SYRUP OF COCILLANA COMPOUND

A physician in a small town in Nebraska writes: “In looking over a prescription file not long ago I found a prescription which I copied and am sending to you. It is a good example of shotgun prescribing. I do not give the name of the prescriber, and you will please not mention from whence this comes. The doctor who wrote this has had about ten years’ experience.”

Here is the prescription given exactly as transmitted by our correspondent:

Sp. sticta	Gtt xv
Sp. ipecac	Gtt x
Sp. bryonia	Gtt x
Sp. macrotys	Ʒi
Bromoform Bronchial Anodyne	℥ii
Syrup Cocillana Comp. q. s. ad	℥vi
Teaspoonful every two or three hours.

It is evident that the prescriber is an eclectic. As a matter of fact, in a second letter from the physician who forwarded the prescription, we are informed that the prescriber is a graduate of an eclectic institution not a thousand miles from where he practices. The “Sp.” in the prescription does not mean “Spiritus,” but specific tincture. The prescriber is an advocate of specific remedies, one of which should fit the condition, but he is broad-minded enough to call help from the outside, and so adds fifteen other remedies to the specific selected, including alcohol. The inability of one mind to remember all the ingredients of so complex a mixture will explain the fact that ipecac is duplicated, occurring both as a specific tincture and as an ingredient of Bromoform Bronchial Anodyne. The latter, the manufacturers tell us, contains in one fluidounce:

Alcohol	5	per cent.
Bromoform	8	drops
Ipecac	¹⁄₂	gr.
Ammonium bromid	24	grs.
Benzoin	1	gr.

Syrup Cocillana Comp., one of the “elegant specialties” of Parke Davis & Co., of which they certainly ought to be very proud, contains, we are told, in one fluidounce:

Alcohol	5	per cent.
Heroin hydrochlorid	⁸⁄₂₄	gr.
Tinct. of euphorbia pilulifera	120	min.
Syrup of wild lettuce	120	min.
Tinct. of cocillana	40	min.
Syrup of squill comp.	24	min.
Cascarin, P. D. & Co.	8	grs.
Menthol	⁸⁄₁₀₀	gr.

This “elegant specialty” of Parke, Davis & Co. is not only a shotgun prescription, but has as one of its ingredients a mixture itself containing three ingredients, namely: Syrup Squill Comp. (Coxe’s Hive Syrup), making ten in all—a beautiful example of scientific pharmacy.

We wonder if our eclectic brother really appreciated that his prescription, written out, would be as follows:

Sp. sticta	Gtt	xv
Sp. ipecac	Gtt	x
Sp. bryonia	Gtt	x
Sp. macrotys	Ʒi
Alcohol	5	per cent.
Bromoform	8	drops
Ipecac	¹⁄₂	gr.
Ammonium bromid	24	grs.
Benzoin	1	gr.
Alcohol	5	per cent.
Heroin hydrochlorid	⁸⁄₂₄	gr.
Tinct. of euphorbia pilulifera	120	min.
Syrup of wild lettuce	120	min.
Tinct. of cocillana	40	min.
Fluidextract of squill	60	min.
Fluidextract of senega	60	min.
Antimony and potassium tartate	1	gr.
Cascarin, P. D. & Co.	8	grs.
Menthol	⁸⁄₁₀₀	gr.

To use a slang expression, this is certainly going some!—(From The Journal A. M. A., March 18, 1911.)

“A Cough Syrup with a History”

The following letter was received from Dr. Geo. P. Tolman, Watsonville, Cal.:

To the Editor:—The enclosed advertisement was underscored and mailed to me by my druggist. The properties of cocillana are similar to ipecac. The dose of the fluidextract is from 10 to 20 minims. Each fluidounce of the extraordinary (!) dark-colored cough marvel of P. D. & Co. contains 40 minims of the tincture. If the tincture of cocillana is 10 per cent. (the average tincture strength) you can see that to get a minimal dose of the drug you would have to take 2¹⁄₂ fluidounces of the syrup.

“Query: Can we still hang on to the old-fashioned cough mixtures freshly compounded by our druggists or shall we put our shoulders to the wheel and help P. D. & Co. save the nation and make a few dollars for the druggist?”

“The secret of its prompt recognition lay in its unusual composition.” Nay; its prompt recognition lay in liberal and persistent advertising. “It quickly made a ‘hit’ with physicians”—because too many physicians, like other human beings, are susceptible to the psychology of advertising. Here is the “unusual composition,” as given by the manufacturers:

“Tinct. Euphorbia pilulifera, 120 mins.; Syrup Wild Lettuce, 120 mins.; Tinct. Cocillana, 40 mins.; Syrup Squill Compound, 24 mins.; Cascarin (P. D. & Co.), 8 grs.; Heroin hydrochloride, 8-24 gr.; Menthol, 8-100 gr.”

The following is a reproduction of the advertisement referred to:

As we have said above, Parke, Davis & Co. should be proud of this “elegant specialty.” It would be hard to find a better specimen of a shotgun prescription; not only does the prescription contain eight ingredients, but one of these ingredients (compound syrup of squill) itself contains three.

As our correspondent correctly states, the drug from which the name (not the action) of the preparation is derived comes from Bolivia and has properties similar—but evidently inferior—to ipecac. That it possesses but little therapeutic value is perhaps best evidenced by the fact that, in spite of the propaganda made for it by Parke, Davis & Co., neither the drug nor any preparation of it is listed, so far as we know, by any other large pharmaceutical house, with one exception. Besides cocillana the preparation contains two other obsolete drugs, wild lettuce and euphorbia pilulifera. The activity of the “cough syrup,” it is needless to say, depends in the main on the drug which is more or less buried in the published formula: heroin hydrochlorid. At one time Parke, Davis & Co. admitted that the preparation owed its chief value to heroin. In a letter to the Council on Pharmacy and Chemistry the firm said:

“The physiologic action of this syrup is that which would be suggested by the constituents. Because of its activity the most prominent action would be that characteristic of heroin hydrochlorid.”

Without doubt the important ingredient, from the point of view of therapeutic potency, is the heroin; and it is this drug doubtless, that makes the mixture a good “repeater.” Syrup Cocillana Compound is a nostrum sailing under false colors. Whether its continued use is due to its mysterious, meaningless, misleading name or merely to insistent and persistent advertising methods of Parke, Davis & Co. is a question. Neither explanation is any credit to the medical profession which tolerates it, or to the physician who prescribes it.—(From The Journal A. M. A., Feb. 15, 1913.)