Chapter VII: Alcohol in Pharmacy

In the _Journal of the American Medical Association_ for November 13, 1897, Dr. T. D. Crothers, editor of the _Journal of Inebriety_, says in a paper upon "Concealed Alcohol in Drugs":--

"A very important question has been repeatedly raised, and
answered differently by persons who claim to have some expert
knowledge. The question is, can strong tinctures of common drugs
be given in all cases with safety; tinctures of the various
bitters which contain from 10 to 40 per cent. of alcohol, and
are used very freely by neurotic and debilitated persons? It is
asserted with the most positive convictions that such tinctures
are more sought for the narcotic effect of the alcohol than for
the drugs themselves.

"In my experience a large number of inebriates who are restored,
relapse from the use of these tinctures given for their
medicinal effects. * * * * *

"The question is asked, how much alcohol can be used as a
solvent in drugs without adding a new force more potent than
that which is brought out by the alcohol? Opinions of experts
differ. One writer thinks 10 per cent. of alcohol in any drug
will, if given any length of time, develop the physiologic
effect of alcohol in addition to that of the drug. An English
writer says that in some cases a 5 per cent. tincture is
dangerous from the alcohol which it contains.

"There is some doubt expressed by many authorities as to the
potency of a drug which is covered up in a strong tincture. It
is clear that the value of a drug is not enhanced, and it is
certain that a new force-producing, or exploding agency, has
been added to the body.

"In experience, any drug which contains alcohol can not be given
to persons who have previously used it without rousing up the
old desire for drink, or at least producing a degree of
irritation and excitement that clearly comes from this source.
It is also the experience of persons who are very susceptible to
alcohol, that any strong tincture is followed by headache and
other symptoms that refer to disturbed nerve centres.

"In many studies I have been surprised at the increased action
of drugs when given in other forms than the tincture. Gum and
powdered opium, have far more pronounced narcotic action than
the tincture. Yet the tincture is followed by a more rapid
narcotism, but of shorter duration, and attended with more nerve
disturbance at the onset.

"I am convinced that a more exact knowledge of the physiologic
action of alcohol on the organism will show that its use in
drugs as tinctures is dangerous and will be abandoned.

"There are many reasons for believing that its use in
proprietary drugs will be punished in the future under what is
called the poison act."

Dr. J. J. Ridge published in May, 1893, in the _Medical Pioneer_, the following statement of the pharmacy of the London Temperance Hospital:--

"When the Temperance Hospital was first opened, it became a
question of practical importance, what should be done with
regard to the alcohol so largely employed as a vehicle and drug
excipient. Not that the principle of the treatment of disease
without the ordinary administration of alcoholic beverages
precludes the employment of alcoholic tinctures, but it was felt
that in such a test case as this it was important to obviate the
objection that while withholding alcohol as a beverage, it was
given in the medicine. As a matter of fact, it is surprising,
when one looks into it, how much alcohol is often given merely
as a vehicle for other drugs, and without the special action of
alcohol being required or desired. In prescriptions which are to
be seen in many text-books, it is not uncommon to find from one
to two or three, or even four drachms of rectified spirit in the
form of tinctures or spirits. This is very undesirable. If
alcohol is needed it should be given in proper measured dose.
But if it is not indicated, then it is not well to administer it
in this indirect manner.

"Experiments were therefore made, partly at the hospital and
specially by Messrs. Southall Bros. & Barclay, of Birmingham,
with the result that new non-alcoholic tinctures were made
replacing the following alcoholic tinctures and wines:--

Tinct. Aloes.
" Arnicae.
" Aurantii.
" Belladonnae.
" Buchu.
" Calumbae.
" Camph. Co.
" Capsici.
" Cascarillae.
" Catechu.
" Chiratae.
" Cinchonae Co.
" " Flav.
" Cinnamomae.
" Colchici Sem.
" Conii.
" Digitalis.
" Ferri Acet.
" Ferri Perchlor.
" Gentiani Co.
" Hyosciami.
" Kino.
" Krameriae.
" Limonis.
" Lobeliae.
" Nucis Vomicae.
" Opii.
" Quassiae.
" Rhei.
" Scillae.
" Serpentariae.
" Stramonii.
" Valerianae.
" " Ammon.
Vin. Aloes.
" Colchici Rad.
" " Sim.
" Ipecac.
" Opii.
" Rhei.

