A TR E ATI S E O N

PR E S CR I PTI O N
I NC O M P AT I B I L I TI E S
A ND D I F F I CU L TI E S
I N CLUD IN G PR ES CR I PT I ON O D D I TIE S AN D C UR I OS I TI E S

F OR PHARM ACI STS AN D P HYS I CI AN S AN D S T UD E N TS

I N PHAR MACY AN D MED I CI NE

BY

W I LLI AM J R OBI N S ON PH G
.
, . .
, MD
. .

E DI TO R O F THE C RI TI C A N D G U I DE A N D TH E AME R I CAN J O UR N A L

OF U R O LO G Y A N D S EX O LO G Y

Formerly P resident New York Boa rd Ph ar macy I m

am; F allow New York Academy
of Medwtne A me rica n Mod A n ociatwn num ber N ew York S tate a nd
' '

, .

County Medical S ociety . A merican A uocial wn for tlw A dva nce

 TO THE ME MORY
OF

CH ARLE S R I CE
or m N o u ns: R E PR E S E NTATIVES or

Pao mssxo r un Pmunucr

IN THIS co m a!

A Mo nmr '
AN D UN sm
u xsn
-
MAN or S m
cu

I GR ATE F U LLY A ND m y

Dnmcu n m s vonm
W J
. . R.
 PR E F A CE
RA NKN E SS deman ds the statement that the s ubj e ct of
Presc ri ption Incompatibilities is of consi derab l y less
importance now tha n i t was twenty or thi r ty yea rs
a go I t was a rare d ay t h en whe n an ed itor of a pharma
.

ce utical j o urn a l o r one who was consi d ered an expe rt i n

solving incompatible ri ddles did not receive orally o r i n writ

ing a d espai ring call for h e l p from some sorely p uzz l ed d r ug
gist who in attemptin g to p ut up a prescri ption as written
,

by the d octor got a n unsightly impossible ma ss a strange

, , , ,

un l ooke d fo r colo r o r perhaps a dan gero usly explosive m ix

-

t ure A nd ph armace utica l j o urna l s d evote d a goo d d ea l more

.

spac e tha n they do now answering t h e “

incompatibl e ”

q ue ri es of thei r s ubscribers T h e fl ood of new remedies and

.

synthetics was then at its heigh t and t h e physicia n still un

we ane d from his h abi t of po l ypharmacal p rescribing insisted
on j oining to gether th ings whic h t h e sp irits of chem ist r y ,

p h armacy and therape utics i nten de d sho ul d be kept as under .

T he i dea at that time was stil l pretty gene ral that t h e va l ue

of a p r escription increased i n d i rect ratio to th e n umber o f
its in gre d ients A nd the res ul t was—not i nfre q uently—a
.

spoile d use l ess l udicro us or even d angero us combination

, , ,
.

T h ings are d i fferent now Our propagan d a d uring the

.

past twenty fi ve years i n favor of simple rationa l prescrip tions

-

h as borne fruit T h e modern physician does not believe in

.

s h otgun prescriptions ; he prescribes one seld om more th an ,

two or t h ree active ingre d ients in a prescription I n fact .

,

t h e ten d ency is n ow towa rds t h e ot h er extre me : sin gl e reme

d ies is the slogan the p h ysician t h us not infre q uent l y d e
,

p r iv ing h imself of val uabl e synergistic o r corrective combi

5
 impossible abs ur dities .

Nevert h eless t h e days of incompatible prescript i ons an d

,

questionable combinations are not entirely ove r Not as .

often as formerly b ut still often eno ugh is t h e a ut h or ap

,

peale d to to clear up difiicult points in p h ysici ans p r escr ip

‘ ’

tions and it is lack of t ime and not lac k of opport unity

,
-

, ,

t h at prevents h im from playing t h e r ole of oracle on ih

compatibilities to t h e p h armace utical profession No t h e .
,

subject of incompatibilities h as not yet altogether lost its

importance A nd eve r
.

y intelligent p h armacist as well as

every self respecting and conscientio us p h y sician s h o uld be
-

on terms of familiarity wit h t h e salient facts of prescription

writing so t h at t h e latter may avoi d and t h e former correct
,

glaring absur dities .

It is j ust a quarter of a century since the a uth or began

to teac h and to write on t h e s ubj ect of t h is book H is fi r st .

Treatise on Prescription Incompatibilities and D i ffic ulti es

appeare d in Merck s R eport w h ere it ran for severa l yea rs
’
, .

In a revise d form it was p ublis h e d i n T h e C R ITI C and G UIDE

for 1 90 3 1 90 4 and 1 90 5 It is not a mere p h rase to st ate
, .

t h at t h e Treatise met wit h ex cep tiona l favor It was cl aimed .

t h at t h e aut h or was the only writer i n t h e fi eld who suc

ceeded in making a d reary and dr
y as d ust s ubj ect rea d ab l e
- -

and interesting A nd being interesting t h e s ubj ect became

.
,

memorizab le ; it left an impression on t h e tablets o f one s ’

memory wh ic h a d reary non interesting s ubj ect rarely does

, ,
-

T h e re quests to reprint t h e Treatise i n a separate vol ume

were quite n umerous— b ut then a b usy practice an d ot h er ,

more interesting literary work ma de compliance with t h e r e

quest a practical impossibility A nd wit h each year t h at .

passe d t h e Treatise became more ina de q uate—beca use new

remed ies came into use an d wit h t h em new incompatibili
ties and t h e composition of certain p h armacopeial galenicals
,

became ch anged so t h at explanations and criticisms which

,
 R E F A CE P 7

he l d good be for e he l d g ood no l o nge r To b ring the Tr eatise

, .

on Presc r i ption Incomp atibi l ities up to date re qui r e d con

sid ab l a d ditions a few eliminations and a t h oro ugh t e
er e ,

vision . I d espaire d of eve r having the time to devote to it.

B ut I recently ach ieve d some l eis ure and I have taken the
O pport unity to s ubj ect the T reatise to a thoro ugh revision

and to b ring it up t o d ate A nd I now take pleas ure i n p re

.

sent ing t h is enlarge d and rev ise d T reatise on Prescription

Incompatibilities and Diffi culties in c l uding P rescription ,

O d d ities and C uriosities to my friends i n the pha rmace utic al

,

and medica l professions .

A word on the k ind of p rescri pti ons and incom patibi l ities
that are disc ussed i n this T reatise T h ey are bon a fi de p re.

scr ip tions and combinations and the incompatibilities ar e

,

s uch as h ave presente d themselves to some dr uggists and

p h ysici ans and are ap t to present t h emse l ves again to others .

I t is not only sup e r fl uous and unnecessarily space consum -

ing b ut i t is m in d conf using and d isco ura ging to p resent

,
-

i ncompatibi l ities in prescriptions whic h neve r h appened and

n ever co ul d h appen beca use no physici an i n h is wi l dest fl ights
,

of fancy wo ul d ever think of writing s uch comb inations .

Let me i ll us trate by some exam ples : O f what use is i t

t o tel l a physician or a pharmacist or a med ical or pha r ma ,

ceutical st udent t h at m ucilage o f acacia is p recipitated by

,

sodi um phosphomo l yb date tha t acetani l i d gives a white p re

,

cip itate with bromine that meconic acid gives a precipitate

,

wit h bari um ch l oride that uret h ane give 0 3 some ammonia

,

w h en h eate d with a so l ution of potassi um or sodi um hy

d r ox id e that ca dmi um salts are p recipitate d by a l ka l i car
,

b onates and ch romates that gamboge wit h ammonia wate r

,

gives a yellow colore d sol ution th at a mixt ure of cocaine,

an d calomel ac q uires a d ark color if the fumes of hydr o

c h lori c aci d are blown over it that a sol ution of methy l

,

t h ionin e h y d roc h lori de is p reci pit ated by potassi um bi chro

m at e t h at piperazine explo d es w h en heated t o a cert ain tem
,

p er atur e with sodi um hyp och l ori te that potassi um sal ts give
,
8 P RE F A CE
a y ell ow p r ecipitate with a ndp l ati nic ch l o r ide
h y d roch l ori c
aci d t h at s ugar is decompose d with ignition by co ncentrate d
,

s ulph uric aci d t h at t h ymol is incomp atible with chromi c

,

aci d etc etc — t h e list co ul d be exten de d indefinitely

,
.
,
. .

It is not merely sup er fluous b ut as stated ab ove is confus

, , ,

ing and d isco uraging to t h e student F or seeing t h at most .

,

drugs have dozens and some even h un d re ds of incomp ati

b ilities h e loses courage and despairs of ever mastering the
,

s ubj ect Wh y many of t h e c h emicals given as incomp atibles

.
,

of t h is that and t h e oth er t h ing are n ot even me dicinal

,

preparations are never used in medicine are never prescribe d

, ,

and conse quently can never form the s ubj ect of p r escr ip tion

incompatibilities ! Wh o ever h ear d o f a doctor p rescribing

acacia with so dium p h osphomolyb date acetanili d wit h bro ,

mine ( elementary b r omine l) ? A nd of what in te rest is it to

a student of incompatibilities to know t h at meconic acid
is incompatible wit h bari um ch lori de ? Have the two eve r been
prescribe d ? A nd has a d octor ever prescribed s ugar with
concentrate d s ulphuric aci d ? Or has anybo dy eve r ord ered
to blow t h e fumes of HCl over a mixt ure of cocaine and
calome l ? A nd so ou S o what is i t all for ? T h e example s
.

I h ave en umerate d are chemical tests and reactions— they are

useful in t h eir place b ut t h ey have nothing to d o wi t h t h e
,

s ubj ect of incompatibilities T h is book will be fo un d free

.

from the sup er fl uities referr e d to and will i t i s h ope d be

, , ,

fo un d more acceptable and more useful on that acco unt .

W J R
. .

12 Maunt Morris P ark W est

 I NT R O D U CT I O N
HE s ubj ect of incompatibilities h as alway
been th e s

b é te noir e of the pharmacist a a n d p h ysici n

Whether .

it is beca use the s ubj ect is really a d ifficult one o r ,

beca use it has not receive d p roper and satisfacto ry tre at

ment in our text books in our pharmace utical and me d ica l
-

j o urna ls or beca use the e ducational stan d ard of t h e pharma

,

cist and p h ysici an is not high eno ugh not, b road eno ugh to
,

en ab l e t h em to master the s ubj ect thorough l y certain it is ,

th at the n umbe r of pharmac ists and p h ysicians who are abl e

to grap ple s uccessful l y with a ll the intricacies of p r escr ip
tion incompatibil ities i s a very l imite d one It sha l l be the .

p urpose of this treatise to so l ve the m any mysteries of incom

p atib ilities It is the a uthor s conviction based upon an e x p e
’
.
,

ric uce of many years th at there is n o s ubj e ct no matter how

, ,

apparently intricate and complicate d that cannot be mas ,

te r e d by a person o f ave rage i ntelligence provi de d it be ,

p resented i n the p roper l ight and in a proper manne r ; th at

there is n o s ubj ect no matter h ow dry that cannot be m ade
, ,

interest in g and attractive .

The a uthor s opport unities for seeing and ana l yzing incom
’

p atible prescriptions have a l ways been exceptiona l ly favor

ab l e on es Besi des the l arge co l lections h e h as m a de in h is
.

quon dam d rug store p ractice he is constant l y re ce ivin g in

-

quir ies from pharmacists in various parts of the city and

co untry regard ing some moote d p oints
,
He is also fr e .
~

quent l y honore d with letters from p h ysicians who on getting , ,

untoward e ffects from some combinations ask for en l ighten ,

ment T hey fr e quently in q uire whet h er it is the fa ul t of

.

th e c ombin ations o r whether t h e dr uggist h ad perh a ps sub

,

9
 10 PRE S CRIPTION INCO MP A T I B ILIT I E S
s tit ute d somet h ing else for what had been p rescribed .

Finally t h e a uth or had bee n for a n umber of years regul ar

,

cons ultant to a n umber of p h armace utical j o urnals and

”

in t h is capacity h e h as had to analyze and exp l ain incom

patible prescriptions almost d aily .

As to w h y I consi der th e s ubj ect of prescription incomp ati

b ilities of s uc h paramo unt importance to t h e pharmacist I ,

can do no better t h an to quote from a p aper of mine on the

s ubject rea d at t h e Twenty secon d A nn ual Convention of
,
-

t h e New Y ork State P h armace utical Association I sta rte d .

t h at paper by stating t h at t h e b usiness of t h e retai l p h arma

cist of t h e present day consiste d of t h ree branc h es : t h at o f
man ufact uring galenical preparations t h at of sel ling p atent ,

me di cines d r uggists s un d ries etc and that o f dispensing

,
’
,
.
,

p h ysicians prescriptions
’
.

T h e fi r st two departments h ave been encroache d upon t o

a very great extent T h e large man ufact uring ho uses wit h
.

limitless facilities improve d mac h inery immense capital and

, ,

mo dern met h o ds have been able to o ffer certain classes o f

preparations to the retail d r uggist at s uch a p rice as to take
away from h im every incentive to do his own manufactur
ing A nd t h ere is no help for that No matter how we may
.
.

d eplore t h e fact t h at t h e druggist o f the present da is

y
unable to sprea d a p l aster or roll a pi l l so d extero usly as d id
the apothecary of a generation or two ago y ou cannot change ,

t h e ten dency of the times F or the sake of sentiment n o

.

dr uggist will spen d several ho urs in making a p reparation

,

w h ic h h e can p urch ase rea dy ma de and as well m ad e at a

lower price .

T h e sale of patent me dicines etc is being eve ry day more

,
.
,

and more monop olize d by the T h is is

'

department stores .

also inevitable as will be a dmitte d by any one w h o h as

,

g ven t h e subj ect some thought and who can r ead the sign s
i

of t h e times .

there is one department which is sti ll the pharmacist s

B ut ’

—
own a department which distinguishes him as a pr ofes
 P RE S C RIPT I ON I NC OMP A T I B IL IT I E S 11

sional m an and elevates h i m above the ordinary merch ant .

I refe r t o t h e p resc ription d epartment That is a dep art .

ment w h ich nobo dy ca n take away from t h e p h armacist ; b e

ca use while no l aw can be pa sse d to prevent people from
,

sell ing or dina ry d r ugs and p atent me d icines the dispensing ,

of p rescriptions can be l imite d to qualifi ed ph armacists only .

An d to t h e d evelopment of th is dep artment t h e pharmacis t

°

sh oul d devote h is best energi es T o do t h is s uccessfully he

.

m ust become a mas ter p r escr ip tioni st and be famil iar wit h
al l the in t r ic acies of prescription in compatibilities N othing .

w ill more sec urely h old yo ur physician s p atronage than his ’

confi de nce in yo ur ability as a p rescript ionist i n yo ur abi l ,

ity to dispose o f d iffi culties and t o preven t untoward res ul ts .

It has al ways been a so urce of wonder to me why the sub

j ect o f incom p atibi l ities has been so sa dl y negl ected i n our
c oll ege c urric ul a The st udent is t a ught t h e various steps
.

of preparing s ul ph uri c aci d or o f the p rep aration of so d a by

,

t h e Leb l an c p rocess ( th ings of w h ich he will neve r m ake any

practical a ppl ic at ion ) b ut he is left in i gnorance a s to how
,

to mix F owle r s so l ution and Magendie s so l ution without

’ ’

p rec ipitation He is ta ug h t the d i fference betwee n c ast and

.

wro ug h t i ron b ut he is left in ignorance as to why a p re

,
.

cip itate occ urs on t h e ad d it ion o f potassi um io d id e to sy rup

of ferro us iodi de an d how to prevent it .

T o me the s ubj ect o f presc r iption incompatibi l ities h as

a l ways se emed of p aramo unt importance It is p ractica ll y .

m ore useful than botany m ore useful th an pha r macognosy

, ,

and even more usef ul than m an ufact uring chemist ry — and I

h ope th e time is not far distant when i t w i ll occ upy th e fir st

r afnk i n the c urric ul um of eve ry schoo l of pha rm acy in the

U nited States .

THE ME AN I N G or IN CO MP ATIB LE ”

Th e wor d incom patib l e a ccord in g to th e definition of

,

the vario us d ictionaries means in capab l e of ex isting togethe r

,

in agreement o r h a r mo ny We c a ll a prescription incompati

.
12 P RE S C RIP T IO N I NC O MP A T IBIL I T I ES
ble when its ingre dients are of suc h a nat ure th at if b rought ,

toget h er one or more of t h e following changes wo ul d tak e

,

place : ( 1 ) Mut ual decomposition of t h e ingre d ients with ,

t h e formation of a new compoun d ; ( 2) precipitation c h emica l ,

or p h ysical ; ( 3 ) e x plosion ; ( 4 ) defl agr ation ; ( 5 ) lique fac

tion w h en t h e ingre dients are prescribe d in pow ders ; ( 6 ) the
,

deterioration or destruction of one or more of t h e in gredients .

B ut it wo ul d be a mistake to s uppose t h at the wor d incom

patible is synonymo us wit h non dispensable Ou t h e con
”
-
.

tr ary as will be seen later t h ere are many combinations

, ,

w h ic h broa dly speaking are incompatible b ut not only m ay

, , ,

t h ey be dispense d wit h out any h esitation t h e incomp atibi l ity ,

is intentional and distinctly desirable .

Incompatibilities are generally divi d e d into three classes

( 1 ) C h emical incompatibility w h ere t h e change is t h e res ul t
,

of a tr ue c h emical reaction e g w h en so di um s alicylate is

, . .
,

prescribe d wit h dil ute d s ulp h uric aci d salicylic acid p r e cip i ,

tates out and so di um s ulp h ate is in sol ution ; ( 2) p h arma

,

ceutical w h en t h e c h ange is the res ult of a p h ysical condi

,

tion i e w h en t h e menstr uum is uns uitable e g w h en

,
. .
, , . .
,

fl uid extract of cannabis in dic a is a dde d to water and the

resin is t h rown out of sol ution ; and ( 3 ) t h erape utic where ,

t h e d rugs prescribe d h ave antagonistic me dicinal properties

( as when chloral and stryc h nine are prescribe d toget h er or ,

digitalis and aconite ) Wit h t h e l atter variety therape utic

.
,

incompatibility the pharmacist h as absol ute l y nothing to do

, ,

nor is h e to permit h imse l f to make any s uggestion s to the

ph ysician in that direction T h e p h armacist is n ot compe.

tent to j udge of what constit utes t h erape utic incompatibility ;

it is none of h is afl air ; two drugs m ay be antagonistic in one
’

respect and synergistic in anot h er and it is for the latter ,

e ffect t h at t h e physician prescribes t h em .

T h e aut h or s classifi cation of incompatibilities which h e

’

intro duce d several years ago and which has been fo un d b oth
useful and practical is as follows ,

( 1 ) Permissible and d esirable incompatibi l ity when the ,

 P RE SC RIPT ION I N C O MP A T IB IL I T I E S 13

e l ting chan ge is of n o significance or where the new com

r su ,

po un d is exp ress l y desire d by the p hysician .

( 2) Preventab le in compatib il ity where the incomp atib il

,

i ty can easi l y b e p re vented either by a ch ange i n the orde r

,

of m ixin g the ingredients or by the ad d ition of acid etc an d

, ,
.
,

( 3 ) A bso l ute o r true in c ompatibil ity wh ere t h e p r escr ip

, , ,

t ion ca nnot possib l y be d ispense d in its origina l form and

whe r e one or m ore in gr ed ien ts m ust be l eft out a l toget h e r
or ot h er ing red ients s ubst it uted It is th is l ast kind of in
.

c omp atibility w hi ch is practic all y synonymo us with non

dispe nsab i l i ty
. This classification I h ave fo un d especia lly
useful for students .
 P R E S C R I P TI O NS
l
0 m aste r th e s ubj ect of incomp atib i ities , e ach p rescrip
T l
tion sh o ul d be read care ful y It is not necess ary to
.

t tempt to m emoriz e all in comp atibil ities ; b ut it is im

a

po r tant to t ry to unde rstan d the ge nera l princip l es A t the .

e nd of the vol ume the incompatib ili ties w i ll be s um mariz ed

,

and classifi e d a l phabe ti ca ll y so tha t they can be e asi l y t e

,

fe rr ed to .

Morp hinae S ulphatis

A o Tannici .

Aq uae Destillatae
In j ect with ear syringe .

I start th is seri es of in compatib l e d ifiicult and od d prescr ip

,

tions with the a bo ve because it is so ve ry common With all

,
.

that has been w ritt en on p r escription in compatibi l ities one

wo ul d th i nk th at s uch a comb ination wo ul d not p resent any
difiiculty to any pharmac ist B ut such it appea r s is n ot
.
, ,

the c ase T he dr uggist seemed to be ve ry m uch s urprised

.

“
and indi g nan t at the fact th at a precipitate forme d wh en
he adde d th e tann i c aci d to th e so l ution of morphine wh ich ,

did not d isso l ve on long shaking

”
Well a p recipitate d oes
.
,

form when t an ni c acid i s ad de d t o morph ine and not on l y ,

to morph ine b ut to all other a l kaloids This is one of th e

,
.

commonest kind o f incom patibil ity that we enco unter i n t he

d rug store practice .

A LK ALO I D S A RE I NCOMPA TI B L E W I TH T ANNI C A 0 11) 0 3 W I TH

S UB S TAN CE S C ONT A ININ G T A NNI N .

The a l ka l oid is precip itate d out of its so l utio n as a tan

nate .

In the above prescription we see a good e xamp l e o f t rue

15
16 PRE S CRIPTION INC O MP A T I B IL IT I E S
incompatibility T h e physician apparen tl y pre sc ribed th e
.

tannic aci d as an astringent to st 0 p a d isc h arge in the ear ;

t h e canal of t h e ear be ing painful h e also prescribe d mor ,

p h ine s ulp h ate wit h t h e intention of d imin is h in g the pa in ,

b ut this latter obj ect is completely d efeate d beca use the ,

morp h ine s ulp h ate is converte d into t h e insol uble morp h ine
tannate wh ic h being insol uble cannot be absorbe d and can
,

not act E ven the astringent action of t h e t an nic acid is

.

d imi n is h e d beca ,
use a part of t h e latter is p recip itate d and
is in comb ination with t h e morph ine .

2 Morp h
. inae S ulphatis gr iv .

Ammoni i Carb onatis 3 j es

S y r S enegae
. 3 ss

Aquae q s ad 3 iij . .

S . Te asp oonful 4 times a day as dire cted ,

.

A very common prescription b ut i ncompatible never the

,

less The morphine is precipitate d in t h e alkaloi d al form

.

by t h e ammoni um carbonate w h ic h is a strong alkal i Of .

co urse p utting a s h ake l abe l on t h e bottle d imin is h es t h e

danger to a great extent b ut it does not entire l y elimin ate
,

it. As a general r ule mixt ures wit h poisono us p recipitates

or se diments s h o uld not be dispense d .

In the above prescription t h e syr up o f senega alon e wo ul d

,

h ave a ten dency to precipitate the morphin e beca use i t con

tains some water of ammonia .

ALKALO IDS A RE P RE CI P I TATE D B Y AN D T HE REF ORE I N CO M P AT

,

I BLE WITH A LK A LINE H Y DRO X IDE S T HEIR C A R B ON A TE S A N D B I

, ,

CARBONATE S A N D W I TH S AL TS HA VI N G A N A L K A L I NE R E A CTION .

S uch are : potassi um h y droxi de carbonate and b icarbonate ;

,

so dium hy droxi de carbonate and bicarbonate ; ammoni um

,

hy droxid e ammonia water ) an d carbonate ; calci um

hydroxi de l ime water ) so di um borate and so di um p h os
phate t h e latter salts having an alkaline reaction Magnesi um
, .

hydroxi de Mg ( OH) 2 has t h e s ame ten dency b ut its sol u

, , ,

b ility is very sligh t and it is se l dom prescribed in comb ina

tion with alkal oi ds .
18 PRE S CRIPTION I NC O MP A T I B ILI T I E S
tic ed T h is precipitate is generally consi dere d to consist o f
.

calci um s ulp h ate or calcium p h osp h ate t h e formation of t h ose ,

precipitates being due to t h e s ulp h uric o r p h osp h oric acid

containe d in small amo unts i n t h e pero x i de o f hy drogen
, ,
.

T h is explanation is tr ue as far as it goes b ut i t does not ,

g o far eno ug h T h e precipitate .

also occ urs in varieties of
peroxi de of h y drogen which contain no s ulp h uric o r phos
h or ic aci d b ut only hy d rochloric aci d It certainly c annot
p
.
,

be due to t h e latter beca use calci um chlori de is a very so l u

,

ble salt No th e chief precipitate is due to t h e formation

.
,

of calci um pero x ide w h ic h is a w h ite crysta ll ine compo und

,
.

T h e e quation is a simple one

Ca ( OH ) : mo , cao, 211 20 .

The question un der disc ussion is not one o f th eo retica l

interest only ; it is of great practica l importance If t h e pre .

cip itation were due to t h e formation of calci um s ulp h ate or

p h osp h ate only no obj ections co ul d be raise d to the p r escr ip
,

tion In fact except for t h e precipitate clogging the ho l es

.
,

i n the atomizer t h e a ddition of lime water to peroxi de o f

,

hy drogen migh t be consi dere d an a dvantage beca use t h e aci d ,

ity of the latter becomes ne ut ralize d and t h e sh arp b urning

taste is lost B ut having learne d t h at the peroxid e be comes
.

decomposed we see that the combination is an inadmissible

,

one .

I T Is B E S T N OT TO P RE S CRI B E L IME W A TE R AN D P E RO XI DE
OF HY DRO GE N IN TH E SAME MI X TU RE .

I migh t add t h at calci um peroxi de is a commercia l prod

uct being sol d un der vario us names as a gastrointest ina l anti
,

septic .

6 . P r otar gol
Z ihci S ulphatis
Aquae Destillatae
M f Collyri um
. . .

T h is prescription is abso l utely incompatible Ou ad din g .

the Z i nc s ulphate to the protargol sol ution the latte r becomes

 S
P RE C RIP T IO N I NC O MP A T IB ILI T I E S 19

com p l ete l y deco l orized wh i l e at the same time a rather ab un

,

dant p rec ipitate takes place ( The precipitate is sol uble in .

amm onia wate r ) T o d ispense i t wit h t h e p recipitate is of

.

co urse inadmissib l e t h e prescription being i nten ded for an

,

eye wash or eye d rops The d r uggist who received t h is pre

A
.
,

sc ription d ispensed i t after fi lte r ing out t h e p recipitate

,
.

ve ry poor way It i s m uch better to l eave out the s ul phate

.

of z in c and noti fy the physician .

P so r asoon I s
'
A S O L U TE L
B Y I N conPATI B L E WI TH Z INC S UL
PH A TE .

7 . Ferri Chloridi
Tr .
3 ss
S y r S imp licis .

Aq uae Cinnamomi q s ad 5 iv . .

I t does n ot se em as i f anyth ing co ul d be t h e matter with

th is inn oc ent prescript ion b ut there is The cinn amic a l de , .

hy de p resen t in the oi l o f cinnamon ( from wh ich the water is

prepared ) reacts with the ferric c hl ori d e ; t h e sol ution at fi rst ,

c l ea r becomes a fte r a sho r t t ime t urbi d and d irty l ooking

,
-

an d a s l igh t d e posit fo rms I t is best to s ubstit ut e anot h e r

.

wate r for the c in namon water with the physician s kn ow l ,

’

edge o f c o urse b ut i f the presc ription m ust be dispense d as

, ,

wri tten the patient sho ul d invariably be in forme d o f the

,

ch an ge i n th e appearan ce wh ich the m edic in e wil l undergo

in a few ho urs Othe r wise h e wi ll be a lmost s ure to bring
.

i t back the next day w ith th e q uestion i f a m istake had

,

not b ee n ma d e o r i f the medicine did not get spoi l ed I f the

,
.

patient is prep ared for s uch a th in g he wi l l n eve r m ake any

’
f uss abo ut it ; on th e c ontra ry h is respect for the d r uggist s ,

kn owl e dge and p redicting powers wi ll be gre at l y increased .

8 . Tr . Ferri Chloridi 3 ij
S pir . P ime ntae 3 j
S y r up i S acchari 3 j
A quae q s ad 3 iij . .

Th e E ugeno l p resen t in th e oi l o f p iment a r eacts with the

fe r ri c ch l oride p rod ucing a t urbidity in the m ixt ur e w it h the
, ,
20 PRE S CRIPTION INC O MP A T I B ILIT I E S
fi nal deposition of a d ark bro wn precipitate The same r eac -
.

tion ta k es place if A q ua P imentae is use d inst ea d of the

spirit T h e remarks concern ing t h e prece ding p rescription
.

apply also to t h is one .

9 A ci di Tanni ci
.

Aq uae Calcis
S Use as a g argl e
. .

Tannic aci d is incompatib l e with l ime water Whe n th e .

two are mixe d a b ul ky bl uish w h ite precip itate r esul ts The

, ,
-
.

precipitate is a tannate of calci um tho ugh its compositio n ,

i s somewhat variab l e The prescription s h o uld h a rdly b e

.

d ispensed .

L IME W A TE R AN D O THE R S OL U B LE C AL CIU M S AL TS A RE I N

COMPA TIB LE WITH TA NNI C A 0 11) .

10 . Gly ceriti Ao . T annici

Aq uae Calcis
S Use as a gargle
. .

T h e same reaction takes p l ace here on l y the preci pitate is ,

of a w h itis h color and is on acco unt of t h e glycer in more , ,

evenly distrib ute d This prescription may be d ispense d b ut

.
,

it is best perh aps to ca ll the p h ysician s attention to the

, ,
’

incompatibility .

11 . Atrop . S ulphatis
E x t Col c . hici S em F l . .

P otassii I odidi
S odii S ali cyl
Tr Guaiaci
.

A q uae F oeniculi s. ad
q
i every four hours
.

S . 3 .

I present this prescription not so m uch for its incompatib l e

p omts as for its pec uliar dosage When the doctor was to l d .

that the dose of atropine of a grain—was a l etha l one ,

 P RE S C RIP T IO N I NC O MP A T IBILI T I E S 21

aft r war
e ds gave us ca rt e bl an ch e so fa r as his presc r ipt ions
were con cern ed ; we co ul d ch an ge t h e dosage leave out in gre ,

dients ( in co m patib l e ones ) etc V e ry often he only wrote ,

.

the in gr e dien ts l e av ing it t o us t o fix the q uantities He has

, .

a very l arge p ract ice n eve rt h e l ess ! ,

Th e inco m patibilities a re : the KI w ith t h e at rop ine ( and

perhaps wi th th e co l chic ine ) and the t in ct ure of guaiac with ,

the wate r ( th e resin precipit ates at once ) T h e t inct ure .

somet im es strikes a bl ue co l or with acacia b ut the l atter m ay ,

b e used to make an em ul sion i n spit e of t h is , .

12 Ar genti Nitri ci
.

Aq uae Destillat
Det ur in vitro nigro et si g na : P r o usu e xte rno .

Th is is a perfect l y inn ocen t and compatib l e prescript ion ,

b ut the m ak in g up o f it afforded a good d ea l o f am usement ;

the senior the j un ior and even t h e boy j oin ed in t h e res ult
, ,

ing me rr iment The i ncident related h ere took place in t h e

.

old l an d ma rk ph a rmacy at th
-
e corner o f Ho uston and C lin
,

ton st r eets thi s city H L Metz a nd then Nicho l as Tausz ig

, , . .
,

p r oprieto rs It was on a S unday the boss w as out and b usi

.

‘
, ,

ness was exceedingly r ush in g One h undred and fi fty to two .

h undre d p rescript ions a day was the gene ra l average b ut t h a t ,

day th e numbe r was m uch gre ate r There we re besi des q uite .

a fe w h a rd p resc ript ions s uch as 500 si l ver coat ed cre o

“ ” -

A
,

sote p i lls 1 20 s uppositories 500 cac hets etc

,
si gn was , , .

R e l ie f cle rk wante d
“ ”
therefore p ut out : Soo n a yo ung .

man p rese nted himsel f who sai d h e had worked in a d r ug

,

store on the othe r si d e b ut co ul d fi nd n o position h e re and

,

wo ul d b e glad to rel ieve for an a fte rn oon T h e fi rst .

two pr sc riptions he mad e up a ll righ t The th ird p r escr ip

e
.

tio n was the above He went to the poiso n c l oset where we

.
,

used to keep all p otent d rugs fo und th e bott l e with th e ,

l abe l A rgen tum nitr icum weighed out th e al l eged si l ver ni ,

trate put i t in a bott l e added the w ate r and sta rte d shaking
, , ,

it ; afte r sh akin g v iol ently for two o r three m in utes fi nd ing ,

 22 P RE S C RIP TI O N INC O MP ATI B IL IT I E S
that the silver n itrate wo uld not disso l ve he emptied th e ,

contents into a mortar and started to po und t h e si l ve r “

,

nitrate ”
T h is of co urse ca use d s urp rise to his fellow pre
.
, ,
-

scr iption ists and on l ooking into the morta r i t was fo un d

,

th at th e allege d silver nitrate was flawseed ! A s y ou pe rhaps

—
know fuse d silver nitrate formerly use d t o come in bottles
,

fi lled wit h fi ax seed T h is was done t o prevent t h e sticks from

.

brea k ing He was unfamiliar wit h t h e fact and t h o ugh t so

.
,

he sai d t h at t h e fl ax see d was a special form in w h ic h silve r

,

nitrate came in t h is country B ut we s uspected that he had .

never han dle d si l ver nitrate before .

13 . Magnes Cal ci n . . 3 iij

P ulv E . b e i 3 ij
P ulv . Z ingib eris 3 j
S odii B icarb on . 3 j
Olei Menthae Pip . gtt . v
Aquae ad 3 iv
After stan ding for a wh ile this mixt ure thickens and solidi
fi es to s uch an extent t h at i t is impossibl e to either sh ak e i t
or po ur it from the bottle The ca use of it is to be fo und .

excl usively in the ten dency of magnesi um oxide to combine

wit h water forming a gelatino us hy d rate : Mg o + H20 ==
,

Mg ( OH ) 2 If the heavy calcine d magnesia—magnesii ox idum

.

p on der osum— b e use d instea d of t h e l igh t ma gnesia the ten

,

deney to gelatinization will be greatly obviated Sometimes .

even when the l ight magnesia is used no ge l atin iz ation takes ,

place T h is is due to the sad fact that in some drug stores

. -

ma gnesia is han dle d so c arelessly ( left in open vessels in a ,

moist atmosph ere etc t h at in a short time t h e ma g nesi a is

,

no longer magnesia b ut magnesi um carbon ate ( th at 1 8 hydro ,

,

carbonate ) and t h is latter does not gelatinize with wate r I

,
.

14 . S pir Ammon At mat

. . .

S pir Menth P iper

. . .

Aquae Calcis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 P RE S C RIPT IO N I NC O MP A T IBILI T I E S 23

A sligh t preci pitate of ca l ci um carbon ate w ill be formed ,

due to the ammoni um c arbonate in the aromatic spirit The .

o ils of both spirits wil l be p r ecipitate d by the lime water ,

makin g a m ilky m ixt ure ; an inelegant comb ination b ut one

th at may be dispensed wit h a s h ake l abe l
“ ”
.

Gly ce rini
Aq uae
S . : U se wit h nasa l do uc he .

Th is is p ractica l ly the well kn o wn Dob e ll s sol ution on l y ’

m
-

od ifi ed in t h e propo rt io ns o f t h e in g red ients A n effe r ves .

cence t akes place due to th e evol ution of carbon d ioxide

,
.

W h at is th is e vol ution due to ? “

To the action of the c ar
b olic aci d on the sod i um bicarbonate many wo ul d answe r , .

No ; i t is ca use d by the action of t h e boric aci d on the so di um

bic arbonate ; the bo ric a ci d be in g formed by th e action of the
glyce rin on the borax A full d i sc ussio n o f th is subj ec t wi ll
.

be fo un d in anothe r p resc r ip ti on .

16 . P o tassii I odidi
Tr . Fe rri Chlo ridi
O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

S . : 3 j ti d
. . .
p . c
.

I t is not ad v isa ble t o d ispense this p rescription as a con ,

sid e rab le amo unt of io d ine is l i b e rate d ; not only by t h e free

hy d rochloric aci d p resent in the t inct ure b ut by the fe rric ,

chlori de itself th us ,

2R I F e1 Cl. 2F e CL 2K Cl L

IT Is BE S T N or TO P na scama T IN CTU RE OF Fu me C H LO RIDE

m m P OT ASSI U M l oo ms .

A quae Camphorae
24 PRE S CRIPTION INC O MP A T I B ILIT I E S
Whil e camp h or is sol uble to a very sligh t extent i n wate r ,

it is almost absol utely ins ol uble in sol utions of salts In .

t h is prescription it is t h erefore precipitate d out fl oating on ,

the top of t h e liq ui d or a dh erin g to t h e bottle as a fi ne sc um .

SALTS S H OUL D NOT B E P RE S CRIB ED TO B E DI SS OLV ED IN

CAMP HOR W A TER P A RTI CU L A RL Y IN C ON CE N TRATE D SOL U TION S
,
.

18 . Q ui ni n . B isulp h
A mm Car . b o n.

S y r S imp l
. .

Aquae Cinnam .

S . : 3 1 doses .

Attention h as been called to t h is incompatib l e prescription

times wit h o ut n umber nevert h eless it seems to be a favori te ,

with many p h ysicians W h y p hysicians w ill presc ribe t h e .

m ost sol uble q uinine salt and t h en precipitate it is beyon d

compre h ension T h ere is only one explanation for it : the
.

p h ysician is not aware t h at a precipitation takes pl ace The .

q uinine bis ulp h ate being seventy times more so l uble than
,

t h e s ulp h ate dissolves easily in t h e prescribe d q uantity of

,

water ; b ut t h e ammoni um carbonate ( li k e al l al ka l ine car

b onates) causes a precipitate of alkaloi d a l q uinine .

ALK ALO I DAL S AL TS A RE T HROW N OU T OF S OLU TION B Y AL

KAL INE H Y DRO X IDE S A N D C A R B ON ATE S .

19 . Hy dr arg B ichlor . .

S yr up Hy p op hosp hit .

S yr . S arsap Co . .

Aquae Menthae P ip .

S . : 3 j 4 times a day .

This prescription is absol utely incompatible The hypo .

phosp h ites are strong red ucing agents and t h e corrosive sub ,

ll mate is entirely re duce d : fi r st to calomel and t h e n to met al

lic mer cury E ither the corrosive s ublimate or th e h o hos
yp p
.

p hl tes m ust be omitte d .

C ORRO SI VE S U BLIM A TE A N D H Y POP H OS P H I TE S A R E A sso

L UTEL Y I N COM PA TIBLE .
26 PRE S CRIPTION IN C O MPA T IBIL I T I E S
mencement of my pharmace utica l ca reer The proprietor .

mixed the two sol utions affi x ed the label b ut on d el ivering , , ,

it notice d a precipitate t h ro ugh o ut t h e entire bottle

,
He .

seeme d to be s urprise d and went again be h in d t h e counter , ,

mixe d t h e sol utions in di fferent or der b ut wit h the same r e ,

s ult After two or t h ree more uns uccessful attempts I was

. ,

sent to t h e doctor O h well if t h ey d on t g o well toget h e r

’
.
, , ,

leave out t h e morp h ine ”

sai d the doctor T h us i g norance ,
.
,

deprive d t h e patient of t h e ingred ient w h ich he was prob

ably in nee d of Al k aloi ds as we al rea dy know are p r e cip
.
, ,

itated by alkalies t h eir h y droxi d es carbonates and b icar

, , ,

b onates ; Fowler s sol ution contains free potassi um carbonat e

’

( potassi um bicarbonate is use d b ut on being boile d becomes ,

converte d int o carbonate ) ; t h e p ure alkaloi d morph ine p re

cip itates A few drops of d il uted HCl a dde d to the arsenic
.

sol ution before it is mixe d wit h the m orph ine so l ution will
, ,

prevent precipitation beca use it wi ll ne ut rali ze t h e potassi um

,

carbonate .

23 . A ntip y rini
Syr . I p ecac .

S yr . P ru n Virgin . .

Aq uae
S . : 3 14 1: a day .

Afl occulent
precipitate is forme d due to th e t an ni c a cid of ,

t h e wil d c h erry combinin g with the antipyrine T h e l atte r .

is a synt h etic base be h aving in most respects as t h e al k aloi d s

,

do wh ic h as we saw before are p recipitate d by tannic aci d

, , , .

T h o gh t h e mixt ure mig h t be d ispense d wit h a s h ake label

u “
,

it is better to call t h e p h ysician s attention to t h e fact so ’

that he may in t h e fut ure s ubstit ute another syrup for th at

of wi l d c h erry .

24 . A ntip y rini
S pir A ether is N itr
.
.

S pir F r ume nti

.

S yr Tolutani
.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0 9 0 0 9 0

S . : 3 i q 2h . .
 P RE S C RIPTI O N IN C O MP A T I BIL I T I ES 27

This p r escription sho ul d not be d ispensed unde r any con

si derati on S o i t was ta ugh t fo rm er l y b ut we are not s o
.
,

st rict now on t his p oin t A nti pyrine with swee t spi rit of .

niter forms a grass green so l ution which is cl aime d to be -

po isono us T he exact n at ure o f the com po un d formed h as

.

not as yet be e n est ab l ishe d The p oisono usness of that com .

po und h as a l so been disp ute d and i s in fac t denied a l t o ,

gether b ut it is best t o be on the safe side and not d ispense

, ,

the comb in ation

U
.

ANTIPY RIN S HO LD NOT B E D S I PE N SED WITH S PI RI T or

Nrraous E r a se .

S odii S ali cyl .

Div . in P ulv No x ij . . .

A ntipyrin e and sod i um sal icy l ate sho ul d n ot be presc ribed

in pow der fo rm as l i q uefaction often occ urs especially i n
, ,

damp weather I h ave seen this prescription d ispens e d and

.
,

when the box reach ed t h e patient t h e re were only a few ,

.

tho ro ughly soa ke d pape rs i n it ; the pat ien t h ad to send fo r

othe r powde rs I repo rted a case i n t h e N e w Yor k Mcd ical
.
-

J o ur nal whe re the pr escribin g o f j ust th ose powd e rs had

r athe r d isa gr ee ab l e conse q uences fo r th e p h ysician .

ANTIP Y RIN A N D SO D I U M S AL I CY L ATE S HOUL D Nor B E P RE

S CRIB ED T OGET H E R IN P O WD ER F OR M .

26 . P ota ss . I odidi
S p ir A e the r is Nitr
. .

S . : 3 i q 2 h . .

Potassi um i od ide an d nitro us ether sho ul d never b e p re

sc ri b ed t ogether bec a use iod in e is set free by the ac ids us ua l ly
,

present in th e nitro us ethe r No matte r h ow fresh the spirit .

of n it ro us ether m ay b e the li b e ration of i od ine and d iscolor a

,

t ion of th e m ixture are s ure to t ake p l ace with in a ve ry s h o rt

tim e N e ut r a l iz ing the sp irit with po tassi um b i ca r bo nate wi ll
.
28 PRE S CRIPTION INC O MP A T IBILI T I E S
not remedy the evi l I experimented in that l ine b ut never
. ,

s uccee de d in making a permanent mixt ure from those two

ingre dients The question in a recent B oard of P h armacy
.

examination : What happens in a mixt ure containin g pot e s

“

si um io di de and a decompose d sample of spirit of nitro us

et h er ? ” is t h erefore mislea ding as there is no l ine of demar ,

c ation between a decompose d and a non decom pose d samp l e -

of sweet spirit of niter .

P OT ASSI U M I ODI DE AS W ELL AS O TH E R I ODIDE S I s I N GO M

, ,

PA TI BLE WITH SPIRIT OF NITRO US E THER .

27 . Hy dr ar g Ox idi Fl avi
.

Cocainae Hy dr o chlor . c

U ngt . A q R osae
. .

S . : lve A pply at ni ght

Ey e sa . .

The physici an prescribes here t h e cocaine with the inten

tion of d iminishing any pain or b urning w h ich t h e oxi de of
mercury may pro duce on t h e infl amed l i ds and conj unctivae .

T h e res ult obtaine d is j ust t h e reverse of the expected one .

The sa l ve has proved exceedingly irritating to t h e eyes T h e .

ca use of this is the formation of some m erc uro us and merc uric
oxyc h lori de T h e p hysician s attent ion sh o ul d be called t o
.
’

this fact and i f he insists on h aving cocaine t h e p ure a l ka

, ,

l oi d sh oul d be substit ute d for t h e hy drochlori de .

28 . Cocainae Hy dr ochlor .

S od B ib oratis
.

A q De stillatae
.

MF . . Collyri um .

T h e so di um borate wh ich has a n a l kal ine reaction p r ecip

, ,

itates th e cocaine in alkaloid al form T h e prope r way to do .

is to s ubstit ute an eq ual q uantity of boric aci d for t h e borax ,

or we may add a little glycerin T h e l atter decom poses t h e .

borax yiel ding sodi um metaborate and boric aci d and the
,
,

sol ution being no longer alkaline no precip itation wil l take ,

place T h e action of glyceri n on borax wi ll be full y d is

.

c ussed in another prescripti on .

 P RE S CR IPT ION IN C O MP A T IB IL I T I ES 29

29 .
Q uin. S ulp hatis
Aci di S ulp h . Dil .

S odii S alicyl .

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

I once watche d a j unior compo und this p resc r ipt io n He .

p u t th e q uinin e in a mortar a d de d some wate r an d then th e , ,

d i l ute s ulph uric aci d ; to t h is clea r so l ution h e a dde d th e

sod i um sa l icylate and l o ! a thick m ass res ul ted He began
,
.

to trit urate vi goro us l y with the pestle b ut the more h e ,

t rit urated the m ore so l id and p asty the mass became He .

then began nervo us l y to add some more s ulph uric aci d th ink ,

in g thereby t o d issolve the m ass ; b ut the mo re ac id he ad ded ,

th e wo rse th e matter see med to become The e ntire con .

ten ts of th e mo rt ar had to be thrown away I f made up i n .

a bott l e bo th the contents and the bottle have to be th rown

,

away as the bottle cannot even be c l eaned so sticky is th

, ,

m ass The s ul ph uric acid here does d o ub l e m ischie f fi r st i t

.
,

d isso l v es th e q uin ine s ul phate th us permitt in g i t to fully ,

rea ct with some of the sodi um sal icylate forming inso l uble ,

q uin ine sal icylate ; second l y it decomposes the rest o f the ,

so d i um sa l icy l ate forming sodi um s ul phat e an d sa l icy l i c ac i d

,
.

the l at te r of wh ich p recip itates I n orde r to be able t o dis .

pense this prescript ion i n a m ore o r l ess presentab l e fo r m ,

the s ul ph uric acid m ust b e l eft out The q uinine s ul phate i s .

rubbe d up w ith abo ut ha l f o f the water the so d i um sal icy l ate ,

is d isso l ved in th e other h a l f and m ixed with the sy rup and ,

th is so l ution is gra dual l y added to the q uinine m ixt ure with

a gi tation T he who l e is dispensed wit h a shake l abe l I n
.
“ ”
.

this way pra c tica ll y n o reaction t akes p l ace the q uinine sul ,

phat e bein g kept in s uspension instead of bein g d issolved .

S OL U BLE Q U ININE SA L T S A RE I NCOMPA TI B LE WITH S OL B L E U

S AL I CY LATE S THE I N SO LU B LE Q U I N I NE S AL I CY LATE B EIN G
,
30 PR ESC R I P TI O N I NC O MPA T I B I L I T I ES
30 . Q uin . S ulphatis
A ci di S ulp h . Dil .

S odii A cetatis
S yr Ru
. bi I d ae i

Aq uae
What h as been said in explanation of the p revio us p r escr ip
tion applies wit h e qual force to this one The b ulky q uinine .

acetate precipitates and t h e balance o f t h e so d i um acetate is

,

decompose d by t h e s ulp h uric aci d with t h e formation o f ,

sod i um s ulp h ate and acetic acid T he prescription is to be .

compoun de d like the previo us one i e the s ul ph uric acid ,

. .
,

m ust be omitte d
S
.

SOLUBLE Q UI NINE ALT S A RE I N CO M PA TIB LE WITH SO LUB LE

ACETATES .

31 . Hy drarg Chlorat V hp ar
. . . .

S . : F or doctor
’
s use .

Late one evening when about to retir e a m essenger came

, ,

wit h a note fro m a d ruggist re questing an explanation of ,

t h e above mysterio us prescription T here is not h ing mys

“ ”
.

ter ious abo ut it It means H y dr ar g y r um Chloratum via

.

Humide p ar a tum t h at is calome l prepare d by th e wet proc

, ,

ess or by preci pitation

, T h e or d inary calomel is as we .
,

k now prepared by s ublimation ( vap or e p artum) T h e calo

,
.

mel prep ared by t h e wet process is in a m uc h fi ner amorp h o us

con dition and is therefore preferre d by some physicians ;
, , ,

for insufilating into the eyes for instance it is s uperior to

‘
, ,

the ordinary va r iety .

32 . Aqua font ana 1 00 grms

I ll a r e p etita 45
E ade m destillata 12
Hy dr ogenii p rotox idi
Nil aliud gtt vi !
Sig . One drop in a teas poonful of water th rice daily .

All physicians know what a p l acebo is b ut m any d ruggists ,

do not It is a har mless or inert reme dy wh ich we ar e some

.
 P R E SC R I P T I ON I NC O MP A TI BIL IT I ES 31

t im es ob l iged to give to ne rv o us patients wh om we fee l need ,

n o m ed ic ine b ut who think they m ust take something ; brea d

,

p ills co l ored water etc a re placebos ; t h e wor d p l acebo

, , .
,

mea ns in Lat in : I wi ll please The above placebo is rep orte d .

to have c ured a l arge n umbe r of ne urotic an d cranky w omen

of thei r imag ina ry ills It was prescribe d fo r one co urt la dy .

by Napo l eon I I I s physici an and was great l y i n vogue w ith

’

th e g r and es dames d e la cour .

As a few of my rea ders ( very very few o f course !) may , ,

not b e strong in Lat in I w i l l transl ate the in gred ients int o ,

E n gl ish ; ( 1 ) Spri ng wate r ( 2) the sa me repeate d ( 3 ) the , ,

sa me d isti ll e d ( 4 ) h y d rogen protoxi de ( i e water ) ; ( 5 )

, . .
,

nothi ng e lse .

Had the demon of c uriosity not t aken possession o f the

gran d e da m e s h e m igh t have gone on to h er last d ay praising
,

an d p resent ing to her frien d s the great p rescripti on of the

famo us Dr N B ut she co uld not resist t h e temptation S h e
. . .

wante d t o k n ow what the wonde rful in g re d ients were S h e .

presented the p re scription to n umero us physicians and ph ar

macists b ut th ey eva de d a direct answe r o r sa id that t h ose
,

we re rare me d icaments the nat ure o f which she wo ul d n ot

unde rstan d A t last sh e fo und a dr uggist who fo r a con
.
,

sider ab le sum of m oney r evea l ed the fatal sec ret T h e wrath .

of the gr an d l a dy aga inst the physici an can be bette r imag

ined th an d escribed .

33 Tr F e rri Ch lor
. . .

S od S ali cyl . .

Gly ce rini
Aq uae
S : 3 i ti d p c
. . . . . .

The sa l icy l ates a re incom patib l e with ferric sa l ts forming ,

fe rr i c sa l icy l ate o f a deep vio l et bl ue co l or T h is p rescription

,
-
.

m ay be di spe nsed b ut i t is better to info rm the physici an

o f the r esul t in g reaction
S
.

F ERRI C AL TS A BE I N COM PA I I BLE wrm S AL I CYL ATES : A ''

32 PRE S CRIPTION INC O MP A T IBILI T I E S
34 . Q uin . S ul p h .

A o S ulp hur ici

. Dil .

Tr . F er ri Chl or . .

Gly ceri ni
Aq uae
S . : 3 i ti d . . .
p . c
.

As th e p h ysician has here evi dent l y p rescribe d t h e d il uted

s ulp h uric aci d merely as a solvent for the q uin ine i t is best ,

left out as tinct ure of fe rric c hl ori d e ( on acco unt of its con
,

taining free HCl ) is an excellent solvent for quin in e salts

in genera l .

35 . Morp hi n S ul ph . .

Camphorae
Me ntholis
P ulv . Althaeae
Div in . p ulv . No . x .

Ment h ol and camph or when rubbed t ogeth er or when l ong ,

in contact become liquefie d T h ere is a way however of

, .
, ,

obviating the diffi culty : to r ub t h e camp h or wit h a p ortion

of t h e alt h ea t h e ment h ol wit h the remain d er ; t h en to d ivi de
,

the camph or and ment h ol separately into ten pow ders ( one
kin d is wrappe d o utsi de wit h bl ue pape r ) T h e patient is .

d irecte d to ta k e one of eac h kin d of pow der at a time I .

do not partic ularly recommen d this metho d tho ugh I can ,

see no special obj ection t o it .

ME N TH OL A N D CAM P H O R L I Q U E F Y A N D A RE T H E RE F ORE I N
CO MPA TIBLE W HEN P RE S C RI B ED I N P O W DE R F O RM .

36 . Morphin S ulph . .

S pir Ammon Arom at

. . .

A q Menth P i p er
. .

S . : 3 j when req uired .

This prescription is a d angero us one t o d ispe nse Th e .

ammon i a will precipitate t h e morp h ine As I said before .

,

poisono us principles sho uld never be d ispense d in a state of

susp ensmn I n pouring out the me dicine a dose e q uivalent
.

,
34 PRE S CRIPTION INC O MP A T I B I L IT I E S

Z INC S U L H A T E D L EA D
P AN A CE TATE B ECOME DEL I Q U E S CENT
W HEN R U BB ED T O ETHER G .

39 . S odu S ali cy l .

Syr R ub I daei
. .

Aquae Gaultheriae 5
Syrup of raspberry contains a small amo unt of c itric ac id ,

w h ic h will decompose a small q uantity of t h e salicyl ate w it h

t h e formation of so di um citrate and t h e precipitat ion of sal
icy lic aci d As t h e q uantity is very small t h e p rescription
. ,

may be dispense d as it is or it may be fi lter ed ,

.

40 .
Q u in . S ul ph .

A ci di S ul ph . Dil .

P ot ass . I odidi
S y r upi
Aquae ad 3 iv

T h is is an example of do uble i ncompatibility The sul .

p hur ic aci d is incompatible wit h potassi um io d id e forming ,

hydriodic aci d w h ic h easily d ecomposes i od ine being set

, ,

free ; and t h e potassi um io di d e wit h t h e free io d ine attacks , ,

t h e quinine sulp h ate precipitating it as q uin ine h y d rio di d e

,

( or I n t h is case it is best t o call t h e p h ysician s ’

attention to t h e incompatibility If he insists on h avin g the .

quinine and t h e io di de in t h e same mixt ure t h e s ul p h uri c ,

aci d m ust be left out ; t h e q uinine is rubbe d up wit h a po r

tion of t h e water t h e potassi um io d i d e dissolve d in t h e r e
,

mainder t h is sol ution gra dually a dded to the q uin ine m ix

,

t ure and t h e w h o l e d ispense d as a sh ake m ixt ure Only

, .

a small q uantity of quinine hy driod i de will be formed the ,

so l ubi l ity of q uin ine s ul phate bein g b ut s l ight ( 1 in

41 . P ancre ati n
B ism S ub nitr
. . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

S odii B icar b on .

