alkermes was a modification of an 8th-century tonic "confectio alchermes." the tonic included raw silk, apple juice, ground pearls, musk, ambergris, gold leaf, rose water, cinnamon, sugar and honey. in pre-modern medicine, it was ranked among the best cardiacs, and was frequently used for the palpitation of the heart, or syncope, sometimes for smallpox and measles and a general restorative.