"These were made by extracting the principles of the drugs in
the usual way except that instead of alcohol a mixture of
glycerine and water was used in the proportion of one-fourth to
one-third part of glycerine, and about five per cent. of acetic
acid. These made very elegant preparations, and in the majority
of cases appeared to have just the same, and just as great
physiological action. Subsequently the ordinary tinctures were
distilled, and the extracts thus obtained dissolved in the above
menstruum, as far as was possible, in most cases the residuum
being found to be inert.

"Gum resins and essential oils were found to be insoluble in
this menstruum, and hence such drugs have been given in the form
of pill, powder or mixture. Such tinctures are those of
assafoetida, benzoin, cannabis indica, cantharides, castor,
cubebs, lavender, myrrh, pyrethrum, sumbul, tolu and ginger. Out
of 62 tinctures it was found that 46 made good preparations, and
16 did not.

"These were employed for several years. But for some time past,
somewhat more reliable preparations have been made for us which
contain _all_ the constituents of the alcoholic tinctures
without the alcohol. They are for the most part made by taking
standardized tinctures, mixing with them sugar of milk, and
distilling off the alcohol. The alcoholic extract remains behind
in a finely divided condition mingled with sugar of milk. This
is broken up, pulverized and compressed into tabloids of a
definite dose, which can be taken either in that form or rubbed
up and dissolved or suspended in gum water.

"The following have been made up in this form: aconite,
belladonna, camph. co., cannabis indica, capsicum, cinchon. co.,
and cinchon. simpl., digitalis, gelseminum, hyosciamus, nux
vomica, opium, strophanthus, ginger and Warburg. Other tinctures
will be gradually added to this list.

"As external liniments those commonly used are the linimentum
terebinthinae and the linimentum terebinthinae aceticum, which do
not contain alcohol. A strong solution of iodine is made with
iodide of potassium.

"The spiritus ammoniae aromaticus is made without the spirit, the
aromatic oils being emulsionized by means of rubbing up with
fine sand, but most of these subsequently rise to the surface.
The spiritus etheris nitrosi is impossible without alcohol, but
nitrite of amyl, and nitrites of potash or soda can be
substituted. The spiritus chloroformi is replaced by aqua
chloroformi, or as a sweetening agent by solution of saccharin.
Thus a favorite expectorant mixture contains carbonate of
ammonia five grains, acetum ipecac, ten minims, and solution of
saccharin in each dose.

"As a special stimulant a subcutaneous injection of a drachm of
pure ether has been given in a few cases; in others digitalis,
or caffeine or ammonia in some form, such as the carbonate
dissolved in a cup of hot coffee; or hot solution of Liebig's
extract, or rectal injections of hot water."

It may be objected by some that glycerine belongs to the family of alcohols, hence hospitals using glycerine tinctures are not, strictly speaking, non-alcoholic. To this the answer is, that while glycerine certainly is classed in the family of alcohols, it is of a very different nature from ethyl alcohol, which is used for beverage purposes. Ethyl alcohol, the alcohol in all intoxicating beverages in common use, and the alcohol generally used in medicine, creates a fatal craving for itself, and is injurious to the body. Glycerine does not create any craving for itself, and has not been demonstrated to have injurious properties, and is not used for beverage purposes.

At the annual meeting of the New York State Medical Society, held in New York City, in October, 1898, a discussion was held upon the use of alcohol as medicine. Dr. E. R. Squibb, a leading pharmacist of Brooklyn, stated that during the last two or three years much had been accomplished in retiring alcohol as a menstruum for exhausting drugs. Of the other menstrua experimented with up to the present time, that which had given the best results was acetic acid, in various strengths. It had been discovered that a ten per cent. solution of acetic acid was almost universal in its exhausting powers. There were now in use in veterinary practice, and in some hospitals, extracts made with acetic acid. They were made according to the requirements of the pharmacopoeia, except that acetic acid was substituted for alcohol. Acetic acid, when used with alkaloids gives the physician some advantages in prescribing, owing to there being fewer incompatibles. In small doses, the percentage of acetic acid in the extract is so small as to be hardly appreciable, and when larger doses are required, the acetic acid can be neutralized by the addition of potash or soda.

Dr. Noble said, in article to _London Times_ before referred to:--

"Modern science has shown that those drugs which are soluble in
alcohol only, are, in all probability, more hurtful than
useful."

