></td><td></td><td></td></tr><tr><td>8 " " "</td><td>.000049 " "</td><td>.00049 " "</td><td>.0049 " "</td><td>.049 " "</td><td></td><td></td><td></td></tr><tr><td>9 " " "</td><td>.000055 " "</td><td>.00055 " "</td><td>.0055 " "</td><td>.055 " "</td><td></td><td></td><td></td></tr><tr><td>10 " " "</td><td>.000062 " "</td><td>.00062 " "</td><td>.0062 " "</td><td>.062 " "</td><td></td><td></td><td></td></tr><tr><td>11 " " "</td><td>.000068 " "</td><td>.00068 " "</td><td>.0068 " "</td><td>.068 " "</td><td></td><td></td><td></td></tr><tr><td>12 " " "</td><td>.000074 " "</td><td>.00074 " "</td><td>.0074 " "</td><td>.074 " "</td><td></td><td></td><td></td></tr><tr><td>13 " " "</td><td>.000080 " "</td><td>.00080 " "</td><td>.0080 " "</td><td>.080 " "</td><td></td><td></td><td></td></tr><tr><td>14 " " "</td><td>.000086 " "</td><td>.00086 " "</td><td>.0086 " "</td><td>.086 " "</td><td></td><td></td><td></td></tr><tr><td>15 " " "</td><td>.000093 " "</td><td>.00093 " "</td><td>.0093 " "</td><td>.093 " "</td><td></td><td></td><td></td></tr><tr><td>16 " " "</td><td>.000100 " "</td><td>.00100 " "</td><td>.0100 " "</td><td>.100 " "</td><td></td><td></td><td></td></tr></tbody></table>

34

### (a) The von Pirquet Test.

On the 8th of May, 1907, Dr. Clemens von Pirquet announced in the *Berliner Medizinische Gesellschaft* that the cutaneous application to children of diluted tuberculin (25 per cent.) constituted a diagnostic procedure of value, in that almost all of the tuberculous cases reacted with a characteristic red papule at the site of vaccination, while the reaction was absent in nearly all of the non-tuberculous patients. However, guided by the results of further quantitative determinations, von Pirquet now uses the Old Tuberculin, undiluted, for the cutaneous reaction.

## DIRECTIONS FOR APPLYING THE TEST.

**Preliminary.** Cleanse the site chosen with soap and water, and carefully dry.

Take the small rubber bulb in the left hand, with the neck of the bulb pointing to the right. One of the sealed glass tubes held in the right hand is inserted into the opening in the neck or cup-shaped end of the bulb, and, with slightly rotary motion, pushed through until the bulb is impaled upon and resting at about the center of the tube. The end of the tube to the left is then broken off and the tube drawn back until the open end is well within the cavity of the bulb. Now break off the other (right) end of the tube. The tuberculin may be expelled by closing the air hole in the rubber bulb with the finger and applying pressure.

**Von Pirquet's Method.** Von Pirquet published the following directions for making the test in the *Journal of the American Medical Association*, Feb. 27, 1909, page 675:

35

My method of applying the test is as follows: The skin of the forearm is scrubbed with ether, then two drops of undiluted Old Tuberculin are dropped about four inches distant from each other. Then, with a vaccinating lancet, the point of which has the form of a small chisel, a superficial circular scarification is made between the two drops (for the control of the traumatic redness following the small scarification). Finally, the same scarification is made inside of the two drops; a few fibers of cotton are put on the drops so that they will not flow. After five minutes the cotton is taken off. No dressing is applied. The papule is examined after twenty-four and forty-eight hours. It is considered as positive when the tuberculin scarifications are clearly different from the control, but the inflammatory reactive area must measure at least one-fifth of an inch (5 mm.).

The site chosen may conveniently be the inner side of the arm, since in this region there are few hairs and the skin is soft and tender.

No other disinfectant should be used than ether; watery antiseptics and alcohol cause the Tuberculin to flow.

The scarifier used by von Pirquet is a chisel-shaped point about 1-16 inch in width. It is held vertical to the skin and rotated. The amount of abrasion should be such that the control spot shows a scab the next day, but blood should not be drawn.

The amount of cotton should be sufficient to hold the Tuberculin in contact with the scarified area, but not enough to absorb it.