P ulv . A romati ci
Gly ce rini
Aq uae
 P RE S CR IP T I ON I N C O MP A T I BIL IT I E S 35

This m ix t ure fre q uent l y exp l odes especia ll y when standing ,

i n a wa rm pla ce O ccasionally the bottle is sh attere d into

.

n ume ro us bits The reaso n is referable to th e l iberation of

.

nit ric acid f ro m t h e bism uth s ubn itrate w h ich in its t urn acts ,

on the so d i um bi ca rbonate with the liberat ion of carbon diox

,

ide T h e e q uation m ay be exp ressed as fo l lows

.

1 . 2B I ON O: 2H3 0 B I ON O. B i ( OH ) : HN O.
B ismuth W ate r B is B is N it ri c
b b x
. .

S u ni tr ate S u ni t rate Hy dro ide A cid

2 . NaHCO. HN O: N aN Oa HO z CO:
N itric S od W ate r C a rb on
b
.

B icar . A cid N itr ate D iox .

As the rea cti ons he r e des cr ibed wi t inv a r iab l y t ak e ll a l mo s

p la ce sooner o r l ate r the physic ian s attent ion sho ul d be

’

ca ll ed to the fact and the s uggestion be m ad e t o employ the

,

s ubcar bo nate instead of the s ubnit rate o f b ism uth .

42 . S tr y chn S ulphatis
.
gr . ij
P otass B romi d1
.

P otassi um brom ide as us ual l y fo und on the m a r kets is in

, ,

compatib l e with st ryc hn ine as i t is with most a l kaloi ds pre

, ,

cip itating them in the fo r m of bromi des C h emica l ly p ure .

bromid es ( and i odides ) do not p recipitate the alkaloids as

r e adi l y as do the comme r cial a rt icles The l atte r in ord e r .
,

to b e more stab l e are c rysta ll iz ed from a lka line sol utions and
, ,

c onse q uently conta in some hydroxide ; and a l k al in e hy d ro s

id es are stronge r a lka l oi d a l p recipitants t h an the bromi des
o r iodid es T o dis pe n se th is prescription w ith the undisso l ved
.

strychn ine brom i d e wo ul d be mani fest l y unsa fe as t oo l arge ,

a dose o f st rychnine may be po ured out in one sp oon .

43 . S tr y chn S ulphatis
.

S y r up i
S pir Frumenti
.

A q uae
36 PRE S CRIP TI O N I NC O MP A TI BILIT I E S
T h is pre scription m a y b e d l spen sed as t h e a l co h ol con ,

tained
t h erein is suffi cie nt to preven t the precip itation of
st ryc h ni n e bromide
St ryc h nine s ulph
.
at e and potas sium

bromi de may be prescribed toget h er if t h e ve h icle cont ains ,

from twelve to fi fteen per cent of alcohol .

.

44 . S try chn S ulp . h .

S odii P hosphati
Mag nes S ul p . h .

Aquae
S : 3 ss thr ee ti mes a day
.
.

This is a favorite prescriptio n of an o l d p ractitione r for

catarr h ”
and atony of t h e stomach
,
and for loss o f app e ,

tite T h e dose of stryc h nine w h ic h i s rathe r l arge has i n

. , ,

no instance produce d any b ad e ffects he cl a ims So d i um ,

.

p h osp h ate being of al kal in e reaction will p recipit ate the

,
,

stryc h nine T h is can be easily p reven te d by a dd in g a few

.

d rops of phosp h oric aci d so as to ne utral ize t h e a lk a l inity ,

of t h e so dium p h osphate .

45 Argenti Nitr atis

.

E x t Gly cy rrhizae
.

P ulv Althaeae .

M .pil No x ij
ft . . . .

If the ful l me dicinal vi rt ues of the silve r n itrate are t o b e

preserve d it sh o uld not be prescribed with organ i c m a tte r
, ,

by w h ic h it is rea dily decompose d L icorice or alt h e a sho ul d .

,

t h erefore not be use d as excipients in silve r n itr ate p ills

,
.

Still more obj ectionable is an excipient prescribed by physi

cians of t h e old school
“
I refer to mica panis or c rumb
.
,

of brea d Besi de being organic matter brea d c onta ins sal t

.
,

( so di um c h lori de ) w h ic h e ffect ually d ecomposes the nit r ate

, ,

silv er c h lori de res ulting T h e best e x cipient to use in making .

t h ese pills is kaolin or argill a alba ( wh ich is c h emical ly a , ,

silicate of al uminum ) with a min ute quantity of an h yd ro us ,

woolfat Instea d of th e woolfat some recommen d v ase l in ;

.
,

b ut t h e latter possesses no a dh esive propert ies and it is d iffi ,

cult to mak e a presentable pill m ass with kao l in an d vasel in .

 P R E S CR IP T I ON I NC O MP A T I B IL I T I E S 37

S ILVE R N I TRATE Is I N CO MP A T IB LE W TH I O RGA NI C S UB

46 . Ar genti Nitra tis gr . x

Hydrastis A quosi
Gly ce rini
Aq uae q . s
. ad 3
S . : an inj ection
Use as .

T h is is a favorite presc ri pt ion of a p rominen t B rook l yn

physician He clai ms he ge ts good res ults fro m it b ut it is
.
,

ce rta inly not the silver n itrate that giv es t h e goo d res ul ts ,

as there i s no n it ra te l eft i n th e p rescription ; i t becomes

d ecomposed by the or ganic s ubstances I f we wan t silver .

n itrate i n so l ution wit h its unimpai re d p rope r ties on l y dis ,

ti ll ed wate r sho ul d b e use d nothing e l se ,

.

47 . Arg enti ox idi

Ex t G ly cy rr hiz
. . P ul v .

Gly ce rini
M . ft pil
. . No . xxx .

N ot on l y is s il ver oxi de in comp atib l e with organic matte r ,

be in g d ecom po se d by it b ut the l iberation o f oxyge n may,

ca use a m in iat ur e explo sion Perforating the lid o f t h e box .

or d ispe ns in g in a l oose l y st oppe re d vial is no reme dy b e ,

ca use in be ing evolve d from t h e pills the gas o fte n breaks ,

the p ills in to l ittle bits T he rea l reme dy is t o use n o organic

.

exci pien ts on l y kao l in ( with a bit o f anh y d ro us woo l fat ) as

, ,

r eco mmende d for pi ll s o f silve r n itrate .

S o dii Chlo ridi

Aq uae Destillatae
S : Use an inj ectio n
. .

This p re sc ription was writte n by a medi ca l p ractit ione r of

the E clectic School and was d ispe nsed by a d r ug g ist after
, ,

having been fi ltere d Th e d octo r having learn ed t h at t h e

.

severe b ur nin g c aused by sil ver n itrate can be e ffect ual ly

 38 PRE S C RIPTION INC O MP A T IBILIT I E S
stopped by a s ubse quent i nj ecti on or app l ication of a so l u
tion of so di um chlori de tho ugh t h e wo ul d simplify matters ,

and save time and labor by or dering bot h ingre d ients in t h e

same prescription T h at t h ere was no silver nitrate left in

.

the bottle nee d not be dwelt upon as it is almost p r esump

, ,

tion to tell intelligent rea de r s t h at so di um c h lori d e d ec e m

poses silver nitrate into the insol uble and inert silve r
c h lori de
O
.

SI LVER NI TRATE I s I NCOMPA TIB LE WITH S L UBL E C HLORI DE S .

49 . Bismuthi S ub nitr . 3 1j

S o dii B icar b on . 3 i
Mucil . A caciae q . s
.

Divi nto p il N o xxiv

. . . .

As explaine d in Prescription No 4 1 bism uth s ubn it r ate .

,

and so di um bicarbonate are somew h at i ncompatible carbon ,

dioxi de being evolve d T h ese p ills wo ul d swe ll and break .

up . This may be avoid e d by using t h e s ubcarbonate o f bis

m ut h instea d of t h e s ubnitrate or by using an excipien t p r ac ,

tically free from water s uch as glycerite of starc h , .

50 A ci di Chr omici
.

A lco holis
S . : ex ternally Use .

Of al l the oxi dizing ofiicial c h emicals s uch as pota ssi um

‘
,

chlorate potassi um permanganate etc c h romic aci d is t h e

, , .
,

most so T h is p rescription s h o ul d not be compo un de d un de r

.

any circumstances C h romic aci d s h o ul d neve r be bro ugh t in

.

contact with any kin d of organic oxi d izabl e m atte r as a ,

dangero us explos ion m ay take place G reat care s h o ul d al so .

be ta k en in h an dling it as i t d estroys any animal t iss ue with ,

w h ic h it comes in contact .

C HROMIC A CI D ( C HROMI U M T RIO X I DE ) S H OUL D N E VE R B E

P RE S CRI BE D WITH O R GA NIC S UB S T A NCES .

r x
51 P ot ass P e rmangan
. .

g
.
.

Gly cer ini

Aq uae
S . Use e xt e rnally .
 P RE S CRIPT ION INC O MP A T I BIL IT I E S 39

52 . P o t ass . P e rmangan .
gr . xxx
P ul v . Liq uiritiae
Ex t . Gentianae
M ft ma ssa in pilul No xxx
. . . . divide nda .

T he remarks ma d e regardin g silve r nitrate are app l icab l e

with sti ll greate r force to potass i um permanganate The .

l atte r is exceed ingly sensitive to organic matter ; it gives oflf its

excess val ue as a n oxi d ize r with t h e utmost rea diness I ts .

val ue as an oxi dizer and d isinfectant depen ds upon the oxy

ge n it l ibe rates in statu nascend/i It is sel f evident there .
-

fore that i n c omb in ing it with organ ic matter ( or wit h ox idiz

,

able inorgan ic m atte r ) its usefuln ess is enti re l y destroyed .

When ord ere d in sol ution it sho ul d be p resc ribed with dis
,

t il l ed wate r only F o r pills kaoli n with anhydro us woo l fat

.
,

is to be em ploye d as t h e excip ient Or wh at is p referable .

, ,

the pe rm anganate is intimately mixe d with kaolin or ta l c um

an d fi lle d into caps ul es ( dry ) I t is also worth remembering .

th a t when a sol ution of potassi um permanganate is used exter

nally as an appl ication a consi d erab l e po rtion of it is de
,

st roye d by con tac t with t h e cotton swabs or l int emp l oyed as ,

a d ressin g etc, .

53
. P u l v Calamina ris
.

Z inci Ox idi
A ci di Car b oli ci
Aq uae Cal ci s
Aq uae R osae
Apply freq uently and freely .

The re i s no inc om pat ibility in the p resc ription b ut it is ,

a good example of how a printer s error combine d with ’

i gnorance on the p art of p h ysi cian and d r uggist m ay l ead ,

t o a d isast ro us acci dent I was aske d by a physician to see

.

in cons ul tation a baby to whom h e h ad t h e day before pre

,

scribe d the above l otion ( The ch il d had an e czemato us and

.

urticaria l e ruption ) Ou cal l ing t h e next m orning th e ch i l d

.
,

was m uch worse ; it had screame d ba dly wh en t h e l otion was

ap plied , refuse d to tak e the br east , had passed no water was ,
40 PRE S CRIPTION INC O MP A T I B I L IT I E S
very restless ; in s h ort i t seeme d dangero usly ill B y t h e
,
.

aid of a cat h eter I d rew off some urine w h ic h was of a green

, ,

is h color and h ig h ly alb umino us I d iagnosticate d carbolic .

aci d poisoning institute d t h e proper treatment and in t h ree

, ,

days t h e c h il d was well I aske d h im w h at he had pre .

scribe d ; on seeing t h e prescription I tol d h im t h at t h e car ,

b olic aci d was excessive ; t h at this was a well k nown for .

-

m ula b ut th at 143 dr not 4 d r is always use d to 4 ozs H e

,
.
,
. .

afterwar d maile d m e t h e page from t h e j o urna l from wh ich

h e had copie d t h e formula and in dee d t h e form ul a had it ,

oz ! Of co urse bot h t h e p h ysician an d t h e p h a rmacist are

.
,

to blame in t h is instance T h e p h armacist sh o uld have borne .

in min d t h at half an o unce of carbolic aci d cannot be d is

solve d in three and one h al f o unces of water and that it i s-

very dangero us—in fact it is absol ute ly ina d missible—to ,

d ispense a mixt ure with carbolic aci d hel d in s uspension i e ,

. .
,

not in perfect sol ution .

54 . Zinci S ulphatis gr . xx iv
P lumb i A ce tatis 3 j
Aq uae 3 vi
S . : Use e x ternally as dir ecte d .

Tho ugh this prescription is inc ompatible i t is one of th e ,

most common examples of d eswab le or intentional in com

p atib ility Many practitioners stick t h eir faith to t h e above
.

recipe consi dering i t a ne pl us ultra inj ection i n gono rrhea ;

,
- -

an d t h ere seems to be no d o ubt t h at t h e s ulp h ate of lea d

exerts a b eneficial protective infl ue nce on t h e m uco us mem

brane of t h e ureth ra l canal while t h e zinc acetate has a ,

non irritating astringent e ffect

-

T h e reaction wh ich t ake s .

place is a very simple one

ZDS O4 Pb ( CzH1 0 2) z ZD ( CzHJ Oz) h
P sot

There is no difficulty in m aking up th is presc ri ption B ut .

h ow often in seeing t h is prescription m a de w as I able t o

,
,
distinguis h between t h e go od p h armacist an t h e
d b ad p h ar
mamst T h ere is not a t h in be it eve so sm all t h a cannot
g r t
.

,
,
42 PRE S CRIPTION INC O MP A T I B ILI T I E S
l oids . Had the physician trie d his utmost get the quin in e to
and t h e stryc h nine precipitate d h e co ul d not have d one any

better t h an to prescribe t h em wit h corrosive s ublimate and

potassi um i od i de E ac h of t h ese c h emicals alone will p re
.

cip itate al k aloi d s b ut when combine d t h ey form the so calle d

-

,
”
“
Mayer s sol ution of iodohy dr ar gy r ate of potassi um whi ch
’
,

is one of th e most potent genera l alkaloi d al p recipitan ts .

To dispense t h e prescription as written is ce rt ainly a d an

g e r ous p roce dure as the patient may get too large a d ose of
,

stryc h nine T h e best t h ing is to comm unicate with the physi

.

cian . I f t h is is not feasible I wo ul d leave out t h e strychn ine

,

on my own responsibility and impress upon t h e p atient th e ,

importance of s h aking t h e bottle eac h time ; and I wo ul d in

form t h e p h ysician by mail so t h at h e can or de r t h e strych
,

nine separately i n t h e form of pills or tablets

, .

A LKA LOI DS S H OU L D N EVE R B E P RE S CRIB E D I N A MI XT U RE

CO NTAI NI NG MERC U RIC C HLORIDE A N D P OT ASS I U M I ODIDE
UU
.

T H E RE I s S URE TO B E A M T AL P RECI PIT A TI ON .

56 . Hy drarg B ichlor .

P ot ass . I odidi
Tr . Cinchon Co . mp .

S y r S arsap
. . C mp
o .

Aquae qs . . ad

The remarks made in the prece ding prescription app l y to

t h is one as well except of co urse t h at t h ere are no poiso n
, , ,

ous alkaloi ds T h e bichlorid e and the iod i d e will p reci pitate

.

t h e alkaloi ds of the cinchona The bic h lori d e wil l also be .

a ffecte d by the tannic aci d in t h e cinc h ona ( Corrosive sub .

limate is a very delicate agent and sho ul d be p rescribed as ,

little in comb ination as possible ) B ut as many p h ysicians .

,

insist on prescribing t h e above mixt ure it shoul d be d is ,

“
p ensed with a shake label .

Thi s is a fav orite presc ri ption with m any German p r ac

 P RE CRI P S TI O N I N C O MP A T IBILI T I E S 43

titioners, and is known in some d rug stores by the n ame

“
German ink ”
The cinc h o tan ni c aci d combines with the
.
-

iron p roduc in g t a nnate of iron yiel ding a green ish black

, ,
-

ink y mi xture B ut as the physi cians prescrib in g it are aware

.

of the chan g e of col or in th is m ixt ure and do n ot min d it , ,

the pharm acist m ust n ot interfere A fter all appearance is .

,
“
n ot e ve ryth in g ; and as some on e has sai d ,
a nasty me di cin e ,

is p referab l e to a nice funera l ”

.

58 Q uin S ul ph
. . . 3 i
A ci di S ul ph Dil .
qs . .

E x t Gly cy rr hiz P l
. .
3 ss .

S y r up i 3i
A quae ad 3 iii

This is an o ld and wel l known prescri ption incompat ibility -

.

The dil ute s ul ph uri c aci d works do uble mischie f F irst by .

,

d isso l ving the q uin in e i t ren de r s the m ixt ure intensely bit
,

ter ; secon d l y by p recipitat in g the glycy r rhizin from t h e

,

fl uide x tr act of glycyrrh iza th e sweetenin g or disguising ,

p ro pe rty of th e l atte r is complete l y dest roye d Omit t h e sul .

p hur ic acid and dispense th e presc ript ion as a

,
“
s h ake

59 Sol Ma gen die

. .

S o l P ot ass I od idi S at ur
. . .

S : Gtt x t i d p c
. . . . . . .

The pha rmac ist sho ul d r e fuse t o d ispense this prescri ption .

Wh il e the dispensin g of a n on poisono us alkaloid l ike q uinine -

in an un d isso l ve d fo rm is more a matter of est h etics t h a n

anyth in g else it is enti rely d iffe rent when we h ave poisono us
,

princip l es to de a l with Po isono us alkaloi d s are to be d is.

pe nsed in l i q ui d mixt ures only when they are in pe rfect

sol ution and when the re is no danger of thei r s ubse q uent
p recipitation With in a ve ry short t ime silky need l es will
.
,

begin t o d eposit and event ual l y al l t h e morph in e wil l be

,

p reci pi tated out as morph in e hydri odi d e Th at it wo ul d be .

a ve ry d angero us th in g to take th is me dic in e by d rops r e ,

q uires no argument .
 P RE S C RIPTION I NC O MP A T I B IL I T I E S
60 . P ot ass Chlor atis
.

A ci di Hy dr ochlor .

Gly ce r ini
Aq uae
.S : As direct ed on a cott on sw ab
,
.

T h e making up of t h is prescription wi ll d epend greatly on

t h e p h ysician s directions and on t h e knowle dge as to h ow
’

it is to be employe d When prescribe d in dipht h eria t o be

.
,

use d for swabbing t h e t h roat t h e p h ysician generally wants

,

t h e sol ution to contain free c h lorine I n t h is case t h e pre

.
,

scription is compo un de d j ust as written ; i e t h e hy d ro . .

,

c h loric acid is po ure d directly on the pota ssi um c h lorate

( crystals ) T h is generates free c h lorine When the r e ac
. .

tion seems to be complete d t h e water is a dd ed and t h e n

, ,

t h e glycerin Howeve r if wante d for intern a l use or wh en

.
, ,

t h e evol ution of c h lorine is not desire d the potassi um c h lorate

,

s h o ul d be disso l ve d i n t h e water and mixed with t h e glycerin ,

and t h en t h e hy drochlori c aci d s h o ul d be a dd ed l ast If .

ma de in t h is manner no chlorine wi ll be evolve d

, .

61 . P ot ass Chloratis
.

Tr . F erri Chloridi
Gly cerini
Aquae
S : 3 ss as directe d
. .

I use d to dispense t h is p rescripti on da ily and severa l ,

times a day beca use I knew h ow i t was to be employe d ; a

,

tablespoonful was to be m ixe d wit h a c upful of warm wa ter

and use d as gargle B ut s h o uld t h e d irections not be known
.
,

the prescription sho ul d not be d ispense d Were t h e dose .

even a teaspoon instea d of a tablespoon I wo ul d har dly d is ,

pense it ; not beca us e the dose ( ten g rains ) of potassi um

ch lorate wo ul d be an excessive one—it is rathe r large and ,

p h ysicians are of late ve ry ca utio us in adm inistering large

doses of K ClOa— b ut beca use the c h emical i s not di ssolve d
°
 P RE S CRIP T I ON INC OMP A T I B IL IT I E S 45

of th e circ umstances and insists on the p rescription being

d ispense d as written the dr uggist h as no alte rn ative b ut to
,

obey .

62 . Calomelanos
P ot ass . B ro midi
Lactis
S acc h .

F t tal doses N o xxx

. . . .

T h is p rescr iption is a dangero us one and sho ul d not be

A
,

dispense d unde r any circ umstances reactio n takes place .

between the merc uro us c h lorid e and pot assi um b romi de with ,

the form ation of merc uric bromi de a very p oisono us com ,

po und The e q uation is as follows

.

2E gCl 41 m : Hg Hg B r. 2KB R 2K CI
Calo me l P o tass . Me r Me rcur ic P o ta ss . P o tass .

B r o mi de cury B r o mi de B ro mide Chlo ri de

Th e presence of wate r o r moist ure seems to b e necessary

for th e reactio n to take place beca use if the pota ssi um ,

bromi de is d rie d s o that all interstitia l moist ure is d riven

,

f n o c h ange occ urs i n the m ixt ure

of,
T h e reaction oc c urs .

immediately h oweve r on the a

,
dd it ion of wate r ( which i s
,

present also in t h e g astric j uice ) E ven when a dministe re d .

separately c alome l and pot assi um bromide sho uld not be

,

given at too s h ort inte rvals a pa rt ; a peri od of o ne or two

ho urs sh o uld inte r vene so as to avoi d th e possible d ange r ,

of the form ation of merc uric b romi d e i n the st omach .

63 . S o l N atr
. n B icar b o n , 25 % .
3 viij
S . : A p p ly e x te rnally all o v er the b
od y with , a pie ce of
co tt o n .

T h is is a s h ort p rescription b ut a v ery interest in g t a l e ,

goes wit h it It was p resente d t o me in my early j unior

.

d ays . One of t h e fi rst t h ings I committe d t o m emory— an d

I wo ul d recommend all d rug clerks to do t h e sam e—was the -

so l ub il ity of t h e c ommonly employed c h emi ca l s I therefore .

, ,

saw at on ce that t h e re was no possibil ity of m aking a twenty

fiv e pe r cent so l ution of sodi um bicarbonate an d so t o l d
.
,
46 PRE S CRIPTION IN C O MP A T I B I L IT I E S

t h e proprietor ; the strongest so l ution that can be made is

abo ut eig h t per cent .

“
Well sai d he y ou h ave n ot had very m uc h experience
“
, , ,

I see ; I ll make t h e sol ution al l rig h t He t h en weighed

’ ”
.

out two o unces of so d i um bicarbonate too k eig h t o unces of ,

water ( t h e righ t q uantity wo ul d h ave been six o unces ) p ut ,

bot h i n a dis h and bro ugh t t h e sol ution to boiling A clear

,
.

”
B ut won t it precipitate on cooling ?
’
sol utio n res ulte d .

remonstrate d I mil dl y “
Wait and see ,
”
T h e so l ution b e . .

came col d and remaine d perfectly clear With a l ook of .

tri umph the boss de l ivered it and very satisfied was he

“
,
”
,
.

However t h e next m orning the docto r who prescribed t h e

,

sol ution came to the store in a perfect rage We m ust have .

ma de a mistake a terrible mistake ; we m ust h ave p ut i n

,

some poisono us st uff some ca ustic i t nearly kille d t h e b aby ;

,

t h e e r uption became m uch worse ; t h e itc h ing was intolerable ,

etc etc
.
,
.

Now w h at had taken pl ace ? Simply t h is : A ny bica r

,

bonate in sol ution w h en strongly h eate d or boile d be c omes

, ,

converted into a carbonate accor ding to t h e following e qua ,

tion :
2NaHCOa he a t N aaCO. C0 : HO
z .

T h e so l ution delivere d was conse q uently not one of sod i um

bicarbonate b ut a strong sol ution of so d i um carbonate I t
, .

was to be app l ie d to a little baby that had a slight er uption .

No won der t h at it prod uced s uch great inj ury ! T h e c h ild s ’

s uffering co u ld be allaye d only by wrapping t h e whole bo dy

in l int so aked in carron oil ; and it took q uite a long wh ile
before it got well My proprietor never afterwar d d ispensed
.

a twenty fi ve per cent sol ution of sod i um bicarbonate

-

.
.

64 . Tr . F er ri Chl or .
3 1j
Gly cerini
3 ss
Aquae Gaultheriae 3 iij
W h at will take place in this prescription ? I t ass umes a
bea tif l violet bl ue col or What 1 s th is due t o ? Oi l of wi n
u u .
 P RE S C RIP T ION I NC O MP A T IBILI T I E S 47

ter gr e enconsists p rincip all y of methy l sa l icy l ate and all ,

salicylates ar e incompatible wit h ferric sa l ts form in g ferric ,

salicylate which is of a deep v io l et bl ue colo r

,
T h e rea o -

tion is expla ine d by the fol lowing e q uat ion

2F e CL 6C H C H 0 F&(0 H 0 ) GCH C1
1 1 5 3
r .
1 5 3 e 3 .

Wh ile some physicians may p rescribe it being unfamiliar ,

with the facts I kne w one p h ysician who use d to prescribe

,

this m ixt ure p urposely in orde r not to let his patients know,

that they were taking i ro n .

65 . Tr . Fe r ri Chloridi
Kali Chlo r atis
A ntip y r ini
Gly cerini

The an tipy r ini, shows that t h e physic ian w ants

q . s .
,

the anti pyr in on l y for t h e co l or i t pro duces w ith th e i ron .

A s t h e ye l low t h roat mixt ure

“ ”
is t oo well k nown some ,

physicians p re fer to m ake thei r p atien ts be l ieve that t h ey

a re taking something n ew A ntipy rin p r oduces a d e p r e d
g
-
.

colo r with fer r ic salts .

66 . Natr ii S alicy l .
3
Spir . Nit D ul cis
.
3 j
Syr . S imp l
Aq uae ad 3 viij

Wh en d is pense d this is a pe rfect l y c l ear sol ution b ut grad ,

ually i t begins to d arken un ti l it is almost bl ack T h is d ark .

e ning is d ue t o a reaction between t h e sod i um sal icy late and

t h e spiri t of n itro us ethe r The patient is l ikely to bring .

back t h e m ixt ure asking if a m istake had not been ma d e or

, ,

if i t d id not get spoiled It is therefo r e im perative to in .

fo rm the patient that t h is m ixt ure wil l get d ark ; he will then
not be alarme d T he exact nat ure of t h e reaction between
.

th e sal icylate and the n itro us et h er as between antipyrin ,

an d nitro us ethe r and m any othe r organi c compo unds is

, ,

not wel l underst oo d I wil l remark here th at w h ere no de

.
48 PRE S CRIPTION INC O MP A T I B I L I T I E S
tails are given as to the reaction w h ic h takes place it is b e ,

cause no defi nite statement can be ma de T o go into spec ula .

tion wo ul d lea d us too far and wo uld h ar dly p rove very '

useful to t h e rea der .

67 . Amm n Ca rb n
o . o .

Syr I pe
. cac .

Syr S ill
. c ae

Syr P ru Virgi
. n . n .

Aquae
S : 3 i q 3 h un til cough is reli eve d
. . . .

T h e acetic aci d present in both t h e syrup o f s quil l and

t h e syrup of ipecac w il l decompose t h e ammoni um carbonate ,

pro ducing ammoni um acetate and carbon dioxi d e T h e m ix .

t ure s h oul d t h erefore be ma d e in a mortar and p o ured i nto

, , ,

t h e bottle only after t h e evol ution of C O2 h as ce ase d .

A cms L I B E R A TE CA R B O N D IO X IDE F RO M CA R B O N A TE S

68 . Liq Plumb i S ub ace t

. .

Mo cil . A caciae
Aquae
S : Dip a cl oth and k ee p const antly wet
. .

Sol ution of lead s ubacetate forms s uch a th ick ge l atino us ,

mass wit h m ucilage of acaci a t h at a cloth cannot be d ip pe d

into it or kept constantly moist wit h it Two ways are Open : .

eit h er to leave t h e m ucilage out or better to s ubstit ute lead , , ,

acetate for lea d subacetate as lea d acetate gives n o pre ,

cip itate with m ucilage of acacia L iq P lumb i S ub acet bein g . . .

abo ut 25 per cent strong th e p rope r q uantity of l ea d acetate

.

wo ul d be abo ut half an o unce

O
.

SOL U TION or L EA D S UB A CE TA TE GI VE S A T H I CK GEL A TI N US

P RECIPIT A TE W I TH M U CILA GE or AC A CI A .

68 . Aci di S alicy lici

N atrii B i car b .

Syr . A ur antii Cort . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Aquae Menthae
A ccor ding to the books , an acid and an a l kal i are incom
50 PRE S CRIPTION I NC O MP A T I B I L I T I E S
T h e order of p roced ure is the same as in the p revio us pre
scription .

71 E x tr Uvae Ursi F l
. . .
3 ss

S p t Ae the r is Nitro si
. 3 j
S p t J un ip e ri Co
. mp .

E x t Tr iti ci F l
. . as 3 ij

S y r up i S imp licis et
Aq uae aa ad 3 iv

I know a dr uggist w h om t h e improper p utting up of this

prescription cost t h e price of a pair o f tro use rs T h e cus .

tomer p ut t h e bottle in h is pocket b ut ret urne d in a min ute ,

wit h th e dark li qui d trickling d own h is w h ite tro users and ,

full of angry words at the d r uggist fo r his carelessne ss in

not corking the bottle properly etc The d r uggist denie d t h e ,
.

a l legation and sai d it m ust h ave been t h e man s own fa ult

,
’
,

b ut a g ree d to make up anot h er bottle wit h o ut ext ra c h arge .

Unfortunately w h ile han d ling th is secon d bottle t h e cork

, ,

popped out with q uite an expl osion st ri k ing th e man s fa de ,

’

wit h consi derable force bespattering h is w h ite front etc

, ,
.

To avoi d any scenes and t o get r id of t h e man before th e

,

ret urn of the boss t h e poor dr ug clerk agreed to settle

,
“ ”

with t h e man and ret urn h im t h e prescription .

I once experimente d wit h a similar m ixt ure to see h ow

l ong t h e evol ution of t h e gas would last F ourteen t imes .
,

at gra dually increasing intervals t h e cor k poppe d out The , .

fi fteenth time it staye d in T h e gas w h ic h is evolve d con

.

sists of vario us oxi des of nitrogen T h e statement is ge n .

e r ally ma d e that this evol ution of gas is d ue to the actio n

of t h e nitro us aci d on the tannic aci d of t h e uva ursi I t .

is tr ue uva ursi c ontains a very l arge pe rcentage of tann ic

acid b ut the latter m ust d i ffer somew h at in its p rope rt ies
,

from t h e or d inary t annic aci d or t h ere m ust be anot h er con

,

stituent co active in t h e reaction

-

I am impelle d to t h is bel ie f
.

by t h e fact that w h en spirit of n itro us et h er is mixe d with

tannic aci d the vol ume of gas evolve d is ve ry insig n ifi cant ;
,

t h ere is a r e d color pro duce d due m ost p robably to t h e ,

formation of a small q uantity of nitrogen tetroxi d e b ut ,

 P RE S CR IPT IO N IN C O MP A T IBIL I T I E S 51

ha rdly ever is there suffi cient gas to expe l t h e cork The .

in gre d ients sho ul d be m ixe d in a large gr ad uate or mo rt ar ;

am pl e t ime s h o uld be a l lowe d for t h e evol ution o f g as t o
cease and a fte r the bott l e is c or k e d eno ugh time s h o uld e l apse
,

before d e l ive rin g it to m a k e s ure that t h e cork will not come

,

o ut ( or it m ay be t ie d wit h a strin g ) T h e n itro us et h e r .

is completely s poile d d ecom pose d i n t h is p rescription and

, , ,

m ig h t as wel l h ave b een left out by the physician .

72 .Fl uid Ex t B uch u .

S p t A e the ris Nitrosi

.

S p t J unip. . Co mp . as
Syr R ub I dae i
. .

Aq uae
A rea ction s imila r t o t h e one i n t h e prece ding prescri ption
takes place i n t h is i e t h ere is evol ution o f gas l iability to
, . .
, ,

exp los ion etc

,
T h e same remarks abo ut d ispensing apply
.

t o th is one .

73 . P ot ass I odidi .

Syr Ferri I odidi

.

Aq uae
I p r esc ri be this combination ve ry fre q uently and some ,

times I w il l fi nd a p rec ipitate and sometimes n ot If chem .

ically p ure p otass i um io d i d e be used no precipitation w ill ,

take p l ace Commercia l K I is c rysta l lized from a sol ution of

.

po tash ( whi ch gives it better kee p ing q ualities ) and c on

ta in s besides as a n imp urity a small amo unt o f pota ssi um
, , ,

c arbonate I t is the hy d roxide ( with t h e carb onate ) which

.

p ro d uces a prec ipitate of fe rro us hydroxi d e I n cases where .

no prec ipitate is fo un d it is p robably due to one of two ,

ca uses ; eithe r i t is fi lte re d out or t h e syr up of i od ide o f ,

iron was not m a de properly and contained an ap p r e ci ab l e ,

quantity of free i od ine ; the latte r combine d with t h e K OH ,

and th us p re vente d p reci pitation I n no case was it referab l e .

t o the emp l oym ent of chemic a lly p ure K I as none of t h e ,

d r uggists kept th is in sto ck it is p rone to libe rate i odine and

52 PRE S CRIPT ION INC O MP A T I B IL IT I E S
74 . A ci di P he ny lici
Collodii
S . : Apply with camel
’
s
-
hair bru h s i
n g ht and morni ng .

Wh en carboli c aci d is a dde d to collo dion a coagulate d mass ,

forms w h ich cannot be applie d wit h a br us h Besi des t h e

,
.
,

property of t h e collo d ion becomes c h ange d ; i e t h e collod ion . .

,

becomes useless as s uc h T h e p h ysician s attention s h o ul d

’
.

be calle d to t h ese facts and t h e s uggestion ma de t o him t o

,

employ creosote instea d of p h enol C reosote forms a clear .

sol ution with collo dion .

C A R B OLIC A CID I s I NCOMP A TI B LE WI TH C OLLODION : A Co

AGUL A TE D M A SS I s F ORMED .

75 .
h
Hy drar gy ri C lor Corros . .
gr j. v

Aq uae Calcis 3 iv
Aq uae P lumb i
Aq uae B estill .
3 ii
S . : P oison ! F or ex ternal use o nly .

T h is prescription a dmirably serves to ill ustrate what d i f

fe r ent res ults we may obtain in some instances by a d ifferent
or der of mixing t h e ingre d ients and h ow absol utely n eces ,

sa ry it is t h erefore to take note of t h e exact or de r obse rv e d

, ,
.

I f t h e sol ution of corrosive s ublim ate be po ure d into t h e l ime

water yellow merc uric oxi de wil l be forme d ; i f t h e l ime
,

water be po ure d into t h e sol ution of t h e corrosive s ublimate ,

brown merc uric oxyc h lori d e will precipitate T h e sub se .

quent a ddition of the lea d water to t h is mixt ure wil l not

c h ange t h e res ult and the patient will receive a s h a k e mix
,

t ure with a yellow or brown precipitate I f on t h e othe r .

,

h and the merc uric ch lori d e sol ution is a dde d at once t o

,

t h e lea d water a milky w h ite h omogeneo us mixt ure is ob

,

taine d whic h remains unc h ange d by t h e s ubse q uent a dd i

,

tion of the lime water A s to t h e exact chemical composi

.

tion of this precipitate my impression is t h at it is a basi c

,

acetate of merc ury toget h er wit h some lea d c h lori d e ; it is

,

also possib l e that a do uble compo und of merc ury and lea d
 PR ES CRIPT I O N I NC O MP A T I B I L I T I E S 53
is forme d F or p ract ica l p urposes it is suffi cient to kn ow
.

that th e r eaction does not t ake p l ac e with the ne utra l l ead

acetate .

I have also seen t h is prescription d ispense d as a perfect l y

c l ear color l ess sol ution Ou investigating t h e following ca use
, .

was d iscovere d : Some d r uggists i nvariably add to t h eir

l i q uor p lumb i sub acetatis a l ittle acetic ac i d for t h e inten de d
p urpose of preventing its becoming t urb i d on expos ure or on
be in g m ixe d with p l ain water That t h ey th us destroy all .

their work and c onve rt th e basic acetat e i nto a no r mal one

d oes not enter t h ei r min ds A t any rate when th e merc uric
.
,

chlori d is m ixed with s uch a lea d wate r no precipitati on

will take place n o r will t h ere be any reaction on t h e ad d i
tion of t h e l ime wate r T h e me rc uric chlori d e will r emai n
.

unim paired a nd un change d ; b ut we m ust not forge t t h at

i nstea d of lea d s ubacetate we h ave lea d acetate and in ,

stead o f cal c i um hy d roxi d e we h ave ca l ci um acetate

76 . Sol Hy dr ar g P erchlor S at
. . . .

A q uae Cal cis

Mucil . A caciae
Here is anot h er examp l e where the or de r of mixing the
i n gred ients controls t h e res ul ts I f the sol ution of the cor .

r osiv e s ublimate is po ure d into th e l ime water yel l ow m er ,

cur ic oxi d e is forme d ; i f t h e l ime water is ad de d to t h e

sol ut ion o f t h e bic h lori de t h e re ddis h brown oxych lori d e of

,
-

me rc ury precip itates I f t h e corrosive s ublimate sol ution is

.
-

m ixe d with t h e m ucilage of acaci a and then wit h t h e l i me

wate r p reci pitation wil l be prevente d altoget h e r or for sev
,

eral days at any rat e T h e m uc ilage of acacia m ust b e the

.

true U S P m ucilage and not one of t h ose d ark almost

. . .
,

bl ac k so ur smelling pro duc ts which pass for m ucilage o f

,
-

acaci a in some d r ug stores -

77 S ol K alii A rse nicosi

. .

Argenti Nit r i ci
Syr . S acchari
Aq uae Menthae
 54 PRE S CRIPTION INC O MP A T I B ILIT I ES
T h is prescription presents a t riple incompatibility T he .

potassi um carbonate present in F owler s sol ution will p re cip ’

it e te t h e silver as silver carbonate ; anot h er portion of t h e

silver will combine wit h t h e arsenite precipitating it as t h e ,

brigh t yello w silver arsenite ; and lastly t h e silver n itrate

-

is incompatible wit h t h e s ugar of the syr up and wit h t h e

peppermint water A s t h e prescription stand s it s h o ul d not
.

be d ispense d ; b ut i t can be ma d e d ispensable B y a ci difying .

t h e Fowler s sol ution two obj ects a re gaine d : T h e potassi um

’

carbonate is ne utralize d and thereby preci pitation of t h e

,

silver arsenite is prevente d ( t h e latter d oes not take place

in an aci d sol ution ) W h e n F owler s so l ution is acidified fo r
.
’

combination wit h al k aloi d al salts etc hy d roc h loric aci d i s

,
.
,

usually employed I n t h e present case H Cl cann ot be use d

.
,

as it wo ul d precipitate t h e entire amo unt of silver as silve r

c h lori de ; t h e most eligible aci d in t h is case is nitric ac i d .

T h e simple syr up s h o ul d be left out altogether ; and instea d

of peppermint water d istille d water s h o ul d be use d The .

compo un d tinct ure of laven der of t h e arsenical sol ution wo ul d

also ten d to decompose t h e silver nitrate A s t h ere are so .

many rad ical c h anges necessary it is best to cons ul t the ,

p h ysician .

78 . Tr . S trop hanthi
S p irit . Minde re ri
Tr . F erri Chlo ridi
Gly ce rini
Aq uae
S : 3 ss three ti mes a day
.
.

T h is prescription was receive d with a q uery as to wha t

t h e brown precipitate was due to and w h et h er it co ul d be
prevente d T h e ca use of t h e preci pitation is t h is : Sol ution
.

of t h e ammoni um acetate is freq uently alkaline ; t h at is ,

it contains some ammoni um carbonate w h ic h h as not bee n

ne utralize d T h is later pro duces a p recipitate o f ferri c
.

oxi de To avoi d this a little extra acetic aci d s h o ul d be

.

a dde d to t h e spirit of Min derer us ( as t h e U S P d irects ) . . .

,
 P R E S CRI PT ION IN C OMP A T IBIL IT I E S 55

to m ake s ure t h at it is acid and t h en only mix it with t h e ,

tinct ure of iron W h en th us ma de a clear transparent

.
, ,

bright r ed so l ution is t h e res ult T h e brig h t red co l or is due

-
.
-

to the ferric acetate forme d accord ing to t h e fo ll owin g e qua

,

tion :
F 9 0 1: 3 N H4 C2H3 0 2 F € ( CzH1 0 2
)a 3 N H4 C1 .

The Ph armacopeia directs Basham s mixt ure to be m a de ’

fresh w h e n wante d for use ; and in examinations t h e q ues

tion fre q uently occ urs : “
Is B asham s m ixt ure a stable p rep ’

arat ion ? and the can d i date is expecte d to answer t h at it is

”

unstable A cceptin g t h e term sta b l e in its or d inary inter

.
“ ”

p r etation the write r wishes to take iss ue w it h t h e examiners

, ,

and say that if p roperly ma d e L i q uor F erri et A mmon ii

, ,

A cetatis U S P I X is q uite a stab l e sol ut ion

. . .
,
He ma d e .

observat i on s on severa l sa mples and in three or fo ur weeks ,

n o trace of decom position was discoverable The explana .

t io n o f the asse rtion t h at the sol utio n in q uest ion is ve ry

unstab l e is perhaps t o be fo un d in t h e fact th at Bas h am s
’

m ixt ure m a d e accor d ing to t h e old pharmacopeias was q uite

unstable as it conta ine d no p rotective agent s uc h as is calle d
,

for i n t h e present fo rm ul a i e g l ycerin ,

. .
,
.

79 . L iq P ot assi A rse nitis

. 3 ij
Ferri Dialy sa ti 3 ij
Aq uae A nisi 3 ij
T h is is an examp l e of do ubl e incom pat ibility The pot e s .

si um carbonate i n the F owle r s sol ution will p rec1 p itate fe r

’

ri c carbo nate whi ch is almost imme diately converte d into

,

fe rri c hyd roxide T h is with the potassi um a rsenite forms

.

a basic fe rric arsenite w h ic h p recipitates It w il l be r e .

membe red t h at freshly p repare d ferric hy d roxide is the ofli ‘

cial anti d ote fo r arsenical poison ing beca use it combines ,

with the a rsenic p repa rations form ing in so l uble arsenites ,

and arsen ates It sometimes happens that n o precipitation

.

( tak es p l ace I f th is is t h e c ase it may b e a ssumed that the

.
,
56 PRE S CRIPTION INC O MP A T IBI L I T I E S

d ialyze d iron h as not been p roperly ma d e i e t h at it con ,

. .
,

tains free aci d T h e free aci d ne utralizes t h e al k al i i n F ow

.

ler s solution forming potassi um c h lori de a nd preventing

’
, ,

precipitation D ialyze d iron w h en p roperly and conscien

. ,

tiously ma d e is ne utral T h e way

,
t o ma k e u p t h is. p r e scr ip

tion is to ne utralize t h e F owler s sol ution with a few drop s ’

of hy droc h loric aci d ( or to take Li q uor A ci d i A rsenosi in

stea d ) add it to the anise water and the m ixt ure to the
,

dialyze d iron .

80 . P ep sini P uri
A ci di Hy drochlor Dil . .

B ism . et Amm no . Citr atis

S y r up i A urantii
Aq uae Menthae
S . : 3 j in Vi no X e r ico .

T h e existence of bism ut h and ammoni um citrate in the

U nite d States and Britis h P har macopmias is a goo d example
of misplace d zeal and misdirecte d energy I t as well as bis .
,

m ut h citrate sho uld be d ropped from t h e next revision

,
.

T h ere is not a single d isease of t h e gastro intestinal canal -

w h ere th e insol uble salts of bism ut h — the s ubnitrate and

the s ubcarbonate— d o not act better t h an this sol uble salt .

I n many con ditions—s uch as ulcer of t h e stomac h ul ce ra ,

tion and infl ammation of t h e bowels— t h e bism ut h sub ni

trate s ubcarbonate etc act well j ust beca use o f thei r insol
, ,
.
,

ub ility ; i e they form a protective coating to the m uc ous

. .
,

membrane and t h us prevent the aci d s from coming i n d irect

,

contact wit h it w h ile t h ere is not a singl e con d ition in which

,

a sol uble bismuth salt is in dicate d Anot h er impo rt ant point .

is t h at t h e subnitrate and s ubcarbonate being insol uble ca n

,
, ,

be given in ve ry large doses ( some physicians give as m uch

as two to fo ur d rams at a dose ) wit h o ut any d anger of
prod ucing toxic e ffects E ven t h e s uppose d a dvantage of th e
.

—
salt in q estion its sol ubility— is a very unce rt ain q uantity ;
u
i e , it l ose s the ammonia rapi dly and the so l ubilit become s
y
, .

,
 58 PRE S CRIPT ION INC O MP A T I B ILI T I E S
There are t h ree kin ds of incomp atibility in th is p r escr ip
tion w h ic h t h e doctor insiste d on h aving d ispense d j ust as
,

written T h e tinct ure of iron d oes not contain eno ugh h y dro
.

c h loric aci d t o ne utralize all t h e ammonia water and ammo

ni um carbonate present in t h e aromatic spi rit T h ere wil l .

conse quently be a precipitate of ferri c hy d roxide T h e sec .

ond t h ing t h e spirit will d o is to precip itate the q uinine , ,

wh ich wo ul d ot h erwise have been rea dily d issolved by t h e

tinct ure of iron ( due to its containing free 11 0 1) t h e t h ir d
point is t h e tannin of t h e digital is will yiel d a greenis h black -

color with t h e iron As to d ispensing the prescription I w il l

.
,

repeat : As long as t h ere is no d angero us poison in t h e m ix

t ure and t h e doctor wants to h ave it th at way let him h ave ,

it. A fourth point of incompatibility might be mentione d

T h e separation of t h e oils from the aromatic spirit by t h e
water ; b ut t h is is of l ittle impo r tance i n comparison with
the ot h er di ffic ulties .

83 . F erri Py r ophosphatis 3 ij
A ci di P hosp horici Dil . 3 ii j
S y r R ub I daei
. .
3 j
Aquae 3 iv
Practically everything sai d in regar d to sol uble ferri c
phosp h ate ( see prescription 1 1 1 ) is applicable t o ferric
pyrop h osp h ate as t h e latter is like t h e p h osp h ate ma de sol u
, , ,

ble by t h e aid of so di um citrate T h e p h osphoric aci d will .

decompose the sol uble ferric pyrophosphate and ca use a p re

cip itate .

84 . P otassu Chlor atis

A ci di Tanni ci
‘
S . : 3 jwater for a gargle
in cup of hot , .

I fe l t almost like apologizing for p utting down th is p re

scription it is so old and so well known B ut I s uddenly rec
, .

ollecte d t h e acci dent in Greenwich street whe e a dr g c l erk

r u ,

blew up half t h e store and near l y l ost h is l ife from the

J nj udiciou s han dling of p o ta ssi um chl orate and sodi um sali
 E
P R S C RI P T O N I I N C O MP A TI BIL I T I E S 59

cy late , a nd t hen I saw t h at no apology w as necessa ry I t is .

j ust t h ose easy well k nown thin gs t h at need be constantl y

,
-

ke pt i n m in d constantly referre d to Potassi um ch l orate is

, .

a great oxi dizin g agent A n oxi d izin g a gent is a s ubstance .

whic h rea d ily gives up its oxygen to oth er compo un ds To .

t h e oxi dizing agents belong t h e c h lorates nitrates p erman , ,

g anate s c h romates etc

,
Oxi di za ble s ubstances are s uc h as
,
.

rea dily combine wit h oxygen TO t h e easily oxi dizable sub .

‘

stances belong s ul ph ur p h osp h or us and most organic sub ,

stances I f the potassi um chlorate were r ubbe d rat h e r vig

.

o r ously w it h t h e tannic aci d i n a mo rt ar an explosion wo ul d ,

al most surely res ult T h e ri ght way is to pow der the p otas
.

si um c h lorate separately ( and even t h is m ust be done gently ,

beca use eve n i f r ubbed vio l ent l y by itself an explosion is

a pt to res ult ) and m ix li g h tly with t h e tannic ac i d on a sh eet

o f pape r by the a id of a horn spat ul a Inst ruct the p atient .

t o be ca ref ul .

85 . P ot ass . P e rmangan .

A ci di T anni ci
Alu m et P otass S ulph
. . .

A ci di B ori ci
M e t ft p ul vis secundum artem
. . .

S . : 3 ss in 4 qts of ho t w ater as a .
,
do uc he every mo rn
ing and nigh t .

The remarks on t h e previo us p resc ription app l y also t o

t h is T h e permanganate s h o ul d be fi rst pow dere d caref ully
.

( it need not be in a fi ne pow d er ) by itse l f then mixe d with ,

t h e boric ac i d al um and lastly with the tannic aci d

,
It .

m ay be remarked that t h e p h ysician migh t as well have l e f t

o ut t h e permanganate beca use w h en t h e so l ution is ma de it ,

i s r ed uced to a manganate by the tanni c acid .

86 . A ci di P i cri ci
Coca in ae Mur .

S . : Apply on lint every ho u r.

60 PRE S CRIPTION IN C O MP A T I BILIT I E S
T h is is a somew h at mo dern p rescription It was written .

by a well known p h ysician w h o use d to be assistant to t h e

-

C h ai r of Materi a Me d ica in one of our colleges P icric aci d .

has been recommen de d as an e x cellent reme dy for b urns .

Wishing to obviate any possible b urning sensation from t h e

picric aci d th e p h ysician or ders some c oc aine wit h it ; b ut
,

in doing t h is h e loses sigh t of the fact t h at picric aci d is an

excellent precipitant of almost all alkaloi ds W h en a sol u .

tion of picric acid is a dde d to a sol ution of cocaine h y d ro

c h lorid e the mixt ure becomes at once t urbi d and soon t h e
, ,

crystals begin to separate out T h ere can be no two opinions .

as to wh at co urse is t o be p urs ue d i n t h e present case ; t h e

cocaine i s to be left out Not only is it useless beca use pre
.
,

cip itated in an insol uble con d ition b ut if appl ie d in that ,

insol uble form it wo ul d do misc h ief by irritating the ten der ,

recently b urne d surface O f co urse the physician is to be

.
,

informe d of the facts in t h e case .

87 . S odii S ali cyl .

A ci di Citr i ci
Syr Rub I daei . .

Aq uae
Ft sol uti o S : 3 ss ti d c.
. . . . . .
p .

years ago One b usy afternoon we receive d the above p re

.

scription T h e proprietor sent in a very polite note to the

.

physician tel l ing him t h at h e was no d oubt aware of the

,

fact b ut it probably had slippe d his min d t h at citri c ac i d

,
,

wo ul d decompose t h e so di um salicyl ate wit h t h e conseq uent ,

precipitation of t h e salicylic aci d ; w h ethe r h e wo ul d not or

d er to leave out the citric aci d or give an eq ivalent amo nt
u u ,

of potassi um citrate a dditionally T h e p h ysician ma de no .

reply b ut appeare d personally after a short while “ Y ou

,
.

u
m st be very pec uliar in making up prescriptions ; I mad e
Up
t h at same prescription a dozen times at X s d r ug store ’

,
 P RE S C RIPT I ON I NC O MP A T I BILIT I E S 61

an d t h ey neve r made any rem ark s ; I a l ways saw that the

p atients had a perfect l y clear sol ution ”
Being of co urse .

absol utely ce rt a in of our being in t h e right we tol d h im that ,

if X obtaine d a cle ar sol ution there was no so d i um salicy l ate

i n h is m ixt ure and we a dvised h i m to take th e prescription
,

t o X s d r ug store g o behind the co unter and watch t h e clerk

’

p repare it He d id The cle rk m ixed all t h e ingre dients as

. .

prescribe d and then fi lter ed the mixt ure

,
T h at p h ysician .

has sinc e then had a good d eal more respect fo r as than he

did fo r X Th e reaction is simple
.

3 N8 C1 H5 0 a HCHOz o o
‘
: NaaCoH3 0 1 3 HC1 H5 0 1 .

88 . P otassn P e rmang .

Mor p h S ul ph . .

Ex t Liquir . .
q . s
. ut fiat mass a
in pil ulas No . xx iv divide nda .

l
As exp ain ed in a previo us prescripti on ( No p otas .

si um pe rmanganate m ust not be bro ug t in contact with or h

ganie matte r as it b ecomes decomp osed I n t h e present in
'

.
,

stance there wi l l be a do uble reaction which will make the

p il l s enti re l y wo rth l ess T h e potassi um permangana te b e .

com es red uced by th e m orph ine and l i q uori ce to potassi um

mangan a te an d m anganese d ioxide ; t h e morphine b ecomes
oxi d iz ed an d h as n o l on ge r the p roperties o f morp h ine T he
,
.

physic ian sh o ul d be appr ised of the facts in the c ase .

89 . Morp h in S ulph . .

S p t Aether Nitrosi
. . .

F l E x t B ellad
. . .

Aq uae
S . : 3 j p ro re nata .

Morph ine with sweet spi r i t o f niter prod uces a ye ll ow

sol ution due to t h e oxidation of the mo rph ine by the nitro us
,

compo un ds present in t h e spirit The prescription m ay be .

d ispense d b ut I wo uld not be astonished if I got l ittl e of the

,

ano dyne e ffects of the morphine an d I th ink the physici a n ,

62 PRE S CRIPTION INC O MP A T I B IL IT I E S
would be thankful if h is attention were cal l ed to the incom
p atib ility .

90 . Morph . S ul p h .

Liquor P otas sn Hy drox

. .

Aquae Chlor oformi

F luidex t Triti ci .

Gly ce rini

This prescription is incompatib l e beca use the li q uor p o ,

tassii hy d rox idi being an alkali will p recipitate the mor

, ,

p h ine. Give this prescription at an examination and al ,

most every one of those answering it at al l wo ul d answer it

in word s in dicate d above B ut t h is presc ription is not in .

compatible Tr ue morphine salts are precip itate d by po

.
,

tassium and so di um hy d roxi des b ut the precipitates are r e ,

d issolve d by an excess of t h e alkal i I n t h is case t h ere is .

more than sufficient sol ution of potass hy d roxi de to re d is .

solve the precipitate d morp h ine and to keep it i n sol ution .

I f instea d of 2 d r t h ere were prescribe d on l y a few d rops

, .
,

of l i quor p otassae t h e p rescription wo ul d be incompatib l e

,

and co ul d not safely be d ispense d .

91 . S tryc h . S ulp h
Liq uor P otassn Hydr os .

Aquae Chlor ofor mi

E x t Triti ci P l
. .