The following from Dr. Jas. R. Nichols, editor Boston _Journal of Chemistry_, is too good to be omitted, although it should be familiar to temperance students:--

"The facetious Dr. Holmes has said, that if the contents of our
drug-stores were taken out upon the ocean and thrown overboard,
it would be better for the human race, but worse for the fishes.
This statement may be a little sweeping; but it is true that all
the showy bottles in drug-stores which contain alcoholic
decoctions and tinctures might be submerged in the ocean, and
invalids would suffer no detriment. Since the active alkaloidal
and resinoidal principles of roots, barks and gums have been
isolated and put in better and more convenient forms, there is
no longer need of alcoholic tinctures and elixirs. Laudanum,
which is a tincture of opium, might be banished from the shelves
of every apothecary, as it is not needed. It is now known that
the valuable narcotic and hypnotic principles of opium are
contained in certain crystalline bodies, which can be isolated,
and used in minute and convenient forms, and that they can be
held in aqueous solutions. Alcohol is no longer needed to hold
the active principles of opium, Peruvian bark or other
indispensable drugs. As regards the vegetable tonics so called,
the best among them is the columbo (Radix columbo) and this
readily yields its bitter principle to water, as does quassia,
gentian, senna, rhubarb and most other valuable substances. A
careful survey of the contents of a well-appointed modern
pharmacy leads to the conclusion that there is no one
indispensable medicinal preparation which requires alcohol as a
free constituent.

"The catalogue of modern remedies is almost endless, and many of
them hold alcohol in some form; but every intelligent physician
knows that 90 per cent. of these alleged remedies have little or
no intrinsic value. The nostrums of the quack, the bitters,
elixirs, cordials, extracts, etc. nearly all contain alcohol,
and this is the ingredient which aids their sale. The whole
unclean list might, with advantage to mankind, be thrown to the
fishes.

"The chemist, more particularly the pharmaceutical chemist, may
inquire how he is to conduct his processes without alcohol. It
is from the pharmaceutical laboratory we derive some of the most
important substances used in medicines and the arts. Among them
may be named ether, chloroform and chloral hydrate, three of the
most indispensable agents known to science, and the employment
of alcohol is essential to their production. Alcohol is a
laboratory product; it is a chemical agent which belongs to the
laboratory; it is the handmaid of the chemist, and, so long as
it exists, should be retained within the walls of the
laboratory. In the manufacture of most of the important products
in which alcohol is either directly or indirectly used, its
production may be made simultaneous with the production of the
agent desired. In the manufacture of ether and chloroform, the
apparatus for alcohol may be made a part of the devices from
which the ultimate agents, ether and chloroform, result.
Fermentation and distillation may be conducted at one end, and
the anaesthetics received at the other. It is true that in a
chemical laboratory alcohol is an agent very convenient in a
thousand ways. But, if it were banished utterly, what would
result? There are other methods of fabricating the useful
products named, and many others, without the use of alcohol, but
the processes would be rather inconvenient and more costly. The
banishment of alcohol would not deprive us of a single one of
the indispensable agents which modern civilization demands, and
neither would chemical science be retarded by its loss."

"It must be remembered that modern science has given us
glycerine, naptha, bisulphide of carbon, pyroligneous products,
carbolic acid and a hundred other agents which are capable of
taking the place of alcohol in a very large number of appliances
and processes."

The sale of liquor in drug-stores is beginning to be deplored by the more respectable pharmacists. At the annual meeting of the Massachusetts State Pharmacists' Association in 1895 the president said in his address:--

"One thing that every pharmacist, who has the best interests of
his calling at heart, must bear in mind is that the liquor part
of their business is being, and must be, slowly crowded out.
Public sentiment has changed greatly in the last few years, and
instead of all being classed alike, the line has been sharply
drawn, and the stores that sell the least amount of liquor that
they possibly can are gaining the confidence and esteem of the
public, and consequently their business is growing from year to
year, while the others are losing ground and dropping lower and
lower."

The _Evening Record_ of Boston contained the following in its issue of March 7, 1896:--

"The number of flagrant offences on the part of druggists in
certain no-license towns--offences not only against the liquor
laws, but also against the laws of decency and humanity--brought
before the board of pharmacy, would appall the public if they
were known. The Looker-On has seen the record of several of
these druggists as transcribed from the police courts and they
are very black records. One druggist after selling liquor over
and over again to one customer, and several times getting him
completely intoxicated, finally deposited him one night in a
snowbank, in a state of frozen stupor, where he would have
frozen to death had not the wife of the druggist's clerk
threatened to complain to the police unless he was rescued.

"The story is told of one of the druggists of a neighboring
no-license town. A man came in and asked for a pint of whisky.
He was asked what he wanted it for. His reply was that he wanted
it to soak some roots in. He got it, and as he went out he dryly
remarked, 'I should have told you that it was the roots of me
tongue that I want to soak.'"