## INTERPRETATION OF THE REACTION.

The following suggestions are taken from an article by von Pirquet, found in the "Handbuch der Technik und Methodik der Immunitätsforschung," von Kraus und Levaditi, Jena, 1908, Vol 1, page 1035:

36

The vaccination spot and the control spot at first exhibit the same appearance as a result of the trauma. This consists of a small wheal formed in a few minutes after the application of the instrument, followed by a delicate rosy halo which disappears in a few hours. On the small, slightly raised, reddish spot a scab forms as large as a pin-head, which may remain for one or more weeks. The intensity of this traumatic reaction varies with the depth of the scarification and with the individual differences in the skin.

Many times the control spot gives a typically positive reaction, but only when near a vaccination spot reacting positively; never with negative cases, also never when the control spot is prepared separately. The reaction in such cases is due to the extension of the Tuberculin upon the control spot.

### The Positive Reaction.
The positive reaction may develop quite quickly (after a few hours) as a reddish zone surrounding the scarified area. The duration of the latent period may vary between three hours and several days, in most cases, however, fully developing in twenty-four hours. Reactions are designated as "sluggish" where the latent period is more than twenty-four hours, and such cases are more often found with older children, especially with clinically unsuspected cases. Children obviously tubercular show the "sluggish" reaction only exceptionally.

The specific reaction begins normally as a slightly raised red spot spreading from the scarification outward and quickly increasing in extent and height. The diameter of the papule may reach 30 mm. (1½ inches), but is usually about 10 mm. (2/5 inch).

Only exceptionally is the center soft and vesicle-like, and pus is never formed. In color, great variation may be observed. In general, strong men with skin of a healthy color show a highly red papule, anemic individuals a pale red reaction. Many times the hyperemia is entirely absent, so that the papule is recognized only through the sense of touch or by lateral illumination. Colorless papules or white spots without exudation are found often in the late stages of tuberculosis, and indicate the inability of the skin to react.

A Comparison of Degrees of the Cutaneous Reaction (von Pirquet's Method).

1. Inoculation with Undiluted Tuberculin Old.

2. Dilution of Old Tuberculin 1: 4.
3. Dilution of Old Tuberculin 1: 16.
4. Dilution of Old Tuberculin 1: 64.
5. Control.

37

**Description of the Papule.** The boundary of the papule is sometimes round, sometimes jagged; occasionally long spurs are seen along the path of the lymph vessels. Often the edge of the papule is formed of small ill-defined follicle-like swellings. When such little knob-like swellings are seen in the immediate region of the papule, the reaction is termed "scrofulous," since this form is found chiefly with scrofulous children and reminds one of lichen scrofulosus.

The hyperemia usually does not extend beyond the borders of the exudation. With an intensive reaction, however, there may be seen many times a rose-red halo surrounding the papule, not unlike that seen in smallpox vaccination.

The maximum, both in extent and height of the inflammatory area, is usually attained in forty-eight hours after vaccination. Exudation then diminishes, the red color disappears, playing into violet and yellow, and gradually passing into a pigment which may remain for a week. The swelling is lost to the sense of touch in from five to eight days. A ready scaling of the epidermis follows.

The younger the children, the more quickly absorbed are the remains of the inflammatory process. This may be completed in three days with infants. If the patient can be seen but once, the best time is forty-eight hours after vaccination.

**Revaccination.** A revaccination may exhibit a positive reaction where a negative result follows the first trial.

## (b) The Moro Reaction.

In the *Münchener medizinische Wochenschrift* of February 4, 1908, Dr. Ernst Moro reported a series of investigations with 68 cases of children between the ages of 1 and 13, in which he applied a tuberculin ointment to the unbroken skin as a test for tuberculosis, using the von Pirquet cutaneous test as a comparison. He found that each of the 33 cases reacting positively with the ointment, likewise reacted positively with the von Pirquet test, and concluded from this that his reaction was strongly specific.

38

Dr. Moro published the following directions for
making the test in the *New York and Philadelphia*
*Medical Journal*, June 27, 1908, page 1233:

I rub into the skin of the chest or abdomen, over an area of 4 square inches, a piece of the following ointment of the size of a pea, for about half a minute, and permit the ointment to remain on the surface of the skin and to spontaneously absorb. The effect of this inunction is observed on the following day or later, observation being usually best on the second day.

The ointment is prescribed thus:

R Koch's old tuberculin................5 Cc.

Anhydrous wool fat..................5 Gm.

