CHAPTER XVIII.

ELIXIRS.

THE word "elixir" is said to be of an ancient origin, and derived, according to Dr. Charles Rice, from two Arabic words, pronounced al-iksir; the Arabic iksir comes from the Greek word pov, meaning a dry powder, such as was used for dusting wounds. For a long time the word was applied by alchemists to the wonderful transformation powder used in the supposed conversion of base metals into silver and gold. Later on, the term was also applied to liquids, and used to designate certain compound tinctures, for which rare medicinal properties were claimed. In this latter sense the term elixir is still used to some extent in Continental Europe, and, as a rule, such preparations are characterized by an unpleasant taste. In modern American pharmacy the word has come to mean an entirely different class of preparations, the distinguishing features of which are a pleasantly aromatic sweet taste, and the presence of alcohol varying in proportion from 20 to 25 per cent. by volume. Prior to 1865, only two elixirs of this kind were used to any extent in this country-namely, Elixir of calisaya and Elixir of ammonium valerianate; but through the efforts of enterprising manufacturers the list was rapidly augmented and reached its height between 1870 and 1875. A reaction, however, gradually set in, and at the present day many once-popular elixirs have fallen into disuse. There can be no doubt that a sweet, aromatic, and slightly alcoholic liquid forms a pleasant vehicle for many remedies, but the presence of 25 per cent. of alcohol may, in some instances, be positively injurious, and, moreover, the active ingredients are frequently present in such small quantities as to render the medicinal value of the preparation doubtful.

The American Pharmaceutical Association, in order to secure. uniformity in the composition of the many elixirs dispensed by pharmacists, has published a series of 86 formulas for elixirs, in the National Formulary. This book was issued in 1888, and a revised edition is shortly to appear. Another series, containing about 275 formulas for elixirs and many valuable directions in manipulation, was published by J. U. Lloyd in 1892, under the title Elixirs and Flavoring Extracts. Many elixirs can be prepared extemporaneously by simple solution of the medicinal ingredient in the desired vehicle; as, for instance, the elixirs of the alkali bromides, citrates, salicylates, and hypophosphites, elixir of pyrophosphate of iron, elixir of gentian, both simple and ferrated, etc.

It is often desirable to impart color to an elixir, but since not all

coloring agents are equally well suited for acid and alkaline liquids, it becomes necessary to exercise proper discretion. For acid or neutral liquids the National Formulary recommends either the simple or compound tincture of cudbear, the former for a bright-red and the latter for a brownish-red tint; of either tincture, two fluidrachms will suffice to color a pint of elixir. For alkaline liquids, such as elixir of ammonium valerianate, the coloring agent should be a solution of carmine, which is best prepared with the aid of ammonia water; the National Formulary furnishes a satisfactory formula for the same.

The Pharmacopia recognizes only two elixirs-namely, aromatic elixir and elixir of phosphorus; the former is simply a convenient vehicle or base for the preparation of many other elixirs, and has the following volume percentage composition: volatile oils, 0.33 per cent.; deodorized alcohol, 24.67 per cent.; syrup and distilled water, each 37.5 per cent. On account of the turbidity caused by the solution of the oils when mixed with the aqueous liquid, the addition of precipitated calcium phosphate becomes necessary; if the mixture be then well shaken, a clear filtrate can at once be obtained.

Elixir of phosphorus contains 0.00025 Gm. of phosphorus in each Cc., and also 55 per cent. by volume of glycerin; since phosphorus is very readily oxidized, the elixir should not be made in large quantities, and should be preserved in well-filled, tightly-stoppered, dark bottles. By following the pharmacopoeial directions exactly, a clear solution can readily be made.

It is not within the scope of this work to furnish numerous formulas for elixirs, but there are two elixirs which are deserving of special consideration, because they have been the source of much vexation to pharmacists; these are the elixir of the phosphates of iron, quinine, and strychnine, and the elixir of pepsin, bismuth, and strychnine.

Elixir Ferri, Quinine et Strychnine Phosphatum. While this preparation was originally intended to be an elixir of the three phosphates, very few manufacturers make this claim for their preparation, and the published formulas simply direct the use of phosphate of iron with the pure alkaloids, or the sulphates or hydrochlorides, of quinine and strychnine. Some of the commercial elixirs of the above name form clear mixtures with water; hence numerous efforts have been made to prepare an elixir which shall be permanent at all temperatures,

and miscible with water in all proportions. Want of uniformity in strength is another unfortunate feature in the many elixirs of phosphate of iron, quinine, and strychnine dispensed by pharmacists; some contain twice as much iron and quinine as others, and the amount of strychnine varies still more.

