Cocaine

If the pure alkaloid is prescribed alone in suppositories it should be dissolved in the melted cocoa-butter (solubility 1 in 12). Medical men sometimes forget to add 'hydrochlor.'or 'mur.'in prescribing cocaine suppositories and pessaries (the latter are much used for vaginitis), and many dispensers hold that in this case the pure alkaloid should be used and dissolved as stated. It has been proved, however, that the finely powdered hydrochloride gives a more efficacious suppository, as it is absorbed directly it touches the mucous membrane, while it is doubtful if the moist surface extracts the alkaloid from fatty solution. This is supported by the statement, on high medical authority, that 'carbolic oil is worthless as a disinfectant; it does not liberate the carbolic acid to moist surfaces.'The hydrochloride and other substances easily soluble in water may be dissolved on the slab with an equal quantity of water, and then thoroughly mixed with the suppository-basis; but when other medicaments are prescribed along with the salt, which may involve chemical decomposition, it is better not to use water.

Powder the ingredients finely, and rub separately with a little of the melted fat before finally mixing together.

Ergotin presents little difficulty when the dose is 3 grains or under, but 5-grain suppositories are not uncommon, and we have seen as much as 8 grains prescribed. With cocoa-butter the procedure is the same as with extracts, a little wax being added to the cocoa-butter, and care being taken to incorporate the ergotin with half of the melted fat. An excellent suppository is made with the gelatin basis, the ergotin being thinned, if necessary, with a little water and added to the melted basis.

Extract Of Belladonna

Liquid alcoholic extract of the root is prescribed by the British Pharmacopoeia for sup-positoria belladonnas. The liquid extract may be used in the proportion of 4 minims for 3 grains of dry extract.

Extracts

It suffices in the case of most extracts to rub the prescribed quantity to thinness on a slab with a little liquid appropriate to the extract (water or proof spirit); then add as much of the melted basis, mix, and so on until half the basis is used, return to the dish, mix well, and pour into the mould.

We have never had any difficulty with even large quantities of green extracts by taking care to soften the extracts with water, and to mix them intimately with the melted, but not too hot, fat, as in the following case:

Fiat suppos. Mitte vj.

Powder the bromide as finely as possible, and place it on a slab; rub down the extract on the slab with 3 to 5 drops of water. Melt 50 grains of cocoa-butter and 5 grains of white wax over a water-bath, and rub up more than one-half of it with the medicaments on the slab. Then transfer to the dish containing the rest of the basis, mix expertly, slightly heating if necessary, and pour into the mould.

The following prescription would be a simple one to compound were it not for the presence of the tannin, so that it is inadvisable to melt the basis:

Mitte vj.

The simplest method of dispensing these is to take 54 grains of cocoa-butter for the six suppositories and shave it into shreds; soften the extract in a warm mortar with a few drops of water, mix the butter intimately with this, add the tannin and the lead acetate, each in fine powder, and work up like a pill-mass; weigh out each suppository and press into the mould.

We quote the following on account of the large dose of extract of opium, rather than for any inherent difficulty which it presents:

Fiat suppos.

It is advisable in this case to use 18 grains of cocoa-butter and 2 grains of white wax (which in all such cases is beneficial). Rub down the extracts in a mortar with sufficient water to make a smooth soft paste; add half of the fatty matter to this gradually, so that a perfect mixture may be obtained. Then transfer it to the dish, and dissolve in the remainder of the fat, aiding the process by the heat of a water-bath if necessary. In making masses for above two dozen suppositories a 1-ounce quinine-bottle is excellent for melting the basis and mixing, a pan of hot water being used as the water-bath.