Gly cerini 551 3j

Th is prescription is by the same physician who wrote th e
previous one T h at one was for the ac ute irritable stage of
.

cystitis ; after that stage had passe d he prescribe d a tonic ,

instea d of a se dative While t h e fi r st prescription was d is

.

p ensed wit h o ut hesitation it was deeme d obligatory to n oti fy,

t h e p h ysician t h at it wo ul d not be quite safe to d ispense t h is

secon d one and h e was very t h ankful for t h e info rm ation as ,

t h e really goo d physicians always are and or dere d t h e stryc h ,

nine in tablet form The reason of t h e incompatibi l ity is that

.
 P RE S CRIPT IO N I NC OMP A T I BI LI T I E S 63

st rychn in e ( alkal oida l ) is precipitated and is not redisso l ved

by excess of alkal i .

92 . L iq Plumb i S ub ace tatis

.

S ol ut A c B ori ci S at ur
. . .

S . : Apply e x ternally .

A m ilky wh ite p recipitate res ul ts when th e two so l utions

are m ixe d d ue to the formation of lea d bo rate This chem
, .

ica l is form ed only i n an a lka l ine medi um Its form ation .

can therefore be prevented in two ways : e it h er by a dding a

few d rops of aceti c aci d to the li q uo r p lumb i sub acetatis to ,

ne utral ize its a l kalinity ; or by taking an e q uivalent q uan

tity of l ea d acetate ( in this case abo ut h alf a d ram ) E ithe r ,
.

expe d ient is permissib l e ; a perfectly c l ear so l ution wi ll re

s ul t in eac h case .

L EAD SAL TS A RE I NC O MP A TIB LE W I TH B omc A C ID I N A N

AL K AL I NE MED IU M .

93 . Plumb i A ce tatis
S odii Bib o ratis
Aq uae R osae
S . : Drop 3 drops into each eye every 4 ho urs .

The sa me reaction wi ll t ake p l ace h ere as i n the p revio us

p rescri ption b ut t h e a l ka l inity is here due not to the l ead
,

sa lt b ut t o t h e b o rax T h e m ix t ure sho ul d not be d ispensed

.

in this con d ition especia l ly as i t i s t o be use d wit h an eye

,

d ropper The best t h in g to do is to use an e q uivalent q uan

.

tity of b o ric aci d ; t h e sol ution will t h en be perfectly c l ear .

Glycerin wil l a l so p revent p recipitation ( F or a f ull d isc us .

sion of th is se e the next p resc ri ption ) T h ere is somet h ing

,
.

e lse w rong w it h t h is p rescription more important even t h an ,

the incompat ib il ity ; name l y t h e employ ment of lead i n t h e

,

eye Sal ts of l ead sho ul d never be employed on t h e eyeball

.
,

as severa l cases of cornea l opacities h ave been reported fro m

their use due to the deposition of l ea d
O O O
.
,

L E AD S AL TS A RE I NCO MP A T I B LE W I T H B R A X I N S L UTI N
LE AD B onu s P RE CIP ITA TE S .
64 PRE S CRIPT ION INC O MP A T IBIL IT I E S
94 . P lumb i A cetatis 3 ss

S o dii B or atis 3 j
Gly cerini 3 ss
Aq uae q s ad 3 iv . .

This prescription d iffers from the p rece d ing one in t h at

it contains an a d ditional ingre dient glycerin w h ic h m akes , ,

“
all t h e d i fference in t h e worl d in t h is case T h e combina .

tion is a goo d ill ustration of w h at act ual aid c h emical knowl

e dge is to us in preventing and correcting i ncompatibilities .

If t h e borax be mixe d wit h t h e lead acetate a prec ipitate will ,

occ ur as explaine d in t h e previo us two prescriptions ; b ut t h e

,

precipitate d issolves on t h e a ddition of t h e glycerin I f t h e .

glycerin be a dde d to a sol ution of t h e lea d acetate and then

m ixe d wit h t h e borax a precipitate will also form w h ic h will
,

re dissolve on s h aking provi de d there be suffi cient glycerin

,

present B ut if t h e glycerin be a dded t o the d issolved bor ax

.

and t h en mix e d wit h t h e s ugar of lea d no precipit ation wil l ,

take place W h at is t h e ca use of t h is ?

.
y

To un derstan d this fully we m ust examine into t h e chem ,

istry of borax Borax is not t h e normal borate of so d i um of

.
,

t h e form ula N a3 B 0 3 Its form ula i s N a23 4 0 7 and c h emically

.
,

it is sodi um penta meta tetra borate or i t is penta meta tetra

- - -

,
- -

boric aci d in w h ich t h e two h y drogens h ave been replace d

,

“ ”
by two atoms of so di um The wor d meta means change . .

A met a aci d is an acid res ulting by t h e s ubtraction of t h e

-

elements of one or more molec ules of w ater from t h e r eg ulwr

or orth o aci d F or instance p h osphoric aci d is 11 3 1 0 4 ; sub
.
3
,

tract one E 20 and meta ph osp h oric aci d— H P OS — is left -

Boric aci d is H3 B 0 3 S ubtract one H20 and meta boric aci d

.
,
-

is obtaine d Now penta meta tetra boric aci d means boric

.
,
- - -

aci d whic h res ults by s ubtracting 5H20 from 4 molec ules

,

of boric aci d 4 X H3 B 0 3 2 H 1 2B 4 0 1 2 ; and H1 2B 0 1 2 H 1 0 0 5

.
4
~

R eplace t h e two h y d rogens by so

dium and y ou get the form ula of t h e offi cial borax— Na B O
,
7
.
2 4

When this borax is mixe d wit h glycerin it is decomp ose d ,

into sodi um meta borate and bo r ic aci d and is no longe r

-

,
66 PRE S CRIPT ION INC O MP A T IBIL IT I E S
d r uggist Here t h e p h ysician expects t h e pharm acist t o ao
.

complish the impossible ; to d issolve a s ubstance in 4 fl ozs . .

of water when it wo ul d req uire fully seven an d a h alf pints

, ,

or 1 20 fi ozs to e ffect sol ution ! Salicylic aci d is sol uble in

. .
,

460 parts of water ; t h at is abo ut 1 g m in 1 oz A s t h e re are ,

. .

1 20 gr n it wo uld re quire 1 20 fl ozs

.
,
B oiling t h e water wo ul d . .

only make matters worse beca use w h ile t h e salicyli c aci d ,

wo ul d be d issolve d temporarily it wo ul d separate out in ,

large nee dle s h ape d c r ystals as t h e sol ution became col d

-

The physician s h o ul d be i nforme d of t h e tro uble .

98 . A o B ori ci
.

Aq uae Destill .

Fiat Collyri um S : Use with eye dropper . .

-

Only abo ut 70 g m wo ul d d issolve in 4 fl ozs of water . . .

,

and t h is is all t h at s h o ul d be use d i e a sat urate d sol ution . .

,

s h o ul d be dispense d T h e p h ysician nee d not be consulte d.

.

T h e a dd ition of glycerin to increase t h e sol ubility of t h e

boric aci d is not a dvisable in view of t h e fact t h at t h e sol u ,

tion is to be use d for t h e eyes Glycerin even when d ilut ed .

, ,

sometimes proves irritating .

99 . Mentholi
Thy moli
E ucaly p toli
Co cainae Hy dr ochlor .

P etrolati L iq ui di
S . : Use wit h sp ar y n i gh t and morning .

This is a very common prescription The fi rst t h ree in .

gr e dients disso l ve wit h o ut any d iffi culty in the li q ui d pet ro

latum b ut t h e cocaine hy droc h lorid e is absol utely i nsol uble
,

therein Cocaine alkaloi d is sol uble and that sho uld be used
.

, .

1 00 . Morphi n S ulph . . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

A c Ol e i ci
.

F or ex ternal use only .

The alkaloi dal sal ts are not so l ub l e in o l ei c acid ; the free

alkaloi ds are Morphine sho ul d be use d instea d of morphine
.
 PR E SC R I P TI O N IN C O MP A TI B IL IT I E S 67

s ulphate I f morphine is not at h and— and it se l dom i s i n

.

t h e average d r ug store— it can easily be p repare d as fo l l ows

Make an a q ueo us sol ution of morphine s ulp hate ad d ammo ,

nia wate r unt il t h e p rec ipitat e ce ases to form co l lect the pre ,

cip itate ( w h ic h is free morphine ) and d r

y it between fi lte r
paper . D i ssolve t h e a l kaloi d in the oleic aci d using very ,

gentle h eat if necessa ry .

101 . S trontii B r o midi

Divi de into p owd . No . xxx .

T here are 1 0 c h ances to 1 that if the above prescription i s

d ispense d as d irecte d t h at is in pow d er form the patient
, , ,

wil l h ave no pow de rs t o take ; he wil l on l y fi nd wet pieces of

pape r Wax pa pe r or parchment paper wi ll not prevent the
.

d eli q uescence altogether St ronti um bromi d e is one of t h e

.

most d eli q uescen t sa lts we h ave and t h e d r uggist sho uld r e ,

fuse to d ispense it i n powd er form The physician s h oul d .

be info r m ed ; he w ill p robably order the presc ribe d q uan

tity to be d isso l ve d i n 1 20 c c o f water ; the sol ution to b. .
e

taken in teaspoonf ul doses ( Some v arieties of stront i um

.

brom i d e a re b ut sl ig h tly de l i q uescent ) .

1 02 . S trontii B ro midi
S trontii I odidi 5 j
Morp hin . S ulp h .
gr n . iij
Aq uae a d 3 ij

T his presc ription p resents a do ub l e incompatibi l ity Not .

on l y is t h e mo rp h ine l iable t o be p rec ip itate d by th e bromid e

and iodi d e of stronti um ( as it is by a ny io dide o r bromide )
b ut th e s ulphate ra d ic l e in th e morphine w i ll precipitate a
pa rt of t h e stronti um as a s ul phate .

1 03 . S trontii B ro midi
P o tassii A e st atis
Lithii C itr atis 3 ij
Tr Digitalis
. 3 ij
Aq uae 3 ij
ad

Th is c scr ip tion was rece nt l y r e ceived from a d r uggist ,

68 PRE S CRIPTIO N I NC O MP A T IBILIT I E S
who w r ote t h at he m ade up the mixt ure i n di fferent ways ,

bu t eac h time got an ab un d ant precipitate H e w as as ton .

ished t h at a chemical re action s h o ul d ta k e place i n s uc h an

apparently simple prescription and wanted to know wh at ,

t h e reaction was T h e reaction is a simple one The l it h ium

.
.

citrate decomposes t h e st ronti um bromi de wit h t h e form a ,

tion of stronti um citrate ( whi c h being insol uble p r ecip i , ,

tates ) and lit h i um bromi de .

3 S I BI 2 211 15 0 0 11 5 0 S l z ( CoHs ) GL1B I

’ '
' '
1 a .

S TRON TI U M S L TS S OUL D
A H Nor B E P RE S C RIB ED WITH 01
R
T ATE S IN SOL UTION .

1 04 . S tr ontn B romidi 3 ij
3 iss
Aq uae 3 iv
The stronti um bromi de is decomp ose d an d preci pita tes as
a carbonate ; b ut in a dd ition to t h is t h ere is q uite an active ,

evol ution of carbon d ioxi de so t h at if p ut at once in a bott l e

,

the cork may be blo wn out T h e reaction is as follows .

S I BI z
' '
2N3 HCO: S COI
'
: 2N8 B I ’
E zo C0 2.

S OL UBLE S RON TI U M S LT A TS S HO U LD N OT B E P RE S CR I B ED IN

SOL U TION W H SOL U B LE CIT AR B ON A rE s O R B IC A RB ON A TES .

1 05 . Aluminis
P lumb i A cetatis
Aq uae B estill .

S : Inj ect two sy r ingefuls 3 times a day

.
.

T h e official al um is a d o uble s ulp h ate of al umin um and

potassi um or al umin um and ammoni um and with lea d acetate ,

forms lea d s ulp h ate which p recipit ates I n t h is case the

, .
,

prescription being inten de d as a gonorrhea ] inj ection t h e ,

precipitate sho ul d not be fil ter e d out unless t h e p h ysician so

or ders T h e reaction which t akes place is as fo l lows
.

K AI 8 0 4 ) 2+2P b ( CzHaOz) F A] ( CzHaOz) a+K CzH3 0 r F2Pb S O¢

A lum L e ad Acet ate Alum A cetate
. P o ta ss . Le ad
A cetate S ulph .
 PR E S C R IP T I O N I NC O MP A T IBIL I T I E S 69

I t may not b e out of place to n ote here th at this so l uti on

'

of al umin um acetate is practically the we l l kn own So l utio

“

w h ich at one t ime was very pop ul ar on the con

”
B urowii
tin e nt b ut l ater c ame in to dis use ; lately al umin um acet ate
,

18 again comin g into extensive use .

1 06 . Aluminis
P lumb i A cetatis
Aq uae D est .

S . : Th ree drops into each eye .

Inth is ca se the p reci pitate sho ul d be careful ly filter ed out

, ,

as the insol uble lead s ul phate wo ul d ca use great i rri tati on

to the eye .

P lumb i A ce tatis
M . p ulvis
ft . . Det ur ad sca tula m .

S . : Ta b lespoo nful in a q uart of water, as a do uc he .

When a l um and l e ad acet ate are rubbe d togethe r i n a

morta r a soft m ass is ob ta in e d d ue to chemica l re action an d ,

the conse q uent l iberation of the ve r y l arge amo unt of wate r

of c r ys ta ll iza tion T h is ca n b e p r evente d by using t h e pro
.

p ortionate amo un t of the drie d salts or by mixing t h e sa l ts ,

l ig h tly wi tho ut trit uration B ut this is not the p oint I

,
.

wish to b rin g out My contention is th at the prescription is

.

a b ad one t o d ispense T h e re ason may ap pear a trivial one

.

b ut it is to be co unte d with nevert h eless T h e insol ub l e l ead .

s ulphate clogs up t h e l ittle holes of t h e vagin a l t ube and

m akes the d o uchin g ve ry inconvenient T h e doctor sho ul d .

be cons ult ed ; per h aps he wo uld a gree t o use zinc acet ate
inste ad Several instances have c om e to my notice where
.
,

l ad i es re fused to use or comp l ained about th e above powder .

The above t h ree p rescriptions well ill ustrate h ow d i fferent

d irections at the e nd o f the same p rescription may d ifferently
d ete rm ine the c ond uct of the ph armacist in dispe nsing tha t
p rescriptio n .
 PRE S C RIP TI ON I NC O MP AT I B I LI TIES

1 08 . Z inci S ulp hatis g r n iij

.

S odii B or atis g ru . x
A q uae R osae 3 j
M . ft Collyri um
. .

A precipitate of zinc borate ( and some zinc hy d rate ) r e

sults . T h e remarks concerning prescription No 9 3 apply to .

this one as well ( See also prescription.

1 09 . I odi R e sub lim . 3j

A dip is L anae 3j
To p ut t h e io d ine i n a mortar ma k e an attempt at pow der ,

ing it and t h en r ub it up wit h t h e woolfat as I saw a d rug

, ,

gist do it s h ows t h e acme of incompetence When solid s are

,
.

to be incorporate d wit h an ointment base t h ey s h oul d be ,

eit h er in t h e fo r m of a fi ne impalpable pow de r or a soft , , ,

smooth h omogeneo us mass ; or w h en po ssible i n sol ution

, , ,
.

It is next to impossible to re duce io dine to an impalp able

pow der A little potassi um io di d e and water s h o ul d be a dde d
.
,

so as to dissolve t h e io dine ( in t h is case abo ut 1 5 grains of

potassi um iod i de and to 1 dram of water ) ; t h en only is
it to be gra dually incorporate d with the woolfat .

110 . P otassn I odi di

A dip is
u ng
M ft . . .

Here again if t h e p h arm acist is up to t h e m ark he will

, ,

fi t dissolve t h e pot s i um io d i de in hot water ( abo ut

rs a s

d rams ) nd h e will
,
a dd a little so d i um thios ulp h ate to pre
a
,

vent the liberation of io dine nd t h e conse q uent d iscol o a a r

tion of t h e ointment H will t h us avoi d t h e possible bring

. e

ing b ck of t h e salve in a f w d ays wit h t h e tale t h at it

a e
“

has turn e d bro wn mamm a is afrai d to use

and it ; wo ul dn t ’

y ou please make up anot h er j ar ?

”

111 . F err i P ho sphatis

A ci di P hosp hor . Dil .

Syr . S imp l .

Aquae
 P RE S CRIPT ION INC O MP A T IB IL IT I E S 71

T his p rescription h as become a standing n uisan ce to every

one w h o h as to do wit h prescription incomp atibilities It is .

one of t h e most freq uent p rescriptions in my collection and ,

it can be fo un d in almost any vol ume of every p h armace utica l

j o urnal T h e reason of i t lies per h aps i n t h e confusion which
.

exists i n t h e aver age dr uggist s and p h ysician s min ds as ’ ’

to t h e d ifference between t h e true c h emical an d t h e offi cial

fe rric p hOS p hate T h e former— F e ( P O4 ) 2— is a w h itish pow
.
3

d e r ve ry slig h tly sol uble in wa te r b ut sol uble i n sol utions

,

of t h e alkaline citrates and in strongly aci d sol utions T h e .

of fi cial p h osp h ate is a combination of ferric p h osphate and

“
so di um cit rate and bears the title ( in its synonym ) solub le
,

ferric p h osp h ate to d isting uis h it from the t r ue c h emic al

”
,

insolub le p h osp h ate Ou a dd in g p h osp h oric aci d t h e so d i um

.
,

citrate w h ich acts as a solvent for t h e i ron salt is decom

, ,

p osed a l ittle so d i um p h osp h ate and citric aci d being forme d

,
.

A s those do n ot act any more as a sol vent for t h e ferric

phosph ate t h e l atte r precipitates
,
T o leave out the p h os.

p hor ic aci d wo ul d be ina d missible as it is an important ,

me d i cinal ingre dient I f d il ute d meta p h osph oric aci d

‘

-
.

( HP Oa a lso calle d glacial p h osphoric aci d ) be use d no

“
, ,

precipitation wil l occ ur F o r my pa r t I see no obj ecti on to

.
,

dispens in g the above mixt ure as written with a sh ake l abel ,

.

1 12 . Ferr i P ho s p hatis S o lub ilis

A ci di P hos p ho rici
S yr . S imp l .

Aq uae F oe niculi ad 3 iij

I n this prescription the physician or d ere d phosphori c acid ,

concentrate d and not t h e d il ute d

,
No p recipitation wil l .

take place beca use as state d above ferric phosp h ate is sol ub l e
,

in strongly aci d sol utions It may also be noticed h ere th at

.
,

if t h e amo unt of t h e aci d be very smal l in proportion to the

amo unt of fer ric p h osp h ate use d no p recipitate w ill form , ,

as t h e aci d is eit h er too d il ute to decompose t h e so di um citrate

at all or on l y a very insignifi cant proport ion of the latter is
,
72 PRE S CRIPTION INC O MP A T IBILIT I E S
d ecompose d, the ba l ance stil l being s ufficient t o act as a
solvent In t h e p h armace utica l j o urnals where t h e above
.

prescriptions are c riticize d the statement is generally m ade ,

t h at sol uble ferric p h osp h ate and ort h o p h ospho r i c acid ar e -

incompatible ; b ut I never fo un d any reference to the fact

t h at t h e proportion of p h osp h oric aci d used ma de quite some
di fference To the q uestion : W h y is a sol ution of sol uble
.

ferric p h osp h ate of a nice green color while a sol ution o f ,

ferric phosp h ate to which a s ufficient q uantity of acid h as

,

been a dde d to re dissolve t h e forme d precipit ate i s pe r fectl y ,

color l ess ? T h e following expl anation may be satisfactory :

T h e sol uble fer r i c phosp h ate is not a simple m ixt ure b ut ,

more or less of a c h emical combination o f two salts It is .

a kind of do uble salt an d t h e best n ame for it i n my op in ion

-

, ,

wo ul d be ferri so d io p h osp h o citrate

" -
”
I t i s t h is d o uble
- -
.

s al t that is of a g reen color On ad ding ph osp h o r i c aci d it.

is decompose d ferric p h osphate ( t rue ) sod i um phosp h ate

, , ,

and citri c acid being formed N one of these compo unds .

possesses a green color .

11 3 . Ex t Hy oscy ami
.

A o Tann i ci
.

A dipis

The extract is to be r ubbed up with a l itt l e dil uted al coh o l

and incorporate d with abo ut ha l f an o unce of the l ar d the
;
tannic aci d is inco r porated with t h e other hal f and the two ,

salves mixe d The tannic acid s h o ul d not be b ro ugh t in im

.

me diate contact and r ubbed with the extract as t h e alka l oi d s ,

of th e hyoscyam us— hyoscine and hy oscy amine ar e th us b

more l ikely to become inso l ub l e tannates .

114 . A ci di Carb ol .

Gly cer . B orog ly ce rini

Aquae
S . : A p ply to the throat wit h a c otton swab .
 74 PRE S CRIPTION INC O MP A T I B ILI T I E S
be convince d t h at the s ubj ect of prescrip tion incompatibili
ties is more important— to t h e d r uggist —t h an botany phy S lCS , ,

p h ysiology or toxicolo gy T h e above pre scription written

.
,

by an eminent p h ysician is a b ad one T h e F owler s sol u ,

.
’

tion precipitates t h e strychnine bot h from t h e nux vomic a

and from t h e s ulp h ate ; it also precip itates ferro us carbonate

from t h e syrup ; besi des the iron forms an inky mixt ure wit h
,

t h e tannin ( cinc h o tannic aci d ) of t h e cal isaya a d to fin ish

-
n —

up— some ferro us arsenite is likely to be forme d T o d is .

pense it as written is absol utely ina dmissible A sligh t m a .

nip ulation wo ul d improve matters a good d e a l A dd very .

carefully some dil ute d hy d roc h lori c aci d j ust to ne utral ize
t h e alkalinity of the Fow l er s sol ution or to make i t ve ry ’
,

faintly acid T h is will obviate t h e precipitation of th e

.

stryc h nine and of t h e ferro us carbonate B ut w e m ust be .

careful n ot t o add too m uc h aci d as ot h erwise t h e ferro us

io di de may be decomposed with t h e l iberation of free i od ine , .

Leaving out t h e Fowler s sol ution altoget h e r wit h t h e p h ysi

’

eia u s permission ) will also obviate most of t h e d iffi culties

’
.

11 6 . Ic hthy l
o

A o Hy dr ochlor
. . Dil .

Aq uae A my g d A mar. .

S . : Guttas q ui ndecim ter in die, in p aululo a q uae post

,

cib os.

This prescription is abso l utely incompat ible d ark r esin . A

ous precipitate c ol l ects on t h e si des and bottom o f t h e b
ot

tle and t h e entire mixt ure becomes wort h less even t h e bot
,

tle has to be thrown away Ic h t h yol wit h o ut any furt h e r .

,

sp e cifi cation is ammoni um s ulpho iehthy olate o r ic h th yo l

,
-

s ulp h onate Mineral aci ds d ecompose it t h e aci d ra dical

.

combining with t h e amm oni um and the s ulp h o ichthy olic ( or -

ic h t hyo l s ulp h onic ) aci d p recipitating T h e physician sh o ul d

-

be notifi ed of the facts T h e d irection rea ds : F i fteen drops

.

three times a d ay in a l itt l e water after mea l s .

 S
P RE CRIPT I O N INC O MP A T IBIL IT I E S 75

11 7 . Ichthyol
Tr N uc V om
. . .

Tr Capsi ci
.

Tr Cannab
. . I nd
Tr . Cinc h . Co mp . ad 3 iij
S . T easpoo nf ul b efo re and after the principal meals
: .

Ichthyo l being inso l uble in a l cohol a precipitate wi ll gr ad ,

ually form ; b ut as t h e ic h t h yol is not d ecompose d and its v ir

tues are n ot impaired t h e mixt ure may be d ispe nse d with ,

a shake label an d with in structions to keep the bott l e

“ ”
,

on the si de If the bottle is stood up and is not sh aken fr e

.

quently th e ich t hyol wil l ( i l lect i n a resinous mass at the

,

bo tt om w h ich it wil l b e im possib l e to detach and d istrib ute

,

thro ugh o ut the bott l e .

118 . I ch thyol
Hy drar gy r i C lor Corros h . .

P ot assi I odidi
Tr Cardam Co
. . mp 3 ss
.

Aq uae Me nthae Pipad 3 vj .

S . : T easpo onf ul 4 times a day R e duce to h alf teasp oon 3 .

-

times a day if the stomac h g ets upset .

Ichthyo l be in g prescribed in s uch a great variety of dis

ord ers it is n o won de r t h at it is occasionally prescribed in
,

combinatio n with d rugs w it h w h ic h i t is incomp atib l e .

R ecently the a b ove m ixt ure was sent to me by a d ruggist ,

asking w h ethe r I co ul d not do an yt h ing to restore or to im

prove it ; it being q uite an expensive prescription he did not ,

fee l l ike t h rowin g i t out b ut of co urse he co ul d n ot send i t

,

out the way it was No he co uld not in dee d ! It was a

.
, ,

very c urio us looking m ixt ure I n a brownis h transpa r ent .

l i q uid there fl oated numero us pieces that l ooked l ike b l ack

pitch . Some of the p ieces were q uite l arge so that they ,

c o ul d n ot get out o f t h e bott l e I tol d h im that t h ere was .

n o way of restoring the prescription nor was there any ,

way of maki ng it up properly from t h e sta rt except per h aps , , ,

by makin g an em ulsion B ut that i f h e d id n ot feel l ike

.
76 I NC O MP A TI BI LITIES
PRE S C RI P TI O N

th rowing away the m ixt ure he sh oul d b re ak the b ott l e filte , ,

r

t h e mixt ure collect the precipitate on t h e fi lt

,
and d ispense er ,

it in 4 8 caps ules ( it was j ust t h e right consi tency to be s

d ivi de d wit h o ut any extraneo us a ddition )

,
nd instr uct t h e ,
a

patient t o take for each dose a tea poonful of t h e fi lt d s er e

li qui d nd one caps ule t h at h e s h o ul d fi t notify t h e doctor

a rs ,

h owever T h e p hysician gave his sanction nd t h e d uggist

.
,
a r

acte d as here s uggested The precip itate was du to t h e . e

formation of potassic nd merc uric icht h yol s ul p h onates a -

w h ic h are muc h less sol uble in water t h an t h e ammoni um

ic h thyol s ul phonate Merc uric c h lori de by itself i n t h e doses
-
.
,

in which it is us ually given may be p rescribe d wit h ich t h yol , ,

beca use in the fi r st place th e precipitate is sl ow in forma

, ,

tion and secon dly beca use it is not of a re sino us c h aracte r

, , ,

( sticking to t h e walls of t h e bottle ) b ut m ay be easily dis ,

trib uted througho ut the contents by shakin g .

119 . Amm n o . S ul p h
hthyolo —
ic .

S try chninae S ul ph .

Q uininae S ul ph .

S y r R ub
. . I daei
Ol Cary op hy llor
. .

Aq uae
S : 3 j ter in die p c
.
, . .

This wo ul d be a d angero us prescription t o d ispense Ich .

thy ol is incompatible wit h almost all alkaloi ds beca use t h e

,

ic h t h yol s ulp h oni c aci d combines wit h t h em and p recipitates

-

them as difiicultly sol uble ic h t h yol s ulp h onates I n t h is case -

bo th t h e strychnine and t h e q uinine wo ul d be p recipitate d

in t h e for m of a sticky resino us mass ; and i t is not h ar d to
imagine t h e patient getting t h e w h ol e grain o f st ryc h nine at
o ne dose The prescription sho ul d not be d ispense d
.
.

1 20 .Ichthyol
Cocainae Hy dr ochl .

Aq uae Dest .

I nj ect 3 ti mes a da
y afte r uri nati ng , .

I n or der to alleviate t h e b urning sometimes ca se

u d by a
 PRE SC RIP T ION IN C O MP A T IB ILI T I E S 77

3 per ce nt ichthyo l inj e ction in very ac ute gonorrheas the

.
,

physi cian orde r s some cocaine with it B ut alas ! the co .

,

cain e wi l l do here n o goo d beca use being an alkaloi d ( see , ,

abo ve ) i t w il l be precipi ta ted as cocaine sulp h oic h th yolate .

T h e cocaine s h o ul d be left out and t h e physician in forme d o f

the facts .

F R O M THE P RECE DIN G F IV E P RES CRIPTION S I T I s SEEN T H AT

I CH TH Y OL I s I NCOMP A TI B LE W I TH ( 1 ) A e ms ( 2) A L CO H O L
O
, ,

( 3 ) ME RC U RI C C HLO RIDE A ND P TAS S IU M I O DI DE A N D ( 4 ) A L

KAL OI DAL S AL T S .

1 21 . S ol . Fowle ri
Hy drar gy ri B ichloridi
Aq uae
S . : 3 i p . c. in water .

T his p r esc ription is abso l ute l y incompatib l e In th e way .

i t is written it wi ll of co urse not be d ispense d by any one not

, ,

even by the merest j unior ty ro A v ar iety of reactions wil l .

t ake p l ace depen d in g upon the re l ative pr opo rtion of t h e

,

in gr edien ts and upon the ord er o f mixin g them A s is we l l .

kn own F ow l er s so l ut ion c ontains free p otassi um c arbonat e

,
’

( potassi um bicarbonate is taken ; b ut as expl ained in p re ,

script ion No 63 any bicarbonate i n sol ution when h eated to

.
, ,

boilin g be comes convert ed in to a carbon ate ) ; this converts

,

the bich l oride int o merc uric c arbon ate merc uric oxide and , ,

merc uri c oxych l orid e ; these merc uric compo unds undergo
f ur the r ch an ges which end i n th e separation o f a g reat dea l
,

of the mercury in th e met all ic state B ut thi s is not a ll T he . .

merc ury disp l aces the potassi um in the potassi um a rsen i te ,

form in g merc ur i c a rsenite and p ossib l y also a rsenate .

B y ad d in g some hy d r ochloric aci d to t h e F owler s sol ution

’

so as com pletely t o ne utral ize th e p otassi um carbonate most ,

o f the tro uble w il l be obviate d ; i e t h er e w i ll be no p re . .

,

cip itate o f merc uric carbonate or oxi d e etc ; in fact the ,

.
,

m ixt ure wil l at fi rst b e perfectly clear and t rans parent b ut ,

grad ual ly there forms a slight precipitate ( of merc uric arse

78 PRE S CRIPTION INC O MP A T I B I L I T I E S
T h e prescript ion m ay be d ispense d with a sh ake
we ll l abel
”
.

1 22 . A o S ali cyl ( fr om
. . Wint ergr een )
h
Mor p i a S ulp h .

S yr . A ur antii Corte x
Aq uae q s . .

Sig 3 1 every three hours

. .

The above prescription w h ich I reprod uce verbatim was

receive d by me from a d r uggist in Portlan d O re gon T he , .

d r uggist writes as follows : I receive d t h is p rescription l ast

evening I trie d h ot water h ot glycerin alco h ol al l of w h ich
.
, , ,

rea dily d issolve d t h e aci d b ut i n each instance on cooling ,

or a dding w ater or syr up t h e aci d sep arate d and had a con

sistency not unlike very so ur milk I h ave referre d t h is p re .

scription to ot h er d rug gists b ut have received no i nforma

tion .T h e p h ysici an informe d me that he had t h is com
po un de d at anot h er p h armacist s and sec ure d a clea r m ix ’

ture I have cons ulte d all of t h e a ut h orities at han d b ut

.

none seem t o cover t h e case I am of t h e op inion t h at i t m ay .

be myself and not the R that is a t faul t K in dly inf orm .

”
me .

T h ere is no way of dispensin g this p rescription as a clear

sol ution T h ere i s no way of d issolvin g 2 drams of sal icy l i c
.

aci d in 3 ozs of an a queous menstr uum It is possible t h at

. .

t h e d octor d id get a clear m ixt ure b ut y ou know what th at ,

means ? I t means simply t h is : T h e d r uggist p ut n o salicy l ic

aci d in t h e mi x t ure o r d id p ut in some sh ook t h e bottle and
, ,

fi lter e d out t h e excess of aci d w h ic h i n t h is case means p r ac

.
,

tically t h e entire amount .

It is sad b ut true th at some dr uggists wil l ta k e l ibert ies

wit h a doctor s prescription will ch ange o r omit in gre dients
’

wit h o ut notifying t h e d octor t h us s ubj ecting a fello w d r ug ,

gist wh o may try to p ut up the prescription h onestly to

, ,

inn umerable annoyances and to s uspicio ns of incompetence

and dishonest
y .
 P RE S CRIPT I ON IN C O MP A T IBILIT I E S 79

1 23 . Liq P lumb i S ub acet

. .

Mucil A caciae .

A q Menthae P
. ip .

S . : Use for ga rg l e .

This prescription is a favorite one with a promin ent lar y n

golog ist of t h is city A dr uggist w h o receive d it not long
.

ago was unable to d ispense it on account of incompatibility .

He t rie d to make i t up b ut obta in ed a mess w h ic h h e co ul d

, ,

not d istrib ute t h ro ug h the bottle A nd so h e telep h one d to .

help h im out of the di ffic ulty This prescription well ill us .

trates the fact t h at incomp atibil ity ofte n depen ds upon t h e

,

relative q uantities of t h e in gredients and up on the or der of

mixing Goular d s extract is incompatible with m ucilage of
.
’

acac ia ( se e R b ut the above may be made up as an h omo

g e neous permanent m ixt ure
,
A dd t h e l i q uor p lumb i to ha l f .

of th e water th e m ucilage o i acacia to the othe r h al f and

‘

, ,

mix the two sol utions ( Th e d ruggist h ad ad d ed t h e li quor

.

p lumb i d irectly to the m ucilag e ) T he m ixt ure has t h e .

ap pe ar ance of dil ute d mi l k .

124 . Tr .Fe rr i Chl o r .

Liq A ci di Arse n
. .

Q ui nin S ul ph . .

I nf us Cinchonae
.
q . s
. ad 3 iij
T h is prescripti on cannot be calle d incompatib l e T h e t inc .

t ure t h e sol ution and t h e infusion all contai n free acid

, ,

t h e fi rst two h y d roc h loric the last s ulp h uric ( aromatic ) Th e ,

.

quin in e is d issolved by t h e free aci ds wit h o ut any difiiculty ‘

,

and neit h er the iron nor t h e arseni c wil l be precipitate d .

T h ere is a d arken in g i n color h owever due to t h e action of , ,

th e cinchotann ic aci d on t h e iron ; b ut even that is prevented

t o a cert ain extent by the acid .

1 25 . Tr . F e rr i Chl or .

Tr N uc V om
. . .

Tr . Di gi tali s
80 PRE S CRIPT ION INC O MP A T I B I L IT I E S
C hi n n i . S ul ph .

o o o o o o o o o o o o o o o o o o o o o o o o o

N atfi i S alicy l
o o

S p ir . A mmon . A rom .

S yr A urant . Cor t .

55 7 5 0
.

A quae

This is a prescription calc ulate d to r uffl e the e quanimity

an d upset the e q uilibri um of the most placi d of d r uggists .

T h e difi er ent incompatibilities and reactions w h ic h are ap t

to take place in it are as follows : ( 1 ) T h e tinct ure of d igi
talis wil l make a black mixt ure with the iron pro ducing fe r ,

ric tannate ; ( 2) t h e tinct ure of nux vomica will do t h e same

t h ing ; ( 3 ) syr up of orange pee l also con ta ins tannin and ,

will pro duce a similar e ffect ; ( 4 ) the so di um s al icylate reacts

with the iron pro ducing ferri c salicylate of a deep vi olet bl ue
,
-

color ; ( 5 ) th e salicylate reacts with t h e quinine s ul ph ate ,

wh ich is dissolve d by the tincture of i r on pro ducing the ,

sticky b ulky q uinine salicyl ate ; ( 6 ) the aromatic spi ri t of

,
.

ammonia containing as it d oes free ammoni a an d ammoni um

, , ,

carbonate will re act with t h e ferric chlori de prod ucing a

, ,

magma of ferric hy droxi de and carbonate which l atter is ,

soon converted into oxid e ; ( 7 ) the spirit of ammonia also

reacts with the quinine s ulp h ate precipitating the free alk a ,

l oid quinine and is ap t also ( 8 ) t o p recipitate st rych nine an d

,

br ucine from the tinct ure of nux vom ica In one i nst an ce .

that the writer recalls before an attempt was m ade to make

,

up the prescription the physician was consulted ; b ut he

,

sai d it sho ul d be made up as written The d r uggist d id so ; .

b ut s uch an awful l ooking sticky p asty mess was obtained , , ,

with some di rty looking l i q uor fl oating above t h at of d is

-

p ensing it t h ere co ul d be no question I t is impossible to .

make it up with al l the ingred ients in any p resentable m an

ner One of two ways is Open : either to leave out the so di um
.

salicylate or to leave out both the quinine s ulphate and the

,

so di um salicylate and use quinine salicyl ate instea d E ven

, .

with this modifi cation a goo d dea l of j udgment i s n ecessary

82 PRE S CRIPTION INC O MP A T I B IL IT I E S
l
fe ct y clear sol ution as I expecte d I got a m ilk wh ite mixt ure ,
-

similar to c h alk mixt ure On ma k ing an i n q uiry I fo und .

,

t h at gen uine diur etin was d ispense d b ut t h e bottle ( one ,

third full ) had been stan d ing on t h e s h elf for over two years .

The druggist had forgotten w h et h er diur etin was sol uble or

not I can t h ink of no c h emical w h ic h is more easily de
.

compose d by expos ure t o the ai r t h an diur etin is T h e t h eo .

bro mine becomes d issociate d from t h e so di um salicy l ate and

is no longer sol uble in col d water F or t h is reason d iur etin .

sh o ul d never be prescribe d in pow ders as the air wi ll dec e m ,

pose it and ren der it inso l uble .

1 28 . Th b eo ro mi ne S odi um S ali cyl

-
3 iv
mx x x ij
S pir N itr ous E t
. her . Z 3 iv
A o P hosp h
. . Dil . 3 ij
S y r R ub I daei
. .
3 ij
Aq uae q s . . ad 3 viij
S . : 3 ss ev e ry h our until de sir e d e f
f e ct has b ee n p r o duce d .

This seems to be a prescription for an urgent case of dropsy

and s uppression of urine If so it is a pity t h at t h e ac id .
,

spoi ls its effi ciency and rapi dity of action t o a certa in extent .

Theobromine so di um sa licylate is incom patible wit h aci ds t h e

-

theobromine separating and precipitatin g out Besi des th e .

phosphoric aci d the citric acid in t h e syr up of r aspberry

,

and the n itro us aci d in the spirit of nitro us et h er wi ll h ave

the s ame ten dency Of co urse sa l icy l ic aci d wi ll a l so b e

.
,

precipitated by the acids .

While some ph armacists wo ul d d ispense the p rescriptio n

as written it wo ul d be wrong t o d o so T h e conscientious
, .

and advance d p h arm acist wo ul d l eave out th e p h osphori c

acid ( and perhaps a l so the syr up of raspberry s ubstit uting ,

a non acid syrup ) ; an d wo ul d infor m the

p hy § ician of the
-
.

changes made exp l aining in detai l t h e reasons w h ich m ad e

,

t h e changes necessary I am cert ain t h a t the physician in .

most cases wo ul d be th ankful for the information .

 PRE S C RIP T ION I NC O MP A T I B ILI T I E S 83

1 29 . Tr . I odi .

Gly cerini
Aq uae
A . : For swa bb ing the throat .

Iod in e i s s o l uble in a l c oho l b ut p r actica ll y inso l ub l e in ,

wate r Wh en the t in ct ure is m ixed w ith the glycer in and

.

'
then w ith the water the io d ine precipitates The e ffi ciency
, .

of t h e reme dy wo ul d then be greatly impaire d i f in dee d t h e ,

application o f un di sso l ve d io d ine wo ul d not prove very irri

tat in g T h e re is an easy way of preventing the precip ita
.

tion ; by ad d ing a l itt l e potassi um io dide ; in th e p resence of

the l atte r iod in e is so l ub l e i n wate r ( l ike i n L ugo l s so l u
,
’

It occ asi on all y h appens tho ugh ve ry se l dom th at a

'

tion ) .
, ,

t inct ure of i o dine is a dde d to water and n o p recipitate takes

p l ace This is th en due to the p resence o f hy drio dic aci d
.

and ethy l io di d e ( traces ) i n the t inct ure wh ich act as a sol ,

vent for th e io d in e T h ese p ro ducts— hyd ri od ic aci d et h y l

.
,

io d i de and simi l ar compo unds—o n l y form if th e tinct ure has ,

been kept for a l ong t ime .

N ow al l th e above re fe rs on l y to the ol d tinct ure w h ic h

,

w as made w ith o ut potassi um io di de The tinct ure of t h e .

p r esen t U S P d oe s c ontain K I and th e above p r escrip

. . .
,

t ion is the re fore a perfectly comp atib l e one .

1 30 . Iodi R esub . - m
G ly ce ri ni
M . ft . so l. sec . a rtem .

S . : gtt . x in aq ua ti d. . .

I t re q uires from 50 to 60 parts of gl ycerin to disso l ve one

p art of io dine only abo ut half the amo unt of t h e p rescribe d
io d ine wo ul d be d issolve d I n or der to m ake i t a ll disso l ve .

and also to p reven t i ts p recipitation when a dd ed to w ater as ,

the p h ysic ian or de rs the a ddition of potassi um iodi de is ,

ind i cate d I t is not only perm issible b ut imperative Abo ut

. ,
.

1 gra m o r 1 5 g rains sh oul d be added .

 84 PRE S CRIPTION INC O MP A T I B I L IT I E S
131 . I odi ne
Oil Tur p e nti ne
Alcohol x

S . : Pro Eq u o.

This is a fre quent

combination intend e d as is seen fro m , ,

the d irections for a h orse Great care m ust be taken n ot t o

,
.

add t h e io dine fi r st to t h e t urpentine as great h eat is evolved ,

and the mixt ure may take fi r e or explo d e ; th e io d ine i s

thereby volatilize d as a violet vapor The right p roced ure .

is to dissolve t h e io dine in t h e a l co h ol and t h e n m ix i t With ,

t h e t urpentine oil very gra dually a dd ed T h e m ixt ure is n ot

,
.

homogeneo us b ut separates i n two l ayers ; t h ere is not eno ugh

,

a l cohol to dissolve the t urpentine the l atte r re q uir ing three ,

vo l umes of alco h ol for sol ution T h e upper l aye r cons ists .

of t urpentine oil D ispense with s h ake l abe l

.
”
.

1 32 . S odu S ulp hitis

A o Hy dr ochl
. . Dil .

Tr N uc V om
. . .

Aquae ad
3 iv
Te asp o onful af ter me al s .

This prescription is incompatible So d i um s ul phite and .

a mineral aci d sh oul d never be p rescribe d toget h er and if ,

prescribe d the dr ugg ist i f he knows eno ugh s h o uld cal l the
, ,

T h e bad o dor is
’
doctor s attention to the incompatibility .

d ue to the fact t h at s ulph ur d io x i de or s ul ph uro us aci d as

g , ,

is evo l ve d t h ro ugh t h e action of the aci d on t h e s ul phite T h e .

e quation is as follows
NassOa+2HCl Z 2N aCl i S O:
‘ ‘

E zo .

h
Of course , t e pec uliar antife rmentative action of t e sul h
h
p hi te is also lost , beca use t e 8 0 2 gra dually volat il izes w ile
,
h
a portion of it is oxi dize d to s ulp h uric aci d .

D o Nor P RE S CRI B E S U LPHITE S HY P OS UL P H I TE S , os Tmo

S UL P H ATE S W I TH M I N E RAL AC I D S .
 PR E S C R IPT IO N INC O MP A T I B ILI T I E S
1 33 . Tr . Fe rri C hl o r .

Muc . A caciae
S yr . S imp l .

Aq uae Menthae
W ho does not know the incompat i b ility in t h is p r escr ip
tion ? I t is ment ione d in some text b ooks ; it h as been d is -

c usse d t ime and again in the p h armace ut ica l j o urnals and ,

p res um a b ly eve ry p h arm acist s h o ul d k now it ; b ut t h ere are

,

h un d red s of p h ar macists and no novic es either w h o d o not , ,

kn ow it Here is h ow a p h armacist p ut up t h e above pre

.

scription not so very long ago : He m ixe d t h e tinct ure of

i ron with the m ucila g e i n a mo rt ar and to t h e dense gelat ,

inous mass he a dd ed and a d d e d hy d roc h loric aci d unt il t h e

p recipitate re d issolv ed ; he t h en m ixe d t h e sol ution wit h t h e
syrup and t h e wate r What a me ss it w as ! On inq ui ry I
.

l earned that he was taugh t that way by another p h arm acist ,

who was q ui te p ro ud of his knowle dge a s to h ow to d issolve

t h e p recipitate forme d by t inc ture o f iron wit h acacia T h at .

there is a m uch easie r and nicer way w h ic h does not n ece ssi
tate the unj ust ifi ab le a dd iti on o f a l ot o f hy d roc h loric ac i d
neve r seemed to hav e entere d th e min d o f eithe r teac h e r o r
p up i l
. It sh ows how l ack of interest in one s work w il l ’

d eade n the th inkin g fac ulties an d t ake away a ll d esire for

experimen tation or initiative o f any kin d T h e above p re .

scription can be m a de up w it h o ut th e l east tro uble so as to ,

g ive a c l ear t ransparent sol ution by simply m ixing firs t

, ,

the t in cture with the syr up t h e m ucil age wit h t h e wate r , ,

an d then the two sol utions togethe r .

1 34 . F erri Dialy sa ti Liq .

S yr R u . bi I dae i
Muc A caciae .
3j 55
Aq uae An isi 3 ij
The remarks ma de i n re gard to the p revio us prescription
apply to th is one as wel l T h at is m ix the sol ution o f t h e .
,

d ialyse d ir on with t h e syrup the m ucil age of acaci a wit h ,

the water an d then m ix the two so l utions

,
.
86 PRE S CRIPT ION INC O MP A T IBIL I T I E S
1 35 . S al ol
S pir A e th N itrosi
. .

Tr . F e rri . Chlo r idi

Gly cer ini
Aquae
Salol is chemically p h enyl salicylate CGH5 C7 H5 0 3 When
, , ,
.

a dde d to t h e spirit of nitro us et h er it d issolves on n ow add

ing t h e tinct ure of iron a deep violet bl ue sol ution res ults -

due to t h e formation of ferric salicylate and p artly al so to ,

t h e action of t h e p h enyl ra dicle on t h e ferric salt On a dding .

t h e glycerin n o c h ange is notice d ; if anyt h in g t h e m ixture ,

gets still darker On a dding t h e water th e m ixture bec omes

.
,

at once very t urbi d and th e deep violet co l or is ch ange d to ,

-

a d irty yellowis h w h ite T h e t urbi dity is due to the p r ecip i

-

tation of the salol by t h e wate r i n w h ich menst r uum salo l is ,

insol uble The mixture does n ot remain permanently th e

.

same b ut und ergoes a notable c h ange on stan d ing ; th e sal o l

,

precipitates sticking to t h e si des and bottom o f the bottl e

, ,

w h ile t h e s upernatant l iq ui d is perfectly transparen t and of

a pale violet color T h e prescription s h ould not be dispense d
-
.

until t h e prescriber has been ma de ac quainted with the d iffi

c ul ty .

1 36 . Z inci I odidi gr . xv
A q uae
S . : 3 j ter in die .

I receive d this prescription with the re quest to expla in

t h e reason for the precipitation th at took pl ace on d issolv
ing th e zinc io di de My correspon d ent wrote t h at h e at fi rst
.

d issolved t h e salt in plai n water ; then t h inkin g t h e p re cip i ,

tate migh t be due to t h e imp urities and t h e carbon d ioxi de

in the water he took distille d water and boil e d it ; b ut t h e
,

res ul t was the same ; t h ere was a fl occulent precipit ate o r ,

r at h er se diment fl e ating abo ut This is a fre q uent occ ur

, .

rence wit h zinc io di de ; i n fact i t a l ways take place unl e ss ,

t h e salt has been ma de b ut a s h ort time and has been kept

 P RE S CRIPT ION I NC O MP A T IBILIT I E S 87

in a small b ottle wit h a gro und glass st opper The r eason -

is a simple one : Z in c iod i de is not a very stable sa l t It .

e asily loses io d ine and h as a great av i dity for oxygen T h ere .

fore there is b ut sel dom a sample of zinc io di d e to be fo und

,

in t h e d rug stores t h at does not contai n a small amo unt of

-

zinc oxi d e or z in c oxyio d i de The only t h in g to d o is to .

fi lte r the sol ution ( I f t h e d ispenser wants to be strictly con

.

scie ntious i t is we ll t o take 2 or 3 grains more t h an pre

,

scribe d so as to make up t h e l oss occasion ed by t h e fi ltr a

,

tion )
.

1 37 . Aq uae A mm . F o rt .

Co llo dii
S . Apply to warts with camel s h air b rush
:
’
-
.

T h is p rescri ptio n was h an de d m e wit h t h e remark t h at

the m1x tur e became so lid ifi e d and w it h t h e q uestio n if ammo ,

n ia wate r was incom patible wit h collo dion It is not t h e .

ammon ia gas t h at is at fa ult here b ut t h e water C ol l od ion ,

.

i s a so l ution o f g un cotton ( pyroxylin or d i nitro cell ulose )

- - -

i n a m ixt ure of alco h ol and ether and is precip itated by ,

wate r I f pla in wate r i s use d instea d o f t h e ammoni a water

.

t h e res ul t is the same A n alcoholic sol ution of ammoni a

.

l( ike th e forme rly official sp ir itus ammoniac not S pirit us

“ ”
.
“
,

a mmoni ac ar omaticus ) wo ul d answe r t h e p urpo se ; b ut it is

”

so sel dom fo und in t h e ave rage d r ug s tore t h at d ifficulty is ,

l ikely t o be enco untere d i n h aving t h e p rescription com

p o un d e d properly .

1 38 . Co llo dn 3 j
A ethe ris 3 ss

A q A mmo n
. . Fo r t .
3 j
Tr I o di
.
3 iss

By a strange coinci d ence n o sooner had I d isposed o f the ,

p revio us p rescription t h an I was re q ueste d to criticize t h e

above .
T h e d ruggist had d ispense d it wit h o ut giving it a
t h o ugh t as at fi r st it loo k e d all righ t ; b ut t h ere really w as
,

very m uch the m atter with it T h e reason t h at no p recipit a .

88 PRE S CRIPT ION INC O MPA T I B I L IT I E S
tion was noticed at once was due t o the extra et h er entering
into t h e prescription b ut after a w h ile t h e pyroxylin is pre
cip itated out completely T h at is not all however
. The ,
.

io dine combines with t h e ammoni a to form ammoni um i o di d e

an d io date ; and it is due t o t h is fact that t h e od or of the

ammonia very quick l y d isappears ( alm ost comp l etely ) T h ere .

being in t h is prescription an excess of io d ine t h e mixt ure is ,

brown at fi rst b ut gra dual ly it becomes l igh ter until i n a

, ,

short time it is perfectly color l ess U n do ubte d ly the excess .

of the io dine combines with t h e et h er t o for m ethyl i od i de .

What is obtained in t h e end ? A l itt l e cotton at th e b ottom of

t h e bottle wit h a s upernatant sol ut ion of ammoni um iodi de
,

and io d ate ( in an e ther eo alcoholic me d i um ) -

The p r escr ip .

tion as written sho ul d not be d ispensed beca use both the

, , ,

protective va l ue of the collo di on and the co unter irritant -

e ffect of the io dine are entirely destroyed I f th e ammoni a .

water is omitted the prescription is al l righ t i n every respect .

As the ammoni a d isappears anyh ow ( from its combinin g with

the io dine ) there can be no obj ection t o that co urse ; b ut the
,

p h ysician sho uld be informe d of the ch an ge m ade .

1 39 . P lumb i A cetatis
Gly ce r iti A o .
T ann c i i
Aq uae
Is th is prescription incompatible and wo ul d I h ave been
righ t in refusing to dispense it ? was a q uery p ut to me r e
”

cently . It s h o ul d be remembere d that the wor ds incomp ati

“

ble and non dispensab l e are n ot synonymo us

”
A pre
“
-

scription may be incomp atible b ut as long as it is not d anger

,

ously poisono us or explosive an d it ca n be po ured from the

,

bottle ( ii a mixt ure ) we m ay d ispense it—if the p h ysicia n

,

so desires There is of co urse no question as t o the incom

.
, ,

p atib ility of the prescription Insol ubl e l ead tann ate is

.

forme d and of co urse p recipitates If the p roportions are

, , .

large an almost solid mass is forme d W h et h e r t o dispense i t .

as written or to inform t h e h sician d e en d s a e at de l

p y p gr a
90 PRE S CRIPT ION INC O MP A T I BILIT I E S
in which he m ixe d the in gre dients the fi r st time and on r e ,

né wal t h e mixt ure had a d i ffe rent c olor No amo unt of argu .

mentati on wo ul d convince the patient that no mistake had

been ma de He sai d h e preferre d to patronize more careful
.

d r uggists In s uc h prescriptions the exact or der o f mixin g

.

sho ul d be note d by t h e aid of fi g ur es as s h own above

, ,
.

1 42 . Zinci P hosp hidi

A o P ho sp ho r
. . Dil .

Gly ce rini
Aq uae Me nthae
S . : 3 j thre e t imes a day , a fter meal s .

This prescription recalls to m in d an interesting d isc ussion

I once had wit h a p h ysician regar d in g t h e d oses of me d icin es .

He claime d t h at t h e d oses of all t h e me d icines p oisono us and ,

non poisono us are too small as given i n t h e books He c ited

-

,
.

m any instances to p rove t h e t rut h of h is assertion and ,

among ot h er t h in gs h e sai d : Here is zinc phosp h ide The

“
.

d ose as given in t h e books is from 1 1 6 to of a gra in We ll -

.
,

I always prescribe i t in and 1 g r n d oses and h ave never -

.
,

seen any b ad or even disagreeab l e e ffects ”

T his statemen t .

astoun ded me somew h at I replie d t h at I wo ul d neve r ex .

ceed g rn and aske d h im i n w h at form h e p rescribe d it

.
,

in pil l o r caps ule ”

was t h e answer
“ “
I n sol ution . H ow ,

” “
do y ou dissolve it ? I aske d Z inc phosph i de is i nsol uble .

in water or alco h ol He rep l ie d th at he never had any tro u

.

ble and sh owed me the above prescription I co uld n ot r e

, .

frain from smiling and t h at gave h im a cl ue that somet h ing

,

was wrong wit h his prescription I then exp l aine d t h at i n the . z

above prescription he had practical l y no z in c phosphi de l eft ;

th at t h e aci d d ecompose d it with t h e p ro duction of phosph ine ,

or p h osphorette d hy drogen and zinc phosph ate and that he ,

wo ul d have d one m uch better t o prescribe zinc phosph ate

from t h e start T h e reaction w h ich tak es pl ace may be ex
.

presse d by the fo ll owing e quation

 PRE S C R IP T IO N I NC O MPA TIBIL IT I E S 91

M P : 1 2H1 P 0 4
“ ”
ZE 1 P .

Z in c P ho s hori c Z in c P hosphine
g .