The result is positive when small papules appear over the area of the inunction or in its immediate vicinity, negative when the skin shows no changes of any kind. With the positive reaction one often observes only a few very pale papules. Occasionally the papules are very numerous and red, and only exceptionally the skin in the region of the inunction is very much reddened and itches. The papules usually disappear at the end of a week. Other local or general symptoms have not been observed.

Plain lanolin may be similarly applied to a corresponding area as a control.

In the *Münch. Med. Woch.* article of February 4, 1908, three grades of the positive reaction are distinguished, as follows:

(1) **Weak Reaction:** On the test area appear, in from 24 to 48 hours, seldom later, from 2 to 10 nodules which are entirely distinct and for the most part markedly red, though rarely they may be indistinctly pale, and having a diameter of 1 to 2 mm. Usually this eruption disappears after a few days without even causing any itching.

39

(2) **Medium Strong Reaction:** On the test area there appears, usually in the course of the first 24 hours, a very large number, up to 100 or more, of red nodules which may be miliary in size or they may have a diameter of as much as 3 mm. The skin in the region of the eruption is decidedly red and the reaction is confined to the spot of inunction, being accompanied at first by slight itching. This appearance remains several days unchanged and fades out gradually.

(3) **Strong Reaction:** On the test area there appears after a few hours, in most cases, a very large number, 100 or more, of large red nodules with an inflamed background. The dermatitis is always accompanied with itching. Many of the eruptions form an exudate and may reach a diameter of 5 to 8 mm. (1/5 to 3/10 inch). They are not confined to the point of application but extend to the immediate vicinity. After a few days the papular eruption dries up and becomes scaly. After two weeks, outside of a brownish pigmentation there is nothing to be noticed on the skin.

**Confirmatory Experiments.** Heinemann (Münch. med. Wochenschrift, 1908, No. 11, p. 556) confirmed the Moro test with adults, and, as a result of investigations including 66 cases, tested side by side with the conjunctival reaction, and 108 cases in which the ointment was the only skin test applied, concludes that with adults the Moro ointment test as a diagnostic measure is at least as valuable as the Calmette test.

Hamill, Carpenter and Cope (Archives of Internal Medicine, Vol. 2, 1908-1909, p. 405) tested the conjunctival (Calmette), the scarification (von Pirquet), and the ointment (Moro) reactions on 132 cases, of which 122 reacted positively. The authors conclude that there was almost absolute uniformity as to the reaction with these three tests.

Moro (Beiträge zur Klinik der Tuberculose, Vol. 12, 1909, p. 207) used his test upon 388 children, with

40

the von Pirquet reaction as a control, from which he concludes that the ointment test gives results almost exactly parallel with those of the scarification test.

**Consensus of Opinion.** While all observers are not agreed as to the exact value of this reaction, the consensus of recent opinion is perhaps expressed by the following conclusions of Dr. Henry S. Patterson, of New York (Archives of Internal Medicine, Vol. 3, 1909, p. 299), based upon a review of the literature and 171 of his own cases in which the von Pirquet reaction was used as a comparison.

(1) The Moro test is absolutely harmless and simple to use.

(2) It is better adapted to use among adults than the von Pirquet test, because it does not produce a reaction so frequently among those clinically free from tuberculosis.

(3) It produces a reaction probably as frequently as the ocular reaction in the tuberculous and in the clinically free cases, but is devoid of the danger incident to the conjunctival test.

### (c) The Ophthalmo Reaction.

Wolff-Eisner was the first to report that a drop of 10 per cent. tuberculin, placed in the eye of a tuberculous patient, produced a characteristic reddening of the conjunctiva, but not when placed in the eye of a person free from tuberculosis.

On the 17th of June, 1907, Calmette reported to the Académie des Sciences that a 1 per cent. solution of purified tuberculin dropped into the eye gave the reaction, but in so mild a form that it could be used in human beings generally. Since then many thousand

Moro's Cutaneous Tuberculin Reaction.

41

cases have been reported, in most of which a 1 per cent. solution was used.

## PREPARATION OF TUBERCULIN DISCS.

The tuberculin is purified by precipitating the active constituents with alcohol and thoroughly washing the precipitate. The precipitate is then dried and made up into discs, each containing 3.3 mg. (0.0033 Gm.). Hence, one disc dissolved in .33 Cc. (5 minims) of sterile distilled water makes a 1 per cent. solution. The disc and the water may be placed in a small conical graduate or a spoon, and the solution of the tuberculin will be hastened by drawing the liquid up and down in the eye-dropper. *The dilution should be used as soon as made.*

## HOW TO MAKE THE OPHTHALMIC TEST.

To make the test, instill one drop of the 1 per cent. solution into one eye of the patient. The other eye then serves as a normal control by which to judge of the changes in the tested eye.

