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Transcriber's Note: Do NOT attempt these formulas.




CANDY MEDICATION

    BY
    BERNARD FANTUS, M. D.
    Professor of Pharmacology and Therapeutics, College of
    Medicine, University of Illinois, Chicago.

[Illustration]

    ST. LOUIS
    C. V. MOSBY COMPANY
    1915




    COPYRIGHT 1915, BY C. V. MOSBY COMPANY

    _Press of
    C. V. Mosby Company
    St. Louis_




PREFACE.


CANDY MEDICATION has given such delightful results in practice among
children that the author believes it should be more widely known
and used. A formulary to serve as the common meeting ground for the
prescribing physician and the dispensing pharmacist seems absolutely
necessary to make this form of medication more generally available; and
it is mainly to supply this formulary that this little book has been
published.

Researches conducted by the author in the Pharmacologic Laboratory of
the University of Illinois during the past five years, as well as the
experience gained by the use of this form of medication in private
practice, form the basis of this publication.

To give the best results, the sweet tablets described in this formulary
should be freshly prepared on physician's order; thereby securing
efficiency and palatability to the highest degree, and enabling
the physician to prescribe the dose and combination needed for the
particular case in hand. To bring these tablets into the category of
extemporaneous preparations, the author has elaborated the process of
"fat covering" which makes the preparation of these tablets no more
difficult than the making of pills or of suppositories.

In the pages that precede the formulary, an attempt has been made to
present the principles that have been used in the elaboration of the
formulae, so that formulae for other medicaments suitable to this form
of administration may be developed.

Concise directions on the care and use of the tablet machine have been
included, to enable any pharmacist equipped with an inexpensive tablet
machine to prepare these tablets without difficulty.

The author is keenly aware of the fact that there are probably still
some imperfections in the formulae given herein; though he has
spared neither time nor labor in making them as perfect as possible.
Therefore, comments and criticisms, as well as suggestions, are most
welcome, and will receive careful consideration.

It is the author's hope that this booklet may be instrumental in
robbing childhood of one of its terrors, namely, nasty medicine; that
it may lessen the difficulties experienced by nurse and mother in
giving medicament to the sick child; and help to make the doctor more
popular with the little ones.

                                             BERNARD FANTUS, M.D.

    _Chicago, March, 1915._




CONTENTS.


    CHAPTER                                                PAGE
       I. Historical Introduction                           11
      II. Tabellae Dulces                                   14
     III. The Uses of Sweet Tablets                         16
      IV. The Making of Sweet Tablets                       23
       V. The Tablet Machine                                27
      VI. The Construction of Formulae for Sweet Tablets    31
            Choice of Flavor                                31
            Subduing of Tastes                              31
            Choice of Color                                 34
     VII. Formulae for the Preparation of Sweet Tablets     35
    VIII. Formulae for Stock Preparations                   72
          References                                        75
          Index                                             77




CANDY MEDICATION




CHAPTER I.

HISTORICAL INTRODUCTION.


THE IDEA of presenting medicine in candy form is really very old.
The term confection, which originally meant a medicinal compound
being derived from the Latin word "_conficere_," to put together, has
been applied since the days of classical antiquity to mixtures of
medicinal substances with saccharine matter. The only official relics
of this once very extensive class of preparations are the confection
of rose and the confection of senna; both of which, however, are
also practically obsolete. The reason for this is not difficult to
find. Neither of them come up to our modern ideas of a confection.
We may officially call them a confection, but a youngster would be
disrespectful enough to disagree with the pharmacopoeia.

More closely akin to candy are lozenges, and yet they are not real
candy. The only one among them that is pleasant is the santonin
lozenge; and it is the only one that is popular. An especially good
imitation of candy form are the deservedly popular so-called German
worm lozenges. It was acquaintance with these that led the writer to
seek for other real candy medicaments. He could find only two such upon
the market: viz., Calomel Tablets under the name of "Aromatic Calomel,"
and Phenolphthalein Tablets under various fanciful trade-names, such
as "Purgen," "Phenolax," etc., unless "Candy Cathartic Cascarets,"
and the French candy laxative known as "Tamar Indien" were also to be
included.

       *       *       *       *       *

Convinced that administration in candy form would be ideal for
children, the author took a number of years ago a course of instruction
with a candy-maker, in the hope of finding in the confectioner's art
some new form of pleasant administration for medicine. He made sulphur
taffy and cod-liver oil chocolate creams;[1] but these and a large
number of other attempts were unsuccessful. It may be of interest,
in this connection, to note that, in 1911, Sir James Sawyer[2]
published in "The Lancet" a process for the production of what he
calls "cremulae" or medicated chocolate creams. They were prepared by
evaporating a mixture of sugar and of milk to the consistency of paste,
in which various medicaments might be incorporated, and which is then
covered with chocolate, as in the popular chocolate drop. This is, as
will be seen, a troublesome process. The author's studies in the candy
shop seemed to point to "fondant" as the most suitable candy form for
purposes of medication. "Fondant", however, has the disadvantage of
becoming hard with age. Free from this objection and closely similar
to the "fondant" is a rather lightly compressed tablet made of finely
powdered cane sugar. And so finally the tablet form was chosen as
the best and most convenient for candy medication--a form which was
already in successful use, as has been stated, for the administration
of calomel and of phenolphthalein. For such tablets the term _tabellae
dulces_,[3] or sweet tablets, might be proposed.