P hosphi de A c1 d P ho sp hate

Th e re gul a r t ribasic z in c ort h ophosph ate is inso l uble in

water ; and as the above m ixt ure was perfe ctly clear it is ,

evi dent that by the aid of t h e exce ss of p h osp h oric aci d th e

zin c aci d ph osph ate was fo rm ed .

T h e reaction would t h en h ave to be exp r e sse d as follows

1 43 . A loini
P odo p hy llini
Cal ome la nos
P u l v S aponis .
qs . .

This forms a strong chol agogue p il l Tho ug h the physi .

cian di rec ts t h at soa p b e taken as th e excipient it is ne ither ,

a d visa ble nor perhaps eve n permissible to d o it Soap is .

p racticall y always a lkal in e due to an excess of so da T h is

, .

l atte r will conve r t the cal omel into merc uro us o x ide ( n o )
and even ass u min g that the l atter wo ul d not gra dual l y decom
po se into me tallic me r c ury and merc uric o x i d e it is cert ain l y ,

dangero us to take inter nally mb out 5 g rs of merc uro us oxi de . .

An othe r excipient such as extract of gentian sh oul d be

, ,

taken The b l a ck co l or notice d whi l e trit urat ing the c a l omel

.

with the soap is due to the above mentioned conve rsion of -

th e ca l ome l into the b l ack oxid e of m e rc ury .

C ALO MEL A ND S OAP A me: I N CO M PATIB LE .

1 44 . Q uin S ulph . .

A o T art arici
. £5 3 iss
P otass I odidi . 3 ij ss
S y r up i R ub . I daei 3 j
Aq uae q s ad 3 iij . .

In B N o 40 I p resented a s imilar p rescription b ut di l ute

.
,

s ul ph uric ac id was use d ins tea d of ta rt ari c acid ; the pres

ence of the l atter pro duces an a dditional precipitate t h us ,

making a trip l e inc ompatibil ity I f the quin in e s ul phate is

.
92 PRE S CRIPT ION INC O MP AT I BILIT I E S
dissolve d in a part of t h e water by the aid of t h e tart ar ic acid ,

an d a sol ution of the p otassi um io di d e a d d e d to t h is a fi ne ,

c rystalline precipitate is imme d iately forme d T h is p r ecip i

tate is not q uinine io d i de as mig h t be s upposed ( that is
,

formed later ) b ut p otassi um bitartrate

,
.

KI HzC4 H4 0 ¢ HI K H CoHeOo .

P o tass . Tar tar ic Hy d Cr e am of Tar tar .

I o dide Ao . r io d 1 c A cid .

It will be remembere d t h at this is the o fficial way of mak

ing D il ute Hy drio dic A ci d T h e hy d rio d ic acid an d t h e bal
.
s

ance of t h e un decompose d potassi um io d i d e soon afterward

attack t h e q uinine s ulp h ate and p recipitate it in t h e form of

,

quinine hydrio dide In dispensing the tart ar i c acid h ad

.
,
‘

best be l eft out .

1 45 I odo formi

}
.

3 ]J
Hy dr ar g Chlor Mitis
o o o o o o o o o o o o o o o o o o o o

. .

This prescription is said by some to be incompatib l e it ,

being claime d t h at io d ine is liberate d from t h e io doform con ,

verting t h e calomel into merc uric io d i de I take exception t o .

t h is statement and afiir m th at t h is combination is q uite com

patible Io doform liberates io d ine only w h en exposed to
.

d irect s unligh t ; and w h en s uc h a pow der is prescribe d it is ,

not generally set in t h e sun It is more often h i dden un der a

.

bus h el . I h ave prescribe d this combination h un d re ds of

times without ever noticing merc uric io di d e A s a r ule the
, .
,

pow der is use d in a few days .

14 6 . Liq . P lumb i S ub acet .

Tr . Op ii
Aquae 3 iv q . s. ad

T h ere is certainly n ot a d r uggist wh o has not at some t ime

or anot h er d ispense d t h is prescription T h o ugh strictly in .

compatible it is nevert h eless dispensed d aily ; and as it seems

,
 P R E S C R IP T I ON INC O MP A T IBIL IT I E S 93

an a lkaloi dal p rec ipitant precip itates the a l ka l oids o f th e ,

p p ium ; anot h e r portion of it combin es wit h the meconic acid

pr esent in the Opi um tinct ure and precipitates as l ea d meco
nate I n the case w h ere lea d acetate is use d instea d of t h e
.

subacetate ( as it is i n t h e Nation al F ormulary — see

“
Lo tio
P lumb i et the p recip itate is not q uite so heavy .

1 47 . Hy dr ar g C lor Mit is . h .

A mmon Car on . b .

S acc h
L t.is ac

M . et ft . p ulv N o 1 . . . Ta] . dos N o . . xxiv .

There is no positive proof on hand that a very poisono us

com po un d is formed on m ix ing t h e above ingre d ients ; never
the less i t is better to be on t h e sa fe si de and not d ispense t h is ,

p r escription Wh en t h e amm oni um carbonate and calome l are

.

rubbe d to get h e r t h e color of t h e pow d e r is c h ange d to black .

T h is bl ack color is due to t h e formation of merc uro us oxi de

( n O ) and ammoni um merc uro us c h lori de ( N Hzn Cl )
and t aking into consi deration the instability of the merc ur
,

ous com po un ds there can har dly be any d o ubt that within
,

a short time a po rtion of them wil l l ose the extra atom of

meta ll ic m erc ury and pass into t h e merc uric state .

1 48 . S ol . Lab arraq ue
S o l Hy droge nii P e rox idi
.

S . : Apply to th roat and nose with cotton swab .

The activity of Labarra q ue s sol ution or sol ution of c hl ori ’

nated so d a d epen d s upon the presen ce t h erein of sod i um hy

,

p ochlo r ite which is easily

,
d ecompose d yiel d ing c h l orine I n ,
.

the p resen ce of the peroxi de t h e hypochlorite becomes r e

duced accor d ing to t h e following e q uation
,

N aClO H O = N aCl H O 0 : a z 3.

As is seen , the peroxid e becomes re duce d to w ate r at the

h
same t ime T e prescription or a p art of it there fore b e
.

com es p ractica l ly w ort hl es s

HY D RO GE N DI O X ID E S H O UL D
.

Nor B E P RES CRIB ED W IT H Se

94 P R E SC R IPT ION INC O MP A T IBIL IT I E S
H YP OCHL ORI TE S ( L A R A Q UE S N JA
’

L U TI ON or B AR SOL U TI O on .

VELLE W A TER ) .

1 49 .Mor phi n S ulph . . g r 1j .

A nti k amnia
Q ui ni n S ul ph . .

S y r Tol ut . .

A c S ul ph Arom
. . qs . . .

Aq uae ad 3 j

Tea sp oonful when req uire d .

T h is prescription forcibly il lustrates a tenden cy which

cannot be con demne d i n too severe terms : the h abit which
some p h ysicians have of prescribing i n combination with offi ,

cial or ot h er well known reme d ies prop riet a r y compo unds

-

, ,

t h e exact composition of w h ic h is not known to them How .

can t h e p rescriber be certain t h at t h e p roprietary a rticle d oes

not react with t h e oth er reme dies possibly wit h a deleterio us ,

res ult to bot h ? How can t h e druggist be i n a positi on to pre

vent or correct an incompatibil ity ? How can t h e physician
k now to wh ich drug to ascribe b enefi cial results following ,

t h e a dministration of s uc h a combination ? S uppose the p a

tient was relieve d by t h e above m ixt ure ; how does t h e physi
cian know w h et h er the relief was due to t h e morph ine an d
q uinine or to t h e antikamnia ? I remembe r one physician
,

used to praise to heaven a certai n alterative compo und ; i t

was t h e anti syp h ilitic par excellence
“
-
”
Y et h e use d to pre .

scribe it invariably in conj unction wit h the io d i des and nie r

c urials I once aske d h im w h et h e r t h e t h erape uti c v irt ues
.
,

h e t h ough t the proprietary preparation possessed m igh t not ,

be ascribe d to t h ose dr ugs ; b ut he still owes me t h e answe r .

To ret urn to t h e above p rescripti on I f t h e q ui nin e is dis .

solve d by t h e aid of the aci d and t h e antikamn ia is t h en ,

a dde d e ffervescence takes place d ue t o t h e evol ution of car

, ,

bon dioxi de W h et h er precipitation will ta k e place o r not

.
,

will depen d upon t h e amo unt of s ulp h uric aci d If en o ugh is .

present to neutralize all t h e bicarbonate of t h e anti k amnia ,

none wil l take place ; b ut if an insufi cient quantity is taken ,

 P R E S C R IP T I ON I NC O MP A T IBIL IT I E S 95
the bicarbonate p recipitates the morp h ine an d the quinine,
an d t h e prescription t h en is a dangero us prescription t o dis

pense The b ulk of t h e antikamnia i e the aceta nili d wi ll

.
,
. .
, ,

in any case remain un disso l ved .

1 50 . . h
Hy dr arg C l or Miti s .

Hy dr og enii P e r ox idi
S . Apply e xtern ally th ree times a day
: .

The statement is genera ll y made that hydrogen d ioxide

o xi d izes or otherwise c h anges merc uro us into merc uric salts .

Th is may be tr ue of sol uble m erc uro us salts s uch as merc ur ,

ous nitrate ( I did not i nvestigate t h at s ubj ect as t h e o nly ,

merc uro us sa lt use d in me d icine is an insol uble one ) b ut it ,

m ust be accepte d w ith great reservation as regar d s calomel .

I shook ca l ome l with hy d rogen dioxi d e for many ho urs and ,

fa il ed to d etect any merc uric chlori d e T h is assertion m ust .

therefore be base d upon the following carele ss observation

When hyd ro gen d ioxi de is kept in contact wit h c a l omel and
fi lte r e d the filtrate will give q uite an ab un d ant p recip itate
,

with sil ver nit rate sol ution ; a p recipitate sol ubl e in ammoni a
wate r and r e precipitate d by n itric aci d T h is s h ows t h e
-
.

presence o f a sol uble c h lori de in t h e fi ltr ate beyon d al l ,

do ub t On f urther investi gation w e discover t h at even b e

.

fore being shaken wi th calome l t h e peroxi de gives a w h ite ,

p recipita te of silver ch l oride beca use th e commercial article ,

al ways contains so l ub l e c h lorides On test ing t h e filtr ate with .

K OB E 2 S o r c op pe r or any ot h er delicate test for merc ur y

, , , ,

none is discoverable It is p ossible t h at on v ery pro l onge d

.

contact some bich lori d e m ay be form ed ; b ut then t h e d ecom

,

position may be due to ot h er ca uses s uch as light etc We , ,

.

may safe l y asse rt however th at ca l ome l and hydrogen diox

, ,

id e are not incompatib l e .

1 51 . Hy dro ge nii P e rox idi

S ol Hy dr ar g B ichlo r idi
. .

S . : Apply externally wit cotton h swab .

This prescription is a ll right . I h ave tested this so l utio n

-
96 P R E SC R IPTION INC O MP A T I B ILI T I E S
bot h t h erape utically on patients and c h emically The anti
, ,
.

septic efi ect was not in any way d iminis h e d and c h emical tests ,

faile d to d iscover any ch ange eit h er in t h e peroxi de or in t h e

corrosive s ublimate .

1 52 . I odo formi 3 j
A q Hy dr og e nu P er ox
.
3 j .

T h e combination is an odd one b ut not incompatible , .

Careful tests failed to d iscover any decomposition in t h e

io doform T h e insol ubility of t h e io doform in t h e menstruum
.

prevents t h e action of t h e peroxi de on it If the io d oform i s .

in sol ution t h en peroxi d e of h y d rogen does d ecompose it as

, ,

will be seen fro m the next prescription .

1 53 . I odo fo rmi 3 ss

A ethe ris S ulp hur ici 3 se

A q Hy dr og e nii P erox idi
.
3 ij
T h is p rescription is incompatible T h e io doform d issolves .

in t h e et h er and on mixing the sol ution w ith the peroxi d e

, ,

io dine is liberate d as can be ascertaine d by a dd ing gel at in

,

ize d starc h w h en a deep bl ue color is d evelope d

, Of co urse -

.
,

t h e r ed colore d et h ereal sol ution is not m iscible w it h the

-

HQ O2 sol ution .

154 . K ali Hy p er mang an .

Arge nti N itr atis

Aq uae De stillatae
The potassi um permanganate d issolves rea dily in w ate r
and so does t h e silve r nitrate
; b ut on m ixing t h e two sol u
tions a precipitate of silver perman ganate w ill form the l at ,

ter being sol uble only i n abo ut 1 5 parts of water accor d ing ,

to my investigations Of co urse the si l ver permanganate will

.
,

not remain l ong as s uc h it being soon d ecompose d into silver,

oxi d e metallic silver potassi um man ganate and m ang an ese

, ,

d ioxi de ( or manganese hydroxide ) .

155 . S od S alicyl. .

S o d B icarb on
.

Aq uae Menth Pip .

. .
98 P R E S C R IPTION INC O MP A T IBIL IT I E S
Pains were taken to explain th at as b ut a small p ropor ,

tion of t h e c alomel ( one tent h or less ) is converte d into cor

-

r osive s ublimate little h esitation nee d be felt in d ispensing

,

calomel and antipyrine w h en t h e former is prescribed in ,

small doses as fractional parts of a gr ain T h e above pre

,
.

scription may be dispense d wit h safety as t h e prescribe d d ose ,

of th e calome l is b ut 1 6 grain and t h e s ublimate t h at w ill

-

form will not excee d 1 60 or 1 1 0 0 grain - -

As to the incompatibility between t h e calome l an d t h e se

d ium bicarbonate t h e a ut h or consi ders it imaginary
,
A t any .

rate for practical p urposes it m ay be d isregar de d alto

, ,

get h er as even some of t h ose w h o cl aim t h at t h e two c h em

,

icals are incompatible say t h at it ta k es from si x t o eigh t

,

wee k s before any corrosive s ubl imate is forme d F ar from .

consi derin g them incompatible I toget h e r wit h t h e entire

’
,

med ical profession consi der calomel and so di um bicarbonate

,

a very eligible combination W h en calome l is prescribe d i n .

large doses t h e ten dency t o griping seems to be d istinctly

,

obviate d by t h e a ddition of a l itt l e so d i um bic arbonate .

1 58 . Mor p h Hy dr ochl
. .

P otass Cy anidi
.

S y r I p ecac
.

Vin A ntimonn
.

Syr . Tolutani
Aq uae
S . : 3 j q 4 h . .

T h is mixt ure w h ich was dispense d wit h o ut a shake l abel

, ,

ca use d quite alarm ing symptoms towar ds the e nd T h e sy mp .

toms were t h ose of an ov er dose of m orp h ine combine d wit h ,

t h ose of an excess of cyani de T h e p otassi um cyanid e reacts .

wit h t h e morp h ine salt precipitating it as morp h ine cyani de ;

,

and a small portion may be precipitate

d as free morp h ine by
t h e potassi um carbonate w h ich is us ually p resent i n p otas
,

si um cyani de It is best not t o dispense t h is m ixt ure I f

.
.

1t i s a s h ake label s h o ul d accomp any it invariably

, .
 P R E S C R IPT ION I NC O MP AT IBIL IT I E S 99

159 . Mer cauro

S tI y Chn Nitratis
'
o 0 0 0 0 0 0 0 0 0 0 0 0 0 Q 0 O 0 O 0 O 0 0 0 0

A tr o p inae S ulp hatis

S . : Te n d ro p s in w ater, fo ur times a day .

This very p otent p rescription w h ic h again i l l ustrates the ,

rep reh ensible d esire of some p h ysicians t o get h alf a dozen

p h ysiologic e ffects out of t h e same bottle was presente d to ,

a d r uggist a few days ago He knew eno ugh to ref use to .

h
d ispense i t as written a d t o in form t e p rescriber that it
n

wo ul d m ake a d angero us combination T h e bromid es of gold .

and merc ury p resent in me r caur o wil l precip itate the alka

l oids
.

1 60 . Ferri e t Q uin . Citr S o lub. . 3 ij

Liq Ammo n
. . A ce tatis3 ij
S y r up i 3 ss
Aq uae 3
Ou d issolving t h e iron an d q uinine c itrate in the water and
a ddin g t h e so l ution of ammbnium acetate a w h ite preci pitate ,

is notice d T h e p recipitate is not due to the iron in this case

.
,

as ferric acetate is very sol uble and ferric citrate is not pre ,

cip ita te d by ammon i a w ater The precipitate wh ic h gra d .

ually forms is q uinine acetate I f the sol ution of ammoni um .

acetate b e st rongly alkaline i e if i t cont ain a n excess of , . .

,

ammoni um ca rbo nate a po rtion of the q uinine citrate w il l

,

be precipitat ed as alk aloidal quinine A t best it is a very ,

.

ine l egan t combin ation .

1 61 . S ali s S eigne tti

Tr Ferri S esquichlor
.

S pirit us N itr D ulc . .

S y r up i To lutani
Aq uae F o ntanae
Coch lear m agn um ter in die post ci b um .

Th is is the p rescription of an o d physician , wh ich I made l

up a n umber of times S a l Seignette is anot h er name for
.

R oche e sa tll l .
( Seignette w as an ap othecary in R oc h elle who
1 00 P R E SC R IPT IO N I NCOMP A TI B I L I TI E S
fi rst introd uce d this do ub l e tartrate of potassi um and so
dium ) On disso l ving t h e R oc h elle salt in t h e water and m ix
.

ing wit h t h e ot h er ingre dients t h e mixt ure becomes t urbi d ,

and wit h in a fe w secon ds a heavy crystalline p recipita te

forms T h e sol ution of the problem is very simp l e

. The .

tinct ure of iron contains a c onsi derabl e amount of free hy

d r ochlor ic aci d T h is aci d ( and also t h e nitro us acid usual ly
.

fo un d i n S pirit of nitro us et h er ) d ecomposes t h e R oc h el l e

salt with th e formation of so di um ch l oride an d c re am of
,

tartar w h ich latter precipitates The reaction m ay be shown

, .

as follows
KNaC.H.Oe R C] NaCl K HCJL Oo .

The alcoho l in the iron ti nct ure and the spiri t aid in th e
precipitation as potassi um bitartrate is almost abso l utely
,

insol uble i n alcohol The i ron has not h ing t o do with the
.

reaction It is tr ue that a sol ution of ferric c hl ori de a l so

.

decomposes R oc h elle salt b ut not beca use it is i ro n b ut b e , ,

ca use it is strongly acid ( containing some free HCl ) .

1 62 . Aquae Hy drog . P er ox idi

Gly cerini
A o Hy dr ochlor
. Dil
. .

S . : 3 ij after each meal .

A d ruggist refused to dispense the above p rescription

beca use he rea d somewhere t h at peroxi de of hy drogen and
glycerin were inc ompatible In fact s uch a statement h as .

been ma de a n umber of times i n p h arm ace utical j o urnals .

The statement is false Hy drogen dioxi de and glycerin are .

perfectl y compatible in any p ropo rt ions and t h e mixt ure ,

does not deteriorate even afte r stan d in g for m onths .

1 63 . Hy drogenn F ero x . 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

A o Chr omici
.

S . : Ca ustic . For doctor s use ’

o nly .

The doctor co ul d j ust as well have allowed this ca usti c ”

1nto the patient s
h an ds as i t was no l on ger ca usti c and
’

,
1 02 P R E SC R IPT IO N INC O MP A T IB IL IT I E S
might seem at fi r st that wi t h this mod ifi cation t h e p r escr ip
.

tion is all rig h t B ut it is not A fter a s h ort w h ile a slig h t

. .

whitis h precipitate will be fo un d t h ro ugh o ut t h e li q ui d and

at t h e bottom of t h e vessel W h et h er t h is is merc ury meta
borate or w h ether it is due to t h e imp urities present in com
.

mer cial borax h as not been de te rmine d ; t h e prescription

,

s h o ul d not be dispense d T h e only way out of t h e d ifficulty.

is to s ubstit ute boric acid for borax ; on mixing Hg Cl2 wit h a

so l ution of boric aci d a perfectly c l ear so l ution is obtain e d
, ,

and one that remains so indefinitely .

165 . S acchari S aturni gr . vj

K ali Hy drio dici gr . vii j
S yr Vi ol ar am
. 3 1V

Aq uae F ontanae 3j
The fi r st in g redient is s ugar of lea d or lead acetate ; the ,

secon d potassi um iod i de th e thi r d syr up of violets ( a sy rup

, ,

wel l known in E urope an d prepare d from t h e fresh fl owe r s of

viol a o dorata our “
sweet bl ue
,
”
v iolet ) ; an d t h e fo urt h -

spring water It does not re q uire muc h kn owle dge of c h em

.

istr y t o be aware of t h e fact t h at t h e first two in gre dients

are incompatible Lea d iodide precip itates
. T h e r eaction .

is as follows :
P b ( Cs Oz ) 3 QKI P hrz 2K CzHaOz .

When t h e potassi um io d i de i s greatly i n excess ove r the

lea d acetate t h e precip itate wil l re d is solve as l ea d iod i de is
, ,

sol ubl e in a concentrate d sol ution of potassi um io d i d e form

ing a do uble i od i de of potassi um and l ea d .

1 66 . I odofor mi
Ol Olivae
.

Aquae H o z z

Pu l v Acaciae. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

This p rescription is incompatible T h e io doform being .

d1 ssolve d in t h e oil the peroxi d e reacts on i t with the evol a

,

tion of io d ine Imp urities i n th e fi x e d oil wil l also sometimes

.
 P R E S C R IPT ION INC OMP A T I B IL IT I E S 103

ca use the liberation of the io dine .

( See also prescriptions
1 52 and

1 67 . Zinci S ulp hatis

B is m S ub nitr . .

A q Hy dr o g e nn Dio x idi
.

Aq uae
I h ave teste d the action of Z n S O4 and B iO N O on the hy 3

d rogen d ioxi d e separately and in combination b ut fo un d no

, ,

d ecomposition ; co nse q uentl y this prescripti on may be con ,

side r ed compatible .

1 68 . Liq Hy dr og e nn P e r ox idi
.

B als . P er uvia ni
S . Ap p ly with camel s hair b rush
:
’
-
.

A t fi r st no d eterioration i n the s tre n gth of the peroxide

co uld be d etecte d On repeate d ly s h aking it as is always
.
,

necessa ry be fore applying it t h e peroxi de wi ll become weaker , ,

b ut then Hg og even i f s h ak en by itsel f witho ut any for

, ,

eigh s ubstance wil l become partially d ecompose d into wate r

,

B ut t h e p h a rm acist has n o reaso n for not dis

'

and oxygen .

p e nsi n g the abo ve pre s cription .

1 69 . Liq Hy drOg enn

. Diox idi
Tr . A rnicae 3 ij
Ex t Calendulae
. Fl d .

Th is p resc ription was presente d t o m e for analysis A fte r .

t h e m ix t ure stood fo r some days I teste d it for t h e p eroxi de

by applying some t o a p us cavity and by t h e potassi um chr o ,

mate and ether test an d fo un d n o appreciable d im in ution in

,

1 70 . Ca p ri S ulphatis
S odii B icar b on .

Aq uae
S : Ap ply with b r ush to ul cerate d s urface
. .

T his prescription is absol utely i ncomp atib l e and the drug ,

gist wo uld do t h e p h ysician a k ind ness by l eaving out the

1 04 P R E S C R IPT IO N INC O MP AT IBILI T I E S
sodi um bicarbonate It i s seen at once that wh at the phys i
.

cian wants is to use t h e copper s ulp h ate as a ca usti c applie d

,

tion B y a dd ing t h e so d i um bicarbonate he completely de

.

stroys the ca ustic e ffect as the copper is p recipitate d as cop ,

per carbonate whic h is insol uble and non ca ustic B y mix

,
-
.

ing the ingre dients and at once corking t h e bottl e t h ere is ,

also danger of explosion as a consi derable amo unt o f CO2 ,

is evolve d The following e quation will s h ow wh at r eaction

.

takes place
CHS O4 QN aHC0 3 CU CO: Nfl zS O1
- C0 : E zo .

The right co urse to p urs ue is to inform t h e p h ysician and

get h is consent to omit t h e sod i um bicarbonate .

C OPP ER S UL P H ATE I s I N COMP ATI BL E W I TH S O DI U M B I CAR

BON A TE .

1 71 . Tr F e rri Chlor
. .

Morph S ul ph . .
gr . iij
Gly ce rini 3 SS
Aquae qs
. . ad 3 j
ii

Thi s is a we ll known incompatibi l ity Morph ine with fe r

-

ri c salts strikes a bl uish green color ; i n fact this is a test for -

morphine T h e formation of t h e color is prevente d by th e

.

presence of free aci d b ut it is rare t h at tinct ure of iron con,

tains so m uch free aci d as to prevent t h e reacti on In th is .

ca se i t is best to i nfor m t h e p h ysician of the facts and l et ,

him act as h e sees fit .

MORP H I N E Is I N COM P ATI B L E W I TH F ERRIC S AL TS .

1 72 . Hy dr ar g I odidi Fl avi . .

P ot ass I o didi . .

S yr . S arsap ar . Co mp .

Aq uae
S . : 3 j 4 ti mes a day .

This is an incompatib l e and extremely dan gero us p r escr ip

t 1 on ; t h e more dangero us beca use i f t h e syr up of sarsaparill a
be a dded at once t h e d ruggis t m ay notice no c h an ge i n the
106 P R E S C R IPTION INC O MP A T IBIL IT I E S
of the U S D ispensatory which says :
. . It ( ye ll o w merc ur
,

ous io d i de ) s h o ul d neve r be given at the same time with

potassi um io di d e w h ich conve rts it imme d i ately int o mer

,

cur ic io d i d e an d metallic merc ury He cons ulte d me as .

“
final a uth ority ”
and I a dvise d him to d ispense t h e pre
,

scription T h e chief di fference between the tw o p r escr ip

.

tions is in t h e dose T h is one contains only 1 6 grain of

.
-

merc uro us io di de w h ich even ass um ing t h at it becomes e u

, ,

tir ely d ecompose d will yield only 1 9 gra in of merc uric

,
-

io di de and t h at is a perfectly sa fe dose T h us the q uesti on

,
.
,
“
to dispense or not dispense ”
fre q uently t urns on t h e s ize ,

of t h e d ose Anot h er d ifference between this and th e p re

.

ce d ing prescription is that m any d ruggists wil l i n th is case

use t h e d ry potassi um io di de m ix it wit h some ine rt pow d er , ,

as alt h e a or l icorice and t h en m ake a p il l m ass wit h some

,

m ucilage of acacia or glycerite of starch I n t h is con d ition .

only a portion of t h e merc uro us io d i de wil l be decomposed .

1 74 . S p ts . Ammo n Aro m . .

. aa 3i
Aq uae Ci nnamo mi 3 ij
This combination forms an unsight l y preci pitate d ue to ,

the combination of the tann ic and gallic aci d s in t h e n utgall

syrup wit h t h e ammoni um carbonat e i n the spirit Syrup us .

g allae or syr up us g allae aromaticus w as a great favorite

, ,

wit h the p h ysicians of two generations ago and a very pow ,

er ful and e f fective syr up it was Now it is almost c omp l ete l y .

forgotten b ut is still occasionally prescribed by those wh o

,

c l ing t o the old tra ditions .

1 75 . Hy dr ar g C l or Mitis
. h .

Amm . Chlor idi

S h Lacti s
acc .

Div . i nto p ulv N o iv . . .

The res ult in this prescription wil l d epen d a goo d dea l o n

t h e q ual i ty of the ammoni um c h lori d e I f a sal t answering .

the P h arm aco pei al re quir em ent s be used there need be no ,

 P R E S C RIP T I ON I NC O MP A TIB ILI T I E S 1 07

fea r of any in compatibi l ity The write r be l ieves th at no .

merc uri c chloride is forme d I f any is forme d it is so infi ni .

,

tesimal in amo unt as to be d isregar d able a l together B ut if .

th e comm erci a l imp ure m uriate be use d the prescription may ,

b e consi d ere d incompatible I n severa l trit urations which .

the w ri te r m a d e h e co uld discover decomposition afte r severa l

ho urs the pow de rs containe d m erc uro us oxi d e meta ll ic me r ,

c ury me rc uric chloride and probab l y also dimer cur ammo

, ,
-

n ium chl oride In some ca se s t h e pow d e r became of a gr ayish

.

color a fte r two m in utes trit uration ’

.

1 76 . Hy dr arg C l o r Mit . h . .

Am mo n Car o n . b .

Al b i
S a cc h .

Div into p ulv No

. . . x ij .

Th is p rescription is positive l y incompatib l e When ammo .

ni um ca rbonate is rubbed with c alomel a gray c olor d evelops ,

at once T hi s is d ue to the format ion of the black ammo

.

n i um me rcuro us ch loride o r dime r cur ammoni um c h l ori de

-

,
-

N Hzn cl This com po un d m ay not be actively poisono us

.
,

b ut the chemica l composition of the ca l ome l an d t h e extern a l

ap pea r an ce o f the powder are so change d that th e p r escr ip
tion sh o ul d unde r n o circ umstances be d isp ensed T h e amm o .

ni um ca rbon ate is to be l eft out T h e w rite r vivid l y remem .

be rs wh e n he received this prescription the fi r st time and

m ade i t up I t was i n th e goo d old j unio r d ays wh en every
.
,

day b ro ugh t som e n ew facts some new kn owledge some new , ,

disc ove ry W h en he saw t h e p ow de r t urnin g bl ack he called

.

the em ploye r s attention to it The l atte r a E uropean Maste r

’
.
,

o f Pha rm acy ( Magister P har maciae ) explained that those ,

two d rugs were i ncomp atible and recommende d t o l eave out

th e ammon i um sa l t w h ich he d id and notified th e physician
, ,

to that effect Th e next mo rn ing bro ugh t a rep l y from that

.

physician ful l o f t h anks and apol ogies .

CALO MEL I s P OS I TI VE L Y I N COM P ATI BLE W I TH A mmo

NI U M C A RB O N A TE .
 P R E SC R IPT I ON I NC O MP A T IB IL IT I E S

Hy dr ar g C lor Mit . h . . 3 j
A o Hy dr ochlor Dil
. . . 3 ss

S y r R hei . Aro m .
3 ss
Aq uae ad 3 ij
A physician wh o wi ll prescribe a h eavy powder lik e calo .

me l in a shake m ixt ure is a very poor p resc r iber Perhaps .

he is not aware of the fact t h at c alome l is inso l uble In . .

t h is prescription the pat ient may get i n one d ose anyw h ere
from 2 to 1 0 grains of calomel and the physician can cer ,

tain ly not expect uniform or satisfacto ry res ul ts T h is is .

the only th ing wrong with this prescription The fear of .

t here being forme d corrosive s ublimate f r om the action o f

t h e h y droc h loric aci d on the calomel is gro un dless The .

writer faile d to discover any with the most d e l ica te tests

O
.

CALO MEL I s N 0 T I N COMP ATI BL E W I TH HYDRO CHL RI C AC ID .

1 78 . Hy dr ar g C l or Mit . h . .

pear so at fi r st glance Syr up of rh ubarb contains potassi um

.

carbonate ; the l atter will convert a portion of the c al ome l

into black mercuro us oxi de and gra dua l ly there m ay form ,

some merc uric oxi de and meta ll ic merc ury .

179 . Tr . Fe r ri C hlor .

P ot ass B rom . .

S odii B rom .

Gly cer ini

Aq uae q . s. ad

The bromi des like t h e i odi des are incompatible with ferri c
, ,

chlor 1 de T h e latter decomposes t h em wit h the liberation of

.

bromine or i odine as the case may b e The e q uation is as

, .

follows
2KB r 2F e CL 2K C] 2F 8 C13 B r a.
1 10 P R E S C R IPT ION INC O MP A T IB ILIT I E S
scription almost t h e entire bismut h s ubnitrat e will be fo und
on t h e bottom w h ile t h e magnesia will be on top T he on l y
,
.

way to obviate t h e difficulty is t o direct the patient to sh ake

the box well before tak in g the powd er T h is method of pre .

scribing w h ile very common with German physicians is not

,
,

to be commen de d Its only recommendation is cheapness

.
.

1 82 . Liq Hy dr og enii
. Diox idi
A ci di Carb ol .

Tr F err i Ch l or
. .

Gly cerini
Aq uae
S : 3 j four ti mes a day in a little water
. .

This is one of t h e best possible specime ns o f incomp atib il

ity On mixing t h e fi r st three ingre d ients a violent reaction
.

takes place at once ; intense heat is generate d a very strong ,

empyre umatic o dor becomes noticeable and the mixt ure ,

frot h s and t urns perfectly black O i co urse nobo dy w o ul d .

,

d ispense s uch a mixt ure The exact reaction is too comp l i

.

cate d to be given h ere ; one t h ing may be stated ; the car

bolie aci d reaches t h e high est poin t of oxi dation and may be ,
”
sai d to be completely b urne d up .

“
u
1 83 . P ot ass P e rmang
. . 3 ss

A ci di Ca r b olici
’

3 ss 5
Aq uae 3 iv
T h is is anot h er examp l e of t h e d esi re to get too m uc h b ut ,

of getting not h ing instea d Both ingre dients are antiseptics.

,

b ut react upon eac h ot h er wit h t h e following res ult : T h e p o .

tassium permanganate becomes re d uce d w h ile t h e p h enol is ,

oxi dize d to oxalic aci d and carbon dioxi de T he fo l lowing .

e quation shows t h e reaction

CoHuOH 1 2K MD O¢ :
7 211 20 20 4

P he nol P ota ss. O x a lic

P e r mang . Ac .

2C O: IL O 6 K 2M n0 1 6 MnOz
Car o n b W ate r P o ta ss M ang anese
x x
.

Dio ide . Manganate D io i de

 P R E S C R IPT IO N INC O MP A T I BIL IT I E S 1 11

No pharmacist w il l th ink of d ispensing this mix tur é as it ,

is too nasty looking ; if the q uantity of pota ssi um perman

-

g anate is l arger a soli d or semi sol i d mass is obtaine d on

,
-

acco un t of t h e manganese d ioxi d e w h ich p recip itates (In .

t h is p rescription t h e q uantity of p h enol is excessive ; not

more than 2 d ra ms wi l l disso l ve in 4 fl ozs of water ) . . .

A c S alicy lici
.
3 j
Aq uae 0 j
S : Dip a cloth and apply to ulcer changi ng every h a lf
.
,

hour
m
.

A b l ack m ixt ure is obtained at once The p otassi u pe r .

m anganate bec omes re duce d t o potassi um m anganate and

m anganese d ioxi de ; while the sal icylic aci d is d ec ompose d into
formi c acid and carbon d ioxide The reaction may b e ex .

p ressed as follows
HCJ L O: I OKM nO. HO z 4 HCHO:
S alicy l . P o tass . W ate r F o rmic
A c id P e r w a ng . A cid
3 CO: 5 K1 Mn0 1 5MD O:
Car b o n P o tass Mang an D io i de x
x
. . .

Dio ide Mang anate

It sho ul d be un d ersto od that al l statements conce rni ng r e

actions in w h ic h pot assi um permanganate is one of t h e fac
tors are only relatively corre ct ; beca use the reaction depen d s
t o a g reat extent upon t h e q uant ity of t h e pe rmanganate
p resent the concentration of t h e sol ution t h e temperat ure
, ,

employe d etc F or instance t h ere can be n o do ubt that i f

,
.
,

suf fi cient pe rm anganate be p resent even t h e form ic aci d will ,

un d ergo f urth er oxi d ation until it is spl it up into carbon

d ioxi d e and water ; th us : H C H O 2 O CO 2 H O 1:
z .

T h e patient w h o had an ul cer of many years stand in g sai d ’

that he had d erive d more b e ne fi t fr om t h is mixt ure than from

.

anything h e had eve r use d His ulcer was event ua lly he ale d
. .

Was it tim e for it to get h eale d was it the formic aci d was it
, ,

t h e balance of the un decomposed s al icylic acid—wh o will

say ?
112 P R E S C R IPT ION INC O MP A T IBILI T I E S
1 85 . Co dein ae
A mmon . hl
C r
o .

S y r Tol u .

Aquae
S . : Te as p oonful every 3 hours .

T h is prescription cannot be consi dere d incomp atib l e It is .

tr ue t h at co d eine having a strong al k al ine reaction l iberat es

, ,

some ammonia gas from t h e ammoni um chlori de ( t h e same as

potassi um or so di um h y d roxi d e d oes ) b ut the q uantity i s ,

so small t h at it may be d isregar de d It is best not to bri ng .

t h e c odeine and t h e ammoni um c h lori de t oget h er at o nce ,

b ut to dissolve each separately an d t h en mix t h e sol utions .

1 86 . O] . Tigl u min . vii j

O] . R i ci ni 3 i
Gly cerini 3 iij
S . : Teas p oonful every h ou r until b o wels h a e v operated
freely .

Physicians and many d ruggists regar d glycerin i n the

nat ure of a fat or fi x ed oil and t h ink t h at both fix ed and ,

volatile oils are freely miscible with it T h ey are quite sur .

prise d when they fi nd out that the contra ry is th e case The .

peop l e atten ding t h e patient m ust be d irecte d to s h ake t h e

bottle very thoro ug hl y each time before admin istering t h e
me d i cine Otherw ise the mixt ure of the two oils wi ll be
.

on top of the glyce rin and the patient may get al l or h al f ,

of t h e croton oil at one dose T h e d ose of t h e croton oi l .

2 d rops every hal f ho ur—seems rat h e r l arge b ut as it w as ,

for a case of l ea d colic where a q uick operation was ab so ,

lutely necessary it was probably all ri ght , .

1 87 . A c S alicy lici
.

Aquae Cal cis

S . : Apply ex ternally .

Glancing cas ua l ly at the p rescription we m ight thi nk th at

the gr eate r p art of the sa l icy l ic aci d wi ll remain undisso l ved ;
1 14 P R E SC R I P T ION INC O MP A T IBILI T I E S
Es sence P e p s ( F ai r c . hil d )
x
E li ir P e p te nzy me
Glyce r i n
Aq uae
S . : 3 i ter in die, p ost ci b um .

T h e correspon dent sen ding t h is prescription aske d wh at

t h e matter wit h it was and w h et h er it s h o ul d h ave been dis
,

p ense d as written This is a very n ice prescription t h eoret

.
,

ically T h e doctor seeks t o combine t h e tonic e ffect of nux

.

vomica t h e hematinic a ctions of t h e iron the ne uro n utri

,
“
,
-

ent effects of the t h ree hypoph osp h ites and the d igestive
”
,

e ffects of pepsin and p ep tenzy me B ut the mixt ure cannot .

be dispense d ; not in a presentable form at any rate T h e ,

.

tro uble is between the hypop h osphites and t h e ferric ch l o

ri des ; t h e insol uble ferric hypophosphite forms at once and
precipitates If t h e sol utions are concentrated eno ugh a
.
,

gelatino us almost solid mass is pro duced

, .

Can t h is precipitation be p reve nte d ? We l l by using a ,

suf fi cient amo unt of hypophosphoro us aci d or pot assi um ( or

so di um ) citrate it can ; b ut this p rescription al rea dy con
,

tains so many in gre d ients t h at it is h ar dly j ustifi ab le to add

any m ore T h e tinct ure of iron m ight be l e ft out altoget h er
. .

However there is a better way wh ich will certainly appe a l

, ,

to the physician , and th at is to s ubstit ute anot h er ferric com

poun d for the ferri c c h lori de T h e most eligible salt i n this .

case is the ammon io ferric citrate ( Ferri et Ammonii citras

-

U S
. . No precipitation takes place between t h is ferric
salt and the hypop h osphites A s to t h e amo unt o f ammonio .

ferric citrate whic h c orrespon d s to the q uantity of tinct ure

or dere d a sligh t calc ul ation will give t h e res ult T in ct ure
'

.
,

of iron cont ains an amo unt of F e Cl corresp on d ing to S,

per cent of metallic iron ; th e citrate of iron contains 1 6

.

per cent of F e Seventy one gr ains of t h e l atter will t h ere

. .
-

fore be the e q uiv al ent in metal l ic iron of h a l f an o unce of

,

t h e former .
 P R E S C R IP T I ON I NC OMP A T IBILI T I E S 1 15
1 90 . Tr . Ferri C hlor .

S y r Hy p o p hosp hitum
.

S . : 3 i ti d . . .

An almost soli d m ass res ults or a th ick l i q ui d with an ,

unsig h tly precip itate T h e ca use is t h e same as in t h e pre

.

vi ons prescription ; t h e formation of ferric h ypophosphite ,

F e ( P H20 2 ) 3 P otassi um citrate d issolve d i n t h e smallest

.

amo unt o f water possible or simply d issolve d in t h e syr up , ,

s h o ul d be use d to p revent t h e formation of the precipitate

or to d issolve it a fter it h as forme d A perfect l y c l ear sol u .

tion o f a green ish color is the r es ult .

1 91 . Tr . Ferri hlor
C . 3 11

S yr .
3 j
Hy p o p hOS p hitum 1

Aq uae ad 3 ij

I f the t inct ure is fi r st mixe d with the water and t h e syr up

then ad de d no precipitation will take place Sho ul d t h e fi r st
,
.

two in gre dients h ave been m ixe d wit h the formation of a pre
cip itate th e wa te r will re disso l ve it F erric hypop h osp h ite
,
.

is sligh tly sol uble in water especially i n t h e p resence of hypo ,

ph ospho r o us aci d a trace of which is present in the syrup

,
.

1 92 . Tr . Iodi i
Liq Hy droge nn
. Diox i di
S . : For ex ternal use .

Th is presc ription is inc ompatib l e and sho ul d not b e dis

p ense d .

I n the above there s oo n commences q uite an active rea o

t ion between the io d ine and the p eroxi d e ; t h e i od ine is c on ‘

ve rte d int o hyp o io do us aci d ac cor ding to the fol l owing rea o
-

T h is as wi ll be seen is simi l ar to the reaction w h ich takes

, ,

p l ace o n m ixi n g chlorine water with sol ution of h y drogen

p eroxi de B ut here the similarity ceases W h i l e the hyp o
. .

chloro us aci d on c omin g into contact with another molec ule of

116 P R E SC R IPT ION INC O MP A T IBILIT I E S
H20 2 becomes re duced to h ydrochloric aci d ( with l iberation
of oxygen : HClO H2 0 2 H Cl HZ O 0 2 ) t h e O ppo
site reaction takes place wit h t h e h ypo iod o us aci d ; i nstea d -

of becoming re duce d to h y drio d ic aci d it becomes oxidized to ,

iodic aci d R eaction as follows

.

HI O 211 20 25 R I Oz 2H20 .

The writer h as establis h e d these facts beyond do ubt ; care

ful ch emical analysis p r oved the absence o f h y d rio d ic acid ,

while s h owing the presence of i od ic aci d in ab undan ce .

1 93 . P ot ass P ermang . . 3 ss
Ferri S ulp hatis 3 j
A c S ulp . h . Dil . 3 ij
Magnes . S ulp hat
3 ij .

S y r Zingi b eris .
3 ij
Aquae q s ad 3 viij . .

This combination m in us th e potassi um p ermanganate is

t h e favorite p rescription of a very well known gynecologist -

of this city in many female ailments The above was writ .

ten by a young practitioner w h o t h o ugh t he wo ul d improve ,

it by a dd in g the salt whic h is rep ute d to be so useful in

amenorrhea The perm anganate is d ecompose d w h ile the
.
,

ferro us salt is converted into the i rritant and ast ringent fer
ric s ul phate ; th us
2KM11 0 4 1 0F € S O4 8HzS O4 2MD S O4 5F ez ( 8 0 4 l 3
P otass . F e rr ous S ulphuric Mang anous F e r r ic
P e r mang . S ulphate A cid S ulphate S ulphate
K 28 0 4 S HzO .

P otass . W ate r
S ulphate

1 94 . Ammoni i B e nzoatis
S odii B enzoatis
Tr . F err i Chlo ridi
Tr Ge ntianae
.

S y r A ur antii P l. .

Aq uae
In this presc r iption a vo l umino us precipitate fi lling the
1 18 P R E SC R IPTION I NC O MP A T IB IL IT I E S
1 98 . 0 1 Tere
. b i thi
n ae
n

Morph . A ce tatis
S . si x hours fif teen drop s
: E very .

This is a somewhat pec uliar prescription On ad ding th e .

morp h ine to t h e oil it will be fo un d t h at it sticks to the si des

and bott om of the bottle and if d ispense d in t h is w ay t h e ,

patient wo ul d get no morp h ine T h e way one dr uggist dis .

p en se d i t was by a dd ing to the oil an approximately e quiv a

lent quantity of oleate of morp h in e A more el igible met h o d .

wo ul d be t h e fol l owing : D issolve t h e morp h ine in a littl e

water add a few d rops of olive oil and a few grains of pow
,

d ere d acacia r ub until em ulsi fi e d and inco r p orate t h e oil

’
, ,

of t urpentine D irect t h e patien t t o s h ak e t h e bottle we ll

.

before using .

1 99 F erri Chloridi
. Tr .

Tr Vale ri an A mmo n
. . .

30 drops three times a day .

The aromatic spirit of ammonia employed i n m aking the

ammoniate d tinct ure will precipi tate t h e iron as ferric hy
d r ox ide It wo ul d be practically impossi b le to ta k e t h e med
.

icine by d rops or even by teaspoon as t h e precipitate is very ,

b ulky and gelatinous T h e re is n o way out of t h e d ifficulty . .

20 0 Hepar S ulp huri s

. 3 i
Liq Hy dr og e nn P er ox idi
.
3 ij
Aq uae R osae 3 ij
S : Loti on Apply at ni ght on ga uz e
. . .

I do ubt w h ether t h is l otion whic h i s expecte d to bea utify ,

t h e complexion has any virt ue in it w h atsoeve r T h e liver

, .

u u —
of s lp h r or potassa sulp hur ata— is as is well known not a ,
,

defi nite compo un d b ut a mixt ure of all or of several of the

,

following comp oun d s : Potassi um monos ulp h i d e K 2s ; p otas ,

si um tris ulp h i de K 28 3 ; p otassi um pentas ulp h i de K zss ; p otas

, ,

si um t h iosulp h ate ( wrongly calle d hypos ulp h ite ) K 8 20 3 ; , 2

and potassi um s ulp h ate K 28 0 4 W h e n d issolve d i n wate r , .

,

l iver of sulph ur yiel ds an orange yellow sol ution ; on a dding -

 P R E S C R IPT ION I N C O MP A T I B IL IT I E S 1 19

peroxi de of hy d rogen the so l ution becomes milky white Al l

, .

the vari o us sulph i des become oxi d iz e d to s ulphates ; the per

oxi de of co urse becomes red uce d to h y d rogen mon oxi de i e
, , , . .
,

water T h e mi lky t urbi d ity is d ue to t h e s ulph ur which pre

.

cip itates f rom the thios ulphate .

20 1 Liver of S ulph ur
. 1 0 g rains
Co rrosive S ub lim ate 4 g r ai ns
Rose water 4 fl oz . .

Th is is a newspape r prescription g iven by t h e newspaper ,

d oc tor in reply to a re q uest for a lotion to remove freckles .

T h e preparation is wort hl ess Ou acco unt of t h e vario us .

compo un d s of whic h s ul p h urate d potassa consists a n umbe r ,

of react ions will take place The c h ief reaction results i n t h e

.

formation of t h e black merc uric s ul phide which gives a black , ,

di rty appearance to the m ixt ure .

202 . Tr . Ferri Chlor idi 3 1j

Tr . Di git alis 3 j
Gly ce rini 3 iv
Aq uae q s ad 3 iij . .

On mix ing the t inct ure of iron with th e tinct ure of d igi
talis a dark mixt ure res ults T h is is due to t h e tannic aci d
.

in the d igitalis combining with t h e iron to form iron tannate .

Ot h e rwise the prescri ption is al l righ t It is best to mix t h e .

tinct ure of iron with t h e other ingred ients and add t h e tinc ,

t ure of digitalis l ast .

203 . B ismuthi s b nitr u .

3 j
A rge nti N itr atis gr . iij
3 v j
E x t Opu.
gr iv.

S acchari qs
. . ad 3 iv
M . etp ulvi s S ig : 3 j t i d
ft . . . . .

On stan d in g t h is pow de r becomes b l ackened on account

,

of the re d uction of t h e silver n itrate to silver oxi d e and t h en

to metalli c sil ver T h e re duction is ca use d by t h e organic
.

ing re dien ts in the prescripti on After a w h ile ther e is no

“
,
1 20 P R E SC R IPTIO N INC O MP A T IBILIT I E S
si l ver nitrate left I f t h e physician insists on having the
.

prescription p ut up j ust as w ritten he can h ave it T h e ,

.

silver nitrate s h o ul d be fi rst re duce d t o a fi ne pow de r t hem ,

careful l y and slowly mixe d wit h t h e bism uth s ubnitrate and

the so di um bicarbonate ; t h e extract of Opi um is to be t h or
o ugh ly incorporate d wit h t h e s ugar and t h e pow d ers mixed ,
.

T h is way of c ompo un ding will give the best res ults T he .

physician is mistaken if h e expects the patient to get a uni

form dose of silver nitrate and extract of opi um in e ach tea
spoonful of powde r .

20 4 . B ism S ub nitr
. .

Argenti N itr .

E x t Opu A quos
. .
gr . iv
S y r A ur Co rt
. . .
3j
Aq uae q s ad 3 iv . .

The ingre dients i n this p rescription are practically the

same as in t h e previo us one b ut t h e reactions are d i fferent
,
.

T h is is due to t h e fact t h at t h e mixt ure is a li q ui d T h e .

si l ver nitrate has here t h ree in compatibilities ; t h e Opi um t h e ,

syrup and the so di um bicarbonate W h en a sol ution of so

,
.

d ium bicarbonate is a d de d to a sol uti on o f silver n itrate t h e

latter is at once completely precipitate d as th e wh ite silver
carbonate In time the l atter is r educe d as al l silver sal ts
.
, ,

are There is another possib l e so urce of tro uble in t h is p re

.

scription ; it is between t h e bism uth s ubnitrate and the so

dium bicarbona te When stan ding in a warm p l ace th is
.
,

mixt ure may exp l o de due to the l iberation of carbon dioxide

,
.

Th is gas is evolve d by the nitric aci d which i s liberate d from ,

t h e subnitrate and acts on the so di um b icarbon ate

, The .

e quations are as fo ll ows :

I . 2BiON Oa 211 20 B iONOa B i ( OH ) a E N Oa
.

II . NaHCo. HN O: N aN Oa C0 : H .O .

In this prescription on l y abo ut 2 drs o f th e sod i um bicar .

b onat e wil l be d iss ol ved ; 4 drs r emain at the bottom o f the .

1 22 P R E SC R IP TIO N I N C O MP A T IBILI T I E S
from 3 t o g r n Thi s is the way th e write r.w ould get
over the diffi culty : Make up the prescription with out the
morp h ine A s t h e p h ysici an evi d ently inten de d 14 gm of
. .

morphine pe r dose ( in t h e p h ysician s min d drop i s always

’

eq uivalent to minim ; 6 g m d ivi de d into 24 d oses make 14 g m . .

per dose ) inclose 24 tablet trit urates of 14 g r n eac h A t t h e

,
. .

same time sen d a note to the physician of abo ut t h e fol l owing

contents :
“
D ear Doctor z—Morph ine s ulphate is inso l ub l e in tinct ure
of capsic um and in et h er ; I t h erefore left it out and sen d 24
tablet trit urates 14 g m each ins tea d so t h at t h e patient may
,
.
, ,

take one with each dose of t h e me d icine ”

I am s ure the .

doctor wo ul d fee l un der great ob l igati on to the pha r m ac ist

for p ursuing s uch a co urse .

207 . S odu Hy p osulp hit . 3 ij

A c S ulp ur Diluti
. h . 3 iij
Gly cer ini 3 iv
Aq uae q .
3 iij
s. ad

S . : 3 ji n cup of w ater, for rinsi ng mo uth ; al so i nternally ,

3 times a day .

This prescription is incompatib l e and cannot be dispensed ; ,

either the fi rst or secon d ingre d ient m ust be l eft out .

S ulph uric acid dec omp oses t h e so d i um hypos ul phite ( wh ich

i s chemically so di um thios ulphate and is now so designated ,

of fi cially ) with the precip itation of s ul ph ur and the evolu

tion of s ulph ur dioxi de The reaction i s as fo ll ows .

NazS aO. H 80 4
2 NazS O. S S O: HzO .

208 . P ep sini P uri

S odii B icar b o n
Mf p ulv . . Tal Dos xx
. . .

S . : One t i d . . . after meals .

P ep sm considere d absol utely i ncompatib l e thera pe utic

1s
,

ally wit h so di um bicarbonate or any ot h er alkali The d i

, .

e stiv e p ow er of e si i
g p p n s s up pose d to be d estroy ed by con
 P R E SC RIP T IO N I NC O MP A T IBIL I T I E S 1 23

tact with an a lka l i Q uite likely that this is the case B ut I

. .

kn ow many physicians w h o contin ue to prescribe pepsin wit h

alkalies beca use t h ey claim they get good res ults fro m the
,

combination T h is reason ing is abo ut as foll ows : T h e gas

.

t ric j uice always contains h y d roc h lori c aci d ( and w h ere it

d oes not l ike i n cance r t h en pepsin will be of little avail
, , ,

anyhow ) w h ic h ne utralizes t h e alkalin e me d i um le aving

, ,

t h e pepsin free to exert its proteolytic infl ue nce B ut some .

,

may say ex periments appear to s h ow t h at t h e p roteolyti c

,

p ower of pepsin which h as been i n contact wit h an alkal i

, ,

is lost foreve r ; t h at even after ne utralizing t h e alkali and

ren dering it aci d t h e pepsin refuses to wor k
,
T o some .

p h ysicians th ose experiments a re not concl usive A test t ube .

-

or a porcelai n dis h is ve ry di ffe rent from a l iving secreting ,

m uco us membrane ; and it is j ust possible t h at a pepsin ,

w h o se powe rs h a ve become so to say d ormant from treat

, ,

men t wit h som e ch emical may s udd enly aw aken on coming

,

into contact wit h s uc h a membrane W h ile we do not regar d .

“
vital force wit h t h e same s uperstitio us reverence t h at was
”

a ccord e d it before t h e epoc h making year of 1 828— t h e year

-

of W oehle r s pre gn an t d iscovery— still we believe t h at not

’

all v ita l p h enomen a c an be or eve r wil l be acco unte d for by

strict l y ch emical processes or expre sse d i n c h emica l e q ua
,

tions ; and h e wh o sees no d i fference between a test t ube and -

a l i ving stomach has yet a good dea l to l earn

,
.

209 . P e psini
R e so r cini
S aloli

A ntiseptics are consi dere d incompatible with pepsin as ,

in h ibiting its d igestive action W h et h er t h ey d o so in t h e

.

stomac h is still sub j udice T h e salol will have no b ad e ffect

.

on the peps in as it is in sol uble in t h e stomach and passes

,

i nto t h e bowels un change d T h e d r ug gist s h o ul d dispense

,
.

t h is presc ription witho ut any q uestions as it is on l y a c ase ,

of ( s uppose d ) t herape utic incompatib ility .

1 24 P R E SC R IPTIO N I NC O MP A T IBIL IT I E S
21 0 . Sol Fowleri
.