The reaction which occurs in the eye of a tuberculous patient is manifested by redness of the caruncle spreading to the conjunctiva, by lacrimation, by a fibrinous exudate on the caruncle, by chemosis, and by some discomfort. These symptoms may vary in severity from the mildest of manifestations to a very severe inflammation, with photophobia and considerable interference with vision owing to the swelling and the increased secretions. The subjective symptoms are usually much less marked than would be expected from the appearances.

## WHEN THE REACTION APPEARS.

The reaction usually begins to become manifest three

42

to ten hours after applying the tuberculin, is at its
height in from six to twelve hours, and disappears in
from twenty-four to thirty-six hours.

In some cases the reaction is late in appearing
(twelve to twenty-four hours) and may persist several
days before clearing up.

## TO REPEAT THE TEST.

In repeating the test on the same patient the other
eye should be utilized, because one application of
tuberculin has a tendency to so sensitize that eye that
a second application to the same eye, made after the
lapse of a suitable interval (ten days to two weeks),
is liable to be followed by a reaction, even in a non-
tuberculous subject.

## FACTS RESPECTING THE REACTION.

Patients in advanced stages of tuberculosis fre-
quently do not give the ophthalmic reaction, probably
for the same reason that they do not react to the
subcutaneous exhibition of tuberculin.

The ophthalmo-reaction does not produce immunity,
but the same patient will react to a subsequent ophthal-
mic test in the other eye, to a cutaneous test or to a
subcutaneous injection of tuberculin.

## PRECAUTIONS NECESSARY.

Although the ophthalmo-tuberculin test has been
used in many hundreds of cases without producing
deleterious effects, it is proper to note that in a few
instances so severe a reaction has developed as to en-
danger the eye, especially when there was already a
diseased condition present.

43

## DILUTING OF TUBERCULIN.

The existing confusion relative to the technique of
diluting the tuberculins has led a large number of
physicians to use tuberculin products which have been
supplied to them in diluted form. It is universally
recognized by authorities on the subject that diluted
solutions of tuberculin are not stable and become
inactive within a few weeks. Much dissatisfaction has
attended the use of the tuberculins in certain cases
because of the fact that the serial dilutions were abso-
lutely inert. Some practitioners have hesitated to
undertake making their own dilutions of tuberculin,
and a general impression appears to exist that the
proper diluting of these products is a matter of great
difficulty and outside the province of the physician.

## NOT A DIFFICULT PROCEDURE.

Such an attitude on the part of the profession seems
hardly justifiable, as the technique of diluting tuber-
culins is not complicated. Certainly the alert physician
of today should much prefer to go to the slight trouble
of having the proper facilities and making himself
familiar with the methods to be employed in preparing
dilutions, rather than use serial dilutions which are
inactive ninety-nine times out of a hundred before they
come into his hands. We submit, therefore, a brief
outline of methods to be utilized in preparing tuber-
culin dilutions.

## APPARATUS REQUIRED.

In order to make the dilutions by measure satisfac-
torily, one needs only a few 1-Cc. pipettes graduated
in tenths of a cubic centimeter, and a supply of 10-Cc.

44

flasks graduated on the neck. The dilutions are best made with sterile physiologic salt solution containing about 0.4% phenol. See pages 25, 30 and 33.

## A STILL SIMPLER METHOD.

With a 20-minim syringe, a graduate, and a pipette from the tip of which drops of liquid will detach themselves in minims, the practitioner is prepared to make his own dilutions of Tuberculin as easily as he can dissolve his hypodermatic tablets in a given quantity of water. The graduate should have a capacity of 4 ounces, the pipette a caliber at the tip of 2 millimeters.

Tuberculin B. E., or T. R. concentrated, contains a definite quantity of tubercle solids—1 milligram in each Cc.

*Problem:* To get 1/4000 milligram and upwards of tubercle solids in a quantity of dilution convenient for injection.