CHAPTER II.

TABELLAE DULCES.


TO BE SUCCESSFUL, sweet tablets must meet the following requirements:

1. They must be perfectly delicious sweets, attractive in form, color,
and odor; and free from the slightest suspicion of disagreeable or
medicinal taste.

2. They must disintegrate rapidly in the mouth; for a sick child will
usually not suck candy as a healthy youngster would.

3. To constitute a real advance in therapeutics, it must be possible
for the average pharmacist to prepare them extemporaneously, so that
the physician may be able to fit the medicament to suit the case,
and that the pharmacist may not be forced to carry in stock a large
assortment of these more or less perishable goods.

In view of these exacting requirements, it may seem remarkable
that over fifty different medicaments are at present available for
administration in the form of sweet tablets. This has been accomplished
by taking advantage of the fact that some medicines are practically
tasteless; that modern synthetic chemistry has enriched our resources
in this direction by the production of a large number of tasteless,
or almost tasteless, and yet active substances; and that many of the
isolated active principles of drugs are easily disguised. In some
cases a chemical trick is successful, e. g., using a little alkali
or a little acid to render the substance less soluble in the mouth.
Some of the bitterest alkaloids, e.g., strychnine, have been rendered
available for candy medication by the use of finely powdered fuller's
earth, or of Lloyd's Reagent, to be described later. Quite a number of
almost insoluble substances of slight but lingering taste can be made
perfectly pleasant by saccharinization.




CHAPTER III.

THE USES OF SWEET TABLETS.


IT MAY seem strange that modern pharmacy which boasts of so many
elegant and palatable preparations suitable for adults, has thus far
done so little to render medicine more acceptable to children; and yet
attractiveness and palatability are even more important for the little
ones than for the grown-ups. Syrups have hitherto been our chief aids
in making medicines more pleasant for children. Unfortunately, however,
many a child has had its palate offended by liquid medicines to such
a degree that it abhors spoon-medicine of any kind, and will struggle
even against the most palatable. When one witnesses the struggling
of the average child against the average medicine, one cannot but
wonder whether at times the struggle does not do more harm than the
medicine can do good, and wish that we had other means of administering
medicines to the little ones. As all children love candy, this would
seem the form most desirable for them. For one who has not used candy
medication there is a revelation in store in the positive enjoyment
and eagerness with which children take these sweet tablets. And many
a petted child that has grown up into a sensitive woman, who believes
she cannot swallow a pill, also cannot and will not take medicine. It
so happens that just these are often excessively fond of candy and
will take candy medicine. Another use for candy medication is in the
treatment of the insane, who frequently will not take medicine, but may
take it in candy form.

It may be of interest to see how many indications may be met, confining
oneself entirely to the list of candy medicaments:

1. For effect upon the alimentary tract:

    _Absorbent:_
        Charcoal.

    _Antacid:_
        Chalk.
        Magnesia.
        Sodium Bicarbonate.

    _Emetics:_
        Apomorphine.
        Tartar Emetic.
        Emetine.

    _Antiemetics:_
        Cocaine.
        Anaesthesine.
        Morphine.
        Bismuth Subnitrate or subcarbonate.
        Chalk.
        Cerium Oxalate.

    _Antidiarrheal:_
        Bismuth Subnitrate or Subcarbonate.
        Tannalbin.
        Morphine.
        Chalk.

    _Cathartics:_
        Calomel.
        Mercury with Chalk.
        Phenolphthalein.
        Elaterin.
        Resin of Podophyllum.
        Resin of Jalap.
        Senna.
        Sulphur.

    _Antispasmodic:_
        Atropine.

    _Intestinal Antiseptic:_
        Magnesium salicylate.
        Mercurials.
        Lactic acid ferment.

    _Anthelmintic:_
        Santonin.


2. For effect upon the respiratory system:

    _Expectorants:_
        Apomorphine.
        Emetine.
        Terpin hydrate.
        Sajodin.

    _Antitussic:_
        Heroine.
        Morphine.
        Sabromin.

    _Antispasmodic:_
        Atropine.


3. For effect upon the circulatory system:

    _Circulatory Stimulants:_
        Digitalis.
        Strophanthin.
        Atropine.
        Strychnine.
        Caffeine.

    _Circulatory Depressant:_
        Aconitine.

    _Vaso-Dilator:_
        Nitroglycerin.


4. For effect upon genito-urinary system:

    _Diuretic:_
        Diuretin.
        Caffeine.

    _Urinary Antiseptic:_
        Hexamethylenamine.


5. For effect upon skin:

    _Diaphoretic:_
        Pilocarpine.
        Dover's Powder.

    _Anhydrotic:_
        Atropine.


6. For effect upon nervous system:

    _Depressants:_
        Morphine.
        Hyoscine.
        Sabromin.
        Sulphonmethane.
        Adalin.

    _Stimulants:_
        Atropine.
        Cocaine.
        Strychnine.
        Caffeine.


7. Antipyretics