Tr Nuc V om
. . .

S yr Ferr i I odidi
.

S . : Te asp oonf ul after meals .

T h e potassi um carbonate in the F ow l e r s solution wi ll p re

’

cip itate the ferro us i od i de as ferro us c arb onate w h ic h is ,

itself rapi dly decompose d It will also ten d to precipi tate the
-

stryc h nine and brucine in t h e nux vomica T h e iron wi ll .

combine with t h e arsenite As seen there are th ree so urces .

,

of incompatibility in this prescription .

21 1 . A luminis 3 ss

Ao . T anni ci 3 ij
Gly ce rini 3 ij
Aq uae 3 ij
S . : S hak e well and , p ut teaspoo nf ul in cup of warm water
for g argli ng .

The fo ll owin g note c ame with th is prescription The

mixt ure at once t urned black ; I ma de i t up aga in with t h e
same res ult I ma de up similar combinations m any t imes
.

before and it neve r h appene d C an y ou explain t h is p een

, .

liar reaction ? ”
T h e d r uggist was tol d th at un do ubte dly the
al um containe d an appreciab l e amo unt of iron E xamin ation .

of a sample of the al um proved the correctness of t h e sur

mise Co mme r ci al a l um is ofte n contamin ated with i ron
. .

21 2 . Pepsini P uri
A c Hy dr ochl
. . Dil .

Tr Genti an Com p
. . .

Elix S impl . .

A q Menthae P il
. .

S . : Cochlear parvum te r in die, p ost ci b um .

A re pepsin and alcohol inc ompatib l e ? Th is question is

also answere d d ifferently by the c h emists and by t h e clini
cians The chemists say alco h ol d estroys t h e action of pep
.

sin ; t h e cl in icians say it makes no d i fference as t h ey get goo d ,

res ults from the e l ixirs and w in es of pepsin Syme s ex p e r i .

’
126 P R E SC R I P T IO N I N C O MP A T IB IL IT I E S
l
ica ) , be quoted
in the d i spensaries , be come inco rpor ated in
text books , and gain cre dence as a well establis e d tr uth ,
-
-

h
witho ut anybo dy taking t e tro uble to verify or disprove the h
s tatement T h e above p rescri ption is a case in point F or
. .

many years it had been h el d t h at to prescribe calome l and

sod i um c h lori de in t h e same pow der meant death or at l ea st ,

great bo dily h arm t o t h e patient from the formatio n of

, ,

corrosive s ublimate B ut is this so ? T h e a ut h or believes t h e

.

prescription is perfectly compatible and that no corrosive ,

sublimate is forme d In twenty fo ur consec utive experiments

.
-

h e could fi nd no m ore t h an insig nificant traces of HgClz ,

s uch as can also be fo un d by trit urating cal omel by itse l f or ,

wit h water or with some other ine rt s ubstance like sil ic a

,

o r kaol in The a uthor was among the fi rst to establish th is

.

fact and to teach h is st udents to a nswe r accor dingly at e x ami

,

nations T h e L atin signat ure m eans : one p owder m ornin g

.
“

”
and night .

21 6 .Hy dr arg Chlor Corros .

gr iv
. . .

P otas s I o didi . 3 ij
Ferri et Ammon Citr 3 i. .

Tr N ucis V om . . .3 ij
Tr Cinchon Compos
. .ad 3 iv .

In m any prescriptions we are confronted with a condition

of a ffairs similar to the one i n w h ich a physicia n is when
he is face to face with an inc urable mala dy He kn ows t h e .

tro uble b ut can o ffe r no reme dy I n the abo ve prescripti on

, .

we know exactly what the t ro uble is b ut we kn o w at the ,

same time that t h ere is no way of i mproving it The so urces .

of tro uble or incompatibility i n this prescription a re n umer

ous. Fi rst of all it is wel l to be aw are t h at ammoni o—
ferric
citrate w h ile rapi dly and completely sol uble in water is in
,
,

sol uble in alco h ol ; and as compo un d tinct ure of cinchon a is

m a de wit h a menstruum consisting chiefly of al cohol t h e sal t ,

wil l not disso lve T h at is n umber one Second the corro

. .
,

sive s ublimate and potassi um io di d e precipitate the alk a

l oids of both t h e cinchona and the nux vomica E ve n if there .
 P R E S C R IP T IO N INC O MP A T IBILIT I E S 1 27

were no n ux
v omica in the p rescription the p recipitation of ,

the c inchon a alkaloi ds a l one wo ul d make the mixture some

w h at dange ro us ; beca use it is well t o remember t h at when
HgC lg K I ( iod ohy d r ar gy r ate of potassi um ) p recipitates
an al k aloi d it b ecomes precipitate d wit h it in t h e form of
, ,

a do ubl e salt S o that t h e merc ury wo ul d be in t h e form of

.

a p recipitate and the patient might get too m uc h at one

,

d ose A th ir d ca use o f unsigh tliness wo ul d be in the bl ack

.
,

inky c ol or prod uced by t h e action of t h e tanni c aci d pres

,

ent in the cinc h ona bitte r orange peel etc on t h e ferric salt
,
-

,
.
,
.

I n sho rt l ooke d at from whatever point of view the above

, ,

is a bad combination and it is advisab l e to refuse to dispense

,

it.

217 B is m S ub nitrate
each
}
. .

Of
Liver of S ulp hur
Zinc S ul phate gr . x
Lead W ater 3 i
R ose Water 3 iij
Aseries of reactions will t ake place in th is prescription .

Z in c s ulp h ate an d l ead wate r will pro duce a w h ite precipitate

of lea d s ulphate and zinc acetate will remain in sol ution
,
.

T h e liver of s ul p h ur wh ich consists of several potassi um ,

s ulphi d es w il l pro duce zinc s ulphi de ( w h ich is w h ite ) and

, ,

with the lead the bl ack s ul p h i d e of l ea d Some black b is .

m uth sulp h i d e will also be fo rmed and there will a l so be

a slight p reci pitation of s ulph ur .

21 8 . Ferri e t Q uin Cit S olub ilis . .

3 ij
P o tass I odidi .
3 iv
S y r S arsap Comp os
. . .
3 ss

Aq uae Menth Pip . .

ad 3 iv
The potassi um iodide p rec ipitat es th e q uin ine as quinin e
io d i de ; t h ere is a lso a slig h t l iberation of i od ine due to t h e ,

fact tha t ferric sa lts namely those having an aci d reaction

, ,
,

d eco m pose potassi u m iod i d e wit h t h e liberation o f io d ine ,

whi l e th ey become r ed uce d to ferro us compo un d s .

1 28 P RE SC R IPT IO N I N C O MP A T IBILIT I E S
21 9 . L aetop ep tini
S odii B icarb on .

. h
Hy dr ar g C l or Miti s .

A ntipy rini
S odii P ho sp hatis
Cafi ein Citr atae
.

S odii B r omidi
F t pulveres No
. . X II .

The s odi um b romide is incompatib e wit t e ca ome l

con h h l l ,

vert ing it into merc uric bromi de and m erc uro us oxi de T he .

antipyrine is sligh tly incompatible w it h t h e c alomel ; t h e

so di um p h osphate w h en trit urate d wit h t h e c itrate d caffeine
and the ot h er salts liberates some of its water of cr y stalliza

tion of w h ich it contains 1 2 molec ules and converts the whole

,

into a pasty mass ; the small amo unt of H Cl containe d i n t h e

lactop ep tine and the citric aci d in the ca ffeine w il l l iberate
some 0 0 2 from the sod i um bicarbonate etc In short this , . ,

prescription is abso l ute l y non d ispensable -

.

220 . A o S alicy lici

. 3 v

S o dii B ica rb onatis 3

Aquae Menthae P ip .
3 iij
On p utting the ingre d ients i n a mortar consi derable e f ,

fervescence was notice d , b ut when the effervescence w as ove r ,

a white pow der remaine d which n o amo unt of rubbing o r
,

shaking co ul d d issolve W h at was the p ow d er ? Was i t a

.

new compo und or was it t h e sal icyl ic aci d ? ”

T h us r uns th e
tale of one of my correspon dents No the pow der was neit h e r .
,

a new compo und nor was it the salicylic aci d It is tr ue

, .
,

salicyl ic acid is b ut very slig h tly sol uble i n wate r ; b ut i n

the presence of sod i um bicarb onate and water a chemica l
action takes place and sod i um s al icyl ate is forme d So d i um .

sal icy l ate is sol uble in less t h an one par t of water F ive .

dra ms of salicylic aci d wil l combine wit h t h ree d rams of so

dium bicarbonate ( molec ular weig h t of salicylic aci d 1 38 ,

molec weight of sod bi carbona te

.
84 which gives us prae
.
,
1 30 P R E SC R IPT ION INC O MP A T IBILI T I E S

g anate are absol ute l y incomp atible T h e sol ution of p e tas .

si um permanganate is decolorize d by t h e peroxi d e wit h t h e ,

form ation of a p recip itate of manganese d ioxi de an d p otas

si um manganate .

The c h emical reaction may be represente d by the fo l low

ing eq uation
2KMn O 2H 0 . M EG MnO 2 211 0
2 20 ; z 2 2

P o ta ss Hy d r o g en P o tassium M an gan W a te r O x y ge n
x x
.
.

P e r mangan . D io ide M anganate D io i de

The peroxide of hy d rogen us ually conta in ing a small quan

tity of aci d for its preservation a small q uantity o f m an ,

gano us s ulp h ate w ill also be fo un d T h e reaction is : .

2KM I 1 0 4 5H20 2 3 11 28 0 1 K 28 0 4
P o ta ss Hy d ro g e n S ulphur ic P ota ss
x
. .

P e r man g an . D io ide A cid S ulphate

2MD 8 0 4 8H20 50 :

M ang anous W ate r x

O y ge n
S ulp hate

Oi co urse , the prescription sho u d not b e dispen sed l .

223 . A conitini
Div in .
pil No 24
. . . S . : One pi ll twice a day .

The a uthor receive d this prescription wit h a note asking

w h et h er t h e dose was too large T h ere is not a single d rug .

or ch emical i n t h e entire range of t h e materia me d ica t h e

dosage of w h ic h h as ca use d so m uc h tro uble to p h ysician and
to d ispenser alike as aconitine h as ; and t h is is due to the
fact t h at there is no ot h e r d rug which varies s o m uc h i n
strength as do vario us samples of aconitine Of two sam ples .

of aconitine one may be m an y times stronge r t h an th e ot h er

.
.

It is time for p h ysicians and p h armacists to know t h at sub

stances like aconitine d igitalin etc are not absol utely dis
, ,
.
,

tinct entities s uc h as potassi um io d i de or so d i um b romi d e .

The n ame of the man ufact urer is of l ittle importan ce wh en

t h e common c h emicals are ord ere d b ut it makes all t h e dif ,

ference i n t h e worl d in the case o f aconiti ne or of digita l in .

I a l ways c l aimed that i n ordering aconit ine the kind wante d ,

 P R E SC R IPT IO N I NCOhfl ATI B I L I TI E S ’
1 31

( whethe r amorpho us or crysta ll ize d ) and the n a me of the

man ufac t ure r s h o uld always be sp e cifi ed Ot h er wise a d ose .

migh t be prescribe d w h ic h will one t ime pro duce no e ffects

w h atsoever and t h e n ext time prove fata l or nearly se
, In .

t h e last ed ition of Hager s Han d b uc h ( 1 899 page 1 5 1 ) it

“ ” ’

is d istinct l y a dvise d to b uy aconitine preparations d irectly

from t h e man ufact ure r “
in original packages having it ,

state d exactly wh at q uality t h e preparation is and what its

”
m axim um dose .

A con itine c r yst Merck and aconit in e Duquesnel are p rac

.
, ,

tically i dent ica l and their d ose may be state d t o be from

,

1 6 00 to 1 1 00 gr n
- -
U n der no consi deration wo ul d t h e write r
.

prescribe or advise a p h armacist to dispense more than 1 1 0 0 -

g r n. o f c rystallize d aconitine ; he may g o as high as one 1 6 0

p rovided he is s ure t h at t h e p h ysi cian is f ully aware of the
potency o f the d rug T h e amorp h o us v ariety may be p re
.

sc ri be d in larger d oses Wh at answer was given t o t h e.

in q ui rer re gar d ing t h e above p rescription ? On l ooking into

the me d ical d i recto ry it was fo un d t h at the physician w h o
,

wrote t h e pres c ription belonge d to the eclectic sc h ool ; t h ere

was then no do ubt t h at it was the eclectic resinoid pow der
t h at was inten ded O f this the dose is from 1 24 to 1 1 2 gr m
.
- -
.
,

an d as m uch as 1/s g r n may be given T h e d r ug gist was . .

t h us a d vised and s ubse q uent i nqui ry from the physician

,

proved that th is was correct .

224 . Q uini n . S ulp h .

A o S ulp
. h . Dil .

S ali cini

Acor r esp ondent writes that on mixin g the quinine with

the aci d and some w ater h e obtaine d a pe r fectly c l e ar sol u
tion b ut o n a dd ing t h e salicin a precipitate formed at once
,
.

“
W h at was t h e p recip itate due to ? Was q uin ine salicy l ate
formed o r was salicylic acid thro n out from sol ution by the
w
1 32 P R E S C R IPTI ON INC O MP A T IBILIT I E S
sulph uric aci d ? Some people will d ig very d eep for a
c a use w h en t h e l atter is as plain as d aylight No c h emical .

reaction of any k in d is fo r med between t h e salicin and t h e

quinine or the salicin and t h e s ulp h uric aci d ; in fact no ,

precipitate of any kin d is forme d W h at was consi dere d a .

precip itate was simply the excess of t h e un dissolve d salicin .

Salic in is sol uble in about 28 parts of wate r ; conse quently

only abo ut a dram wi ll dissolve in the menstr uum of t h is pre
scription ; 5 dra ms will be i n s uspe nsion ; it is t h is un d is
solve d portion t h at our correspond ent m istook for a p recip i
tate.

225 . Cocain Hy dr ochlor

. .

Q ui ni n S ulph
.

Tannini
Menth ol 3 i
Aq uae R osae q . s. ad 3 vj
S . : Use as a g argle .

What possible b enefit can a patient derive from using

s uch a conglomeration ? I am convinced th at not only wo ul d
he derive no b ene fit b ut h is con dition wo ul d become aggr a
,

y ate d The coc aine wo ul d be p recipitate d as cocaine tan

.
,

nate which being in sol uble wo ul d h ave no e ffect T h e qui

, , , .

nine wo ul d be present partly as q uinine s ulp h ate and p art ly

as quin in e tannate both insol uble ; t h e ment h ol wh ic h is here
,

in excessive dose is i nsol uble in water and on reac h ing the ,

fa uces and pharynx in an un d isso l ve d state wo ul d prove

intense l y irritating ; even the astringent e ffect of t h e tannic
aci d wo ul d be to some extent destroyed as a part of it ,

wo ul d be use d U p to fo rm ins ol uble c ompo un d s with the

alkaloi ds In short the combination is a wo rt h less one ; the
.
,

patient wo ul d h ave fared m uch better if t h e p h ysici anhad

prescribe d h alf a dram of tannic aci d in 6 o unces of wate r .

Had the prescript ion been for inte rn al use t h ere m ight yet be
some sha dow of exc use for p utting i t up ; we wo ul d sa y :
We ll the gastro intest in al j uices will d ec om pose the insol
“
-

,
1 34 P R E S C R I P TION INC O MP A T IBIL IT I E S
the hex amethy lenamin very vigoro usly ; simply m ix them
ligh tly and fi ll t h e caps ul es .

229 . At oph an
U rotrop in
Mf . P ulv .Tal Dos x ii. . .

One p owder in gl ass of water .

T h e same is tr ue of this p rescripti on There is nothing .

incompatible between atop h an and urotropin T h e d ruggist .

nee d h ave no h esitation in d ispensing t h e p rescription .

23 0 . S o dii B o r atis 3 iss

A o S ali cyl
. . 3 i
Gly ceri ni 3 x
S y r up i q s. ad
.
3 iv
The or dinary druggist wil l simp l y mix the borax and the
sa l icylic aci d wit h t h e syr up overlooking t h e fact that all ,

t h e salicylic aci d is not sol uble in the menstr uum The .

proper way to dispense this p rescription is to d issolve the

salicylic aci d in a part of t h e glycerin by t h e aid of a gent l e
h eat and t h e borax in the ot h er half of t h e glycerin The .

sol utions are then m ixe d and t h e syrup a dde d Made th is way .

a clear sol ution is obtained witho ut any un d i ssolve d sal icy l ic

aci d in s uspension A not h e r way q uite permissible wo ul d be
.

to dissolve t h e salicylic aci d i n a smal l q uantity of alcohol d is ,

solve t h e borax i n the glycerin by the aid of a gentle heat mix ,

the so l utions and add the syr up .

23 1 . Liq uor . Cr esolis Comp os .

Hy dr ar g Bichlor
. .

P otass P e rmang an
. .

3 i in two q uarts of water for do uc he .

This presc ri ption forms an incomp atible mess T h e r eac .

tions t h at take place in it are too n umero us t o mention ( 1 ) .

T h e potassi um permanganate is in compatible w it h t h e cresol

sol ution ( 2) T h e merc uric chlori de is incompatible w ith
.
 P R E S C R IP T IO N INC O MP A T IBIL I T I E S 135

the cresol sol ution ( 3 ) The po tassi um permanganate is in

.

compatible wit h t h e merc uric c h lori de and ( 4 ) T h e merc uri c ,

ch l ori de is incompatible with the cresol sol ution T he p rope r .

way to m ak e up this prescription is n ot to mak e it up at all

an d to notify the p h ysi cian I know that it is not an ex.

tr e me ly pleasan t thing to have to sen d aro un d or t o call up

t h e p h ysici an and tell h im t h at h is p rescription cannot be
ma de up ; he ge nera ll y gets r utfl ed B ut in a case like this .
,

not h ing else is l eft to be d one The prescription is too in .

compatible to be dispense d and to l eave out the potassi um ,

perm an ganate for in stance migh t p ut t h e druggist into

, ,

greater t ro uble wit h the physician than to attempt t o exp l ain

matte rs be foreh and .

23 2 . S odii S alicyl .

U ro trO p ini
S pir A e the ris
. Nitro si 3
Aq uae 3
Th e on l y difficulty with t h is prescription is that afte r a
l itt l e while it ac q ui res a dark color on acco unt of the acti on
between t h e n itro us et h er and the salicylate of s od i um T h ere .

is no in compatibi l ity bet ween the salicylate of so di um and t h e

urot rop in .

23 3 . Diur e tini
P o tassii I o didi
. h
Hy drarg C lor Cor ros . .

Aq uae
S . : 3 i 4 times a day .

T h is presc ri ption is incomp atible The merc uric chloride .

and t h e p otassi um io d i d e w h ic h as we know form iodoh

, y dr ar
gyr ate of potassi um will eit h e r at once o r event ually p r e cip i
,

tate the t h eobromin I f t h ere was no m erc uri c c h lori de i n

.

t h e p rescri ption i t co ul d be d ispense d with a shake l abel .

B ut i t is rat h er risky to d ispense a p rescription which con

t ains merc uri c ch l oride as a p recipitate .
136 P R E SC R I P T ION I NC O MP A T IBILIT I E S
23 4 . P he nace tini
Tr . F erri Chlo ridi
E li x . S imp l
.

Aq uae
S . : Teasp oo nful every 3 h our s .

Whi l e t h e t h erape utic wis dom of prescrib in g phenaceti n

an d tinct ure of ferric c h lori d e in t h e same m ixt ure m ay we l l

be q uestione d still t h ere is not h ing incompatible in t h e c om

,

bination and t h e d ruggist nee d h ave no hesitat ion in d is

p en sing it T h e prope r
. way is to rub t h e p h enacetin by

itself carefully in a mortar t h en ad d t h e simple el ixi r gra d

,

na l ly t h en t h e tinct ure of iron and t h en t h e water

,
U n der .

certain circ umstances a red color may res ult f rom t h e act ion
of the phenacetin on the tinct ure of i ron .

23 5 . P rot arg ol
Aq uae
S . : For ex ternal use o nly .

There is of co urse not h ing incom pat ible between protargo l

an d water b ut t h e way of d ispensing a prescription contain
,

ing protargol makes q uite a d iffe rence If y ou p ut t h e p ro .

tar g ol in a mortar and begin t o r ub it w it h wate r y ou w il l

get l umps T h e same t h ing will happen i f y ou p ut t h e pro
.

tar gol in a bottle and fill it with water and s h ake it There .

is only one way of making a protargol sol ution p roper l y and ,

t h at is to meas ure the p rescribe d q uantity of water i n a gra d

uate and sift the protargol i e sprea d it ove r the water
, , . .
,

with a sifting motion and let it stan d unti l d issolved A

, .

clear sol ution is t h en obtaine d The a ddition of glycer in to .

the protargol t o aid i n the so l ution is n ot permi ssible .

23 6 . A c Citri ci
.
g ram
Kali Carb o nici q 8 ad sa tur a tio ne m . .

Aquae g ms .

S : 3 ss q uaq ua nora secun da

. .

A d ruggist from Mi l waukee sends i n the above prescription

and asks for a th or o ugh c l ear explanation He writ es tha t
, .
1 38 P R E S C R I P TI ON INC O MP A T IB ILIT I E S
in water heate d to t h e boiling point and in t h e sol ution so ,

forme d dissolve t h e salicylic aci d and ferri c pyrop h osph ate ,

h eat being applie d if necessary to complete t h e sol ution .

Ma de in t h is way t h e mixt ure ass umes a bea utiful cl aret

color perfectly clear and transparent It p robably owes its
,
.

color to t h e formation of a sligh t amo unt of ferric salicylate

whic h passes into sol ution .

238 . Liq uor Hy drog enn

. Diox idi 3
Gly cer ini
S . :aft er e ach me al
5 ij .

T h ose w h o see inc ompatibilities where none exist h ave as

serte d that h y d rogen d ioxi d e and glyceri n are incompatible .

There is absol utely not h ing incompatible between t h e two

ingre dients and a mixt ure of t h em may be kept for several
months witho ut any fear of d eterioration We so stated i n .

a previo us prescription b ut t h ere is n o ha rm in an occasion a l

,

r epetition .

239 . Ao Car
. b lici
o

Tr . I o di as gr . xv
Muc . A caciae 3 i
A lcoho lis ( p uri ) 3 v

A d isa g reeable looking me ss Mucilage of acacia sp oils t h e .

combination wit h o ut doing any goo d It s h o ul d be left out .

wit h o ut any q uestion Wit h o ut the m ucilage the p r escr ip

.

tion is al l right .

240 . A drenalini C hl or .

Arge nti Nitratis

Aq uae
S . : I nj ect 3 ti mes a day .

An absol utely incomp atib l e p rescri ption The c h lori de of .

t h e a d renalin precipitates t h e silver nitrate i n t h e form of

silver chlori de T h e a d renalin also re d uces t h e silver to
.

metallic silver while the a d renalin its elf is oxid ize d and b e
comes wort h less A h example of incompatibility which is
.

bey ond any hope of re l ief or improvem ent The ph y si ci an .

,
 P R E S C R IP T IO N I N C O MP A T IB IL IT I E S 139

wh o evi dently had to deal with a very congeste d uret h ra ,

perh aps one t h at blee ds on t h e inj ection of silver n itrate ,

tries to obviate the un d esirable e ffects of t h is salt by using

a drenalin B ut h e only spoils both c h emicals It h e d oes want
. .

to get the efi ects of bot h t h e silver nitrate and t h e a drenalin

chlori de the only way to do it is to make them up in two
,

separate inj ections and tell the patient t o use t h e ad renalin

ch l ori de sol ution say fi ve or ten min utes after the silver
,

nitrate inj ection T h e docto r or ders a d rena l in chlori de

“
.
”
,

b ut w h at h e means of co urse i s the solution of adrena l in , ,

ch l ori d e 1 t o ,

24 1 . P otass . B r omidi
P ot ass . Citr atis
S pir Chlo ro formi
.

S .
3 : 88 per do se .

T h e sal ts an d t h e wate r precipitate th e ch l oroform out of

the spi rit May be dispense d with a s h ake l abe l b ut it is
. ,

a d isa greeable prescription .

242 . U ng Zi hci Ox . .

Aq uae Calcis
Mf . un g .

T he doctor ord ers t o m ake an ung uent um It cannot be .

d one. Y ou cannot m ake an ointmen t from one o unce of

zinc oxi de oi ntment and t h ree o unces o f lime water The .

prope r way to d ispense this prescription is to melt th e zinc

o x i de ointment and mix it with the l ime water in a bott l e ,

shakin g it wel l T h at wil l make a nice thin cream

.
.

243 . S p ir . Camphor ae
Aq uae Me nth P ip . .

3 i every h o ur .

Ou m ixin g t h e sp irit of c amphor w ith the water the cam

p h or w i l l precip itate t T h ere is no way of obviating it .

except by m akin g an em uls ion It wo ul d be better to order .

t h e two d rams of spirit of camp h or separately and te l l the

.
1 40 P RE S C R IPT IO N IN COMP A T I B ILIT I E S
patient to use fi ve m inims droppe d in a teaspoonful or tab l e
spoonful of water T h e n t h e p at ient gets t h e p roper d ose
.

eac h time To d ispen se it t h e way it is written t h e camp h or

. ,

may not be properly d istrib uted an d t h e patient may ge t

une qual doses of the camp h or in each teaspoon To take .

t h e proper amo un t of camp h or ( twelve grains ) d issolve i t ,

in some olive oil ad d pow d ere d acacia and make up an

,

em ulsion with peppe rm int wa te r wo ul d be al l righ t as far

as s uspen ding t h e camp h o r is concerne d B ut t h at wo uld .

be taking toe many l ibe rties with the p resc ri ption .

244 . A luminis
B oracis
Gly cer in i
Aq uae
S : Use as a gargle
. .

Whi l e borax with al um gives a preci pitate of a l umin um

hy droxi de still t h is p rescription m ay be d ispen se d
, The .

borax is t o be dissolve d in the glycerin the al um i n the w ate r , ,

and the sol utions mixed .

24 5 . A sp irini
P otassii I od idi
Aq uae
S : Te as p oon as directe d
. .

It is claime d t h at aspirin with sol ution of potass i um i od ide

is apt to decompose with t h e formation of h y d rio d ic aci d I .

believe this is a p urely t h eoret ica l consi deration I kn ow .

a physician w h o has dispense d t h is prescri ption ve ry ft c

q uently for rhe umatism and there seems to be nothing wh a t
ever the matter with it .

24 6 . Hy dr arg C lor Mit

. h . .

M f p ulv No
. . . . i Ta] D0 8
. . . 1111 .

S . : One twi ce a day , for 3 day s, then th ree times a

then 4 times a day
day for 3 days , .

Most l ikely a small amo unt of merc uric i od i d e w ill form

1 42 P R E S C R I P TION I N C ONEPA TI B I L I TI E S

250 . S od11 B e nzoatis

Aq uae Calcis
S . : 5 i 3 ti mes a day .

T h e greater part of t h e sod i um benzoa te will disso l ve B ut .

t h ere will be a precipitate of calci um benz oate O f co ur se t h e

”

mixt ure will no longer contain lime wate r t h e lime h aving ,

combine d wit h t h e benzoate t o form calci um benzoate T h e .

l ittle calci um benzoat e i n precipitation i s of n o val ue and

migh t as we ll be fi lte r e d out As a m atte r of fact it wo ul d .

have been j ust as well for t h e p h ysician t o or der t h e so di um

benzoate d issolve d i n 4 o unces of plai n water If t h e p h ysi .

cian does not belong to t h at small type t h at gets r uf fle d at

eac h remark it would be best to notify him of t h e incomp ati
,

b ility .

251 . A o S ali cyl

. . 3 ij
Gly cerini 3 ij
Aq uae q s ad 3 iij . .

T h ere is not eno ugh glycerin and wate r h ere t o d issolve

t h e salicyl ic aci d Borax increases cons i d erably t h e solub il
.

ity of salicylic aci d T h ere are t h erefore two ways of d is

.
, ,

p ensing t h e prescription : to r ub up t h e sal icylic aci d wit h th e

glycerin and water allowing as m uch to d issolve as w ill d is
,

solve and leaving t h e rest in s uspension d ispensing th e pre ,

scription with a s h ake label — or to add abo ut one dram of

borax d issolving t h e borax and sa l icy l ic acid i n t h e glycer in
,

and water by t h e a id of heat T h e prescription can th en be .

dispense d as a clear sol ution B ut whether the p h a r macist .

h as a righ t to a dd t h e borax wit h o ut the p h ysician s per

.
’

mission is a question which cannot be answere d d ogmatic ally .

252 . P ot assi e t S odii Tar tr .

3i
A o S ulp hur ici
. Ar mo .
3 iij
Aq uae Me nth Pip . 3 ij
.

S : 3 ij 3 ti mes a day after me al s

.
.

The p rincipal incompatibility here is between the s ulph uric

ac i d and the p otassi um and sodi um t art rate T h e s ulp h uric .
 P R E S C R IP T IO N INC OMP A T IB ILI T I E S 1 43

aci d decomposes the salt p otassi um bitartrate precipitating

, .

T h e oil of cinnamon and tinct ure of ginge r ( in t h e aromatic

s ulp h uri c aci d ) will also separate out givi ng t h e mi x t ure a ,

clo udy appe arance .

253 . S o dii S ali cyl . 3 iij

S y r up i Limonis 3i
Aq uae 3 iij
‘
I he citri c acid containe d i n the syr up of lemon W ill decom
pose a portion of t h e so d i um salicylate crystal s of s alicyl ic ,

aci d fl oating i n t h e mixt ure T h e prescription s h o ul d be d is .

p e nsed with a s h ake label If t h e p h ysician gives permissio n

.

t o fi lter out the precipitate d salicyl ic aci d t h at fact s h o ul d

be note d on t h e prescription so t h at i n repeating th e p r escr ip
tion the sam e proced ure may be followe d .

254 . S od B e nzoatis
.

S y r up i L imo nis
Syr . Ac . Citri ci
Aq uae
T h e remarks m a de in t h e p revio us prescription apply wit h
full force to t h is o n e Instea d of salicylic aci d precipitating
.

we will have benzoic aci d p recipitate d by t h e citric acid con

tain ed i n the sy r up of l emon and t h e syr up of citric aci d .

255 . P e p sini P uri

A c Hy drocy an
. . Dil .

Aq uae
S . : 3 1 a fter me als .

I f t h e p h armacist p ut up t h e p rescription as written the

patien t wo ul d probably neve r ta k e more t h an one dose of it .

He wo ul d be d ea d very promptly after T h o ug h t h e p r escr ip .

tion calls very plainly for dil ute d hyd rocyanic aci d t h ere ,

i s no d o ubt that t h e p h ysician meant d il ute d h yd roc h lori c

aci d t h at it was simply a sl ip of t h e pe n T en m inims of
,
.

d il ute d h y d rocyani c aci d if of proper strength woul d very

likely p rove fatal I n t h is case t h e p h ysician was calle d up
. ,
1 44 P R E S C R IPT ION INC O MP A T I B ILI T I E S
h e was full of t h anks an d of co urse he sai d dil ute d hy d r o
c h loric aci d was w h a t h e meant .

256 . Ace tani lidi

Spir A e the ris Nitr osi
.

Aq uae
S : . 3 i q 2 hr until re li eved . . .

T h is prescriptio n ac q uires a yello w color gra d ual l y t urning ,

re d Some complex nitro us com po un ds are forme d d ue to t h e

.

reaction between the acetanilid and t h e spirit o f nitro us

et h er The compo un d s formed are not ve ry at a ll poiso no us
.
, ,

and t h e prescription may b e d ispense d B ut why p hysic ians .

will persist in pre scribing acetanilid in a liq ui d mixt ure is

beyon d un derstan ding The only proper way to p rescri b e .

acetanili d is i n t h e form of powders tab l e ts o r caps ul es , .

257 . Aceta
nilidi

R eso r cini as
S . ex ternal use
: F or .

W h en the two chemicals are rubbe d toget h e r a moist mass

or a li q ui d i s obtained B y merely gently sifting t h e two .

pow ders they may be d ispense d as a pow de r b ut there is

always d ange r of t h ei r becoming li q uid A cetan ilid sho ul d .

not be prescribed with resorcin .

258 . A ce tanilidi
Thym l o

R esorcini
M f pil No
. . . . XV .

When thymol is r ubbe d with acentan ilid a l i q uid is oh

taine d Acetanil id and resorcin also fo rm a li q ui d o r semi
.

liq ui d mass T h e prescription i s incompatible : i t is impos

.
‘

sible to d ispense it as a permanen t pow de r .

259 . A ce tozone
A q uae
S . : F or e xt e rn a l use .

A cetozone i s only very slig h tly sol uble i n wate r only 1 ,

in 1 5 60 .
Only a little over a grai n will dissolve i n fo ur
1 46 P RE SC R IPT I ON I NC O MP A T IBILIT I E S
writer several extremely anxio us hours A ny p h armacist of .

any experience wo uld un derstan d t h at t h e stryc h nine sul

p h ate was meant to be d ivi d e d into fi fteen pills B ut the .

boss was out w h en the prescription was presented and the

j unior clerk ma de i t up p utting of a grai n o f st r ychn in e
,

in eac h pill The p atient a d elicate yo un g woman to ok the

.
, ,

pill at six o clock and anot h er one at t en A t abo ut e l even

’
.

s h e woke up with a very quee r sensation compla in ing that ,

s h e was feeling very funny an d th at sh e t h o ught she w as

dying .It took a very stren uo us n igh t of work with the
a dministration of l arge d oses of potassi um b romide and
ch
-
lor al before t h e patien t was out of d anger .

263 . S od11 Gly cerinOp hosph .

Div in . p ul v
No ii . . x .

S . : One p owder 3 times a day .

It cannot be done So d i um gly cer inop hosphate is eithe r in

.

the form of a semi li qui d mass or of very hygroscopic p ow der

-

It is impossible t o dispense it in p owd e r fo rm The o nl y .

way to dispens e so di um g ly cer inop hosp hate is in l i quid fo rm .

264 . P ot assi Gly cer inop hosp h . 3 i

Div in cap s N o
. ii . . x .

One caps ule 4 ti mes a day .

It cannot be done Pot assi um gly cer inophosphate ca nn ot

.

be d ispensed in caps ules It is alm os t a li q ui d o r extremely

.

hy gr os0 0 p ic powder It can only be d ispensed in l i quid fo rm

.
.

265 . Calcu Gly cer Op hosp h .

P o tassii
S odii
Div in . p ul v . N0 . xx .

S . : One
p owder in wate r 3 time s a day .

Of the three gly ce rophosp hates the calci um is the on l y one

that is not hygroscopic an d can be d ispense d i n p ow der form .

B ut the potassi um and so di um

g ly cer op hosp hates make the
presc r iption an impossible one .
 P R E S C R IP T IO N INC OMP A T IBIL IT I E S 1 47

266 . A c B e nz oi ci
.

Aq uae Cal ci s
S : F o r e x te rna l use
. .

A po rtion of the benz oic aci d will combine with the lime
form ing calc i um benzoate a sm a ll portion wil l d issolve wit h
,

w h at is now plain water and the rest wil l remain un d issolve d .

It s an excee d in gly poo r p rescription and t h e p h ysician sho ul d

’

be informe d both of t h e incompatibility between benzoic aci d

an d lime water an d of the slight so l ubi l ity of benzoic acid .

26 7 . Ao Galli ci
.

Ferr i S ulph p ulv . .

Cup ri S tdp h .

Zinci S ul p h .

S . : 3 i
q uarts of water
in 2 .

As ferro us s ulph ate a lways contains some ferr ic sal t there

w ill be a black precipitate or black combination between t h e
ga l li c aci d and t h e ferro us s ulp h ate An unpleasant p r escr ip .

tion which a d e l icate fema l e p atien t wi l l not app reciate very

,

m uch .

268 T anni ci
. Ao .

Co p pe ras
Al um
S : 3 i in q uart of wa te r as directed
. .

This pow de r di ssolve d in wate r wil l m ake a nasty inky

mixture d ue t o the action betwee n the tann ic acid and the
c op pe ras or fe rro us s ul phate I t wi l l soil b a dly the un der
.

wea r and th e l inen and to p rescribe s uch a combination is

,

e q uivalent to ask ing a patient an d a fem ale one at that to , ,

syrin ge h erself with di l uted ink .

269 . A g urin
S odii S ali cyl .

Aq uae
S : 3 1 eve ry two h o urs
. .

A g ur in is t h eobromine sodi um acetate wh ich m ust not b e ,

148 P R E SC R IPT ION INC O MP A T I B IL IT I E S
prescribe d wit h any acid s or alkalies The citric aci d i n the .

syr up of lemon d ecomposes ag ur in precip itating the th eo ,

.

bromine It also decomposes t h e sod i um salicylate p r ecipi

.
,

tating some salicylic aci d .

270 . A luminis
B or acis
Aq uae Chlor ofo r mi
S . : Use as a
or a sprayg arg le .

There will be a precipitate of al umin um hy droxi d due to

t h e reaction between t h e so d i um borate and t h e al um T h at .

precipitate m ig h t as wel l be fi lte r ed out for i t can do no ,

goo d as a gargle or a spray It co ul dn t b e use d in a spray

.
’

anyway as it wo ul d be at t h e bottom as a precip itate and if ,

we s h ook it well and trie d t o use it it wo ul d clog the spray .

The salts will also h ave a ten dency to separate t h e chloro

form out of t h e ch loroform water It i s a b ad prescription .

and t h e p h ysician sho ul d be so informed of co urse in a po l ite , , ,

d iplomatic m an ner .

271 . Alumini et P ot S ulp

. h .

Aquae Cal cis

S . : F or e xter
l use only na .

Here we h ave a d o uble incomp atibi lity T h e s ulp h ate r ad .

ical of t h e al um will precip itate t h e calci um as calci um sul

p h ate and t h e h y droxi d e of t h e calci um will precipitate t h e
al um as al umin um h y dro x id e It is a b ad prescription and .

t h e d ruggist is perfectly j ustifi ed in d ispensing fiv e d rams

of al um d issolve d in ei gh t o un ces of plain water The l ime .

water does no goo d only misc h ief , .

272 . Aly p ini

A rg enti Nitr .

Aq uae
S . : Use as i nj ecti o n .

W h en alypin is pre scribe d wit h o ut any sp ecifi cation a lypin ,

chlor l de is d ispense d t h is bein g the us ual combination in

,

which a lypin appears on the m arket Of co urse t h e chlori de .

1 50 P R E S C R IPT ION I NC O MP A T IBILIT I E S
to increase t h em in t h e next prescription B ut t h is is j ust as .

b ad beca use t h e silver precipitating out th e astrin gent and

,
,

fect of the silver nitrate is lost and the prescripti on

sp ecifi c e f

is worthless The p h ysician s h o uld be informed that si l ve r

.

nit r ate and so di um borate are incompatib l e .

277 . A r gonini gr . xij

Z inci S ulp h
Aq uae destill .

S . : Use as i nj ecti on ni ght and morning .

A r g oninis abs ol utely incompatible with zi nc sul ph ate . A

precipitate is fo r me d T h e only way to dispense t h is pre .

scription is by leaving out either the ar gonin or t h e zin c

s ul phate B ut of co urse the prope r way is to inform th e
.

physi cian .

278 . A rgonini
Ac T anni ci
.

Aq uae
S . : F or p ai nti ng s or e th roat .

T h e same remarks ma de in the previo us pr escr iptio n app l y

to this one A r g onin is incomp atib l e with tannic acid and
.
,

the two sho ul d never be prescribed in the same m ixture .

279 . Zi hci S ulp h .

Plumb i Acet .

Aquae
S . : S h ake w ell je t
. In c fo ur times a day .

A r gonin is incompatib l e
with zinc sulphate and with l ead
acetate T h ere is also an incomp atibility here between t h e
.

zinc sulp h ate and the lea d acetate The prescription is a .

b ad one If the doctor insists up on having it d ispense d t h e

.

way it is written he m ay h ave it b ut he ce rtain l y sho ul d be

, ,

informe d of the incompatibili ties of ar gonin and to l d that ,

the proper way to p rescribe ar gonin is j ust by i tse l f .

 P R E S C R IPT IO N I NC O MP A T IB IL IT I E S 1 51

Zinci S ulp h .
gr . x ij
Aq uae
To b e use d as an i nj ecti on .

L ike m ost o f t h e organic silve r compo unds argyro l is in

compatibl e wit h zinc s ulphate and the two sho ul d never be
prescribe d in the same mixt ure .

Ao Tannici
.

Aq uae
Mi . so l
.

S . : F or p ai nti ng the th roat .

A rgy rol is absol utely incompatib l e w ith tannic acid and the
two sho ul d n ever be pres cribe d in the same m ixt ure T h e .

p rope r way wo ul d be to l eave out the tann ic aci d and to

inform the physician .

28 2 . Hy drargy ri B ichlor .

Z inci S ul p h .

B ism S ub nitr . .

S . : Use as i nj ecti on . S hk
a e w ell .

A r gy r o l is in compatible both with zin c sulphate and with

merc uric c h lori d e In fact merc uric chlori de and argyro l
.

form one of t h e finest examples of in compatibili ty It m ight .

not be out of place to state here that merc uric chlorid e is

one o f the most effi cie nt substances we h ave to r emove stains
of argyrol on the h an ds o r l inen .

S . : gtt . x in water t i
. . d p
. . c .

T h is is a dangero us p rescription The merc uric iodide and .

the arseni c io did e wo ul d p recipit ate t h e stryc h nine an d the

pati ent m ig h t get an ov erd ose t o w ards the end .
1 52 P R E S C R IPTI ON INC O MP A T IBIL IT I E S
284 . Liq . Hy drarg I o d
Arseni et . .

Q ui n Hy dr ochlor . .

S try chn S ulp . h .

Aq ue a

S . : 3 i ter in die p . c .

T h e same r emarks app l y t o this prescription

‘
‘

B oth the .

quinine and the stryc h ni ne woul d gra dually precipitate in

combination wit h t h e arsenic and merc uric iod i d e .

285 . Liq Ac A rseno si

. .

Syr . Hy p o p hosp hit Co . mp .

S . : 3 i in water after meals .

The hypop h osphites it is cl aime d wi l l r ed uce the a r seno us

, ,

oxi de to metallic arsenic Still it is not a dange ro us pre .

scription to dispense though it is better to notify t h e physi ,

eian of the incompatibility .

286 . A ur i et S od11 C hlor .

L iq P ota ss A rse nitis

. .

S . : gt t . x in w ater three times a day b ef o re meals .

T h e potassi um arsenite red uces the gol d c h lori de to meta l

l ic gold The prescription is considered an i ncompatible
.

one.

287 . S od1 1 B e nz .

A c P ho sp h
. . Dil .

Syr . L imonis
Aq uae ad

One wo ul d t h ink th at even the ol dest me d ical gr a duate who

forgot or never knew any chemistry wo uld not prescribe
so d i um benzoate wit h an ac i d Still this was written by a .

rather prominent p h ysician It was p robably an oversight .

on h is part T h e brig h test p h ysici an wil l now and then m ake

.

a bl un der in prescribing His min d is occ upied wit h the .

d iagnosis and prognosis of t h e case before hi m an d he c an not

be bla me d if the fi ne c h emical points are not always p resent
in his min d O f co urse it is t h e duty of the ph a rmacist to be
.
154 P R E SC R IPT ION INC O MP A T IBILIT I E S
291 . P e p sini
A o Hy dr ochlor
. .

B i em . et Amm . Citr .
3
Aq uae 3
The h ydroch l oric aci d decomposes t h e bi sm uth sa l t splits
,

it up ,
bism ut h citrate being precipitated B ism uth and am
.

monium citrate sho ul d never be prescribed with hydroch loric

acid .

292 . B ism S ub nitr

. .

P ot ass . I odidi
E l ix . P ep sini
Aq uae
S . : 3 i three ti mes a day .

In t h is prescription t h ere is a grad ua l form ation of th e

r ed bism ut h io d i de It may be dispense d b ut the patient
.
,

s h oul d be ca utione d beforehan d that the mixt ure will un dergo

a certain c h ange in color .

293 . B ism S ub nitr

. .

A o Tanni ci
.

S y r up i
Aq uae q s ad ,
. .

S . : T e asp oo nful as req uired .

In t h is prescription t h ere wi ll be a gra dua l formation of

t h e yellow tannate of bism uth It may be dispensed b ut t h e .

patient s h o ul d be tol d of the ch ange t h at wi l l l ike l y take

place in t h e mixt ure .

294 . Caffei n Gitt . .

S trontn Br m o .

Aq uae F oeniculi
S . : 3 1 eve ry three h ours .

Here t h ere will be a decomposition between the citrated

c affe in and t h e stronti um bromi d e wit h t h e formation of ,

st ronti umci tr ate , which is insol ubl e in wat er and pre cipitate s .
 P R E S C R IP T I ON I N C O MP A T IBIL IT I E S 1 55

S . :i in water as req uired

3 .

Th is p r esc ription was d ispensed in a p aper box and in a

short time it becam e converted into a wet l umpy m ass E fi er .

vescent citrate d ca f feine is hy gr osc0 p ic and sho ul d be dis

p ensed in we ll stoppered bott l es onl y .

29 6 . Air ol
Calomel
S . Apply ex ternally
: .

A fter a wh il e partic ul ar l y in the presence of moist ure

, ,

there wi ll b e form ed some r ed merc uric io d i de A ir ol w h ic h .

,

is chemi cally bism uth iodo s ubgallate rathe r rea dily yiel ds -

its i od ine and th is reacts on the ca l ome l to form r e d mer

,

curic io d i d e On a de licate s urface l ike the p rep uce this

.

pow d e r may p rove q uite irritat ing if a cons iderab l e amo unt
o f merc uric iodide is fo r med .

297 . Cafl e in . S od Ben. z .

A o Hy dr och
. lo r . Dil .

P e p sini
Aq uae
S : 3 i afte r meals
. .

The hy d roch l oric a cid sp l its up the do ub l e sa l t of ca ffeine

an d sodi um benz oate and besides decom poses the sod i um
,

be nz oate with the p re cip itati on of be nz oi c acid

, .

P e psini p uri
A o Nitrohy dr och
. l or Dil . .

Aq uae ad ,
.

S : 3 ii afte r meals
. .

B ism uth sa l icy l ate i s incom patib l e with acids The aci d .

decomposes the sa l t with the l iberation of sa l icy l ic acid T h e .

p rescription sho ul d not be dispensed The physician s h o ul d .

be in fo rm ed of the incompatibi l ity and sh ould l e av e out either

the bismuth sa l i cy l ate or the acid .
1 56 P R E S C R IP TIO N INC O MP A T IBILIT I E S
299 . As aprol
De r mato l
A c N itr ohy drochl
. . Dil .

E lix . S imp l .

Aq uae
S . : Teaspo on in water after meals .

Asaprol is bism uth b etanaphtholate D e rmatol is bism uth .

s ubgallate Bot h are in compatible wit h aci ds w h ich de com

.
,

pose t h em splitting off t h e betanap h t h ol in t h e fi rst instance

,

and gallic aci d in t h e secon d I n t h is prescription t h e aci d .

s h o ul d be left out T h e p h ysician sho ul d be n otifie d so t h at

.

he may p rescribe t h e aci d separately .

3 00 . Calcis S ulp hur atae

Div in . p ul v . No . x ij .

S . : One p owder one ho ur after e ach meal .

Cr ude calci um s ulp h i de sho ul d not be d ispense d i n pow de r s

beca use it is easily decompose d by t h e carbon d ioxi de of t h e
ai r liberating s ulp h urette d h y d rogen
, T h e proper way t o .

prescribe it is in the form of tablets in wel l close d bottles .

30 1 . S pi t . Camp hor ae gtt x .

Aq uae 3 iv
S . : 3 1 per dose .

On mixing the two t h e cam phor wil l precipitate As there .

is b ut a small quantity of camphor a m uc h better way wo uld ,

be simply to use the o fficial c amphor water .

3 02 . Camp hor ae .

Ac . Car b
li ci o 3 ij
S . : F or ex ternal use .

W h en camp h or and pheno l are r ubbed together a l i q uid

is obtaine d In t h is case t h e mixt ure s h o ul d be r ubbe d in a
.

mortar until a perfectly clear so l ution iS ob tained The '

so li d phenol sh o ul d be taken and not t h e li q uid as t h e l i q ue ,

fi ed p h enol containing as it does a cert ain amount of water

makes a turbi d sol ution with camphor .
158 P R E SC R IPTI ON I NC O MP A T IBIL IT I E S
sure t h at a mistake had been ma d e beca use h e was under the
impression t h at h e wo ul d get a powde r whic h was to be ,

sprinkle d over an ulcer .

30 6 . Chl oral
Camp h o r
lP he no

S . Apply e x ternally .

T h e remarks of the previo us prescript ion apply to this one

as well It migh t be a dde d t h at t h e p ure c rystallized and
.

not th e li quefie d phenol s h o ul d be use d .

307 . Chlor e tone

Menthol
A c B o ri ci
.

Mf . . p ul v . F or ex ternal use .

When e qual parts of chlor etone and m entho l are r ubbed

toget h e r a li q ui d is obtained In t h is case however the p re .
, ,

scription may be d ispense d beca use it contains only 10 grains

of ment h ol T h e proper way wo ul d be to r ub the chlor etone
.

wit h half t h e boric a cid t h e mentho l with th e other ha l f ,

and t h en m ix t h e two powde rs .

308 . Hy drar g . B ichlor .

aa
Chinosol
S . : For ex ternal use .

Chinosol is incompatib e with m erc uri c ch ori de l l and whi l e

bot h are excellent antiseptics the two sho ul d never be p re
scribe d toget h er .

3 09 . P otass . Chloratis 3 ij
S odii Thiosul p h . 3 i
Gly cerini 3 ss

Aq uae ad 3 vi

S . : 3 i fo ur ti mes a day i nternally ; also to b e used mix ed

with wat er as a g argl e .

In an aci d sol ution so di um th ios ul phate red uces ch l orates

W i th the liberation of chlorine and hy d roch l ori c acid This .
 P RE S C R IPT IO N INC O MP A T I BIL IT I E S 1 59

p rescription however m ay be dispense d on l y care sh o ul d

, , ,

be taken not to trit urate the sodi um thios ulph ate with the
potassi um chl orate as a litt l e exp l osion migh t p erhaps res ul t
, .

310 . P otassii Chloratis gr . iij

Hy dr ar g Chlor Mitis . .
gr i .

S acchari gr . v
Mf . . p ul v
No 1 Tal Dos zij . . . . . .

S : One 4 times a day

. .

One d ruggist who was a ls o a physician refused to dispense

, ,

th is presc ripti on beca use he was t a ught or he had read or

tho ugh t h e had rea d somewhere th at potass i um chlorate w i ll
oxi d iz e calomel to merc uric chlori de There is no fo un d ation .

for t h is a ll eged fact and the p rescri ptio n may be dispense d .

3 11 . P otassii Chlor atis

Hy dr arg C l or Miti . h .

B ism S ub nitr . . .

M f . . p ul v
For ex ternal use . .

Th e sam e m ay b e said abo ut th is p rescription It m ay be .

dispense d wit h o ut any apprehension T he potassi um ch l orat e .

sho ul d b e pow d ered se parately or sho ul d be used in fin e pow ,

der and the three p owde r s sho ul d b e m ixed light l y .

312 Magnesii S ul ph
. .

Aq uae Cro tonis

S : 3 ss every h o ur
. .

This p rescription i s p resented h ere for its fun niness

and the wr i te r c an vo uch for the fact beca use b e witnesse d
i t h imse l f The prescription was p rese nted to the boss who
.
,

handed it to the c l erk a very exce ll ent prescriptionist b ut , ,

not l ong in th is co un try He weighe d out one o unce of m ag .

nesium s ul ph ate then went to the poison cl oset took the

, ,

croton oi l p ut e igh t d rops in a mortar p ut some magnesi um

, ,

carbonate in t h e mortar and began to add the water grad

ually trit uratin g brisk l y and getting re ady to fi lter the mi x
,

t ure When the boss aske d him w h at he was doing h e sa id

.
,

he was p reparing C r oton wate r , and he was used to p r ep ar ing

1 60 P R E SC R I P T ION INC O MP AT IBIL IT I E S
waters extemp oraneo us l y by r ubbing up two d rops o f the
oil wit h an o unce of water He d id not know t h e expression .

“
Croton w ate r wh ich simply referre d t o New Y ork tap
”

water He t h o ugh t the p h ysician wante d a c roton oil

.
“

water He felt strengt h ene d in his assumption by t h e fact

.

t h at t h e prescription was meant as a c at h arti c and there

was nothin g m ore pl ausible t h an t o h ave some croton oi l an d
m agnesi um s ul phate in the same m ixt ure .

313 . B ar n S ulp h .
3 11

S . : For doctor s ’
use .

There is no better ill ustration of th e necessity for physi

eia us writing out a prescription clearly d istin ctly an d fully ,

w h erever t h ere may be t h e sligh test possibility of misunder

stan ding t h an t h e above prescription I t also shows the im
,
.

portance for a d r uggist to be up t o date t o know what is ,

going on in t h e line of materia me dic a and t h erape uti cs t o ,

be fully au cour ant w ith wh at physicians are ap t to p re

scribe T h e above sim ple p rescription of j ust one l ine cost
.

a man his life ca use d t h e arrest of two p h ysic ians and of the
,

d ruggis t and an en d less amo unt of anxiety and expense t o

,

al l t h ree besi des t h e anguish and the s uffering of the family

,

of the dea d man .

D r uggists h ave for many years been dispensing bari um

s ul phi d e w h ic h as is well known is used as a depilat ory to
, , ,

remove sup er fl uous h ai r T h e d r uggist who receive d the

.

above prescri ption did not know t h at of l ate we h av e been

using very fre quently bari um s ul p h ate ( instea d of bism uth
subni trate ) i n taking x ray pict ures o f t h e gastro intestin al
- -

canal S o when t h e d r uggist receive d t h e above p rescription

.

he promptly d ispensed two o unces of b ari um s ulphi de On .

receiving the bottle t h e p h ysician emptie d it mixed it with ,

th e proper amo unt of wate r and m a de the patient dr ink it .

T h e patient very soon began to feel ba d ly and in an ho ur he

was dead in spite o f a ll th at was done to save h im .
1 62 P R E S C R IP TIO N INC O MP A T IBIL IT I E S
3 15 . Coll odn
Tr . I odi 55 3 ij

T h ere is not h ing wrong with th is p rescription . I t may be

d ispense d as wr itten .

31 6 . Her oini

Aq uae
S . : 3 i q 3 ho urs
. .

Wh en heroin is prescribed witho ut any S p ecifi cation heroin ,

hy droc hlori de is us ually dispense d Heroin being an alka .

loi d will be precipitate d by t h e ammoni um carbonate and by

t h e tannic aci d of the syr up of wil d c h err y Stil l I h ave .

seen it d ispense d m any times wit h o ut any t ro ub l e only it ,

is safer to dispense it with a shake l abe l .

317 . A drenali n
Aq uae Hy droge nii Diox idi
S . : F or e x ternal use .