Take 1 minim of the Tuberculin, and dilute with 4 ounces (¼ pint) of distilled water or carbolized saline solution. One minim of this dilution will contain 1/1920 minim of Tuberculin; eight minims will contain 8/1920 minim of Tuberculin. But as 1 minim of Tuberculin=1/16 milligram of tubercle solids, we must divide the total amount of Tuberculin in minims by 16 to get the amount of tubercle solids in milligrams. Dividing 8/1920 by 16 we get 1/3840 milligram of tubercle solids, or approximately 1/4000 milligram—a practically safe initial dose, contained in eight minims of a dilution made by adding 1 minim of Tuberculin to 4 ounces of diluent.

The Opsonic Outfit.

A—Blood Tube, 10 mm. (56 in box). B—Rubber Nipple (blind). C—Wax

Pencil. D—Emery Paper (32 pieces). E—Opsonizing Pipette (56 in box).

F—Blood Pipette (56 in box). G—Blood Tube, 6 mm. (56 in box).

45

Increase the dose gradually by 1 minim of similar dilutions, making 9/1920, 10/1920, 11/1920, etc., of a minim of Tuberculin—expressed in milligrams of tubercle solids by dividing by 16, making the denominator 30720, the numerator being the number of minims of dilution used. 9 minims=9/30720 milligram tubercle solids, in simple fraction 1/3400 milligram; 10 minims=10/30720 milligram (1/3000); 11 minims=11/30720 milligram (1/2800); 12 minims, 1/2600 milligram; 13 minims, 1/2400 milligram; 14 minims, 1/2200 milligram; 15 minims, 1/2000 milligram; 16 minims, 1/1920 milligram; 17 minims, 1/1800 milligram; 18 minims, 1/1700 milligram; 19 minims, 1/1600 milligram; 20 minims, 1/1500 milligram.

For larger doses, should such be necessary, the dilution should be made with 2 ounces of diluent, diminishing the volume of the dose while increasing the Tuberculin content. Thus 1 minim of a dilution made by adding 1 minim of Tuberculin to 2 ounces (or 960 minims) of water or salt solution would contain 1/960 minim of Tuberculin, which divided by 16 for milligrams of tubercle solids=1/15360. If the dose required is 1/1400 milligram, use 11 minims: 11/15360=1/1396; 12 minims=12/15360, or 1/1300 milligram; 13 minims=13/15360, or 1/1200 milligram; 14 minims, 1/1100 milligram; 15 minims, 1/1000 milligram; 16 minims, 1/960 milligram; 17 minims, 1/900 milligram; 18 minims, 1/850 milligram; 19 minims, 1/800 milligram; 20 minims, 1/770 milligram.

For still larger doses, dilute 1 minim of Tuberculin with 1 ounce of water or salt solution. One minim of

46

this dilution will contain 1/480 minim of Tuberculin,
which divided by 16 for milligrams of tubercle solids=
1/7680. Eleven minims=11/7680 milligram tubercle
solids, or 1/700; 12 minims, 1/640 milligram; 13 min-
ims, 1/600 milligram; 14 minims, 1/550 milligram; 15
minims, 1/500 milligram; etc.

It will be observed that the doses mentioned are graded
by increases of a trifle less than 10 per cent., each dose being
about one-tenth larger than the previous one. Dr. E. C. L.
Miller, speaking of ready-prepared dilutions of tuber-
culin, says (Archives of Internal Medicine, August, 1909):
"In administering Tuberculin each dose should be larger than
the preceding by a certain per cent. (geometrical progres-
sion) rather than by a certain fixed quantity (arithmetical
progression)."

47

THE OPSONIC INDEX.

The Outfit for the performance of the opsonic test
is packed in a neat pasteboard box of convenient size
and contains the following:

56 Opsonizing Pipettes.

56 Blood Pipettes.

56 Blood Tubes, 6 mm.

56 Blood Tubes, 10 mm.

1 Rubber Nipple (blind).

1 Wax Pencil.

32 Pieces Emery Paper.

In addition to the articles mentioned above the
Opsonic Outfit includes one bottle of Hastings' Stain.
By referring to the illustration the exact form of each
piece of apparatus may readily be seen.

The necessary information concerning it is pro-
vided in a booklet containing two articles, one by E.
M. Houghton, Ph.C., M.D., entitled "A Review of the
Opsonins and Bacterial Vaccines," and the other by
E. C. L. Miller, M.D., the title of which is "Directions
for Determining the Opsonic Index of the Blood." Both
are well worthy of careful reading, as they contain a
complete *résumé* of the technique of the subject. The
book also contains a bibliography on the general sub-
ject of opsonic therapy.

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