As a rule, the elixirs of phosphate of iron, quinine, and strychnine prescribed by physicians and offered for sale by manufacturers are supposed to be of one-half the strength of Easton's syrup, and to contain in each fluidrachm 1 grain of phosphate of iron, grain of phosphate of quinine and grain of phosphate of strychnine. This strength has also recently (1894) been adopted by the American Pharmaceutical Association, although the formula of the new National Formulary (revised edition) will direct the quinine and strychnine to be held in solution as alkaloids, and not as phosphates. Some of the elixirs of phosphate of iron, quinine, and strychnine, made with pure alkaloids, form turbid mixtures with small quantities of water (1 or 2 volumes), but become perfectly clear if more water be added (8 volumes); this is particularly the case with those containing an additional amount of simple syrup or some glycerin. Of the various formulas in use for this class, the following furnishes a very satisfactory light-colored (yellowish-green) preparation :

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Dissolve the alkaloids in the alcohol, add the syrup, and then 8 fluidounces of aromatic elixir. Dissolve the iron salt in the distilled water, by aid of a gentle heat (neutralizing the solution with ammonia, if necessary), mix with the alkaloidal solution, and add sufficient aromatic elixir to bring the total volume up to 16 fluidounces. If an elixir is desired containing the quinine and strychnine as phosphates, in perfect solution with the phosphate of iron, and yet not unpleasantly acid (for a large excess of phosphoric acid will accomplish the purpose), some other substance must be added which shall prevent precipitation. After numerous experiments I have found ammonium acetate to produce the best results and to yield an elixir which, even if made of double the stated strength, remains clear at a freezing temperature and mixes clear with water in all proportions. The very small proportion of ammonium acetate required is not in any way hurtful, and need not be considered any more than the alkali citrate in the soluble phosphate of iron.

All elixirs containing soluble phosphate of iron will darken materially if exposed to light, and particularly that made by the following formula: hence they should be preserved and dispensed in ambercolored bottles.

Dissolve the quinine and strychnine in the alcohol, add 6 fluidounces of aromatic elixir, and then the phosphoric acid. Add the ammonium carbonate to the acetic acid contained in a beaker or graduate, and when the solution is complete, add enough distilled water to bring the volume up to 6 fluidrachms. Mix the ammonium acetate solution with the solution of quinine and strychnine phosphates, and add enough aromatic elixir to make the liquid measure 14 fluidounces. Dissolve the iron scale salt in fluidounce of distilled water by the aid of a gentle heat, and if the solution be acid to test-paper, neutralize exactly with ammonia water, and add enough aromatic elixir to bring the volume up to 2 fluidounces. Finally mix the two solutions.

This preparation conforms in strength to that claimed for the majority of the elixirs offered on the market, containing, in each fluiddrachm, 1 grain of phosphate of iron, and grain of quinine and grain of strychnine, both in combination with phosphoric acid. If an elixir of twice the strength be desired, it can be readily obtained by doubling all the ingredients except the aromatic elixir.

With some samples of soluble phosphate of iron, a slightly increased quantity of the ammonium acetate solution may be necessary, possibly owing to a loss of water and consequent relative increase of the proportion of the iron salt.

Elixir Pepsini, Bismuthi et Strychnine. One of the chief difficulties in connection with this elixir has been the preparation of a neutral liquid which shall permanently retain all three of the active ingredients in solution. Pepsin is active only in acid fluids, and its action is inhibited, and in the course of time destroyed, by alkalies. The official bismuth and ammonium citrate is not a very stable compound, and although perfectly soluble when freshly prepared, in plain water, it loses this property in time, owing to decomposition of the ammonium citrate; in alkaline liquids it retains its solubility, but an alkaline fluid will not only interfere with the pepsin, but may also throw the strychnine out of solution. The best that has been accomplished thus far has been a neutral solution of these three active ingredients-of doubtful stability, however, and likely to lose the bismuth salt by precipitation.

Since physicians desire and extensively prescribe the elixir of pepsin, bismuth, and strychnine, it becomes the duty of the pharmacist to so prepare it that a permanent solution shall result; this can only be done with a liquid of acid reaction. In 1888, the

late R. Rother called attention to a permanent solution of bismuth and sodium tartrate of acid reaction, and suggested its use in place of the bismuth and ammonium citrate. I would recommend the following formula, which I have found to yield an unexceptionable preparation :

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1. Dissolve the pepsin in a mixture of 1 fluidounce each of glycerin and water. 2. Dissolve the strychnine with the tartaric acid in 23 fluidounces of water, and add the balance of the glycerin, the bismuth solution, the caramel, and the aromatic elixir. 3. Finally, pour the pepsin solution into the other liquid. In place of the pepsin a corresponding quantity of glycerite of pepsin, free from mineral acid, may be used, and in that case the water and glycerin must be reduced accordingly.

This preparation contains grain of official pure pepsin, 2 grains of bismuth and sodium tartrate, and 4 grain of strychnine, in each fluidrachm.

The glycerite of bismuth and sodium tartrate referred to in the above formula can be prepared as follows:

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Dissolve the bismuth salt in the nitric acid previously diluted with 10 fluidrachms of water; to the solution, slowly add 16 fluidounces of water. Now add 860 grains of powdered tartaric acid, and then, gradually, 977 grains of sodium bicarbonate. Dilute the magma of bismuth tartrate with 32 fluidounces of water. Set the mixture aside for five or six hours and wash by decantation and repeated affusion of water, until all nitric acid has been removed; drain the precipitate on a paper filter. Mix 977 grains of sodium bicarbonate with 5 fluidounces of water and gradually add 860 grains of powdered tartaric acid, warming slightly to obtain a perfect solution. Transfer the precipitate of bismuth tartrate to the solution of sodium tartrate and stir until dissolved; filter the solution, add the glycerin, and evaporate it on a water-bath, or dilute it with water, as may be necessary, so that the liquid shall measure 16 fluidounces. Each fluidrachm of this solution contains 16 grains of bismuth and sodium tartrate with an excess of sodium tartrate.