This prescription is absol utely incomp atible and sh ould not

be dispense d T h e a d renalin is c ompletely d ecompose d or
.

oxi d ize d by t h e hy d rogen d io x id e .

T h e p h ysician writes for one h al f o unce of adrenal in -

W h at he means of co urse is one h alf o unce of t h e sol uti on of -

a drenalin c h lori de 1 to 100 0 It wo ul d be a migh ty expensive .

prescription if it were to contain one h a lf o unce o f p ure -

.

adrenalin .

31 8 . S 0 1 E p inep hrini
.

Hy dr ar g C l or Co r ros
. h . .

A q B e still
. .

Use as i nj ection .

l
A bso utely incompatible T h e epinep h rin is . d ecom posed
an d t h e merc uric ch l oride is re d uced t o c alome l and then t o
t h e metall ic state .
 P R E SC R IPT I O N INC 0 MP A T1B I L I TI E S 1 63

31 9 . E x alg in '

Mf. . p ul v
No 1 D T D xi j
. . . . . . .

S . : One powder when req uired .

When ex algin is trit urate d with phenacetin a moist o r a

soft m ass is obtaine d T h e prescription cannot we l l be d is
.

p e nse d in pow de r form I t can be d ispense d by p utting t h e

.

e x alg in and the phenacetin in separate pow d ers and d irecting

the patient to take one of eac h powde rs at a dose It can .

a lso be dis pens e d in caps ul es by p utt in g fi ve grains of e ach

of the ingredients m a caps ul e witho ut any m ixing or trit ura
ti on
.

3 20 . Ex algini
P he nace tini
S odii S ali cyl .

A c S ali cyl
. . 55 g r . v

M . p ulv . Tal Do s. . xxx .

One 3 times a day .

Th e fir st two ingredients i n th is prescription are the same

as in t h e previo us one and the same remarks h o l d goo d We .

co ul d m ake one powde r cont ainin g the phenacetin so d i um ,

sa l icy la te and the salicy li c acid anot h er p owde r con taining t h e ,

e x alg in an d direc t th e patient t o t ake one powde r of each

,

G uai aco l
Mi .
p il No xxx
. . .

S . : One pill fo ur times a day .

I t simp l y ca nnot be done It is no use attempting to m ake .

p ills cont ain in g two mi nims of creosote and si x m in ims of

guaiaco l T he w rite r is wel l aware of the various m ane uve rs
.

and exci pients employed to make creosote an d guaiacol pills .

In fact h e himse l f used t o be an expert i n th is fi eld an d as

a pharm acist w as ve ry p ro ud of h is abil ity to t urn out i n
qui ck orde r two th ree or fi ve h un dre d creosote pi ll s B y
,
.
1 64 P R E S C R IPTIO N INC O MP A T IBILI T I E S
using a little yellow wax melted of co urse a l s o some pow
, ,

d ere d licorice or m agnesia etc some sort of pil ls can be

,
.
,

ma de B ut all t h is is not h ing b ut a waste of time and e ner éy

.

it is a s h owing— f of useless vi rt uosity

’
-
of It is the write r s .

op inion h is op inion as a physician and not a pharmacist

, ,

t h at no decent creosote pills can be made th at wo ul d do the

patient any goo d Ma de in the form o f p ills the quantity of
.

t h e creosote m ust be so smal l as to be h ardly of any va l ue ,

and if ma de to contain a c onsi d erab l e amo unt of creoso te

with very l itt l e excipient the e ffec t is ap t to prove ir r it ating

,

and ca ustic The p roper way to admin ister creosote is in l i q

.

uid form properly d i l uted or in the form of some of its

, ,

chemica l combin ations It wo ul d be a very fair and honest

.

t h ing to enlig h ten the physician on this poin t so th at he may ,

be disco urage d i n the fut ure from orde r ing c r e osote or

guaiaco l i n pill form .

322 . Creos ot e
G uai acol
Cr eosotal
Duotal
Thio col gr . v
M p u l v Tal Dos 200
. . . .

S : One powder ni gh t and m o rning and aft e r e ach meal

.
.

Of course t h is is a ri dic ulo us prescription T h e physician .

was very anxious t o c ure his p atient and to give h im at once

al l t h e anti t uberc ulosis reme dies th at he had heard of B ut
-

h e overlooke d t h e fact or perh aps he di d n t know it th at

,
’
,

creosote and guaiaco l and cr eosotal are l i qui ds and cannot

be dispense d i n powder form Duotal o r guaiaco l carbonate .
, ,

and th iocol pota ssi um guaiaco l s ulp h onate are crystal l ine
, ,

s ubstances and can be d ispense d in p ow ders T here are no .

two ways abo ut this p rescription—the only thing the d r ug

gist can do is to notify t h e p h ysician an d advise him to dis
pense t h e fi rst t h ree in gre d ients i n l i q uid form and the
secon d two in powder fo rm or to dispense them a ll in a l i q
uid mixt ure .
1 66 P RE SC R IPTI ON INC O MP A T IB IL IT I E S
or a l thea it can ,
be m anage d The p ills howeve r w ould be
.
, ,

too large and it ,

wo ul d not be a b ad i d ea to in q uire o f t h e
p h ysici an i f he wo ul d not p refer to s ubstit ute ca l ci um
glycerophosp h ate for t h e so di um glycerop h osp h ate .

3 26 . Guaiacolis Cryst all

pil N o L Div in . . . .

Two pill s three time s a day .

T h ere is a p ure c rystallize d guaiaco l which can be made

into pills b ut i t rea dily d eli quesces and it is best to p re
,

scribe g uaiacol as state d i n a p revio us p rescription in li qui d

, ,

form .

3 27 . Hy dr ar g A mmon . .

S ulp huris
P o tassii Car bo n
.

A dip is
F or e xt e rn al use .

When ma de up this oin tment is yell owish wh ite B ut afte r .

a while it gets darker until i t becomes gray or bl ack T h ere .

is a reaction between t h e s ulp h ur and t h e potassi um carbonate

and the ammoniated merc ury by which some s ulp h i de of ,

merc ury and the black merc ur ammoni um c hl ori de is form ed -

.

3 28 . Hy dr ar g C lor Corros . h . .
gr .iv
P o tassii I o didi 3 iv
Aq uae 3 vi
S . : 3 i4 x a day .

Of course this prescription is al l righ t I t is one of the .

commonest prescripti ons that a d ruggist h as to d ispense .

Nevertheless strictly speaking i t i s in comp atible beca use

, ,

mercuric io di de is forme d wh ich red issolves in an excess o f

potassi um io d i de forming t h e do uble io di de of p otassi um and
,

mercury t h e s o calle d iodohy dr ar gy r ate of potassi um or

,

Mlay er s reagent wh ich is s uch an excellen t p recipitant of

’

alkaloi ds .

I know of a case of a j unior clerk wh o re fuse d to d ispense

this prescription When b e m ixed the merc uri c chl orid e
.
 P R E S C R IP T IO N INC OMP A T IBILI T I E S 1 67

and the potassi um io d ide and noticed the formation of a red

precipitate he being a careful yo un g fell ow was afraid to
, ,

d ispense it He waited until t h e senior c l erk came in who

.
,

expla ine d to him that the precipitation was a ll r ight .

3 29 . Hy dr argy r i C l or Cor h . . 3 13
P o tassii I o didi
Syr . S arsap . Co mp .

Aq uae
S . : Teaspoon 3 times a day .

A n experience d d ruggist wi have no difiiculty with thi s ll

p rescription He wil l notice at once th at the doctor absent
.
.

min ded ly t urne d the quantities of the two principa l ingr edi
en ts a ro un d H e meant two grai ns of m erc uric chloride an d
.

two d rams of potass i um i od ide b ut instea d he wrote two ,

dram s of merc uric c hl ori d e and tw o grains of potassi um

i odi de Of co urse ma de up th e way the p rescription is writ
.
,

ten a te aspoonf ul of the medicine wo uld ki l l the patient I

, .

am pe rsona ll y of the Opinion t h at he m ad e the same mistake

wit h the sy rup and water that he rea ll y meant one o unce ,

of sy rup an d three o unces of wate r B ut as it is of l itt l e con .

se quence w h et h er one o unce o r three o unces of compo und

syrup of sa rsapari ll a i s d ispensed th e q uantities of the l ast ,

two in gre d ients m ay be dispens ed as written .

330 . Hy drar g B ichlor. .

L iq Fo wler i
.

S . : gtt viii in water

. a fter meals .

T his prescription is incompatib l e Th e me rcuric ch l oride .

is re duced to calomel and to meta l lic mercur y wh i l e the ,

arse ni te i s changed into arsenate Th e p resc r iption is in .

compatible and sho ul d not be dispensed .

331 . Hy dr ar gy r i C l or Corro s h . .

A q uae Cal ci s
S . : F or ext er nal use .

This p rescri ption , whi l e chemic ally spe ak i ng in comp atib l e ,

1 68 P RE SC R IPT IO N INC O MP A T I BILI T I E S
is al l right It f orms the we l l known ye ll ow wash ( Lotio
.
-

Flava ) When l ime wate r is added t o mercuric chlori d e the

.

yello w merc uri c oxide is forme d The reaction is as fo l lows : .

Hg Cl2 Ca ( OH) 2 CaCl2 E gO E 20

332 . Hy drargy r i Chlor Corros . .

Aq uae Cal cis

S . : P oison . For ex ternal use .

In this prescription we also get a precipitate of the yel l o w

oxide of merc ury B ut t h e prescription contains too m uch
.

merc uric ch l ori de and if it is to be app l ied to an infant t o ,

a delicate s urface or to a raw s urface it sho ul d be done with

, ,

great ca ution as great irritation of the skin m ay occ ur or ,

even an absorption of merc uric ch l orid e which may ca use ,

dangero us or toxic symptoms .

33 3 . Hy dr argy r i C l or Miti s h .

Aq uae Calcis
S . : Apply e xternally every ho u r.

This forms t h e well known black wash w h ich is a favori te -

app l ication to chancroi ds p h age denic ulcers and so forth , .

Wh en calome l is a dde d to l ime water t h e black merc uro us

oxide is formed The formul a is as follows.

2E g Cl Ca ( OH) 2 CaCl2 n O 11 20

334 . Ung . I o di
U ng . B elladon .

Hy drarg C lor Mit . h . .

M f U ng — S
. . . . P ile Oi ntme nt .

It is not advisab l e to p rescribe io dine ( e l ementary io d ine )

and merc uria l salts i n the same prescription R ed merc uri c .

iodide is apt to form which is very i rritat ing C al ome l in

, .

ointment form acts well in hemorr h oid s B ut r e d merc uri c .

io di de even in very d il ute preparations is pai nful and irri

tatin g as it has proved in thi s cas e
, .
170 P R E S C R IPT ION INC O MP A T IB IL IT I E S
3 38 . I o doformi
B als P eruvi ani .

A dip is Ben z.

S . : Apply on lint .

Certain statements hav e been made th at io doform is in

compatible with balsam of Per u T h ere is n o fo un dation for .

these statements The two go very well toget h er and th e

.

prescription is perfectly al l rig h t .

33 9 . Tr I odi.

A mmon
Aq . .

Linim S ap oni s .

S : F or e x te rnal use
. .

The io d ine wil l combine with th e ammoni a t o form ammo

ni um io di de Where there is sutfi cie nt ammonia to combin e
.

wit h t h e entire amo unt of io d ine the col or of the io d ine wi ll

be destroye d and t h e preparation will be color l ess beca use
ammoni um io di de is colorless Whenever i odine is bro ught .

into d irect contact with ammonia t h ere is also sl ight dange r ,

of io di de of nitrogen being fo rme d which is a n explosive ,

compoun d B ut in small q uantities w ith wh ich we generall y

.
,

have to deal i n prescriptions the danger is more a theoret ,

ical than a practica l o n e .

3 40 U n g I odi
. .

Un g Hy dr argy ri .

M f U ng S Ap p ly 3 times a day
. . . . .

The io dine comb ines wit h t h e m eta l l ic merc ury and with
the oxi de of merc ury whic h is us ually present in t h e mer
c urial ointment to form merc uric io di de This is m uch more .

irritating t h an eit h er io dine ointment or the merc uria l oint

ment itself A s t h is prescription is often or dere d for ep i
.

d i dymitis and orchitis and as the skin of the sc rot um is ve ry ,

ten der it i e the s k in is often completely removed by th is

, ,
. .
, ,

ointment It also b urns very severely in some cases If it

.
.

does t h e only t h ing to d o is t o was h it 0 3 with soap and

,

W arm W ater and t h en a pl an molli nt ointment l ik cold

p y e e e
 P R E S C R IP T ION INC O MP A T IBIL IT I E S 1 71

c r eam or zinc oxi de ointment or some talc um p owder or bis ,

m uth subnit rate .

34 1 . Liq F o rmaldehy di
.

S . : Use e x ternally as dir ected .

Th is p rescripti on is abso l utely in compatible T h e forma l .

dehy d e is oxi dized by th e peroxid e of hy d rogen to formic

ac i d and the HQ O2 is d ecompose d A n example of t rying to
, .

get too m uc h and of getting nothing .

34 2 . Lithu Citr atis

S odii P ho sp hatis
A q uae
S . : 3 ij in g l ass of water ni ght and mo rni ng .

In th is prescription we get a precipitate of l it h i um phos

p h ate O f co urse i t may b e dispense d wit h a shake label
. .

34 3 . Magn . S ul p hatis
S odi i P hos p hatis 55 3 iv
S . : 3 ij in g l ass of wat e r on g oi ng to b ed.

Here w e get a precipitate of magn esi um phosp h ate It .

wo uld be m uch better to dis pense t h e magn esi um s ulphate

and the sod i um ph osphate in separate conta iners and tell t h e ,

patient to t ake a sp oonf ul of each in half a gla ss of wate r ,

an d d rink them sep arately It is better th e reaction s h o ul d

.

take p lace in the stomach t h an in t h e glass .

344 . Menthol
Al coh ol
Aq ua e
S . : Apply ex te rnally .

T h e ment h o l d issolves rap i d ly in the alco h o l b ut on a dding ,

the water it precipitates We get a clo udy m ixt ure wit h

.

the menth o l p recipitate d out Incomp atible p re sc ription

.
,

which h on estly speak in g sho ul d not b e d ispe nse d

, , .
1 72 P R E SC R IPTIO N I N C O MP A T I B IL IT I E S
345 Ferri Chloridi
. Tr .

Methyl S ali cyl .

S : gt t x in water afte r me als

. . .

Here one can see that the methy l sa l i cy l ate h as b een pr e

scribe d for the express p urpose of disguising the color of
the tinct ure of iron One twenty fourth of a d rop of methyl
.
- -

salicylate ( w h ich is t h e dose i n this case ) can h ave no me

d icinal action B ut as patients are fami l ia r with or d inary
.

tinct ure of iron and are apt to sneer at it physici ans often ,

d is g uise its color either wit h a l itt l e antipyrine or so d i um

sa l icylate or any ot h er salicy l ate .

346 0 1 Oliv ae
. .

Menthol
Glyceri n
S : F or e xternal use
. .

Mentho l is very so l uble i n ol ive oi l as in a ll fix ed or v o l at il e

oi l s B ut t h e oi l is not miscible with gl yce rin contrary to
.
,

t h e impression of many physicians A s stated e lsew h ere .

,

many peop l e bot h l ay and professiona l regard g l ycerin in

, ,

the nat ure of a fat and t h ink it m ust b e m iscib l e with other
fats B ut it is not This prescription does not m ake a very
. .

elegant mixt ure b ut may be dispensed with a sh ake labe l

, .

3 47 Me nth ol
.

P et rol ati liq .

3
Glyceri n 3
S : Use with at omizer
. .

The remarks of the previo us prescription app l y to this one '

as well Menthol is very sol ub l e in li quid petro l at um b ut

.
,

l i qui d petrolat um is not sol ubl e in or miscibl e with gl ycerin .

34 8 . P e psini 3 ij
P ancr eatini 3 ij
A c Hy dr ochlor
. . dil . 3 iv
Syr Z ingib . .
3 i
Aq uae
S : 3 i afte r meals
.
.

Pancreatin is consid ered to be abso l ute l y incompatib l e with

1 74 P R E SC R IPT ION INC O MP A T IB ILIT I E S

3 53 . P r ot arg ol
P lumb i A cet .

A rg enti N itratis
A q B e still
.

To be
i nj ecti on us e d as .

Abso l utely incompatible P rotargo l i s incompatible both .

wi t h silver nitrate an d wit h lea d acet ate and lea d acetate is ,

also incompatible wit h silver nitrate .

3 54 . P yr ami don
S p ir A ethe ris
. Nitrosi
Syr . A ur antii
Aq uae
S : 3 ij eve ry 4 h o urs
. .

The sol ution ac quires a bl ue or violet color Wh at we said .

abo ut t h e incompatibility of antipyrin with spirit of nitro us

et h er applies h ere as well T h e compo und forme d may not .

be poisono us most l ikely is not b ut i t is bette r not to pre

, ,

scribe pyrami don with S pirit of n itro us ether .

355 . P yrog all ol

P otass P er mang . .

S . i in b asi n of hot water for fo ot b ath

: 3 .

T h is prescription is abso l utely incompatible The p y r ogal .

10 1 is oxi dize d the pota ssi um permanganate is re duced

, .

3 56 . R esor cini
Q ui nin . Bisulp h . 55
In cap s .
g el at . No 1 . . Tal . Dos . xx .

This prescription is all righ t T h ere is no obj ection to .

d ispensing resorcin and q uinine bisulp h ate in caps ules b ut ,

t h e prescription wo ul d be incompatib l e if t h ese two ingr ed i

ents were or dere d to be dispensed in so l ution as then we ,

wo ul d get a precipitate .

3 57 . A luminis
S odii B oratis
M . ft . p ulvis
S . : 3 38 in 2 q uarts of water .
 P R E SC R IP T I ON INC O MP A T IBIL IT I E S 1 75

Wh en powdered a l um is r ubbe d wit h borax t h e mixt ure

becomes moist due to the liberation of t h e water of crystal
lization B y m ixing t h em gently t h is p h ysical c h an ge m ay be
.

prevente d The pow d er s h o ul d be dispense d not in a p aper

.

box b ut i n a wi de mo ut h e d stoppere d bottle

-
T h e really .

better thing wo ul d be t o ord e r t h e exsiccate d al um instea d of

t h e ord ina ry pow dere d al um .

3 58 . S odii P er b or atis
Aq uae
S : For e x ternal us e
. .

When sodi um perborate is d issolved in w ater a chemica l

react ion t akes place hy drogen dioxi de and so d i um meta
,

borate being forme d T h e prescri ption may be d ispense d

.
,

beca use th at is wh at t h e doctor generally wants — a fres h ly

prepared sol ution of hy d rogen d ioxi de .

3 59 . S ol P ot ass
. . Io d . S at ur .

S odii Thiosulp hatis

S . gtt x in milk t i d
: . . . .

This p rescripti on is seen fre quent l y The sma ll quantity .

of so d i um thios ulp h ate has n o me dic ina l action It is a dde d .

for the p urpose of preventing the l iberation of io dine A .

so l ution of potassi um iodi d e if kept for any l ength of time

somet imes gets brown due t o the setting free of sma l l q uan
,

t ities of io d ine The so di um t h ios ul phate combines wit h any

.

free iodine th at may be p resent i n the sol ution and t h e sol u

t ion th us remains perfectly color l ess It is for the same .

reason th at we somet imes add sodi um thios ulph ate to p otas

si um iod ide ointment .

3 60 . P o tassii I o didi
S odii I odidi

E ss P e p sini
.

Aq uae
S . : 3 i 3 times a day .

The ch ange in the co l or o f this m ixture w il l d epend a go od

1 76 P R E SC R IPT ION INC O MP A T IBIL IT I E S
l
d ea upon the p urity of the io di des and the spirit of nitro us
et h er As a rule it gets brown after a s h ort time due to t h e
. ,

libe ratio n of io dine from io di des by the nitrous ethe r .

361 . Spir . Ammon . Ar mo .

S odii Br m o .

Syr . A ur antu

S . : 3 i as di rect ed .

This mixt ure becomes m ilky t urbi d for two re asons B oth -

,
.

t h e so di um bromi de an d the water l iberate t h e volatile oi l s

from the aromatic spirit of ammonia .

3 62 . S try chn . Hy dr ochlor .

A c Hy drochlor
. . Dil .

E li x . P e p tenzy me
Aquae
S . : 3 1 after me als .

T h is prescription is a ll right Hy d rochl oric acid is said .

to give a precipitate wit h strychnine hydroc hl ori de b ut th is ,

is t r ue only of th e strong hy drochloric n ot of t h e di l ute acid , .

3 63 . Tri onal
C hl o a r l Hydr. .

Mf . . p ul v . No i . . Tal Dos . . iii .

S . : One as req uired .

T rional and ch l ora l hydrate when r ubbed to g ethe r form a

soft mass .

3 64 . Trional
S ul phonal
Urethane 55 gr . v
F or one p owder . Ta k e at once .

When triona l and sul phona l and urethane are r ubbed to

gether there is also a soft or semi li quid mass A s the p re
,
-
.

scription ca ll s h owever fo r one p ow der to be taken at once

, , , ,

the ingredients may be put in wax paper witho ut being mixed ,

and i f t aken at once there wi ll be no tro uble .

1 78 P RE S C RIP TIO N I NC O MP A T IB I L I T I E S
ingredients sep a r ate l y mixing the pheno l with the finely
,

pow dere d boric aci d and then mixing al l the ingredients a

serviceable powde r may be obta ined .

369 . Thy molis I o didi

S . : Apply ex ternally .

It is stated th at thymol iodi de is in compatible wit h starch .

It is claimed that some io dine may be liberat ed and combine

with the starch to form io d ide of starch T h ere is not h ing .

to t h is criticism F irst of a l l there is no l iberation of io d in e

.

when the two are m ixed b ut even if the re were no harm

,

wo ul d be done Ou t h e contrary it probably wo ul d be adv an

.

tag eous F or wherever thymol io di de is app l icable so ca l le d

.
,
-

io di de of starch is a l so appl icab l e S o there is n o h arm in .

mixing thymo l io did e and st a r ch tog ether .

3 70Thymol I odi d
. . .

Cal omel 55 3 ij
Apply ex te rnally .

When kept for a l ong time o r thoro ugh ly trit urate d ; o r ,

in the presence of moist ure r ed merc uric io d i d e may be ,

forme d b ut a l itt l e of it won t h urt I have pe rsonally pre ’

.

scribe d thymol io di de and calome l a n umber of times as a n

app l ication t o chancroi ds and only wit h goo d res ults .

3 71 . Zihci S ulp h .

Ac .Tannici
Aquae
S . : Use as inj ection .

This p r escr iption is a l l right Genera l ly speaking tanni c .

,

acid is incompatible with zinc s ul p h ate z in c ta nnate being ,

precipitate d B ut t h is occ urs only when t h e two c h emicals

.

are in concentrate d sol ution It d oes not take place when.

t h e chemicals are in d il ute sol ution .

 P R E S C R IP T ION INC O MP A T IBIL I T I E S 1 79

Thymol
A l coh o l 5 mils .

Water to m ak e 1 00 mi ls .

Disso lve thymol in alcoh ol perma nganate in water ,

and mix sol utio ns .

T ablespoo nf ul to 2 q uarts of tepi d water fo r foot

lotio n .

This p resc ri ption was copie d from a pha r mace utica l j o ur

nal w h i ch in its t urn had copie d it from The P r escr ib er The .

P r escr ib er is s uch a careful competent j o urn al t h at one can,

n ot he l p be in g s urprise d at seeing t h i s p resc ri pt ion r ecom

m ended in its pages Potass i um pe r ma nganate i s incom
.

p atible with thymol an d also incompat ible w it h alcoho l A fte r .

stan ding 5 wh il e the po tassi um pe rm an ganate becomes com

ple te ly re duced and wort h l ess The q uan t ities a re cop ie d cor
.

rectly ,
j ust as they appeare d in the pharm ace utica l j o urn a l .

B ut to us they see m ri d ic ul o us l y sm a ll Perh aps i t is a typ o .

graphi cal e rro r and the a utho r of the prescription meant 3

grams of pot assi um pe r man ganate and 5 grams o f thymol
instead of 3 deci g rams and 5 deci grams respective l y , .

3 73 . A c S alicy lici
. . 3 ij
Ao . T annici 3 ij

3 iv
M i p ul v S : F oo t
. . . .
pow der . S ha k e int o stockings
every morning .

Th is p r esc ription as I hap pe n to kn ow was prescribed for

, ,

a ve ry bad ca se o f brom i dros is t h at is o ffens ive sweat ing o f , ,

the feet The patient was t ol d to p ut on eve ry day a c l e an

.

pair of so cks and p referably wh ite so cks not colore d ones

, ,
.

Wh en the patient t oo k off his socks the fi rst ni gh t he was

s urp rise d and somewhat sh ocke d to fi nd both his feet and h is
socks dyed an inky black T h e d octo r was a l so s urprise d b e
.

ca use he expected no s uch th ing ; he expe cted the p owde r to

1 80 P RE SC R IPTIO N I N C O MP A T IB ILI T I E S
be p ractica l ly wh ite or s l ight l y gray ish from the tanni c aci d
and t h e kaolin T h e t ro uble wit h this prescription is t h is :
.

K aolin us ually contains some i ron A l um also now and t h en .

contains a small q uantity of iron Salicy l ic aci d with iron .

as y ou know gives a deep violet co l or while tannic acid gives ,

a bl uis h black color To ma k e t h e reaction complete a l ittle

.

water is generally necessa ry w h ic h was furnis h ed by the ,

perspiration of t h e feet T h e powd e r itse l f also very soon

.

ac quire d a black color .

3 74 . Tr . Di git alis
Tr . S tr o p hanthi
S p arte inae S ulp h .

S try chn . S ulp h .

Aq uae
S . : Te asp oo nf ul 4 ti mes a day .

T h is prescription p resents no i ncompatibi l ity eithe r phar ,

maceutical or t h erape utic On t h e contrary from a t h era .

p eutic point of vie w i t is a synergistic presc r iption t h at

,
”
,

is all the dr ugs act as cardiac tonics B ut that is j ust the

, .

tro uble wit h it T h e dose of each ingre d ient separate l y ex

.
,

cept per h aps of the sparteine is not excessive and m ay be , ,

a dministere d witho ut tro uble B ut the sum tota l of t h e .

amo unts of t h ese d r ugs one fortifying t h e ot h er is excessive

, , ,

and in this case the patient n early d ie d from one d ose It .

took several ho urs before he was bro ught out of d anger .

3 75 . A ntik amni a
A nti pyrin
P henaceti n
A cetanili d
P henal gi n
Caffei ne
F or o ne
p owde r . Mak e a doze n.

F or r l i
ne u a g a .

T h is prescription was given to a woman wh o s uffered from

extreme ne ural gia and she came pretty nearly be ing rid of
1 82 P R E S C R IPT IO N I NC O MP A T IB IL I TI E S
who was very green i n the b usiness . He used one qua rte r of -

a grain of corrosive s ublimate to eac h pow de r Now what .

t h e doctor wante d was one q uarter of a grain of calome l -

.

Of co urse he s h o ul d h ave written t h e prescription more care

ful l y b ut any competent d ruggist wo ul d know w h at to dis
pense One quarter of a grain of merc uric c h lori de is not
.
-

s uc h a terribly big d ose and may be given to ad ul ts witho ut

tro uble B ut it so happene d that in th is case the patient was
.

a newborn infant only abo ut two weeks old and it d ie d ve ry

, ,

p romptly afte r t h e fi r st po w der The d r ugg 1st was arrested .

,

it cost h im a big sum of money and he is not entirely ove r ,

his tro ubles yet .

3 78 . Me nth ol
E ucalyp t ol
Z inci S ul p h .

liq
A lb olene .

Use wit h at omizer .

T h is is an annoying b ut unfort unately too fre quent p re

scription T h e ment h ol and e ucalyptol d issolve in t h e li q uid
.

alb ole ne b ut t h e zinc s ulp h ate d oes not

, No matter how .

fi nely y ou may p owd er it and i ncorporate it wit h the alb olene ,

y ou cannot use i t properly wit h an atomizer It remains at .

t h e bottom T h e d octor s h o ul d be notifi ed and a dvise d to

.

leave out the zinc s ulp h ate or to prescri b e i t separately in

a n a queo us sol ution .

379 . Me nthol
S ol . A dr e nalini
P i nole um
S . : U se as a s p ray .

T h e ment h ol d issolves in the pino l e um b ut the so l ution of ,

a drenalin w h ic h is an a queo us sol ut ion d oes not mix The

, ,
.

water and oil do not m ix and it is a b ad prescription to be

d ispense d to use in a spray .
 P R E S C R IPT IO N INC O MP A T I B ILI T I E S 1 83

38 0 . Hy dr argy ri C lor h . Corr

P yr og all o l
P etrol ati
Lanae
A dip is
S : Apply to s calp
. .

Pyroga l lo l and merc uric ch lorid e are incompatible Mer .

c urie c h lori d e is re duce d and the pyrogal lol is o x i d ize d E x .

posing the o intment to lig h t and ai r also c h anges its color

'

rapi dl y .

Camp hor ae
Chlo rali
Hydrat .

Apply to ne uralgic spots .

Th e p rope r way t o d ispense th is prescription is to use th e

p ure alkaloi d a l c oc aine instea d of the cocaine hy d roc h lori de .

It migh t be a dd ed th at coc aine app l ie d externally to t h e

unbroken ski n is pe rfectly useless beca use it is not absorbe d , .

Cocaine exe rts its anesthetic p rope rt ies only on m uco us mem
b ranes or where the sk in is abrade d .

382 . Tr . Io di
Ex t . Goular di
3 i to g lass of water for e x ternal use .

We get here a ye l low precip itate of lea d io di de Strictly .

speak in g the prescription s ho ul d n ot be d ispensed b ut as it

, ,

is for externa l use and is not going to do any h arm it m ay

, ,

be dispe nsed with a shake l abe l .

Gly cer ini

Aq uae
Apply f ull strength .

Chlor in ate d l ime is incompatib l e with g l ycerin B y mix ing

m
.

the two d irectly an expl osion may occ ur A co plex chem .

ica l reaction takes p lace in wh ic h t h e glycerin becomes oz i

d ized by the ch l orine to oxalic an d event ually carbonic aci d , ,
.

B y rubbing the chlorinated lime with the wate r into a smooth

1 84 P R E SC R I P TION INC O MP A T IBILIT I E S
m ixt ure and t h en a dding the glycerin the vi olence of the ,

reaction is lessene d b ut it is not entirely eliminate d

,
.

38 4 . Massae V a lle ti
K ali Car b on ci i
S try chn S ul p h . .

A c A rse nicosi
.

Mf. .
p il
. No . 1 . Ta] . D os L X
.

S . : fter me als
One p ill a .

The potassi um carbonate here is entire l y unnecessary It .

only increases the b ulk o f t h e pill and by t h e deli q uescent

action is apt to spoil it P h ysicians are use d to prescribe .

ferro us sulp h ate and potassi um carbonate so as to h ave freshly

prepare d ferro usc arbonate A nd i t is p robab l y more a matter .

of h abi t t h an of act ual necessity t h at the potass ium car

bonate was or dere d i n t h is prescription .

3 85 . E ur op hen
A my li
A pply ex ternally to ul cer .

E ur op hen is stated to be incompatible with starch beca use

a l ittle io dine may be l iberate d from t h e former w h ich wo ul d
combine with the l atter to form i od i de of starch As state d .

in commenting upon anot h er similar p rescription even i f that ,

were the case n o harm wo ul d res ul t T h e so ca l led iodi de o f .

-

starc h makes a very goo d v ul nerary app l ication The p re .

scription may be d ispensed wit h o ut any q uestion .

38 6 . I ocamfen
Aq uae
S . : Apply ex ternally on ga uze .

I ocamfen is not miscib l e with water and the prescription

s h o ul d not be d ispense d The p roper met h od of us in g iocam
.

fen is either p ure or m ixe d with oil .

387 . E ur Op hen 3 i
Ung Aq uae . R os ae 3i
The bo rax c ontained in the cold cre am may l ibe rate a small
 1 86 P R E SC R IPTIO N I N C O MP A T IBILIT I E S
Ti nct ure ite,
aco n

Ti nct ure g el semi um ,

Ti nct ure hyo scyam us ,

Ti nct ure di gitali s fat free 55

,
-

S yr up gly cy r comp ound .

qs . .

Dir ecti ons : Two teasp oonfuls in w ater every

This prescription whic h is strictly bona ti d e and which

,

appeare d in a recent iss ue of the B ullet in of Pharmacy is ,

presente d h ere merely as a c urio us example of polypharmacy ,

wh ich was once very prevalent b ut which is n ow l ucki l y al

most t h o ugh not entirely obsolete Now an d then we still see
, ,
.

s uch a prescription i n a d rug store an d as the d octor claims ,

that h e gets won derful res ults from it there is noth ing l eft ,

to do b ut to dispense it .

3 91 . S antoni ni
Cal omel
S acchari
Div in
. p ul v . No . iii .

One p owder in the mo r ni ng .

This prescriptio n is presented here mere l y for the overdos e

of santoni n w h ich it contai ns While we may often excee d .

t h e maxim um dose given in th e P h armacopeia and in text

books on materia me dic a and t h erape utics sti ll t h ere is a ,

limit and w h ere t h ere is t h e l east do ubt it is bette r to be

,

on t h e safe si de Here the dr ugg ist ve ry wisely refuse d to

.

dispense t h e prescription beca use he consi d ere d seven gra ins

of santonin to a d ose too risky
. He telep h one d t o t h e p h ysi .

cian and t h e latter apologized saying t h at h e meant to h ave

, ,

t h e quantities d ivi de d into eigh t instea d of t h ree pow ders ,

b ut evi dently h e left out t h e R oman V D ivi de d into eigh t .

pow de rs the prescription is al l right beca use the dose of ,

santonin is then w hi ch is not an excessive d d se

grains “
, .
,
.
.
 P RE SC R IPTI O N I N C O MP A T IBILIT I E S 1 87

3 92 . He lmitol
P otassii B icar b o n .

Liq . P o tassae
Pl . Ex t . B uc uh
P l Ex t. . Uvae U r i s

Aq uae
S . : 3 i fo ur ti mes a day .

Helmitol is c h emically h examethy l enamine methylene ci -

t rate and it is incompatible with a lkalies as it is incompatib l e

,

wit h aci ds A s t h is p rescription contains two alkal ies p otas

.
,

si um bicarbonate and potassi um h y droxid e t h e presc ription ,

is an incompatib l e one T h e proper t h ing is to notify t h e

.

physician T h e incompatib il ity is not a d angero us one and

.
,

if the p h ysician cannot be reache d the p rescripti on m ay be

d ispense d as written T rue th e helmitol is d ecomp ose d b ut
.
, ,

th e hexamethy l enamine tetramine is le ft T h e patient may

-
.

not derive ve ry m uch b ene fi t from the prescript ion b ut what ,

is t h e d r uggist to d o ? As l on g as not h in g d angero us hap

pens noth ing partic ularly toxic and he is unab l e to reach
, ,

the p h ysician and have him change the p r escription he has ,

no ot h er way out .

Aq uae .

S . : 3 i fo ur times a day .

S ali formin i s c emica l y h l h examethy l enamine

It sa l icy l ate .

is not good to p rescribe it i n water beca use it hy dr olizes i n

water into its c onstit uents T he prope r way to prescribe i t .

is either in tablets or dissolve d i n some e li xi r .

3 94 . P e psini O p timi
B e tainae Hy drochlor .

Aq uae .

S . : 3 i after meals

T h is p rescription is pe rfectly a ll right B ut the d ruggist .

”

wh o received it refused to dispense it He tho ught tha t th e .

1 88 P R E SC R IPT IO N I NC O MPA T IBIL I T I E S
dose of betaine was ex cessive and the reason he tho ught it ,

was excessive was t h at h e t h o ugh t it was an alkaloi d A nd .

t h e reason h e t h o ught it w as an alkaloi d was t h at h e conf use d

it wit h and t h o ugh t it was t h e same t h ing as b etaeucain .

Betaine is a colorless crystalline substance containing abo ut ,

24 per cent of absol ute h y d rochlori c aci d and is use d in

.

vario us digestive disorders as a s ubstit ute for hy d roc h loric

aci d Its average do se is eig h t grains w h ic h correspon ds t o
'

.
,

abo ut eigh t minims of dil ute d hyd rochl ori c aci d A nd t h e .

d ose in this prescription is j ust right B etaine is a l so known .

'

un der its tra de name A cidol .

3 95 . Chl r z ne o a e

A c B ori ci
.

Aq uae
S . : U se e x te rn ally as directe d .

Chl orazene which is a tra de n ame for dichloram ine T is

,
-

incompatible wit h aci ds even wit h s uc h a weak aci d as boric

,

aci d A nd we migh t use t h is opport unity to state that in

.

presc ribing new reme dies physicians sho ul d be partic ularly

careful not to or der them i n c onj unction wit h ot h er sub
stances It is only if they are t h oro ugh ly fami l iar wit h all
.

t h eir possible incompatibil ities something whic h is not likely ,

to be the case with the average p h ysician may t h ey in dulge

m
,

in experi enting ; ot h erwise t h ey s h o ul d prescribe them by

themse l ves o r j ust the way the a uthoritative text b ooks a dv ise
’

3 96 . C hlorami e
n -
T
Hydroge n P erox i de
Listeri ne
F or ex ternal use only .

The remarks of the p revio us p rescription apply t o t h is on e

as well W h y a physic ian who has a powerful antiseptic
.

shoul d want to comb in e it with severa l others is har d to

un derstan d b ut s uch is h uman nat ure
, C h loramine T is in .
-

compatible with h y drogen peroxi de with al coho l and with a ,

n umber of ot h er s ubstances .
1 90 P R E S C R I P T ION INC O MP A T IB ILIT I E S
A s is well known h examet h ylenamine acts best when the
,

urine is acid A nd t h e best d r ug to make t h e urine aci d is

.

the aci d so di um p h osp h ate as describe d i n t h e N e w and

N on Offi cial Re me dies ; not the o fficial so d i um p h osp hate
-

whic h is chemically N azHP O4 b ut t h e aci d p h osp h ate or b i

phosph ate w h ic h is chemically N aH P 0 4 B ut it is not ad
, 2 .

visable to prescribe the two i n t h e same m ixt ure T h e aci d .

so di um p h osphate sho ul d be a dministere d sep arately It is .

n ot a c h emical o r ph armace utical incompatibil ity and the

dr uggist has no right to refuse to d ispense t h is presc r iption ;
b ut it is best t h e physician s h o ul d know .

Those who think that shot gun polypharmacy has gone -

entirely out of t h e fashion may be somewh at s h ocke d by ,

contemplating t h e following p rescription w ritten by a real ,

live p h ysician and repro duce d i n t h e J ourhal of the A mer i

can Medical A ssociation Here i t is : .

401 R Merck s Col c hi i n

’
. c

S try chn . Ph os.

S od i odi d
. .

S od s ali cyl
. .

Tr . B ell adonna
B ry oni a alb .

Capsi cum .

A r ni ca mont .

P ulsatill a
R h us to x .

P hy to locca
Cimicif R ac . .

Col c hi cu m .
3 xv
R ee d and Carnr ick ’
s x
E li . P e p te nzy me . 3 x
M . S . : k e i xty ( 6 0 ) mi
Ta s n i ms ( drop s ) in a gl assf ul of
wa t r n h ur ft r e
e , a o a e ach meal Ta k e e very 2 h o urs
.

if very se vere .

We do not say that it did not do the patient any go od ( or

ha rm ) b ut i t is a c uriosity anyway
,
, .
 P R E S C R I P T IO N I NC O MP A T IBILI T I E S 191

Th e fo llowing prescription is taken from the J our na l of

the N A R D ( J an uary 8 1 9 14 )
. . . .
,
“
F rom an Illinois p h armacist comes the follow ing b reezy
n ote :
A co unt ry p h ysician move d i n to our city to build up a prae
tice He knew me and we got q uite ch ummy and I tol d him
.
,

t h at in or d er to be up t o d ate h e m ust write presc r iptions and

not do d is pensin g .

He agree d b ut sai d h e d id not know prescription forms as

, ,

h e had neve r written one ; so I tol d him to write t h e best h e

co ul d and I wo ul d make out w h at h e wanted all right The , .

fi rst p rescri ption was as foll ows and I have it on file in its ,

re gula r or d er
4 02 . Q uini ne a little
S trichnine no t so much

I ro n a littl e m ore

Mak e so me caps ules ; t ak e one every three h o urs .

A n d the e d itor says

Comment is h ar dly necessary on l y it shows probably bet , ,

te r t h an anything co ul d t h e l ooseness and crimina l care l ess

,

ness d isplaye d i n t h e average d ispensing doctor s offi ce

” ’
.

T h is is eit h er a j oke or a fi b o r it is tr ue I f it is a j oke

,
.
,

it is in poor taste If i t is a fi b it is an ins ult t o t h e me d ica l

.
,

p rofession If it is tr ue it i s a shame t h at s uch p h ysicia ns

.
,

sho uld exist .

B ut ass um ing that it is t rue t h at s uch physicians d o e xist ,

wh at is t h e mora l of it ? T h e m oral is plainly and distinctly

and i n d isp utab l y th is : that physicians of s uch type who are ,

s o incompetent to write a p rescription should not write pre ,

scr iptions b ut sh ould d isp ense r ead y ma d e p r ep ar ations from

rep utab l e m an ufact uring ho uses I repeat s uch physicians .

,

sho ul d not exist and it is a shame that they sho uld be per
,

mitte d to p ractice b ut it is a con d it ion and not a t h eo ry that

,

confronts us and if s uc h p h ysici ans do exist and they are

,
.

perm itted t o treat p atients is it not b etter for the p atie nts
,

that they s h o uld d ispense than to attempt t o write p r escr ip

1 92 P R E S C R IPT IO N I NCO MP A T IBIL I T I E S
tions when they do not know the doses and are not familia r
wit h c h emical and ph armace utica l i ncompatibilities ? T h ere
is a ve ry goo d re ason for t h e vogue o f good et h ical p ro
p r ie tar y preparations a n d al l t
,
h e d iatribes against d ispensing
by t h e p h y sician or against h is prescribing of wel l th o ugh t
,

out skillf ul l y prepare d proprietary p h armace utica l s wi ll be

,

in vain .

I present the following t h ree prescri ptions as specimens of

herb recipes T h ey were written by an old herb doctor with
.

an enormo us practice They we re given t o m e by one of

.

my patients w h om t h at d octor had treate d for ove r a

“ ”

year for impotence with t h es e combinations P ractical l y

.

every patient receive d the same p rescriptions .

40 3
. S p anish S arsap arilla n V2 oz .

Y ell ow D ock R o o t V2 oz .

S k unk Cabb a ge R oo t 34; oz .

h
B uc u 34; oz .

R h ub arb R oo t 34; oz .

S cullcap ML oz .

Li corice R o ot 1 4 oz
7; .

S enna oz .

B l oo d R oot oz .

A nise S ee ds oz .

Steep t h ese i n s ufficient h ot water for 3 ho urs to h ave 3

pints of tea whe n strained A dd when c old 3 oz R y e
. .

Whiskey D ose 2% tablespoonful s 3 times a day 1 5 min utes

.
,

before mea l s or one ho ur afte r .

404 .Nerve R oot

Mountai n A sh B ark
Cle avers
R h ub ar b R o ot
E l eca mp ane R oot
White R oot
Li cori ce R oot
S cullcap
A nise S eeds
White Gi nger R o ot
1 94 P RE SC R IPT IO N I N C O MP A T IB ILI T I E S
be ing free it decomposes th e sod i um sa l icylate with the forma
,

tion of sodi um citrate and salicylic aci d which latte r being , ,

b ut s l ightly sol ub l e in w ater precipitates T h is incomp ati

,
.

b ility can be easily avoi de d by using an e quivalen t quantity ,

W hic h means j ust one half of p ure cafi e ine

'
-
.
,

40 7 . I odi
P otassu I odi di
Argyr ol
Aq ua B e still
Use for p ai nti ng throat .

This prescription is abso l utely incompatible T h e ar gyr ol .

is destroye d silver io d i de being forme d

,
Si l ver io d i de is .

therape utica l ly active in fact sometimes too active b ut t h at

, ,

does not c h ange t h e fact t h at t h e prescription m ust not be

d ispense d beca use we no l onge r h ave ar gyro l in it The .

p h ysician s attention s h o uld be calle d to t h e incompatibil ity ,

and if h e still wis h es to h ave the prescription dispensed as

written it is h is a ffai r
, .

4 08 . R esor cini
P etrol ati Liq ui di 3 i
Mf . . so l. U se e x ternally .

R esorcin not being sol uble i n li q ui d petrol at um i t c an be ,

r ubbe d up and dispense d as a s h ake m ixture B ut a m uc h .

better way is to d issolve the resorc in in a few drops of ether

and then mix with the petrolat um .

409 . R esor cini

Gly ce rini
Apply xt
e e rnally with camel s ’
hair b rush .

There is nothing wh atever p rescription wrong wit h t h is .

One druggist refused to d ispe nse it sayin g t h at t h e two ,

were incompatible and also that resorcin was n ot sol uble in

glycerin T h ere m ust h ave been some m is und e rstan d ing
.
.

R esorcin is perfectly sol uble in g l ycerin and perfect l y com

patible with it .
 P R E S C R IP T IO N I NC O MP A T IBIL IT I E S 1 95

41 0 . S tr o ntu B r o midi
S odii B ica r b o n .

Mist i e t S o dae
. E b e

S . : Ta b lespoo nful after ea ch me al .

T h is prescription gives not only a precipitate b ut a copio us

e ffe r ve scence T h e precip itate is d ue to the formation of
.

stronti um carbonate A nd where a sol uble carbonate is use d .

in c omb inat ion w it h a sol uble stront i um sal t t h at is all we

get B ut where a bicarbonate is use d we get also besi des
.
, ,

th e precipitate a n evol ution of carbon d ioxi d e w h ic h ca uses

,

the efi e rv escence T h e follow ing e q uation exp resses t h e chem

'

ica l re action :
S I BI :
' '
2 NaH CO. S r COa 2 N aB r C0 : E zo

If t h e d octor ins ists upon the prescription be in g d ispense d

it may b e dispense d b ut it sho ul d not be p ut in the bottle ,

unt i l al l th e fo rm at ion of gas has cease d and t h e bottle in ,

w h ich it is p ut s h o ul d be of larger capacity t h an t h e p r escr ip

tion c all s fo r Of co urs e it sho uld be dispe nsed with a s h ake
.

l abe l .

Cocain . Hy dr ochlor .

Aq ua B estill
For inj ection .

He re we w ill ge t g ra dually a white precipitate of s il ve r

c h lori de due to t h e interaction between t h e c h lori d e of the
Coca ine and th e silver of t h e protargol B ut the trouble can .

be easily prevented by us in g cocain e nitrate in stea d of co

ca ine hydroc h lori de .

41 2 A ci di S ulp hur osi

.

Aq ua Hy drogenii P erox idi

Use as a g arg le .

E ac h of the two in gre d ients is antiseptic b ut when the ,

two are m ixe d bot h are d estroye d and a ve r y weak sol ution
of s ul ph uri c aci d is obtained T h e rea ctio n is expressed in .

the fo ll owing e q uatio n :

1 96 P R E SC R IPTION INC O MP AT IBIL IT I E S
H.so.+ 11 20 2 m o4 11 20

T h is prescription is anot h e r examp l e of t rying to get too

m uc h and of getting not h ing .

4 13 .
Q uininae S ul p h .

A sp iri ni gr . v
M . f . cap s. vi No . 1 . Tal Dos . . .

S : One cap sule eve ry 5 h ours

. .

F or some time t h e p h armace utica l j ournal s carried the

important information t h at q uinine was incompatible with
”

aspirin beca use a very dangero us poisono us comp oun d q uino

, ,

toxin was forme d from w h ic h many d eaths res ul te d I put

, ,
.

no cre dence in t h ose reports at th at t ime and I d o not now ,

.

A s far as I know t h e two c h emicals are p e r fectly compatible

, .

I have p rescribed t h em and h ave seen the m prescribed with

out any b ad res ults .

414 . I . Tr . I odi
S . :t easp oonfuls to q uart of water
Two .

11 Tab Hydr B ichlo r

. 55
. No x 1 1 . .

One in 2 q uarts of water as directe d .

The yo ung la dy p atient was or dere d to use the two do uches

imme diately following one anot h er S h e d id so and e s pe .

r ience d a severe b urning wh ich laste d fo r ove r an ho ur Sh e .

was ordere d to use these do uches morning and n ig h t and in ,

S pite of the severe b urning prod uced by the fi rst inj ection sh e
,

continue d t o use t h em for three o r fo ur d ays unti l the sore

ness and pain became unen durable When sh e app l ie d to .

another doctor for treatment he fo und the entire vagina l

m ucous membrane i n a state of severe infl ammation an d so
sensitive t h at the intro duction of a sp ecul um ca used ex cru
ciating pain .

T h e p hysician who had presc ribed those do uches with the

best of intentions was evi dent l y not aware of the fact or ,

it had slippe d h is mind t h at io dine and merc uric chlori de ,

p ro duce merc uric io dide which is extreme l y irritating When , .

do uches of io dine and of bich l ori de are orde r ed they must

1 98 P R E SC R IPT IO N INC O MP A T IB ILI T I E S
scription before us T h at p rescription is certainl y incom
.

p atible incomp atible chemically p h ar mace utical ly and thera

, ,

p eu tically Nevert
. h eless t h e physician insisted on h avi ng
it d ispense d j ust as w ritten and sai d t h at if t h is d rugst ore
d id not d ispense it as h e wante d it h e wo ul d g o somew h ere ,

else He cl aime d t h at he got fi r st class res ults wit h it in

.
-

t h e worst cases of d yspepsia that h is patients were satisfi ed

, ,

an d t h at it was not t h e d r uggis t s b usi ness to teac h him o r

’

to make rem arks abo ut hi s prescriptio ns A nd w h at are y ou .

going to do abo ut it ? Y ou simply have to d ispense it A s .

I sai d m any times before as long as t h ere are no over d oses

, ,

no toxic preci pitates no danger of explosion n o irreparable

, ,

deli quescence and t h e mixt ure is presentable eno ugh and

,

fl ui d eno ugh to be po ure d from the bottle and the doctor in ,

sists upon h aving i t d ispense d as w ri tten t h e p h armacist h as ,

no c h oice in t h e matter A fter all he is the se r van t and n ot

.
,

the master of the physician .

417 . F owl e ri
S ol .

S y r F err i I odidi
.

S : Te asp o onful in water 3 times a day after meals

. .

T h is prescription has been d ispense d times wit h o ut num

ber T h e p rincipal tro uble is wit h t h e carbonate of potas
.

si um containe d in the sol ution of potassi um arsenite w h ich ,

precipitates t h e iron as ferro us carbon ate Most l ikely some .

ferro us arsenite is also fo rm e d gra dually T h e p recipit ation .

can be avoi de d by using t h e sol ution of arseno us aci d which

is of the same st rength as the so l ution of p ot assi um a rsenite .

41 8 . Tr . V omi cae
N ucis
Tr Ge ntianae Comp o s
. .

Aquae Menthae P iper

S i gn: 3 i t i d p c . . . . .

The t urbi dity in t h is p rescription is due to t h e fat con

tained in t h e nux vomica wh ich is kept in sol ution in t h e

alcoholic menstr uum of th e tinct ure of nux vomica separat ,

ing on the tinct ure being m ixe d w ith a hydro alcoholic and -
 P R E S C R I P T IO N INC O MP A T I B IL I T I E S 1 99

a q ueo us menstr uum . Of c o urse the p rescription may be dis

p e nsed as w ritten .

41 9 . B ismuthi S ali cyl .

Ac . Hy dr ochlor . Dil .

E ss . P e p sini

S . :T ab lesp o o nful aft er me al .

Hy d roc h l ori c aci d is incompatible with bism ut h salicyla te

( t h e o ffi cial salicyl ate of bism ut h is not a tr ue sali cylate b ut
a s ubsalicyl ate ) a part of t h e bism ut h is d ecompose d bism uth ,

c h lori d e an d t h e n oxyc h lori d e being fo r me d and salicyl ic

aci d sepa rating out and fl oating i n the mixt ure T h e pre .

scri ption may be d ispense d b ut it is a b ad one ,

.

420 B ism uth S ali cyl

. . .

N atrii B icar b o n .

Mist . R he i et S o dae
Aq ua e Creoso ti
S : 3 ss te r in di e p o st cib os
. .

So d i um b icarbonate and bism ut h salicylate in an a queo us

m ixt ure will gra dually d evelop carbon d i oxi de w h ic h will ,

eit h e r ca use the popping out of t h e cor k or b ursting of t h e

bott l e Sod i um bicarbonate or p otassi um bicarbonate will do
.

this with a n umber of salicy l ates s uch as bism ut h salicylate , ,

lit h i um salicylate o r magnesi um sal icylate T h e prod ucts of

,
.

d ecomposit ion that are forme d by so d i um salicylate are bis

m ut h hy d rocarbonate c arbon d ioxi de and water Carbonates,
.

d o not ca use an evol ution of c arbon d ioxi de only bicar ,

bon e tes .

P R E S C R IP T IONS WIT HO U T C R IT I C I S M
Th e follow in g prescriptions ar e p r esented without any
criticism Similar combinations h ave been analyze d i n t h e
.

prece d ing p ages and th e st ud en t ph arm acist or physician

, ,

can test h is knowle dge of incompatibilities by attempting ,

now and t h en to criti cize some of the prescripti ons W h ere

,
.
20 0 P R E SC R IPT ION IN CO MP A T IBIL IT I E S
ther e is doubt or unce rta inty in the reader s m in d a refer
’
,

ence to the A l phabe tic al S umm a ry or the In dex s h o ul d h el p

to solve the d iffi culty .

421 . Tr . I o di

Aq uae
Gtt x in water
. 4 times a day .

422 . S ol Adr e nalini C

. hl or .

P etrol ati Liq .

Use as spray .

4 23 . Tr . I odi
A mmon Fort
Aq . . .

Linim Chloroformi .

Use with f ri cti on .

4 24 . Ao . T annici
Aq . Hy drog . P erox .

Use as g arg le .

4 25 . Ar genti Nitrici
S ol Arsenic F owleri
. .

Aq uae
3 i afte r each mea l .

426 . Dob ell s S ol utio n ’

pint
Diox og e n
F or e ternal usex .

4 27 . Zi mei Chloridi
Aquae
Use as i nj ecti on twi ce a day .

4 28 . Zi hci Ox idi
A q uae Destill .
3
Use as i nj e ction 4 t imes a day .

429 . R es orcin
B ism S ub nitr . .

M f ung . . .

S . : A pply night a nd mor ning .

20 2 P R E S C R IPT ION INC O MP A T IBIL IT I E S
U n g I odi .

U n g Hy dr ar gy ri
.
3 i
A p p ly 3 ti mes a day .

Chlo r ali Hy dr .

P o tassii Br m o .

Aq uae
Tab lesp oonful at n g i ht .

Chlor ali Hy dr ati

S od11 Br m o .

E li x . S imp l .

O ne t easp oon at n g i ht . May be repeated in a n ho ur if

ef
f c e tive .

44 3 . Q ui n . S ulp hat .

S odii S ali cyl .

M . f . p ul v 1 M ke su h p wders xxi v
. . a c o .

O ne powder 4 times a d y a .

Q ui S ulph
n . .

S od11 S ali cyl .

Aq uae
3 i eve ry 4 hou s r .

44 5 . A ci di B o ri ci 1 0 %
S ol .
,

Apply on compresses .

44 6 . A mmonn Car b on .

A mmonii Chloridi
Hy dr arg Chloridi .

F or o ne c a ps Mak e 12 caps ules

. .

O ne 3 ti mes a day .

44 7 . Ac P i cri ci
.

Aq uae
F or e xternal use . R ush!

44 8 . Tr . I odi
S ol . Co rr . Su blim . 1 1 0 00
-

S . For e xt r al
e n use o nly .
 PR E S C R IPTI O N I NC O MP A T IBILIT I E S 20 3

Antip y rini
S pir . A e the ris N itr .

Aq uae , q . s . ad

Gran . A conitinae

One eve ry h ou r .

Tr . Ferri Chlor idi

Tr . Can tharidis
Gtt . x ii te r in die .

S ol P otass
. . Chlor , 1 0 % .

Use as gargle .

A c Car
. b o l .

Collodi on
P aint with c amel s ’
hair b r ush a r ound . b o il .

S ol . P ota ss . P e rmang .
,
25 %
Apply e x ternally as directed .

iii
gr .

3 iv
Ca uti on ! A p ply small q uantity every h our until p ai n is
reli eved .

Aq uae B estill .

3 i 3 times a day .

E li x ir . S imp l

O O O O O O O O O O O O O O O O O O O O O O O O O O O O
204 P R E S C R IPTION INC O MP A T IBILIT I E S
Tr P e rri S esq uichlor
. .
3 i
A quae, q . s. ad

3 i
4 ti mes a day .

459 . Aquae Destillatae U S P , . .

R ece nte p aratae sterilizatae ! ,

P r o usu docto ris .

4 60 . Q ui n . S ulphat .

Ac . S ul p h . Dil .
, q . s.

Tr . F erri Chlori di
S y r up i
Aq uae
3 i ter in die .

4 61 . A ntip y r ini
Aq uae B estill .

F or ex ternal use !

4 62 . Hy dr ar gy ri B ichlo r .

P otassii I o didi
Arg enti Nitratis
Aq uae
3 i 3 ti mes a day .

4 63 . P h en ol
F or e x te r nal use .

4 64 . Ic hthy
l o

Cr eosoti
G uai acol
Div . in cap s . No . xxx .

S . : Tw o c a p sul es 3 ti mes a day .

4 65 . Hy dr ar g Chl or Mit is . .

Ung . I odi
M . f . ung .

S . : A p p ly with friction 3 times a day .

4 66 . S ol . Mag endie 3

Aq uam , q . 3 . ad

S . : 3 i pro re na a t .
206 P R E S C R I P TION INC O MP A T IBILIT I E S
476 . E mulsionis Ol ei Morr huae, 50 %
S p ir Frumenti
.

S .
3 ss after meals .

4 77 . Oleor es C ub eb ae .

P I E x t B uc u
. . h
Ol . S antali
Aquae
3 i 3 ti mes a day .

Hy drargy r i S u li m b .

P otassii I o di di
A o Nitr ohy dro chlor
. .

E ss P e psini
.

Aq uae
3 i ter in die after meals .

4 79 . Tri on al
Veronal
Me di na]
Ft . p ul v 1 . . Tal Dos . . vi .

O ne on retiring .

Morph . S ulp h .

Heroini 7

Dionini
Codeinae
A mmon . Mur .

S y r Tol ut
. .
3 i
Aq uae q 8 ad , . .

3 i 3 ti mes a day .

P otass Chlo r atis .

G ly ce r . Ao . Tanni ci
3 i in w ate r for gar gling .

48 2 . P ilocar p inae N itr .

B ay R um
To b e used o n scal p ni g h t and morning .
 P R E S C R IP T I ON I NC O MP A T IBIL I T I E S 20 7

P o tassu Br m o .
3 i
3 i
3 ss

Calcn Br m o .
3 ss

S tron tii Br m o .
3 ss

P o tassii A ce tatis 3 i
S odii Citr atis 3 i
Lithii Citr atis 3 i
Aq uae q s , . .

3 8 5 in g lass of wa ter on r i si ng and on g o ing to b e d .

Ic hthy o l , p ure 3iv ( l)

T e asp oo nful 3 times a day a fter each meal .

T ab l o i ds Thr ee B romi des B . w . a nd Co . No . C .

Th ree tab lets in g l ass of water 4 time s a day .

A dip is Lanae

S . Apply ex ternally n g i ht and morni ng .

4 87 . Z ime i S ulp hatis

in aps No xxx
c . . .

S . : Two caps ules 3 times a day .

Arseni Triox idi

Q ui n . S ul p h .

gr . iii
20 8 P R E S C R IPT ION INC O MP A T IBIL IT I E S
S o l P ot ass A r sen
. . .

Hy dr ar g . B ichlor .

Q ui n S ul ph . .

Tr Ferri Chloridi
.

Aq uae q s ad ,
. .

3 i ter in die p . c.

4 91 . Tr . Cinchona e
Tr . Fe rri Chlo ridi
Tr . Cantharidis
Gtt . xv t . i d
. . in Vi hy Wat c e r .

4 92 . Airol
Aq uae
Use as in j ec tio n .

Ammon . B enz
S odii B e nz .

A o Hy drochlor
. . Dil .

E ss . P e p sini
Aq uae
3 ii after meals .

4 94 . Q uin S ulph . .

Tr Di gital is
.

Liq F e rri e t Amm on Ace t

. . .

3 i q uaq ua h ora tertia .

Ex t . Thyroi d
Ex t . A drenal
Ex t . Orchitic
M . f . c aps . No 1 . . Ta] Dos . . lx .

4 96 . Ex t . P ar athy ro ideae
To mak e 60 c aps ules e ach to co ntain the us ual dose .

4 97 . Ap othesi ne , o

S . : F or e x ter nal use .

21 0 P R E S C R IPT ION INC O MP A T IBIL IT I E S
50 5 . S ulp huris Lo ti
P o tassii B itar tr .

M f . . Tab . No 1 . . Mitte C .

S . : O ne t blet 4 a or 5 times ad ay .

50 6 . Lup ulini
Camp horae
M . f p il 1
. . . Ta] Dos . xxiv
. .

S . : O ne pill at 6 p . m a nd . one o n retiri ng .

507 . I odoformi
B ism . sub nitr .

Div . in b ee il . uret hr . No . x 1 1.

S . : I nsert one 4 t imes a day .

508 . Tr . I o di

S . : Gtt .iv in w ter eve y 2 h a r ours .

50 9 . Po t n Br m
ass o .

C hl al
or

Div . in s uppos . rec t . No . x n.

Inse rt one at ng ti h .

51 0 . 0 1 R i cini
.

M . f E muls. .

S . : 3 85 every hour .

51 1 . S try chn . S ulp h .

Q uininae B isulp h .

A c S ulp
. h Ar m
. o .

Liq . F e rri et Ammon A cet . .

S . : Two teasp oonsful 4 times a day .

51 2 . B romoformi
Aq uae
M f Emuls leg e ar tis
. . . .

S : Teasp oo nful every

.
hour until re lieved then every ,
3

51 3 . hl l
C ora

ca mp ho r
1

0 0 0 0 0 0 0 0 O O . 55 50 0
Apply ex t rnally
0 O 0 0 0 0 0 0 0 0 O O 0

S . : e .
P R E S C R IP T IO N I N C O MP A T IB IL IT I E S 211

Camp ho r ae

Coc hlea r p arvum ter in die .

A ci di Nitri ci Diluti

T ab lespoonf ul after meals .

Teaspoonful afte r meals .

D ro p 3 dro ps into each ey e mo rning and ni ght .

Caustic . U se wit h to
cau i n .

Oi. S ant ali

212 P R E S C R IP TIO N I N C O MP A T IB IL IT I E S
The following prescriptions i ncl uding the comments wer e sent , ,

to me at my r eq ue st b y Mr J L L ascofi a w ell known ph armac ist

-

. .
,

of this city whom I t ak e t hi s op p ort unity to t h ank for h

,
is co urtesy .

They ar e all prescripti ons th at were dispense d at his pharmacy .

521 . Tr . Ferri Chloridi

Antip y r ini
S p i rit us A etheris Nitrosi
Aq uae ad

NI . D S . . A te as poonful every ho ur .

The antipyri n is ad ded to prod uce a co l o r rea cti on wi th

the iron and as s uch is harm l ess ; b ut w ith the a ddition of the
sweet spirit of niter a s h arp chemical reacti on takes place
,
.

A t fi rst t h ere is a p urp l e mixt ure fo rmed with the i ron and
the antipyrin t h en when the n ite r is added it t urns l ight
,

green and t h en w h en allowed to st and becomes olive green

, ,

and later brown Chemica l ly an iso nitroso—

. antipyr in is -

forme d which is consi dered by many a poisono us compo und .

This prescription as written is incompatibl e The on l y rem .

edy is to use the simple S pi ri t o f ethe r which was done in ,

this case by consent of the prescribe r [ A s the antipyrin is .

ad de d merely as a coloring agent whi l e the spirit of nitro us ,

ether po ssesses decide d thera pe utic properties it is be tter to ,

leave out t h e former i e the ant ipyrin and l e ave in the

, . .
, ,

latter the spirit of nitro us ether —W J R ]

-

. . .

522 . P otassii Citr atis

Liquor is Ammoni i A cetatis
S pirit us A ethe r is Nitro si 5 5 ,

Tinctur ae Cardamomi Co mp osit ae

A q uae, q 3 ad . . . .

A te asp oonful every t h eer to fo ur hours in water .

When t h e above is compo unded fo ur ch anges of co l o r tak e

p l ace as t h e res ult of chemical ch ange A t fi r st it is l ight .

brown then r e d t h en straw col or and fi nally becomes pur

, , ,

ple T h is is all due to the p resen ce o f the niter whi ch con

.
,

tain s nitro us aci d .

214 P R E S C R IPTIO N INC O MP A T IBILI T I E S
sults w h ich is fi r st o f a d ark s h a de ; it gradua ll y gets l ighter ,

t h en yellow and finally becomes colorless [ Thi s is of co urse

,
.

d ue to t h e io dine combining wit h t h e amm oni a fo r m ing the ,

colorless ammoni um i odide —W J R ] . . . .

527 . Or thofor mi
Ol e i Olivae
M . ft . sol .

In or der t o make a unifo rm and clear m ixtur e it is ne ces ,

sary to h eat t h e two in g re d ients as the orthoform is insol uble ,

in t h e col d oil .

528 . S odii I odidi

F err i Q uin e t S try chn P hosp h
E lix iris ,
.
,
. . .

M D S : A te asp oonful three times a day after meals

. . . .

In t h is prescription the p h osp h ate sa l t s are incompatib l e

with t h e so di um iod i de therefore we use th e which
,

makes a clear and uniform so l ution We fin d the same incom .

p atib ility when using bromi de salts .

529 . Ti nct V omi cae

. N ucis
Tin ct Cardamomi Co mp . .

E lix Ferri Q uininae e t S try chninae

. P hosp hatum
E lix ir i Di gestivi ( N F ) . .

S . : A teaspoonful after each me al .

In t h is case one sho ul d a l so use the N F prepa r ation of

, .

the w h ic h contains the tinct ure of ferr i c cit ro chl oride -

,

ot h erwise the mixt ure is t urbid and not unifo r m (N B . . .

E lixi r I Q S p h osp h ates is not o fficial now )

. . .
.

53 0 . B r ome tone
Pyrami do n
D T D Ca p sul ae N o 1 2
. . . . .

Sig : One eve ry 3 o urs until

. h re lieved .

W h en t h ese two ingred ients are mixed a soft m ass r esul ts .

To avoi d t h is I a dde d a smal l amo unt of Magnesi um O xide

and trit urate d it very gently fill ed in caps ul es and d ispe nsed ,

m a glass stoppere d bottle -

 P R E S C R IP T IO N I NC O MP A T IB ILIT I E S 21 5

53 1 . S p arteinae S ulphatis
S acchari L actis
M . f
. tabe lla e ( fr eshly p r ep ar e d ) No . 12
.

Sig . : One every 4 h o urs .

I n m aking ordinary tablets we a l ways use dil ute d alcohol ;

in th is case we use d ether and absol ute al co h ol ot h e r wise ,

the tablets wo ul d be too soft and stick toget h er ; i t wo ul d

also be im possible to remove them from t h e mo l d .

532 . He r oin i Hy drochl .

Q uininae Hy dr ochl .

Cre osoti Carb o natis ( Duotal)

Tal . dos oft caps ules No
. s . xxx .

Sig . : One every 4 h o urs .

We ma de a pil l mass of the fi rst two i ngre dients We .

placed t h e p il l in each caps ule then dropp ed 1 0 m in of t h e , .

d uc ta l i n each soft caps ule sea l e d them p r operly and washed

,

them off with p ure alcoho l .

53 3 .
Q uin inae Hy drob ro m .

Camp ho rae Monob ro matae

Cre osoti Car b onatis

Divide i nto cap sul es No . xxx .

S ign: One th ree times a day .

T o t h e creosote carbonate I added acacia and a few d rops

of wate r emulsifi ed it a dd e d the fi rst th ree ingre d ients w h ich
, ,

we re previo us l y m ixe d in a separate mo rtar an d m a de a ,

mass with t h e ad dition of 3 0 grains of magnesi um oxi de and

s uga r of m ilk It was impossib l e to d ispe nse this in soft
.

capsules and it was also d iffi cult to m ak e a mass Witho ut

,
.

the addition of Mg o the C reosote C ar bo nate wo ul d separ ate .

21 6 P R E SC R IPT ION INC O MP A T IBILIT I E S .

Olei Amyg dal D ul ci s .

Aq uae Calcis
Aq uae R osae, q 8 a d . .

S ig . : D ab on sk in every 2 h o urs .

This lotion is fre quently p rescribe d by a prominent skin

specialist w h o complained t h at a solid m ass forms on t h e

botto m of t h e bottle t h e l ime and rose water be ing separated

, ,

and not fi t for use He aske d me to experiment wit h it and

.
,

I solve d t h e problem by d ispensing it as follows : I m ixe d

t h e zin c oxi d e wit h do uble t h e amo unt MgCO8 i n a
mortar to t h is I a dd e d t h e almon d oil and l ime w ate r pre
,

viously mixe d t rit urate d t h is well a d d e d t h e glyceri n and rose

, ,

water and p ut t h is m ixt ure i n t h e 8 0 2 b ottle T h en mixed . .

t h e ment h ol wit h t h e p h enol in a morta r and a dded it to t h e

mixt ure It forme d a n elegant lotion wh ic h was perfectly
.
,

w h ite and uniform T h e reaso n fo r t h e a dd ition of MgCO3

.

is to make it more alka l ine The physician accepted my sug .

gestion .

53 5 .hr Camp o grammes

Mi d ma k e 3 0 pills
x an .

We trit urate t h e camphor with abo ut 1 gram of pow dered

soap and a dd a few d r a s o
p f castor oil T h is makes a mass .

w h ic h does not h ard en It sho ul d be d ispense d in a glass

.

container well corke d [ I n t h e a ut h or s Opinion i t wo ul d

’
.

be simpler and altogethe r preferable to pow de r t h e camp h or

and fi ll it dry in 3 0 caps ules It is goo d to inform t h e doctor .

th at it is m uch bette r to d ispense camp h or i n caps ule t h a n

in pill form — W J R ] . . .

536 . hr Camp o

M th l en o

Mi xd m k e 25 pills
an a .

Trit urate t h e camphor ment h ol T o t h e res ul ting l i q

and .

u1 d add a mixt ure of extract of glycyrr h iza and pow dered

glyc y rr h iza and t h en a few d r o ps of water
, This makes a ,
 P R E SC R I P T ION INC O MP A T I B IL IT I E S
to accept my s uggestion t h at boric aci d be s ubstit ute d for the
borax [ B ora x b eing al k aline is in compatible w it h alkaloi ds
.
.

See prescription 28 —W J R ] . . .

54 0 . Cre osoti
B al sam of Tol u
M . ft . pill Mitte
,
N o 50 . .

It is easy eno ugh to p ut th is prescription in caps ul es b ut ,

to make pills of it the fol l owing met h o d sho ul d be a dopte d

,

E mulsify t h e c reosote with a little acaci a a dding fi nely pow ,

dere d balsam of tol u wit h eno ugh p ow dere d glycyrrh iz a to

,

ma k e a suitabl e mass [ A ve r y ingenio us met h od in deed

.
,
.

A nd if t h e doctor insists on prescribing c reosote i n pill

form t h e p h armacist has no c h oice ; b ut I feel in duty b o un d
,

to utter my protest once more against the i rr ational p ractice

—
of p rescribing and dispensing l i q uids i n pill form W J R ] . .

541 . Gall
Ox gm .

Oil of T urp e nti ne cc

. .

Glyce r i n c. c.

Ft . sol S i gn : Di ssolve o ne fo urt h p art

.
-
in a q uart of
water and use as an enema .

Comp oun de d in the order i n wh ich the in gre dients are

name d it will be impossible to prod uce a clear and uniform
mixt ure ; b ut by trit urating t h e ox gall with a little o f t h e
glycerin and em ulsi fyin g the oil of t urpentine wit h t h is add ,

ing lastly t h e remain der of the gl y cerin a sati sfactory m ix ,

t ure will be e ffecte d .

542 . R eso rcini

Mentho lis
B enzoinolis Liq .

Sig . : U se as a spray .

As resorcin is not sol uble in the oil w e d isso l ved it in ,

or 1 5 drops of et h er t h e menth ol bein g d issolved i n th e

,

pr evmu sly warm ed n ic e clear sol ution was ob tai ned

. A .
 AL P HAB E TI CAL S U M MA R Y
OF
PR E S C R I P TI ON I N COM PATI B I LI TI E S

A cacia . A so l ution of this g um forms a thick unsigh t l y

p recipitat e with a sol ution of le ad s ub acetate ( b ut n ot wit h
l ead acetate ) a concentrate d sol ution of b or ax fer ric salts
, ,

and a lcoh ol or alcoholic t in ct ures T h e precipitation with

.

bo rax d oes not occ ur if the m ixt ure contains a fairly large
amo unt of sy rup o r glycerin ; there is no p recipitate wit h
ferri c salts i f the m ixt ure contains a consi derable amo unt
of free aci d or if the ferri c salt is well d il ute d wit h water ,

sy rup or glycerin Wit h alco h ol t h e precipitate takes place

.

on l y w h e n th e percen tage of t h e alcohol is 60 or ove r I t .

is co l ore d bl ue by tinct ure of guaiac A caci a often acts as

.

a p reventative of p recipita tion Notab l y it p revents the

.

p rec ipi tation of alk aloi d s by tanni c acid o r eve n potassi um

me rc uri c io di de ( Mayer s reagent ) ’
.

A cetanili d With sp irit of nitro us ether i t gives a yello w

.

so l ution t urnin g t o red I t l i quefies on being trit urate d wit h

.

phenol resorcin and thymo l ; with ch l ora l h y d rate it gives

,

a d amp pow der .

A cetates .So l ub l e acetates give a deep red color with ferric

sa l ts d ue to the fo rm ation of ferric acetate ( as i n Bas h am s
’

mixt ure ) . With q uinine sa l ts t h ey give a b ulky pasty pre

cip itate of q uin in e acetate [ T ry.fo r instance,
q uinine b
,
i
s ul ph ate with so d i um acetat e ] Morphine acetate loses some
aceti c aci d on ex po s ure and becomes less sol uble Lea d .

acetate o n exposure l oses some acetic aci d attracts carbon ,

di oxide and becomes p a r tially conve rte d into lead carbonate .

219
220 P R E S C R I P T ION INC O MP A T IB ILIT I E S
A cetozone D ecomposed on being heated w ith w ater or i n
.
,

contact wit h alkalies .

A ci da A ci ds Practically al l aci ds decompose carbonates

. .

and bicarbonates wit h e f fervescence and t h e l iberation of car

bon d ioxi d e and t h e formation of salts of t h e correspon ding
,

aci d Hy drocyani c A ci d is an exception R emember t h at

.
.

Carbolic A ci d is chemica l ly not an acid and does n ot act l ike

one .

A cid um Gly cer ophosphoricum is not use d per se and wil l

t h erefore be referre d to un der t h e hea d of its salts t h e
‘

g ly cerop hosphates .

A cidum A ceticum In common w ith ot h er aci ds i t de

. 1 .
,

composes carbonates forming an acetate and liberating C0

, 2.

2 Wit h a mixt ure of alco h ol and s ulp h uri c aci d as i n aro

. ,

matic sul p h uri c aci d i t forms acetic ether or ethy l acetate

,
.

A cidum Ar senosum See A rseni Tr iox id um . .

A cidum B enzoicum This aci d is b ut sligh tly sol uble i n

.

wate r b ut very sol uble in alco h ol : i t is t h rown out from its

,

alcoholi c so l ution by t h e a dd ition of wate r Its sol ubil ity i n .

water is increase d consi derably by t h e presenc e of borax .

See Benzoates .

A cid um Carb olicum See Pheno l . .

A cidum Ch r omicum See Chr omn Tr iox idum . .

A cid um Gallicum Gives bl uish black color with ferric sa l ts

.
-

and also wit h ferro us ( beca use practical ly we sel dom meet

with c h emically p ure ferro us salts entirely free fro m ferri c

compo un ds ) With ammoni a compo un d s ( aromatic spirit
.

of ammonia ) it gives a variably colore d mixt ure and p r e cip i

tate With lime water a bl uis h w h ite ( or rat h er d i rty ) pre
. -

cip itate Wit h excess of so di um bicarbonate is said to gi ve

.

in digo bl ue color wit h bl ue green p recipitate V igoro us tr itu -

ration wit h potassi um permanganate m ay ca use an expl osion

wit h t h e b urning up of t h e acid .

A ci dum Picricum T rinitrop h enol 1 Liable to explo d e

.
. .

unl ess careful ly ha nd led 2 Must not be rubbed o r heate d . .

222 P R E SC R IPT ION INC O MP A T IBIL IT I E S
sol ution it is precipitate d only by tannic acid and merc uric
potassi um io di d e ( also gol d c h l ori de ) .

A ethy lis Car b amas U ret h ane P ro duces a li quid or m oist

. .

mass w h en trit urate d with antipyrin benzoic acid b etanap h , ,

t h ol camp h or h y drated c h loral ex algin menthol reso rcin

, , , , , ,

trional salol sal icylic aci d thymol

, , ,
.

Agurin See Theob r ominae Sod io A cetas

.
-
.

A lk al oi ds Great care is necessary i n prescribing these b e

.
,

ca use most of t h em being potent d r ugs p recipitation may ,

ca use serio us conse q uences by an over dose of the alka l oid ,

being po ure d out i n one dose Whenever feasib l e a lka l oids .

,

s h o ul d be prescribe d by themse l ves eit h e r i n so l uti on or in ,

t h e form of gran ules pills etc A lkaloi ds sho ul d not be pre

, ,
.

scribe d wit h : Potassi um hy droxi de carbonat e and bicar ,

bonate ; so di um h y droxid e carbonate bicarbonate and bora te , ,

( also p h osp h ate ) ammoni a wa fer and amm oni um car b onate ;
lime water io d i des bromi des tanni c aci d ( or s ubstances con
-

, , ,

taining tannin ) ; merc uri c c h lori de ; gol d chlori de Besides .

t h e foregoing quinine is also i ncompatible with sa l icy l ates and

,

acetates T h e reason t h e a l kaloi ds are incomp atib l e with the

.

above en umerate d s ubstances is beca use the a lkaloids are

precipitate d by t h em F or instance if we prescribe morphine
.
,

s ulp h ate and ammonia water or ammoni um carbonate ( or the

aromatic S pirit of ammonia wh ich contains those s ubst ances ) , ,

p ure alkaloi d al morphine which is b ut very slig h tly so l ub l e

, ,

will precipitate ; if we prescribe morphine s ulph ate and tan

nic aci d morp h ine tannate wil l p recipitate ; i f we prescribe
,

st r yc h nine s ulp h ate and merc uric c h lori d e a doub l e salt of ,

stryc h nine and merc ury will p recipitate etc ,

.

I t is well to bear in mind th at as a genera l r ule which , , ,

h owever has a n umber of exceptions t h e p ure alkaloids are

, ,

insol uble or very sligh tly so l uble in wate r b ut sol uble in al ,

cohol in fix ed oils and i n oleic acid It is j ust vice versa with

, .

alkaloi da l salts
—
.

( N .B The alkaloi ds o r their sa l ts offi cial i n the pha r

.
, ,

macopeia are : Aconitine aethy lmor p hine apomo r phine

, , , ,
 A LP HAB E T I C A L S U MM A RY 223

atropine b etaencaine cafi eine cinchoni dine cinchonine co

, , , , ,

caine , co deine co l chicine cotarnine, d iacety l morp h ine, , ,

emetine homatrop ine hy d rast ine h yd rast inine hyoscyamine

, , , , ,

m orphine pel l etierine physostigmine pilocarpine quinine

, , , , ,

scopo l amine sparteine stryc h nine t h eob romine t h eop h ylline ;

, , , ,

in practice cod ein e may be p rescribe d wit h alkalies beca use

, ,

the p ure a lk aloi d is itself q uite sol uble i n water ) .

Aloinum P recipitated by tanni c aci d ; b ut as al oin i s al

.

most in variably prescribe d i n p ill or caps ul e form i t is h ard ly ,

nec essa ry to consi d e r its allege d i ncompatibilities .

Alumen A lumini e t P otassii o r A lumin i e t A mmonn S ul

.

pb as 1 A l um is incompatible with t h e alkaline hy drates and

. .

thei r carbonates and lime water a l umin um hy droxi de being ,

prec i pita ted 2 Wit h borax al umin um borate ( and some

. .
,

h ydro x i de ) be in g p recipitated It h as al l the i ncompatibi l i .

ties of the so l uble s ulph ates .

Aly pin 1 T h is l ocal anesthetic being i n the nat ure of an

. .

alkaloid is precipitate d by alka l ine hy droxi des and carbonates

and by m ost of t h e alkaloi da l reagents or p recipi tants 2 A s . .

t h e alypin or d ina rily used i s alypin hy drochlori d e i t gives ,

n at ura l ly a preci pitate w ith silver nitrate W h en i t is de .

sired to p rescribe alypin w ith silve r n itrate a l ypin n i trate , ,

which is also obta inable sho ul d be ordere d ,

.

Amy li N itris A my l Nitri te A s amy l n itrite is now dis

. .

p e nsed exc l usive l y by itse l f in the form of glass p earls it is , ,

us e l ess to d isc uss its incompat ibi l ities .

Antipy rina 1 With ferri c c h lori de eit h e r i n th e form of

. .

so l uti on or t in ct ure and othe r fe rric salts antipyrin e gives

a d ee p— red co l or ( Not w ith the sol ution of ferri c citro
.

ch l ori d e un l ess a min era l aci d i s a dde d ) 2 Wit h calomel

,
. .
,

partic ularly in the presence o f moist ure an d of so di um bicar

bonate a smal l p a rt of the calomel is c onve rted into merc uric
,

chlori d e 3 With spiri t of ni trous ether a b ea utiful green

. .

co l or is forme d ; i f th e spirit is neut ra l in re action the form a ,

ti on of th e co l or is de l ayed and t h e a ddition o f a crystal of

p ot assi um bica r bon ate m ay de l ay reaction for severa l days .
224 P R E S C R IPT ION INC O MP A T IBILI T I E S
T h is green compo un d which is iso nit r oso antipyrine is c on - -

, ,

tr ar y to prevalent belief h ar d ly if at all poisono us 4 R ubbe d

,
. .

wit h hy drate d c h loral p h enol p iperazine o r sod i um salicy

, ,

l ate a soft mass or li qui d is fo rme d

,
.

Ar g e nti N it ras Silver nitrate i s a d elicate chem ical and

.

is easily d ecomp ose d by l ig h t an d i n co nt act wit h organic

matte r It s h o uld always be kept i n amber col ore d or bl ue
.

bottles I t is best p rescribe d alone d issolve d in d ist illed

.

and fres h ly boile d water Its principa l i ncomp atibilities are

.

sol uble c h lori d es w h ic h a t once p recipitate silve r c hl ori de

, ,

borax ( silver borate precipitating ) and ta nnic aci d ( p recip i

tate of silver tannate ) .

Ar g onin Silver Casein It is incompatib l e a precipitate

. .
,

being forme d wit h : silver n itrate zin c s ul p h ate c arbo l i c aci d

, , , ,

tannic aci d and lead acetate .

Aris tol Se e Thy molis I od idum

.
.

A rgy r o l Incompatibl e with zin c s ul p h at e l ea d acetate

.
,

and tanni c aci d a precipitate being fo r me d

, .

A s argyrol stains t h e ski n an d linen ba dly it i s wel l to ,

know t h at t h e s tains are q uickly and comp l etely remove d by

a sol ution of merc uric c h lori de .

Arse ni I odi dum A rsenic io di d e sho ul d not be prescribe d

.

in sol ution wit h alkal oi dal salts as m any of t h em are p r e cip i ,

tate d .

A rse ni Triox idum Incompatib l e with dia l yzed i ron and

. 1 .

some ot h e r ferric salts d ue to t h e fo rm ation of t h e insol uble

,

b asic ferric arsenite 2 Incompatible with hypophosphites

. .

in aci d sol ution and h y pop h osp h oro us aci d beca use re duced ,

to metalli c a rsenic 3 Sai d to be i ncompatible wit h strych

. .

nine salts precipitating strychnine arsenite

, .

Asapr o l Calci um Beta Nap h thol S ul p h onate 1 Is d ecom

. -

. .

pose d by mineral aci ds beta nap h t h ol being precip itated ,

-

2 With sol ution of antipyrine a p recipitate is fo r me d

.
.

A uri et S odii Chloridum G ol d and so d i um chlori d e sho ul d .

best be pre scribe d alone and preferably i n pill form 1 I t , . .

is apt to precipi tate al kaloids b ut such p r ecipita tion may ,

226 P R E SC R IPTI ON INC O MP AT I B IL IT I E S

unchange d for a long time 4 Wit h an a queo us sol ution of . .

tannic aci d it gra dually fo r ms t h e yellow tannate of b ism ut h .

5 T h e same is tr ue of gallic aci d

.
.

Cafi eina It is well to kn ow t h at th e sol ubility of ca ffeine

'

and its salts is increase d by t h e p resence of so d i um salicylate ,

so di um benzoate and antipyrine It is for t h is reason t h at for .

h ypo dermic and intravenous inj ecti ons we general ly use

“
d o uble
”
salts of ca ffeine s uc h as cafi e ine so di um salicylate ,
-
.

Cal ci um B e tanap htho l S u

-
l pho nat e See Asaprol . .

Cal x S ulphurata S ulp h urate d lime i s incompatib l e with

.

minera l aci ds which decompose it forming hy dr ogen sul

, ,

p hide et c
,
.

Camph ora 1 C amp h or forms a li q ui d o r soft m ass wh en

. .

trit urated wit h c h loral p h enol guaiacol carbonate betol an , , , ,

tip y r ine or t h ymol 2 Water a dde d to an alcoh ol ic sol ution

. .

of camp h or ( sp irit of camp h or ) t h rows t h e cam p h or out of

sol ution 3 A strong sol ution of a sal t s uc h as potassi um
. .
,

bromi de in camphor water wil l t h row t h e camp h or out of

, ,

sol ution .

Campho r a Monob romata Monobromate d camphor forms a

. .

li qui d or soft mass w h en trit urate d wit h chloral phenol salo l , ,

o r t h ymo l .

Gar b o C h arcoal is best not prescribe d i n m i xt ures con

.

taining al k aloi d s gl ucosi des or tannic acid as it is apt to

, ,

precipitate t h em .

Car bo nates 1 T h e alkal ine carbonates act practica l ly as

. .

the correspon ding h y droxi des in precipitatin g alkaloi ds etc ,

.

2 T h ey give an e ffervescence wit h a l l aci d s ( wit h t h e ex

.

cep tion of hy drocyani c acid ) wit h t h e liberation of carbon

dioxi de 3 T h ey form precipitates wit h sol uble salts of mag

. .

ne sium calci um bari um stronti um iron m anganese silver

, , , , , , ,

al umin um antimony copper and zi nc

, , .

Ch l oralamide See Chlor alformamidum .

.

Chlor alforma mi dum C hlor alamid e F orms a soft m ass i f . .

r ubbe d wit h antipyrine ment h ol or camp h or , .

Chl or al um Hy dratum Hy drate d Ch l oral Chlora l Hy .

.
 ALP HAB E T I C AL S UMM ARY 227

drate 1 When rubbed with campho r fo rms a thi ck c l ear

. .
,

li quid : camphor c h loral 2 F orms a li qui d or soft mass w h en

-

. .

trit ur ate d wit h any of the following : p h enol guaiacol car ,

bo na te q uinine s ulp h ate t ri onal agur in hedonal

, , , , .

Chloretone 1 F orms a liq ui d o r soft mass if trit urate d

. .

with phe nol menthol anti pyrin e ( a l so ex algin or euphor in )

, , .

2 Said to be decompose d by alkalies an d aci ds

. .

Chinosol Ox y quino lin S ulphate

. 1 A n a queo us sol ution . .

gi ves a precipitate wit h alkaline hy droxides and soap so l u

tion . 2 Incompat ible wit h merc uric chlori d e
. .

Chl orates 1 C h lorates are strong oxi d izers and sho uld
. .

not be t rit urated o r heate d wit h any oxi dizable s ubstance ,

s uch as t h e following : c h arcoal s ugar s ul ph ur s ul phi des , , ,

and s ulphites t h ios ul p h ates hypophosphites nitrites ( l)

, re , , ,

duce d i ron io d ine tannic aci d gall ic aci d salicylic aci d

, , , , ,

phenol starch lycopod i um Nor s h o ul d t h ey be trit urate d i n

, ,
.

the dry state w ith glycerin and h oney ; in the p resence of

wate r however t h e m ixt ure is q uite safe 2 W h en h y d ro
, , . .

chl ori c aci d is ad de d t o a c h lorate free c h lorine is given off ,

an d a n umbe r of oxi d es of c h lorine a re formed .

Chromii Triox idum Chromic A cid Absol utely incomp ati . .

bl e with alcoh ol et h er glyceri n and other organic so l vents , , ,

d ecompositio n taking pl ace sometimes with d angero us vio

l ence ( exp losi on ) Incompatible w it h hydrogen dioxide . .

Citr ophen See P ar ap henetidin C itrate

. .

Cocaina Asi d e fro m the us ua l alkaloidal incompatibi lities

.
,

i t is well t o know that an ointment of yel l ow merc uric oxid e

and c oc a ine h y d roc h lori d e s uc h as is not infre q uently pre ,

s cribed fo r i nfl ame d eyeli ds i s apt to be more irritating ,

than th e o intment of the merc uric oxi d e a l one witho ut t h e ,

coca ine T h is is due t o t h e fact t h at t h e cocaine hydro

.

chlorid e probably form s some merc uric c h lori de .

Cod eina 1 C odeine is precipi tate d by m ost of the alk a

. .

loidal precipitants b ut not by the alkaline carbon ates and ,

bicarbonates 2 It is us ua l ly state d t h at co deine is incomp ati

. .

b l e w ith some ammoni um sa l ts s uch as ammonium c hl or ide , ,

228 P R E SC R IPT ION INC O MP A T I BILI T I E S
beca use ammoni a is liberate d T h is is a p urely t h eoretica l .

incompatibility Ammoni um c h lorid e and co d eine h ave been

.

prescribe d for years in tens of t h o usan ds of p rescriptions , ,

and may cont in ue to be p rescribe d witho ut any fear o r ap p r e

hension .

ll
Co o dium co urse collo di um m ust not be mixed
. 1 . Oi
wit h water as t h e gun cotton will at once p recipitate from
,
-

its alco h ol et h e r menstr uum 2 A mmonia water also gives

-
. .

a precipitate 3 A gelatino us mass is formed w ith pheno l

. .

and with a n excess of creosote 4 T h e tinct ure of io dine of . .

t h e present p h armacopeias i e one t h at con tains potassi um ,

. .
,

io di de may be mixe d with collo d ion wit h o ut p recipitation

,
.

Cr e osot i Car bo nas Cr eosotal C reosote carbonate i s sel

. .

dom prescribe d wit h ingredients wit h w h ich it is incompatib l e .

Cre osotum 1 Creosote gives a b l uis h or violet bl ue color

. .
-

with ferri c salts ; t h e colo r c h anges to greenish and t h en di rty

brown ; us ually unless t h e sol utions a re very d i l ute there is
, ,

also a brown precipitate 2 F orms a wh ite p recipitate wi t h . .

sol ution of lea d s ubacetate 3 I f present in co nsiderab l e ex . .

cess forms a gelatino us mass w it h c ollo d ion .

Diacety lmorphinae Hy dr ochloridum H eroin Hy dr ochlo .

rid e Heroin being an alkaloi d h as t h e us ua l alkaloi dal in

.

compatibilities It is state d that bot h alkalies and acids rea d

.

ily convert it into morp h ine .

Diur etin See Theob r ominae So d io S alicy las

. -

E pine phrin A d renalin S uprarena l in S upraren in S upra

.
, , ,

cap sulin A d n e p h
, r in E pinephrin is one of t h ose s ubstances
.

that are best p rescribe d alone It gets rea d ily decomp ose d .

and worth less in t h e presence o f oxi d izing agents It s h o ul d .

not be prescribe d wit h silver nit rate merc uric chl ori de hy , ,

d rogen d ioxi d e etc W h enever a sol ution of a d renalin has

, .

ac q uire d a brown r e d or even pink color i t has become

, , ,

deteriorated and s h o ul d be d iscar de d

'

E x algin Met h yl A cetanili d

.
F orm s a soft m ass wh en .

r ubbe d with phenol mentho l hydrated ch l ora l r es orcin

'

, , , ,

sa l icy l i c acid
23 0 P R E S C R IP T ION INC O MP A T IB IL IT I E S
so di um h y droxi de ( b ut not ammo ni um h y d roxi de ) cause a
precipitate of ferric h y d roxi de .

F e rri Py r ophosphas ( S o lub ilis ) E veryt h ing said abo ut

.

ferric p h osp h ate applies to ferric pyrop h osp h ate .

F e rr ous S al t s T h ere are b ut two ferro us salts offi cial the

.
,

sacc h arate d carbonate and t h e s ulp h ate ; t h e first is always

prescribed i n t h e dry state ( in the for m of pow de rs pills o r ,

caps ules ) and t h e secon d almost always ; so t h e probability of

coming across any i ncompatibles of ferro us salts is very r e
mote .

F e rrum Me talli c I ron

. R e duced I ron
. R e duce d I ron .

m ust n ot be trit urate d with p otassi um permanganate or p otas

si um chlorate ; w h ile t h e d anger of an explosion is rat h er t e
mote still un der cert ai n circ umstance s i t may occ ur
,
.

F luidex tr acta Most fl uid extracts being ma de wit h al co h ol

.

and containing resino us o r ot h er extractive matters give a

precipitate w h en mixed wit h water .

Gl ucos ide s M any gl ucosid es are precipitate d by tannic

.

aci d and are as a r ule d ecomp ose d by aci ds and alkal ies
, .

Gly cer inum 1 Glycerin is absol ute l y incompatible with

. .

potassi um permanganate and c h romi c aci d 2 Wit h so di um . .

borate a complex reactio n occ urs glycerol borate and so di um

,

metaborate being forme d ( or as i t is claime d by some sod i um

, ,

glyceryl borate and g ly ce r ob or ic acid ) b ut for all t h at t h e,

two are not incompatible and may be sa fely p rescribe d to

get h er .

Gly ce ritum B orog ly cerini The bori c aci d is in chemica l

.

combination wit ht h e glycerin probably i n t h e fo rm of glycery l

,

borate ; on mixing i t wit h water i t i s dec ompose d and t h e ,

liberate d boric aci d m ay precip itat e out if t h ere is not suf ,

fi cie nt water to h ol d it i n sol ution .

Gly cer ophosphate s The only rea l incompatibility of the

.

gly cer Op hOS p hate s are t h e mineral aci ds w h ic h d ecompose ,

them wit h t h e liberation of glycerop h osp h ori c aci d T h e so .

d ium glycerop h osp h ate and t h e potassi um glycerop h osp h ate

are very de li quescent and ca nn ot be p resc ri be d in powde r o r
 A LP H A B E T I C A L S U MM A RY 23 1

caps ul e fo rm C alci um glycerop h osphat e is not de l i quescent

. .

Gly cy rrhizinum Ammoniatum T h is is decompose d by .

minera l aci ds glycyrrhizic aci d p recip itating and t h e sweet

, ,

tas te being c h ange d to bitter It s h o ul d therefore never be.

p rescribe d with s ulp h uri c aci d hy drochloric aci d etc , ,

.

Guaiacolis B enzoas B e nzosol

. D ecompose d by alka l ine .

hy d roxi d es in to guaiacol and a benzoate of t h e alkali .

Guaiacolis Car b o nas D uo ta l 1 F orms a soft mass when

. , .

r ubbed with c h loral hy d rate 2 Like ot h e r guaiaco l salts it

. .

is d ecomposed by alkali hy d roxi des being split into g uaiaco l ,

an d a carbonate of t h e alkali .

Guaiacolis S alicy las D ecompose d by alkaline h y d roxi des

.

into guaiacol and a salicylate of t h e a lkali .

Guaiacolum T h e incompatibilities are practically those of

.

c r eosote
.

He r oin See D iacety l morphine

. .

Hex amethy lenamina U rot ropin F ormin A minoform

.
, , ,

Cy stog e n .T h o ug h t h is d r ug is prescribe d i n enormo us

amo unts sti ll we know of no d r ugs wit h w h ic h i t is incomp ati
,

ble It is claime d t h at i t is d ecompose d by hot wate r b ut we

.
,

are not s ure even of t h is statement We h ave been or dering .

i t d issolve d i n hot water fo r a great many years and t h e dr ug ,

does not see m t o be i nj ure d t h ereby T h e only t h ing we want .

to ca uti on t h e patient abo ut is to take t h e hexa d issolve d i n or

followe d by a large amo un t of wate r as ot h erwise it m ay p rov e ,

i rritat ing t o t h e stomach .

Holocainae Hy dr ochl oridum Being a n alkaloi d i t h as the .

,

i ncompatibilities of all alkaloi ds .

Homatr opina Being an alkaloi d i t h as t h e incomp atib il

.

ities of al l alkaloi ds and partic ularly of atropine

,
.

Hy dr ar gy r um Ammoniatum is decomposed by pota ssi um

'

so d i um or calci um hy d roxi de ammoni a being se t free and t h e

,

yell ow mer cur ox y ammonium c h lorid e being forme d .

Hy drar gy r i Chloridum Corr osivum C orrosive s ublimat e .

has many i ncompatibilities 1 It migh t not inco rrectly b e

. .

stated that it is incom patibl e to a cert ai n exte nt with water ,

23 2 P R E S C R IP T ION I N C O MP A T IB IL IT I E S
beca use an a queo us so l ution of i t is grad ua ll y decomposed ,

being partly c h ange d into calomel A mmoni um c h lori de pre .

vents t h is change and for t h is reason corrosive s ublimate ,

tablets are generally m a de to contai n some ammoni um c h lori de .

Hy droc h loric citric or tartaric aci d also prevents t h e c h ange

,
.

2 The salt with w h ic h merc uri c c h loride is most fre quently

.

prescribe d is potassi um io di de Strictly speaking the com .

bination is incompatible beca us e r e d merc uric io di de is

,

forme d b ut t h is salt q uickly d issolves i n the excess of p otas

,

si um io d i de t h e d ouble salt potassio merc uric io di d e being

, ,
-

forme d ; and fro m a p ractical t h erape utic poin t of view t h e ,

combination is unobj ectionable 3 It is incompatible wit h the . .

hypop h osph ites as t h ey re duce t h e corrosive s ublimate to

calomel and event ually to metall ic merc ur y 4 I ncomp ati
, . .

ble wit h arsenites w h ich re d uce it to ca l omel and t h en to

,

metallic merc ury 5 I t is incom patible w ith be ca use it pre

. .
,

cip itates most alkaloi d al salts

,
6 It is i ncompatible wit h l im e
. .

water and wit h potassi um a nd so d i um h y d roxi de w h ic h p re

cip itate it as merc uric oxi d e or merc uric oxyc h lori d e 7 Am . .

moni a water and ammon i um carbonate p reci pitate it as

ammoniate d merc ury or merc uri c ammoni um c h lori de 8 . .

Potassi um carbonate or so d i um ca rbonate gi ves a precipi tate ,

consisting of a mixt ure of merc uri c o x yc h lori d e and merc uric

.

oxi de 9 Potassi um bicarbonate or so d i um bi carbonate also

. .

gives a precipitate fi r st w h ite then t urning to r ed of vario us

, , ,

ox y chlo r id e s of merc ury with a slig h t e t

,
fe r vesce nce 1 0 It is . .

incompatible wit h borax w h ich precipitates i t as merc uric

oxyc h lori de of a re dd is h brown color
, .

Hy drargy r i Chl oridum Mi te 1 A s calomel and io doform . .

are fre quently prescribe d toget h er i t is well to know that a ,

c h emical combination takes place between t h e two part ic ularly ,

i n t h e presence of moist ure some r ed merc uric io di de being

,

forme d T h is i s also tr ue of ot h er comp o un ds containing

.

io d ine such as aristol air ol and e ur op he n 2 Calomel sho uld

, , . .

not be prescribe d wit h cocaine o r cocaine h y d roc h lori d e in eye

salves , as a small amo u n t of m erc uri c chl orid e is f orm ed W hich
23 4 P R E S C R I P T IO N I NC O MP A T IBILIT I E S
I chth y o l .Ic h t h yol is c h emically ammoni um sulp hich
1 .

thy olate an d is d ecompose d by aci d s t h e sulp hichthy o lic o r

, ,

ichthy olsulp honic aci d p recipitating i n t h e form of a sticky

mass 2 I t gives a precipitate wit h potassi um io di de p otas
. . ,

si um bromi de zinc s ulph ate an d al um T h ese are really the

, ,
.

only i ncompatibilities of any pract ical impo rt ance T h e ot h e r .

so calle d incompatibilities are only s uch i n theo ry and need not

be taken into acco unt .

I odofor mum 1 Iod oform m ixe d wit h calome l may under

. .

certain circ umstances ( exposure to lig h t ) ente r into chemica l

action and for m some merc uric io d i de 2 I t is per h aps slowly . .

d ecompose d an d also d eod orize d by tanni c aci d 3 It is not . .

i ncompat ible wit h Balsam of Pe ru statements to t h e contrary ,

notwit h stan ding .

I odum Io d ine is p rescribe d practically in two forms on l y

.

t h at of t h e tinct ure and t h at of t h e ointment T h e t in ct ure .

of t h e present pharmacopeia contains potassi um i od i de and is

t h erefore rea dily miscib l e with wate r whic h was n ot th e case ,

wit h t h e tinct ure of io dine of the old p h armacopei as T h e .

t inct ure h as few incompatibilities 1 I t i s best to be careful . .

abo ut mixing it wit h ammonia water as t h ere is a possibility ,

— a sligh t one— o f io di de of nitrogen ” being formed w h ich ,

w h en i n t h e d ry state is highly explosive 2 With m etall ic . .

merc ury io dine combines t o for m fi r st merc uro us and t h en

merc uri c io d i d e T h is is a point of practical i mportance
.
,

beca use doctors often prescribe ung io di and ung hy d r ar gy r i . .

i n t h e same prescription and s uch a n ointment sometimes

,

proves high ly irritating and b urning due to the form ation ,

of merc uric io di de 3 Io dine w h en a dde d t o oi l of t urpent ine

. .

occasionally ca uses a violent reaction 4 Tinct ure of i odine . .

or L ugol s sol ution precipitates most alkaloids

’
.

L actophenin P h eneti din Lactate Incomp at ib l e with b e

. .
,

ca use decompose d b y aci ds and al k alies , .

L i quo r Ar se ni et Hy dr ar gy ri I odidi D on ovan s So l ution .

’
.

T h is d o ub le io d i de sol ution p recipitates nearly all alkaloids .

Li quor Cal ci s Lime wa ter .

A bsorb s c arbo n dioxi de fro m
.
 A LP HA B E T I C A L S U M M A RY 23 5

the ai r form ing ca l ci um carbonate w h ic h p recipitates S h o ul d

, .

t h e refore not be expose d t o t h e ai r Incompatible wit h n ume r .

o us s ubstances d isc usse d un d er t h ei r prope r h ea d ings

, .

Liq uor F ormaldehy di 1 F ormal d e h y d e is incompatible

. .

w ith hy d rogen d ioxi d e w h ich oxid izes i t to formi c aci d Io dine .

is c l aime d to do the same t h ing 2 I t is incompatible wit h . .

potassi um pe rmanganate and we take a d vantage of t h is in,

compatibility i n d isin fecting roo ms by the formal dehy d e

pe rm an ganate met h o d 3 Wit h ammonia form al de h y d e com
. .

b ines to form h examethylenamine It is for t h is reason t h at .

ammoni a water is an e ffi cient anti dote in poisoning with

form a ld ehy d e .

L i quor Hy dr og enu Diox idi W h ile h y d rogen dioxi de is a .

strong oxi dizing agent i t is s o sel dom prescribe d i n combin a

,

t ion t h at its importance as a n incompatible factor i s not very

,

great Many of the statement s mad e regar d ing it are not tr ue

. .

S o it is us ually st ate d t h at hy d rogen d ioxi de conve r ts calome l

i nto m erc uric ch l ori de ; this is not se ; t h e calomel un dergoes
no ch ange A few poin ts are important t o bear i n m in d 1 It
. . .

is absol utely incompatible with potassi um pe rmanganate 2 . .

I t is incompatible wit h carbolic acid 3 Incompatible with . .

form al dehy de 4 Its incompatibility w it h glycerin is myt h

. .

i ca l T h e two m ay very well be p rescribe d together

. .

Liquor P lumb i S ub acetatis 1 Wit h m ucilage of acacia it . .

fo rms a t h ick gelatino us mass if concentrate d ; i f dil ute d ,

-

st rin gy p ieces are formed Lea d acetate does n ot form a pre

.

cip itate with m ucilage of acacia 2 F orms a precip itate wit h . .

a strong sol ution of p h enol .

L i quor P otassii Ar senitis Besi d es t h e incompatibilities of .

a rse nites F owler s sol ution i s incompati b le wit h alkaloi ds

,
’
,

beca use i t contains some potassi um bicarbonate ( an d car

bonate ) .

L i th ium S al ts T h e only incompatibilities of practical im

.

portance of t h e l it h i um salts are potassi um so d i um and am ,

mo nium carbon ate and p h osp h ate T h ey give a p recipitate of .

l ithi um c arbonate and lithi um p h osp h ate .

23 6 P R E S C RIPT I O N INC O MP A T IB I LIT I E S
Magne si um S al t s T h e sol uble ma gnesi um salts pa rt ien
.
,

lar ly in concentrate d sol ution are precipitate d by the a lkalin e ,

h yd roxides ( as magnesi um h y droxi de ) by t h e a lkalin e car

b onate s ( as basic magnesi um c arbonate ) and by alka l ine p h os
p hates ( as magnesi um p h osp h ate ) .

Mel Honey is s uppose d to decompose borax with the liber

.

ation of boric acid b ut t h i s is no incompatibility b ut an ad

, ,

vantage and w h ile t h e well known old time p reparation of

,
-

mel b o d e
r is — h oney wit h borax — is becoming obsolete t h ere is ,

no h arm i n it and t h ere s h o ul d of c o urse be no hesitation in

,

d ispensin g it .

Me ntho l 1 W h en ment h ol is trit urate d w it h cam phor

. .
,

t h ymo l hy d rate d c h loral or resorcin the mixt ure becomes

, ,

li qui d 2 W h en water is a d d e d to a n alcoholic sol ution of

. .

ment h ol t h e ment h ol separates out i n t h e form of oily drops

,
.

Methy lis S ali cy las Met h yl salicylate o r oi l of swee t birch

.
,

or artifi cial oil of W intergreen gives a deep violet co l or wit h ,

ferri c salts .

Morphin a 1 B esi d e s the genera l in c omp atib i l iti es o f al

. .

k aloids morp h ine gives a bl ue c h angin g to dirty green color

, , ,

with ferric chlori de i n ne utral a q ueo us sol ution A ci d or .

alco h o l prevents this color reaction 2 It gives a ye l lowis h . .

color wit h spirit of nitro us ethe r 3 It is c laimed to be . .

oxi dize d by chlorates .

N ov o caine Novocaine being an a l kaloi d its sa l ts are pre

.
,

cip itate d l ike ot h er alka l oi d a l salts by a l k al ine hydroxides

, , ,

carbonates etc , .

Ol ea F ix a Fi xe d or F atty O ils
. 1 Th e us ual error of t h e . .

inexperience d d r uggist is that fi x e d oi l s are rea dily so l uble i n

or miscible wit hglycerin T h ey are n ot Nor are they sol uble . .

i n alco h ol t h e only exceptions being casto r oil and croton oil

, .

2 With alkaline h y droxi des fi x e d oils combin e and form so aps

.

or em ulsion like mixtures T h is is taken ad vantage of i n a

-

n umber of p h armace utical preparations .

Ol ea V olatilia V olatile or E ssenti al Oil s V olatile oils a re

.
.

sol uble in alcohol and only to a slight extent in wate r When .

23 8 P R E S C R IP T ION IN C O MP A T IB IL IT I E S
sho ul d therefore n ot be prescribed with a lkaloids as i t wo ul d ,

ca use their preci pitation 2 A s piperazine is hygr oscopic i t . .

sho uld not be prescribe d i n pow de r form 3 Partic ula r l y . .

with acetan ili d or antipyr ine i t is ap t to form a l i quid or soft

mass .

P epsinum Pepsin is consi dere d inc ompatib l e with alkalies

.
,

alco h ol and h y d roc h loric aci d of a h ig h er c oncentration t h an

,

per cent A ll those s ubstances on p rolonged contact are

.

s uppose d to destroy its di gest ive activity .

P er ox ida Peroxi des are incompatible with acids which de

.

compose t h em with t h e l iberation of hy d rogen peroxi de When .

d issolve d in water the same reaction takes place only m ore

, ,

sl owly .

P et r olat um 1 Petro l at um l i q ui d or so lid is not miscible

. .
, ,

with glycerin water or alcohol ; wit h t h e soli d petrolat um smal l

,

quantities of t h ose li quid s can be incorp orate d 2 In incor . .

p or ating alkaloi d s wit h petrolat um i t is best to use the free

al k aloi d s instea d of the alkaloi dal salts beca use t h e former are ,

sl igh tly so l uble in petrolat um b ut not t h e latter ,

.

P he noco ll Hy dr o chl orid e Phen ocol l is alka l oida l i n its .

character and h as t h e general incompatibilities o f the alka l oi ds .

P he nol C arbolic A ci d P h enylic A ci d 1 Incompat ible

. . . .

with collo dion forming a gelatino us m ass 2 Incompatible

,
. .

with hy d rogen d ioxi de becoming oxi dized t o pyrocatec h in , ,

h ydro quinone etc 3 Incompatible with potassi um perman

,
. .

ge nate becoming oxi dize d to oxalic acid an d carbon dioxide

,
.

4 Incompatible wit h nitric aci d becomin g conve rte d into

.
,

picri c aci d 5 It re duces silver salts 6 I n dil ute sol ution

. . . .

( 1 per cent ) i t gives a violet bl ue color wit h ferr ic salts

. .

7 P h enol fo r ms a li q ui d or a soft mass w h en trit urate d wit h

.

t h e following s ubstances : acetanili d antipyrin betanap h t h ol , , ,

camp h or monobromate d camp h or h y d rate d c h loral ment h o l

, , , ,

nap h th alene pyrogallol resorcin salol and t h ymol

, , ,
.

R emember t h at carboli c “ ”
aci d i s not an aci d and will n ot ,

for in stance l i b erate 0 0 2 from a carbonate or a bicarbonate .

Pheny lis S alicy las Being a sa l icy l ate it has the incompat
.
 A LP HA B E T I C AL S UMMARY 23 9

ib ilities of th e l att e r ; b ut it ge ne rally ne ed s fi rst to be di ssolved

in an alcoho l ic menst r uum before it deve l ops its reaction I t , .

forms a li q ui d or soft m ass when trit urate d wit h antipyrin

( d am p pow de r ) camp h or monobromate d camp h or c h loral
, , ,

hy d rate ex alg in nap h thalene p h enol t h ymol and uret h ane

, , , , .

P lumb i A ce tas 1 Incomp atible wit h pot assi um and sod i um

. .

hy dr oxide ( lea d hy d roxi d e ) potassi um and sodi um carbonate ,

( lea d carbonate ) borax ( lea d borate ) 2 Incompatible wit h

, . .

H2 8 0 4 o r s ol uble s ulp h ates wit h HCl or sol uble c h lori des , ,

wit h so l uble io d i des bromi des and p h osphates 3 Wit h tan

, . .

n ic aci d and pyrogallol 4 Wit h sol ub l e benzoates and sali . .

cy lates . 5 Wit h many alkaloi ds

. 6 Bot h on acco unt of chem . .

ica l reaction and the liberation of water of crystallization i t

forms a soft mass w h en r ubbe d wit h al um zinc s ul phate , ,

pheno l acetanili d o r sa l icyli c ac i d

, .

P otassii P ermanganas Potassi um perm anganate be l ongs

.

to t h ose few s ubstances in m e d icin e w h ic h sho ul d always be

presc ribed alone i f or de re d in a q ueo us sol ution It is very
,
.

easily acte d upon by a l arge n umber of chemicals and prae ,

tically by all or g anic s ubstances and i t i s partic ularly t h e ,

l atte r that m ust be avoi de d 1 It is incompatible w it h hy . .

drogen d ioxi de a very complex reaction taking place wit h t h e

, ,

res ult that bot h t h e permanganate and t h e d ioxi de are de

s troyed 2 I t is absol utely incompatible wit h glycerin alco
. .
,

ho l and carbolic aci d 3 It s h o ul d neve r be trit urate d as an

. .
,

explosion may res ult with sulp h ur c h arcoal s ugar tannic, , , ,

aci d picric aci d or ot h er organic s ubstances

,
.

P otassii et S odii Tar tras R oc h elle Salt P ractically al l . .

aci ds d ecom pose it combining wit h t h e so d i um ra d ical and

,

pota ssi um bita rtrate ( cream of ta rtar ) precipitating .

Pr otar g ol 1 Protargo l i n sol ution is precipitate d by zinc

. .

s ul phate lea d acetate merc uric chlori de al um and silver

, , , ,

n it rate 2 I t is best never to prescribe i t with al k aloi ds as a

. . ,

precipita te is apt to occ ur 3 The add ition of g ly cer m to . .

p rotargol i s reprehensible as a protargo l sol ution containing ,

glycerin is more i rritating than a p ure a q ueo us sol ution 4 . .

24 0 P R E SC R IP T ION I N C O MP A T IB IL IT I E S
Being an organi c compo und p r ota r go l is i ncompatib l e with ,

p otassi um permanganate .

Py rami d on 1 G ives a bl ue and violet color with spirit of

. .

nitro us et h er 2 Wit h a sol ution of q uinine b is ulphate it

. .

g ives a w h ite precipitate 3 If t rit urate d wit h hy d rat e d . .

c h loral it forms a soft m ass .

P y r o gall o l 1 Gives a p urple co l or wit h lime water w hich

. .
,

changes to d irty brown 2 G ives a w h ite prec ipitate gra dua l . .

ly t urning d ark with l ea d acetate 3 Absol utely incomp ati . .

ble wit h potassi um permanganate 4 I t forms a li q ui d or . .

soft mass w h en trit urate d wit h antipyrine camphor ph eno l , ,

or ment h o l .

Q ui ni na 1 Sol utions o f qui nine salts are incompatible

. .

with beca use p recipitate d b y sol uble acetates benzoate s

, , , ,

salicylates and tartrates

,
T h e c orrespon ding acids do not .

ca use a precipitate 2 A precip itate is also sai d to be given

. .

by resorcin 3 T rit urate d wit h t h ymol q uinine s ulp h ate

. .

p r od uces a soft mass 4 Of co urse sol utions of q uinine and

. .

its salts have all t h e general incompatibilities of alka l oi ds .

R e sor cino l 1 R esorcin eit h e r i n s ubstance or in sol ution

. .

t urns re dd is h t h e n dark when expose d to ai r an d ligh t 2 It

,
. .

precipitates a sol ution of q uinine s ulp h ate or b is ul p h ate 3 . .

Whe n trit urate d w it h acetanili d antipyrine camp h or cam , , ,

p h or monobromid e pheno l or me ntho l i t forms a li q uid o r soft

,

mass .

S al ol See P heny lis S alicy las

. .

S al oqu i nine T h is c h emical is i nsol uble in wate r b ut so l ub l e

.

in aci d s fro m w h ich aci d sol ution i t i s preci pitated by alkaline

,

h yd roxi des and carbonates and t h e other general alkaloi da l

precip itants .

S ant o ni n Santoni n i s practically i nsol uble i n water b ut is

.
,

sol uble in t h e presence of alkalies comb in ing wit h t h e latter ,

to form a santoninate It t urns yellow on expos ure to ligh t . .

A n a queo us sol ution of so d i um santoninate or any ot h er

santoninate is precipitate d by tannic aci d .

S apo Soap is general l y a lka l ine an d when p rescribe d as

.
,
242 P R E S C R I P T IO N I NC O MP A T I BILI T I E S
and pa rt ic ul arly io di d es liberating bromi ne and iodin e 4
,
. .

Wit h sod i um salicylate t h e mixt ure ac q uires a dark color 5 . .

Wit h tannic aci d and s ubstances containing t ann ic aci d s uc h ,

as b uc h u uva ursi t h ere is q ui te an evol ution of gas ( vario us

, ,

oxi de s of nitrogen ) and t h e bottle s h o ul d not be stop pered

unti l all t h e gas h as escape d Th ese reactions t ake place p rin
.

cip ally wit h a spirit h aving an aci d reaction b ut it is very rare ,

in dee d to fi nd a spirit of a perfectly ne utral reaction .

S pi rit us A mmoniae Ar omaticus When m ixe d with wate r .

or a q ueo us menstrua t urbi d ity res ults d ue t o t h e separation ,

of t h e oils It has all t h e i ncomp atibilities o f ammonia water

.

and ammoni um carbonate .

S p irit us Gly cery lis N itratis Nitroglyce ri n is so se l dom

.

p rescribed wit h ot h er dr ugs t h at t h ere is n o occ asi on to con

si der its incompatibilities I n fact it always s h o uld be pre
.

scribe d alone not only for pha r m ace utical or chemica1 b ut for
, .
,

t h erape utic reasons .

S t r o nti um Stronti um salts are p recipitated by a lka l i ne

.

hy droxi des and carbon ates so l uble p h ospha tes s ulph ates
, , ,

( chromates ) and citrates

, .

S try ch nina S ee A lkaloids Hy d roch l oric acid w ith a sol u

. .

tion of st ryc h n i ne hy d rochlo ri de is sai d to g ive a preci pitate .

B ut t h is can on l y refer to t h e strong h y d rochlori c aci d an d ,

s uc h a combination is not like l y ever to be met wit h i n p ractice .

S ulphonethy lmethanum T ri onal T h is h ypnotic is not

. .

likely to be prescribed with s ubstances wit h whic h i t form s l n

compatible combinations O ne migh t remembe r t h at if trit
.

ur ate d wit h hydrate d ch l ora l or urethane a soft mass wil l r e

s ul t.

S ulphonmethanum S ul phona l T his is a very stable sub

. .

stance and we kno w of no incompatibilities I t is claime d to .

li quefy w h en trit urate d with hy d rate d chloral .

S ul ph ur T h e only t h ing i n i ncompatibilities to remember

.

abo ut s ulp h ur is not to trit urate it wit h a strong oxi d iz er s uch ,

as potassi um permanganate or po tassi um chlorate A h ex .

plosion may occ ur .

 A LP HAB E T I C AL S U MM A RY 43

Theob r ominae S odio A ce tas A gur in 1 Incompatible wit

-
. . . h
, l
aci ds which sp i t up the salt 2 B eing alkaline i t is apt to . .

precipitate some of the a lkaloids from the sol utions of thei r

salts .

Theob r ominae S odio S al icy las D iur etin -

1 Absol ute l y . . .

incompatib l e wit h aci d s which S plit up t h e salt 2 B e ing . .

a l kal ine i t is apt to precipitate some of t h e alkaloi d s 3 Being . .

a sa licylate it has the incompatibilities of a sa li cylate .

Thy mol Whe n rubbed w it h aceta ni l i d antipyrin camphor

.
, , ,

monobromated camp h o r ca rboli c aci d hy drate d c h loral men

, , ,

tho l sa lol or q ui n ine s ulphate thym o l fo r ms a li q ui d or a s oft

, , ,

Thy molis I odidum A ristol 1 I t is not advisable to

. .

tr i tura te i t st rongly with ca l omel as the l iberate d io d ine may ,

conve rt a portio n of the calomel i nto merc uric io di de 2 Con . .

trar y to ca rel ess statements i t is q uite compatible wit h starc h

,
.

Tinctura I odi T h e old p h armacopeial tinct ure wo ul d give

.

a p rec ipi ta te when m ixe d with water or a q ueo us preparations .

Th e t inct ure of the new pharmacopeia h owever containing as , ,

i t d oes po t assi um iodi de is perfect l y m iscib l e wit h a queo us

,

me nst rua Of co urse t h e tinct ure has t h e i ncompatibilities of

.

iodine and p otass i um io did e ( q modifi ed by the alcoho l

. .

Trini tr ophe nol See A ci dum P icr icum. .

Trional S e e S ulp honethy lme thanum

. .

Urea I t is not l ike l y that ure a wil l be p rescribed in com

.

b inatio n with othe r s ubstances b ut we might mention that ,

when trit ura ted with hydrated chl ora l it pr od uces a soft mass
or a l i q ui d .

Zinc S al ts So l ub l e zi nc sa l ts are incompatib l e with solub l e

.

hy droxi d es ca rbonates phosph ates and with bo r ax Wit h

, , ,
.

tannic acid zin c sa l ts gi ve a p recipitate on l y in concentr ated

so l utio n .
24 6 IND E X
p
P r e scr i tion No
c omp chalk p owder
.

A ci dum sulp huricum arom . . water . 26 0

A ci dum sulp hur osum hydrog en pero x i de
A ci dum tannicum al um
ar gy ro l

b i smuth sub nitrate

copp e r as
+ + al um
morp hi ne sulphate
p otassi um chl orate
ot assi um perman anate
+ p g
so l o f li me ( li me w ater )
.

zi nc s ulph water .

Acetanili d resorci n
sp ir nitro us eth er
.

thymol res or ci n
A cetozone water
A ce tp hene tidinum e x alg in
'

+ t1
'
. fe r ri c c hl o ri de
A cidol. S ee B e tainae H y dr o chl .

A conitinae itras
n co ll o di

A dre nali n chl or silver nitrate

.

hydrog en di oxi de
A dre nalini sol pi nole um
.

A g urin so d sali cyl . syr of lemo n. .

sp artei ne s ulp h syr up . .

A ir ol cal o me l

c al omel li me water
Al cohol ch romi c a ci d

A l k al oi dal salts olive oil

Alk al oi ds mer caur o

mercuri c hl ri de
p otassi um i odi de
c o

Al umen b or ax c o o o rm wate r hl r f
b or ax glyce ri n water
co p p er as tanni c aci d
+ l ead acet ate

+ le ad acetate ( in p owders )
+ li me water
+ so di u m b orate ( in p owder )
+ tanni c aci d
 IND E X 24 7
p
P r e scr i tio n N o .

A lyp inum sol ution

D ob e ll s ’
27 3
silver nitrate 27 2
Ammo nu b e nz o as tr fe rr i c . c hlori de 1 94
Ammonii carb o nas cal o me l 1 47
mo rp h in e sul ph ate 2
q uini n b isulph ate . 18
syr i p ecac . . 67
67
185
Ammo ni um su lph o i chthyol
-
. S ee I chthy o l .

Antikamnia an tipy ri n p he na ceti n t

ace an ili d p henal

mo rph s ulph . . q uin sul p h. aro m sul ph

. . . ao . .

Antim e t potass tartr

. . . tannic ac ( sy r wil d che r ry )
. .

Antipyri ne .ca lomel

calo mel so d . b icarb on .

res orcin ph enaceti n

s alol camphor
so di um sali cyl ate

spir nitro us ethe r

.

tannic a ci d ( ih syr wil d che rry ) .

tr fern c ch l o ri de
'

ammo ni ae coll o di o n

tr i odi ne
. s oap lini me nt
Aq ua ammoni ac fo rti or eth er co l lo di on tr . i odi ne
camp h or ae bromi des
Aq ua ci nnamomi ti nct of ferri c chl o ri de .

Aqua cr oto nis magnes s ul ph . .

Aq ua g aulthe riae tr of fer r i c ch l ori de .

organic bt e
s u s anc s 4 5, 4 6 ,
organi c s ub t es anc s ( in liq ui d for m)
! org ani c s ub tan s ces ( in p o w de r f orm)
24 8 I ND E X
p
P re scr i tion N o
lthea
.

45
p owd . a

protargo l l ead acet ate 35 3

s odi um b o rate 27 6
+
sodi um ch l o ri de 48
8 0 1 adre nali n ch l or 24 0
+ . .

5 0 1 p ota ss ar se nit e 77
+ . .

syr hyp o ph osph it es

. 20
Ar g onin ta nni c aci d 278
z inc s ul p hate
z inc sul p h le ad acet ate . b ismuth s ub nitrate
Argyrol mercuri c chl ori de
i odine
p otassi um i odi de
tanni c aci d
zinc sulph ate
A ristol S ee Thy molis I o didum
. .

A sap r ol nitr o hy dr ochlo r ac .

Aspiri n formi n S e e a lso A cidum A ce ty l S alicy licum

.

+ pot ass i o di de
.

+ q u i ni ne s u lp h ate
+ u r otro p i n

Atoph an urotr Op
'

Atr op inae s ulph as c ollodi o n

( ex cessive dose )
p otassi um i odi de
A uri et sodii chloridum sol p ota ssi um a rse nite .

AL S AMU M P eruvian um hy d x i de
B i odoform l ard
rog e n di o

B ar ii s ulph.

B etainae hy dr o chlo r idum pepsin

B ismuthi et a mmo nii citras hydrochlori c ac id
hy dr ochlor a ci d pep si n .

B ismuthi salicy las hydrochloric aci d

mi st r hei e t so dae
.

so di um b icarb onate
B ismuthi sub nitr as ca lci ne d magnesi a
+ p o tassi um io di de
+ sod b icar b on
.
.
250 IN D E X
p
P re scr i ti o n N o
c amphor chloral
.

Cocainae ~
hy drochloridum 38 1
ll odi on
co 21
liq ui d petrolatum 99
morph s ulph . atro p ine s ul ph
. petrolat um .

picri c a ci d
q ui n s ulph . tannic ao . menthol rose wate r . .

s odi um b or ate
Codein a ammon chlori de .

Collodi um alk aloi dal sa lts

ammoni a water
a mmoni a water ether tr io dine .

cre os ote
phenol
tr i odi ne
.

zinc chlori de
Creosoti carb onas q uin hy drob r om camph or monob ro m
. . .

ergot in
Cr eosotum b al sam tolu
coll odion
g uai acol ( in pil ls )
g uai acol cr eosotal duotal thiocol ( ih powders )
tr ferric chlori de
.

Cupri s ulph as g alli c aci d

s odi um b icarb onate

E R MA TOL nitrohydrochloric acid

D Diur etinum . S ee The o b r o m . S odio S alicy las
-

Diuretinum ph osph oric aci d

sol iro n a nd ammon
. . ace t .

tr fer ric ch lori de

.

water

P I N EP HR I N mercuric chlori de
E E ss p e p sini
. dil hy drochlor
. . ac. magma mag nesia .

E ur op hen a myl um
c ol d cre am
E x algin phenacetin
p henaceti n sod s ali cyl . .

E x t hyoscyam us
.
t anni c ac l ard .
 f’ re scr ip tio n N o .

54 1
Ferri et ammo nii citras p otass i odi de . 213
Ferri et quinina e citras potassi um iodi de 218
+ so l ammo niu
. m aceta te 1 60
Ferri 11 1
so L
+ ac phosphoric
. 11 2
P erri p y r o p hosp has + se p h osph or . . 83
P erri sulphas + gallic aci d 267
so d carbon
. . 3 24
Ferrum dialy satum sol pot assi um arse nite . 79
F l uidex t b uch u
. spir nit rous ether . 72
water 3 36
F luide x t cannab is indi ca e
. water 4
F luide x t g ly cy r r hiza e
. dil s ul ph ur ao . . . 58
F lui dex t hy oscy ami
.
po t ass b icar b o n water . . 3 36
F luidex t uvae ursi
. sp ir nitro us ether . 71

LY C ER I NU M gen di ox i deh yd
G
ro

liq ui d pe t ro l at um menth ol
o live o il me nthol

s odi um b or ate
sod. b or . so d . bi rb ca

Gly ce ritum ac . ta nnici + le ad acetate

so l. of lime

G uaiacol creoso te ( ih pill s)

A L A Z ON E t ab lets
He lmito l ta ss b icar b o n so l p ot ass hydr ox i de
p o . . . .
.

Her oma ammo n carb o n .sy r wil d cherry . .

h h q in h d h l cre ote a r b o nate

He ro ini y droc lo r u y . r oc o r o s .
c .

( in caps ules )
Hex ame thy le ami +
n n a s od i u m a ci d p h osp h ate o r sod 1 um b 1

Ho locainae hy droc hlo r . b or x a

252 IN D E X
P re scr i ti o n N o p
lphate
.

Hy drargy r i c hloridum corrosivu m argy r ol zinc su .

chinosol
epine ph rin
Fowl e r s s ol uti on’

hydr ogen diox i de

li me water
+ li m e wate r + le ad wate r

li me wate r + m u c of a cac i a .

p ot ass i odi de .

p otass i odi de . al k al o i ds

p ot ass i odi de . c omp syr sarsap . . .

potass i odi de . iron a nd a mm citrate tr n u x vom . .

comp tr ci nchona . .

p ota ss iod . tr ci nchona c omp . . .

p otass p e rmanganate
. c o mp sol cresol . .

p otass sulp hurata

.

+ pyro g allol

so d b orate
.

sol p ot ass arse nite

. .

syr hyp op hosph ites

.

tr i o di ne
.

Hy drar gy ri chlor idum mite + ammoni um carb o nate .

+ a mmo ni um chl ori de

anti pyri ne

antipyri ne so d b icar b o n . .

anti pyri ne s odi um b romi de s odi um ph osph ate

sod bi carb cafi eine citr
. . .

hydrochloric ac .

hydrogen di ox i de
+ i odi ne oi ntment
i odoform
li me water
potassi um b romi de
p otas si um chlorate
p otassi um chl orate b ism sub nitr . .

+ tassium iodide
p o

+ s ali cylic ac
+ lime wat e r .

+ 80 3 1) 0 0 0 0 0 0 o o . c o o o o o o o o o o o o o 0 0 0 . 0 0 0 . 0 0 0 0 0 0 0 0 0 0 0 0

+ s odium b i carbonate
 I NDtEX
p
P re scr i tio n N 0
hydrog n
.

e dioxi de 5
merc uri c chlori de lea d water 75
so d. be n z.

t annic ac id
Liq uor cre oso lis c mpo . merc ur i c chl o ri de pot ass perman
.

ga n
Liq uor ferri dialy sati m u c acacia syr ras pbe rry . . water
hydrogen diox ide
Liq uor hy droge nii diox idi adre nali n

b alsam of Pe ru
b ismuth s ub nitrate
calomel
ch romic aci d
ether i odoform
g lyceri n
hypochlorites
i odoform
i odo form olive oil
+ La b arr aq ue s so l uti o n
’

lime water
merc uric chlo ri de
phenol tr ferri c ch lo ri de .

potassa sulphur ata

p otassi um pe rma nganate
sol formal dehyde
.

s ul ph uro us aci d
syr hydriodic aci d
.

tr arni ca
. fl ex calen dul a . .

tr io di ne
.

zi nc s ulphate
Liq uor p lumb i sub acetatis + b o ric aci d
m u c acacia .

tr i um
. op

mercuric chl ori de lime wa te r

Li quor p otassii arse nitis
.

di alyz ed iro n
g ol d a nd s odi um ch l ori de
mercuri c ch l ori de
+ morp h i ne s ul ph ate
 IN D E X 255
p
P r e scr i tio n N O .

silver n itrate 77
417
syr f rro us i odi de
. e F o wle r s sol ut io n ’
elix . li saya
ca 1 15
syr ferro us i odi de
. tr nux vo mi ca . 21 0
tr ferr i c chl o ri de
.
81
Liq s odae chlo r in
. hydrog e n diox i de 1 48
Lithii citras s odi um phosph at 342
stro nti um b romi de 1 03

b i muth bnitrate
M A GNE S I I ox idum s su p a ncre ati n .

Magnesii s ul phas aq ua croto nis

sodi um phos phate
sp 1 r pe p pe rmi nt. wate r
Massa fe rri car b onatis + p ot assi um ca rb o nate
salicylic ac .

Menthol alcohol water

camph or

chlor e tone
i e hy droc hl
co ca n q ui n . . l
su p h . t anni c ac .

e ucalyptol zinc s ul p h . liq . alb o le ne

thymol e ucaly p tol c oc aine hy drochl . liq ui d pe

tro latum
Mer cauro s try c hn . s ulph atropi ne sul ph
. .

Mist r he i
. e t sod ae dil . hydrochl oric aci d
Mo r p hinae a ce ta s
of t urpe nti ne o il

Morp hinae hy dro chlor pot assi um cyani de .

Morp hinae sul phas ammoni um c arb o nat

a nti k am ni a q uin sulp ht aro m s ul ph . . . . ac.

Fo wl e r s s ol uti on ’

ol e i c aci d

pot
l ass h dr ox
so .
y . .

sy r . e
s neg a
256 IN D E X
p
P r e scr i ti o n N O
syr wil d cher ry
.

.
3
tannic aci d 1
tr cap sic um
. ether
tr fer ri c chl o ri de
.

acaciae so l l ea d s ub acetate
.

tr i odi ne
. al cohol

LE UM olivae gly ce
O O leum terebi nth morph acet . . .

Ole um tig lii 0 1 ri ci ni. glycerin

Ol e um ri ci ni g lyceri n
Orthoform olive oil "

AN CR EATI NUM hydro hl ric a ci d

P
di l . c o

pep si n dil hy drochlo r se

. . .

P ep sinum p a ncre ati n lacto p e p tine hy dr ochlor aci d .

mist r hei et s odae

.

ac h
.
y drochlor b ismuth and ammoni um citrate
.

alcoh oli c ti nct ures

b et ai ne hy drochlor .

+ m i x t rh u
.b a rb and so da

p ancre atin di l hy dr ochlor ac

. .

resorci n s alol
sodi um b i carb onate
P erox i de of hydro g e n S ee Li q H y dr og e nu D iam
. idi
. .

P e trol at um liquidum g lyceri n me nthol

P h enaceti n ex alg in

ex algin sod s ali cyl . .

P henol camph or

ca mp ho r chloral

coll odi o n
ex cessive q uantity
hydrog en dio xi de tr fe rric chlori de .

pota ssi um permanga nate

silver nit rate
thymol camph or b oric ac .

tr i odi ne
. m u c acaci a alcohol
.

Ph e ny lis salicy las ca mp h o r anti pyrin

spir nitro us e th er
. tr ferric ch l o ri de .
258 IN D E X
p
P re scr i tion
tartar i c aci d
ti nc o f fe rric
. chl i de
or

P o tassii p e r mang anos fe rr o us s ulphate dil . s ulph uric aci d .

g lyce r i n
hydrog en di x i de o

morp h ul ph . ext s . .
g ly cy rr .

org i s ub st n e ( i
an c a c s a pill fo rm )
phen l o

pyro g all ol
sa li cyli c aci d
silver nitrate

tannic aci d
thymol al coh ol

P otassn e t so d11 t ar iras ac id alco h o l

arom s ul ph ur s e
. . .

fe rr ic chlo ri de
+ t r .

P rotargo l cocai ne h y drochlor .

l e a d a cet ate silver nitrate

wate r
zi nc s ulphate
P ulvis cre ta e c o mp eli xir of vitriol
.

Pu l v t hei comp + dil hy dr ochlor s e

. . . .

Pyrami don b rome to ue

spir nitr o us ether
.

Pyr ogallol mercuric chlo ri de

p ot assi um permanganate

UI N IN AE b isul phas . ammoni um carbonate

resorcin
sod i um b enz o ate
umina e hy dr ochloridum ammoni um carb o na te
uinin . sulph as aci d s ulph dil . fl uid ext g lycyrr hiza
. .

aspi ri n
arom spir ammo ni a
. tr ferr ic chlo ri de
. .

potassi um i odi de dil s ul p h ur a ci d . .

p ot ass i odi de
. tarta ric aci d
sod acet ate
. dil s ulph ac . . .

sodi u m be nz oate
 IN DE X 259
Dr L 8 cr 1Dti N
+ sod . sali cyl + d11 sul ph ur di l
. . .
: 2 9
ferric chlo ride + dil s ulph aci d
. .

+ tr .
. .
34

R
ES OR CIN OL aosta ni
aceta nili d thymol
antipyrine ph ena cetin
b e nzo inol
g lyce rin

pe tr olat um liq uidam

ALI C IN UM q uin s ul ph s ul ph uric

S di l se
. . .

S alifo r min water

S alol . S ee P hefl y l S alicy las .

S a10 phen so di um b ica r bo na te

S anto ninum calomel

S a po c alomel
S hot g un prescripti on ex am ple o f ,

ace tas q uin s ulph dil s ul ph uric a ci d

. . .

b e nzo as q uin bisulp h .

dil phos p h
. . ac . syr . of lemo n

quinine s ulph .

syrup of lemon sy r . o f cit ric id

ac

tr ferric c hlo ri de
.

ac . salicy l
.

stronti um b ro mi de
h
o ras acacia sy rup water
acacia water
ac sa li cyl
.
g lyce rin . water

alum ( ih powder ) .
260 I NDE X
p
P re scr i tio n
lead acetate
le ad acetate g lyce ri n
sod b icarb
.
g ly ce ri n .

zinc s ulph ate g lyceri n

S od1 1 b romi dum camphor w ater
S odii l
g y ce rino p hosp has — in powders
q ui n s ulph + stry chn s ulph ( in pills )
. . . .

S o d1 1 hy p osulp his S e e S odii Thiosulp has

. .

S odii iodidum el ix iro n, q uinine st ryc nine p hosp h

. a nd h .

S odii p erb oras water

S od11 p hosp has lith i um citrate
mag n . s ulph .

Sod 1 1 salicy las antip y ri

citrated ca ffe ine

citric a ci d sy r o f rasp b erry .

dil s ulph ac
. . .

dil s ulph ac
. q uin s ulph . . . .

hex a spir nitro us ether «1» water .

sodi um b ic arb onate

spir nitro us ether
.

syrup o f lemon
sy r of r asp b erry
.

tr ferr ic ch lori de
.

sulp h is hydrochloric s e .

S od11 thiosulphas potass chlorate .

s ulphuric aci d
S ol Magendie Fowler s sol ution
.
’

potass io di de .

S ol mor phin ae s ulph

. .

S p arteinae sulphas ( in tab lets )

S pir aetheris nitrosi
. aceta nili d
antipyrin
H ext b uchu
. .

i odi des
mo rph s ulph . .

pot assi um i odi de

p y r amidan
sod sali cyl
. .
262 I ND E X
p
P re scri tio n N o .

HE OBR OMI NA E S OB I I -
salicy las aci ds
mercuric chl ori de po tassi um i odi de .

tr of i ron
.

Th eo b romine so di um
-
acetate sp art eine sulph syru p .

stry chn s ul ph
. .

Thymol acet anili d resorcin

camph or pheno l bo ric ao .

Thymolis iodidum cal om e l

starch
Ti nct ura di gitalis tr ferric chl or i de .

tr stroph anth us
. spa rtei ne s ulph stry chn sulph . . . 3 74
Ti nct ura ferri chloridi ammon be nz oate so d be nz oa t e . . .

ammo n tr vale r ian

. .

anti pyrin

cinn amon water

creoso t e water

hyp ophosphites
methyl s ali cyl .

m uc c i . syrupa ac a water
oil of W intergreen
phena cetin
phenol hydrogen diox i de
p otassi um b romi de
pota ssi um io di de
q uin s ulph arom spir ammonia
. . . .

re so rci n

sa lol spir ni tro us ether .

sodi um b romi de

sod salicylate
.

sol ammon a ce tate

. .

sol arseni c triox i de

. q uin s ulph inf cinch ona . . .

sol p ot ass arse nite

. .

spir pi me nta
.

sy r hypophosphites water
.

tr ci ncho na
.

tr digit alis
.

r genti an
+ t .

tr . n ux vom tr digital is q uin sulph sod

. . . . . .

s ali c l aro m s ir a mmo nia . .

 I NDE X 26 3
p
P re scri ti on N o .

Tinct ur a guaiaci water 11

Tinctura i od i alb o le ne 525
ammoni a water 526
ammo ni a water s o ap li ni me nt 33 9
coll odi o n 31 5
g ly ce ri n wate 1 29
1 92
merc uri c i de c hl or 41 4
so l lea d
. sub a cet at e 3 82
Tinct ur a nucis v o m cha rcoa l . 3 04
comp tr o f ge nti an
. . 41 8
F owle r s so l utio n sy r fe rro us i odi de eli x cali saya
’
. . 1 15
tr di g i ta li s
. tr fe rr ic chl ori de ph osph o ric ao
. .

Tinct ura O pi l so l le a d sub ac e t ate .

Tinct ura valerianae ammoniata + tr fe rri c . chl or i de

T rinitrophenol S ee A cidum P icricum
. .

s ul phonal ur et hane

U reth n
a trio nal s ulphonal

I N CI chlor idu m collod ion

p hosp hidum p h o ph
s or ic a ci d

+ b ism . sub nitr . + lead water + liver o f s ul ph ur

le ad acet ate
+ l ea d acetate ( ia powder form )
liq alb o lene
.

sod . b o ra te
 B I R TH C OR

Th
eLimitation ofOffspring by
th
e Prevention of Conception
BY

W ILLI AM J R O BI NSO N , M D . . .

With an I ntroduction by

A JAC O B I ,
. MD . .
, LL D. .

E x P n n da d of The A merican M edical A ssocia te .

'
-

All the arguments fo r and aga inst the v o untary l

limit atio n o f o ffspring or b irt h co nt ro concentrat e d in l
one b oo k o f 2 50 page s .

T he Limit atio n o f Ofl spring is now the b urning

questi on o f t he day I t has b e e n mad e so b y Dr Wil l i am
. .

J R obin so n who was a pi o n ee r in this count ry to demand

.
,

that p e op l e b e pe rmitt e d to o bt ain the kn o w l e dge how to

l imit the numb er of their chil dr en how to pre v ent con ,

ce ption whe n n ec essary F o r many ye a rs he fough t

.

practi ca ll y al one ; his pro pagan da has mad e h undreds of

ou —
t h sands of conv e r ts now the gro und is pre p are d and
the pe op l e are re ad y to liste n .

Written in pl ain po p ul ar l an guage . Ab oo k

whi ch
e very b o dy intereste d in hi s o wn w e lfare and the w elfar e

of the r ace sh ou l d re ad .

P R I CE

THE C R I T I C A ND G U I D E CO .

12 MT MO RR I S
. PA RK w NEW Y O R K
 Dr R ob inson s work de als with man ’

y phase s of
.

the se x q ue stio n b othin the ir individual and social as

,

pe e ts . I n this b ook the scie ntifi c k no wle dge of a

h
p y sicia n ,
e mine nt as a sp ecialist in e v e ry t hing p er
tain in g to the p hy sio log ical and me dical side of the se
to p ics, is comb ine d with the v igo ro us so cial v iews
of a thin ke r who has r adical ide as and is n o t afr aid
to giv e the m o utsp ok e n e x p re ssio n .

A fe w of the su b jects which the h

aut o r discusse s
in tre nchant fashio n are

The R e la tio ns Be twee n the S e e s and Ma n s I nhumanity x ’

to W o ma n The I nflue nce o f A stine nce o n M an s S e ual b ’

x
x
Health a nd S e ual Po we r — The Do u le S ta ndar d o f M ora lity b
.

fec t o f C o ntine nce o n Ea chS e x — The Limita tio n o f

.

and th e Ef
Ofi sp the M os t I mp o r ta nt I mmedia te S te p fo r th e B e tte r

me nt o the Huma n Race , fro m an E co no mic and E uge nie

S tandpo int W ha t To Do W ith the P ros titute a nd Ho w To
Ab o lishVe ne real D is ease —The Q ue stio n o f Ab o rtio n Co nside red
.

I n I ts E thica l and S oc ia l Aspe c ts Tortur ing the W ife When

.

the Hus b and I s At F a ult I nfl ue nce o f the Pros ta te o n Man s

’

—
.

Me nta l Co nditio n The Most E ffi cie nt Ve ne re al Prop hy la ctics

.
,

e tc . . e tc .

“
S EXUAL PROBLEMS O F TO DAY w ill give -

most of its reade rs information they ne v er possesse d

b e fo re and ide as the y ne v er had b efore or if they

had , ne v er he ar d the m pub licly ex pre sse d b efore .

C lo th b o und 3 2 0 P a g e s , 3 2 P o s tp a id
-
,

THE C R I T I C A ND G U I DE co .

12 M T MO RR I S
. PAR K W . NEW YO R K
 FO R MEN A ND W O MEN
By W I LLI AM J . R O B I NS O N , M D . .

I llustra te d

This is one of the mo s t imp ortant, most usefu l

b ook s th at we h av e e v e r b ro ug h t o ut I t is no t de .

v o t e d to ab s trus e d is cu ssi o ns or d o ub t fu th e o ries : it l

ll
is fu of p ractica l i nformati o n of vital i mp ortance to
e v e r y woman and t h ro ugh h e r to e v e r y man, to e v e r y
wife and t hro ughher to e v e ry hus b and .

l l
The si mp e p ract i ca p o i nts cont a i ned in its p ages
l ll
wou d r e nde r mi i ons of h ome s h app i er ab o d es th an
th ey are no w ; t he y wou d p re v e nt the d isrup tion of l
l
many a fami y ; the y sh ow how to h o d the ove of a l l
man how to p res e rv e se xua a t t ract ion, how to re l
ll ll
,

mai n oung b e y ond the us ua y a o t t e d age Th is .

b ook estroy s many i nj ur i ous e rrors and sup e rs titi ons

and t each e s truth s th at h a v e ne v e r b ee n p rese nte d in
any o t h e r b ook b efore I n sh or t this b oo k not on y
.
, l
i mp arts i nt e r e s t i ng facts ; it gi v es p ractical p o i nts
ll
wh i ch wi mak e t h ous ands of wo me n, and th o usand s
l
of me n h a pp ie r h e a th ie r , and more satisfi ed with ife
, l .

l
C e r t ai n si ng e ch ap t e rs or e v en p ara gra p hs ar e a one l
wort h the p ri ce o f the b o ok .

l
Y ou may safe y or d e r the b ook with out d e ay B ut l .

l
if y ou wis h, a comp e te syno p s is of contents W i b e ll
sent v an .

Clo th b o und . P r ice

THE C R I T I C AND G U I DE C O .

12 MT MO RRIS PARK w
. ., NEW YO R K
 BIRTH CONTROL
[Pr a ct ic a l E ug e n ics]
By W I LLI AM J R OBI N S O N M D
.
, . .

One o f the b e st p ractical b o o k s fo r the g e ne r al

re ade r. I t do e s no t de al with chro mo so me s ,
—
unit chara cte rs de te rmine r s simp le x , d up le x
,

o r nullip le x he te ro zy go te s ho mo zy go te s, e tc
-
, .

N or do e s it hav e a wo r d to say a b o ut M e nde l s

’

swe e t p e a s I nte r e sting and imp o rtant as the se

.

things a re the y hav e b ut little re la tio n to human

,

here dity an d to the q ue stio ns : Ho w can we im

p r o v e the hum a n s to ck a nd wh o, sh o uld a n d
sh o uld no t mar ry ? The se p ractica l q ue stio ns
this b oo k tr ie s to answ e r He nce the sub title :
.

P ractical E uge nics .

2 0 8 p ag e s , clo th b o und . Pr ice

U N C O NT R O L L E D B R E ED I NG
OR

F E CU N DI TY vs . C I V I L I Z AT I O N
b
A contr i utio n to the study o f o v er p alatio n as the ca use
o f W ar and the ch b
ief o stacle to the ma ncipa tio n o f W o men
B y A DELY N E MO R E
W ith an I ntroduction b y Arno l d B enne tt and P re face and
N o te s b y W illia m J R o inso n M D
. b , . .

C lo th B o und , Pa p
e r, 60 0 .

THE C R ITI C A ND G U I D E CO .

1 2 MT MORRIS PAR K w
. NEW YO R K .
 A PRAC TI CAL TR EATI S E ON

THE CA U S ES , S Y MPT O MS A ND

TR E A TME N T O F
S EXUAL IMPOTENCE
An d O the r S e x ua l Diso rde rs in Me n a nd Wo me n
BY

W I LLIAM J . R O B I NS O N, MD . .

C hie f of t he De p a r t m e n t o f G e n it o U r in a r y Di se a s e s a n d De r m a t o lo g y
H
-
,

B ro n x os p i ta l and Di s p e n sa r y; E d i t o r T he A m e r ic a n J o ur n a l
of U ro lo g y , Ve n e r e a l an d Se x ua l D i s e a s e s ; E d i t o r a nd

F o un d e r f T he C r i t ic an d G u id e ; A ut ho r fS ua l
N
o o ex

Pr o b le m s o f To d a y; e ve r T o ld T a le s ;
P r a c t ica l E ug e n ics . e t c.

B R I EF S YN OP S I S OF C ON T T
EN S .

—M a stur b ati on I ts P r eval ence , C auses V e n e ti as S ymp toms,

R P art I
e sul ts, py
P ro h lax i s
.

and Tre atme nt C mtus I nte rr u tus

.
,

p ,

and i ts

P ar t I I —V ar letl e s C ause s and T re atme nt of P onution s, S p er mator

m torr hea and U rethrorr he a
,

rhea , P r o
p yp y
.

m S e x ual I m ote nce i n the M ale hase of i ts wi d e l

y p
P 11 1 -
E ve r .

var ing ca use s and tr e atme nt, wi th i ll uminating case r e ort s

p
.

—
S ex ual N e urasthe nl s C ause s, Tre atme nt, case r e ort s,
P ar t I V
p
.

and its r e lati o n to I m ote nce

y
.

P ar t V — S te ril i t , Mal e and F e male I ts C ause s and Tre atme nt

y
. .

P art 17 1 —
S e x ual D i sor d er s in W oman, I ncl udi n F r ig i d it , V agi ni s
m us , A d he r e nt C ll tod s, and I nj ur i e s to the P e n n e in C oi tus g
y Rp
.

P art V I I P — m
p l m E ti ol o g C a se e or ts and Tr e atme nt

p
s .

—
.
,

Ml sce ll aue ous To ics I ncluding : I s M asturb ation a

P art V I I I
— m u u
.

h P u f —
T
R B
w E j l t i n n o
—
V ice 7 T o K in d s o f P r e a t r e a c a o e re q e c
—
.

u "
u m The e latio n etwe e n e ntal
Oottnu
y
“
i
and S e x
.

ua
U
l
se
A
l
ct
e
i vi t
S
—
e x
B
a
tg
l E
F
x
a
c
m .
t
il
e
i e
e
s
nt
a n d S ex u al V 1g or S e x
.

u al P ea: .
—
ve r si ons.
P art I I — p
Pr e scr i ti ons and Mi nor P oints .

Thi r d e di t io n r e v i s e d a n d e n la r g e d .

Clo th b o und 4 22 p a g e s ,
. P o s tp a id .

THE C R l T l C A N D G U I DE C O M PA N Y
12 MT M O RR I.S P A R K w N E W Y O R K C I TY .
 THE DI S OR D E R S OF THE
S E X U AL S Y S TE M

He who throws l ight on t h e dark and in tricate

p rob l e ms of sex ,
he l ping to un ravel t h e myste r i es of

and to c ure t h e co mplex sex ua l d isorde rs doe s indeed

,

a signa l se rvice to h umanity .

We believe t h at in brin gin g out our l atest work ,

Sex ua l Impotence an d O t h e r Sex ua l D isor de rs in

Men and Women we h ave given the profe ssion one
,

of t h e most useful one of the most v al uable boo k s t h at

,

have eve r been p ubl ished . A gratifyi ngly l arge num

b e r of p h ysicians h ave told us t h at t h e book not onl y
h elpe d t h e m to treat successfully sexua l weakness and
ot h e r di so r de rs i n thei r p atien ts or in t h emse l ves b ut
,

t h at i t opened t h ei r eyes to the sign ifi cance of m any

things w h ich the y did not un derstan d b efore .

Those who h ave rea d the b ook know its va l ue and

importance ; those w h o h ave not m ay b e inte reste d to
r ead wh at the me d ical j o urna l s have to say a b o ut it .

Here are a few extracts

No Ame ri can auth ority has give n more se ri ous tho ugh t
to the subj ect of s ex ual di se ases th an the a uth o r o f th is
vol ume ; h e h as give n to us in it th e b est th at in him lies
“

N o physi ci an w ho has had to co mb at th is di stressing condi

ti on and those co nditi ons de p e ndent up on it has any do ub t
, ,

of its se ri o us i mp o rt ance
. A nd w e all reco gni ze the we ak
ness o f th e lit er ture on th
a e s ubj ect. Dr R ob inso n ta kes
. .
 S E XU A L I M PO TE N CE
In this b ook we h ave a complete tr eatise on sex ual dis
orders and t heir treatme nt with des cripti on s of a ctual ,

i ndi vi dual c a e s giving the indi vi dual symptomatology and

°
,

in divi dual tre atment W h en given in this manner the de

.

scription b ecomes indeli b ly impre ssed on th e memory and

e nab les a p hysician wh en h e ge ts a case to u n derstan d and

classify it witho ut a great amo u nt of diffi culty
—Ch
.

ar lo tte Medical J ourna l .

The n ame of the a ut or is ample assurance t at t is h h h

h h
treatise is not a re as nor lac ing in onest opinions fear k h
x
lessly e p ressed The style of the write r is nota ly per
. b
h
sonal , clea r, strai g tforward and conversational The e . x
haustion of the first edition in less t an two mont s from h h
b h kb
the day of p u lication s ows unmista a ly the need of
a b o k of this ch act r It lso sh ows that th profe sion
o ar e . a e s

i
s a t l s t b coming alive to it sh ort ming in th matter
a e s co s e

o f sexual di order nd i b g inning to b

s willing t le n
s a s e e o ar
—S uth m C lif ni P titi n
.

o e a or a r ac o er.

Perh ps no s ubj ect pertaining to h uman ill h be n so

a s as e
negle t d by medical te
c e hers or medical text b ks as ac -
oo

th s ubj ect dis uss d in th i

e vol ume Wh ile legitimat
c e s
. e
me di l literature w in discreetly silent on
ca te chi g
as se x a n s,
th q u k liter t u
e ac w teemi g with misinformation
a re as n ,

whi h c ,th a uth r intimat

as e did more real h arm th n
o e s, a

did s x ual i gnor n e or se x a b u

e Th d tor will find
a c se . e oc

th is w rk i structiv —I lli i M di l J um l
o n e no s e ca o a .

As is to b e ex pect d R b in n goes into th s ub je t e o so e c

th ly
or o d c ll a sp de a sp de with th r ult th at h
, an a s a a , e es e

has evolve d a vol ume f ull of meat and of great val ue to

h h
the p ysician , w ose ing en uity is often tax ed to the ut
most to discover the w ys and w erefores at the ottom of h h b
i mp oten ce The racy Ro b insones que style a dds inte rest to
me —Medéca l Times
.

the text mat ter of the volu .

, .
 At last we have a c ear , plain, concise b oo k on the treat l
ment of Gonorrhe a and its various complications written ,
ex pre ssly for the ge ne ra practitio ne r l .

No Ph ysicia n who has occasio n to treat Gonorrhea ca n do j ustice lo his

P atient withou t a study of this latest a nd d ea rest volume on the sub ect
j .

THE T REAT MENT OF

A nd I ts Co mp lica tio ns in Me n and W o me n .

Fo r the G e ne ral Practitio ne r .

By
W I LL I AM J R O B I NS O N ,
M . D .

h idee ol the eeope of this work m y b e n ined trom the Che pter Headings;
x. S er iousness of G onorrhea
Ex te nt and 2 Classifi cation of Ure th ral . .

I nflammation 3 Gonorrhea! Ur e thritis in the M ale 4 The G erm and the

y p y
. . . .

Diagno sis 0 ! Gonorrhea 5 Course and S m to ma tolog of Acute Go norrhe a.

Rp B
. .

6 Treatme nt of Acute Gonorrhea 7 Case e orts 8 Co mmon acte rial Ure

yp
. . . . .

th ritis 9 Chm croidel Ure thrltie

. . xc S hilitic Ure thritis u Chemlcd . . . .

Urethritis u Prophy hctic Ure thriti s 13 Trauma tic Ur e thritis x4 Tox ic

f y y
. . . . . .

Ure thritis 1 5 Ure thritis rom h e m and Masturb a tion 1 6 The W idel Var
. . . .

ing Co nditions Kno wn a Chronic Go norrhea 17 Tre atme nt of Chr onic G onor
R
. .

rhea 1 8 Le ng th of Time
. . eq uir ed to Cur e Chro nic G onorrhea! Conditions 19 . .

I nstr uments U se d in Trea tment 20 Ab ortifie Tr ea tme nt 21 P re ve ntio n of

p p
. . . .

G o nor rhea 32 M inor Com lications of G onorrhea ( Phimosis. P ara himosis,

f R
. .

Balaniti s. Adenitis, P ain ul E rec tion end Chorde e . e te ntio n of Urine ) 23 Acute
p
. .

P rosta titie 24 Chronic Prostatitis 3 5 E ididymitis 2 6 S e minal Ve sicu litis

R
. . . . . . .

37 G onorr hea of the ec tum 28 Gonorr hea of the Mouth 29 S tr ictur e

R
. . . . . .

30 .Go norrhea] heuma tism 3 x Gonorrhea vs To b a cco , Alcohol and S e x ual

. . .

I ntercourse 3 2 G onou hee in W o me n 3 3 Vulvova ginitis in Little G irls 3 4.

p —
. . . . .

G o non he d O hthalmie 3 5. M inor P o ints Part I L Mate ria M e dica of Go nor

p
. .

rhe a! end N on G onorr heal r e thr itis and The ir Co m lications.U 3 6 S ilver S alts
— pi
- .

In orn nic and Organic. 37 . Misce llaneo us Antise t cs and Astring e nts. 3 8.
Ve getab le Astring e nts 39 Local Anesthe tics 40Anti G o norrheal R e mediel
Urinary p y
-
. . . .

for I nternal U se 4 1. . Antise tics. 42. Lub ricants 43 F ormu lar . . .

3 1 5 p a g e s, c lo t h, p o st p a i d
ADDRES S

C R I T I C AND G UI D E C0 .

1am mom s . PAR K w NEW YORK C ITY

 A S Y M P O S I U M
E D I TE D B Y

EDEN and C EDAR PAUL

One o f the g r e a te s t b o o k s o n B ir th C o n tr o l i n -

the E n g li sh o r a n y o the r la n g ua ge B y wr ite r s .

o f i n te rn a ti o n a l re p uta ti o n .

CO NTE NTS
I ntroduction, b y W m illia
R b s n ; M althu o in o
B iogra hical a
and Critical S tudy , b y A e Lo n ; B lrth Contro and the ri ag e -

E arne rs, b y Char le s V Dry sdale ; R ace S uicide in the Unite d

d i o ial
.

S tate s, b y Lu w g Q ue sse l ; E ug e nics, B irth Control, and S c

al ono i d i
-

ism, b y E de n P u ; Ec m cs of the B irth S trik e , b y Lu w g

Q ue sse l ; D eclin e in the B irth R ate , N ationality , and Civilisation,
d ar d d i
-

by E w B ernste in ; P hilosophy of the B ir th S trik e , b y Lu w g

Q ue sse l ; Ov er P opulation as Cause of W ar , b y B D u
-
a The . nl o
D ecline in the B irth R ate , b y R M an sehk e ; Dy sg e nic Te n e ncie s
al or d
-
.

of B irth Contr ol and of the F e minist M ov e me nt, b y S H H f

-

; . .

W ome n and B irth Control, b y F W S te lla B rowne ; E ditorial S um

‘

ary nclu n
-
. .

m and C o sio .

Pr ice

S MALLOR LARGE FAMILIES

B I R TH CO NTR O L F-
ROM THE MO R AL ,

RAC I AL AND EUG E N I C S TANDPO l NT

BY

Dr . C V . . D R Y S DAL E
DR . HA V E L OC K E LL I S
D R W I LL I AM J R O B I N S O N
. .

P R O F ES S O R A . G R O TJ A HN

P r ice

THE C R ITI C A ND G U I D E CO .

12 MT M O R R I S
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THE AMERICAN JOURNAL
O

UROLOGY AND SEXOLOGY

W I LLIAM J . R O B I NS O N , MD Editor

The onl y j ournal in the E nglish lan

g uag e de v o te d t o S e x olo g y D is cu sses .

H uman S e x uality in all its p hases :

se xual e thics se xual p sycholog y
, the ,

anatomy p h
, y sio log y an d p a tho lo g y of
the se x or gans v e ner ea l p r op hylax is
, ,

limitation of offspr ing , p o sitiv e and

ne g ative e ug e nics, e tc . P ub lishes the

b est w or k fr om the p e ns of the for e most
A me rican and E ur op ean se xologists .

N ob od y ear nestl y inte r ested in the new

S cie nce of S ex can afford to b e W ithout
this j ournal .

P ub lishe d Mo nthly

Price per annu m; l

sing e copie s, 50 cents.

AD DR ES S

THE AMERICAN JOURNAL OF SEXOLOGY

12 MT M O R R I S
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 PAS T, PRES ENT AND F UT UR E

W ill mo no a my o r v a r ie t y p r e v a il
m the f utur e
'

%
ls c o ntine nc e inj ur io us
Aye ex tr a ma r ita l l
r e a tio ns e ve r

usti f i ab le
J
S ho ul d the r e b e o ne mo r a l sta n d
a r d fo r me n a nd w o me n

W ill o ur p r e se n t mo r a l c o de p e r sist ?
Th ese and similar que stions are h e re discusse d
b y original and unb iase d th inke rs as we ll as by
o rth odox co nse rvative s . No matter what your
opinio n o n th e su b ject may b e no matte r w he the r
,

yo ur ide as o n the re latio ns o fthe sexe s are those

o f th e 1 5 th 2,0 th o r 2 5 th ce n tu r y y
, o u s h o uld
read th is h o o k N o. bo d y w h o is e ar ne s tly inte r

ested in th e se x q ues tio n h a s a r ig h t to h av e an y

O pinio n on it wi th o u t h a vin g re ad t h is vo lu m e th, e

rice h
o fw ic h in cl oth is in c lu d in g p o sta ge
p
.
, ,

THE C R I T I C A ND G U I DE CO .

1 2 MT MO R RIS PARK
.
w . NEW YO RK c m
 A U N I Q U E JO U R N A L

T HE

CR I T I C AND GU I D E
M o n thly
'

Dr R ob in so n
. s F amous Little

I t is the most origina l jo urna l

I t is the in the co un try . onl y
k
o ne o f its ind , and is in teresting fro m co v e r to co v er The re is no .

ro utine , d ea d ma tte r in it I t is o ne o f the ve ry fe w jo urnals

.

th a t is Op e ned with anticipa tio n j ust a s soo n as it 18 re ce ive d and

o f wh ich e ve ry line is read with rea l inte rest .

No t only the sp ecial rob le ms o f the medical ro fession

itself
f
are
dealt withm a vigoro us anc p ro gr essiv e sp n t, b ut
'

e la rge r , social
i
aspe cts o f medicine and p hy siolo gy are di scusse d in a fearless and
radi cal ma nne r .

M any pro b le ms untouched by ot b

he r p u lica tio ns, such as the se x
question 111 all its varied p hase s the e co nomic causes o f disease and
e r p ro b le ms in medical so cio lo gy a re trea te d b o l dl y and freely
,

o th ,

fro m the standpo int o f mode rn scie nce I n discussing q uestio ns

b hyp
.

which are co nsi de red ta oo b y the e r co nse rva tiv e ,

-
the e dito r
say s what he wants to sa y ve ry plamly witho ut re gard for M rs
r ndy
.

G u .

fi n C R I TI C AND G UI DE wa s a p ionee r in the p ro pa ganda fo r

b t
ir hco ntro l, v ene real p ro phy la is, se x e d uca tio n o f the x g , and youn
x
free discussion o f se ual p ro e ms in ge ne ral bl
I t co ntains more
k b any
.

inte resting and o utspo en ma te r o n he se su je cts than t o ther t

W hile of grea t to the p ractitio ne r fo r the rape utic sugges

v alue
tio ns o f a —
ractica l , up to da te and d e finite ch ara cte r , its e ditoria ls
P k
-

a nd spe cia articles a re wh a t ma e TH E C mn c A N D G U I D E uniq ue

a mon umal s, re ad ea ge rly ali e b y the med ica l p ro fession and k
the m fifi °

gent laity .

P UB L I S HE D M O NTHL Y

C R ITI C A ND GU I DE CC .

12 MT MO RRI S
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