Candy Medication

CHAPTER I.. Historical Introduction.

HISTORICAL INTRODUCTION.

THE IDEA of presenting medicine in candy form is really very old. The term confection, which originally meant a medicinal compound being derived from the Latin word "conficere," to put together, has been applied since the days of classical antiquity to mixtures of medicinal substances with saccharine matter. The only official relics of this once very extensive class of preparations are the confection of rose and the confection of senna; both of which, however, are also practically obsolete. The reason for this is not difficult to find. Neither of them come up to our modern ideas of a confection. We may officially call them a confection, but a youngster would be disrespectful enough to disagree with the pharmacopoeia.

More closely akin to candy are lozenges, and yet they are not real candy. The only one among them that is pleasant is the santonin lozenge; and it is the only one that is popular. An especially good imitation of candy form are the deservedly popular so-called German worm lozenges. It was acquaintance with these that led the writer to seek for other real candy medicaments. He could find only two such upon the market: viz., Calomel Tablets under the name of "Aromatic Calomel," and Phenolphthalein Tablets under various fanciful trade-names, such as "Purgen," "Phenolax," etc., unless "Candy Cathartic Cascarets," and the French candy laxative known as "Tamar Indien" were also to be included.

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Convinced that administration in candy form would be ideal for children, the author took a number of years ago a course of instruction with a candy-maker, in the hope of finding in the confectioner's art some new form of pleasant administration for medicine. He made sulphur taffy and cod-liver oil chocolate creams; but these and a large number of other attempts were unsuccessful. It may be of interest, in this connection, to note that, in 1911, Sir James Sawyer published in "The Lancet" a process for the production of what he calls "cremulae" or medicated chocolate creams. They were prepared by evaporating a mixture of sugar and of milk to the consistency of paste, in which various medicaments might be incorporated, and which is then covered with chocolate, as in the popular chocolate drop. This is, as will be seen, a troublesome process. The author's studies in the candy shop seemed to point to "fondant" as the most suitable candy form for purposes of medication. "Fondant", however, has the disadvantage of becoming hard with age. Free from this objection and closely similar to the "fondant" is a rather lightly compressed tablet made of finely powdered cane sugar. And so finally the tablet form was chosen as the best and most convenient for candy medication--a form which was already in successful use, as has been stated, for the administration of calomel and of phenolphthalein. For such tablets the term tabellae dulces, or sweet tablets, might be proposed.

CHAPTER II.. Tabellae Dulces.

TABELLAE DULCES.

TO BE SUCCESSFUL, sweet tablets must meet the following requirements:

1. They must be perfectly delicious sweets, attractive in form, color, and odor; and free from the slightest suspicion of disagreeable or medicinal taste.

2. They must disintegrate rapidly in the mouth; for a sick child will usually not suck candy as a healthy youngster would.

3. To constitute a real advance in therapeutics, it must be possible for the average pharmacist to prepare them extemporaneously, so that the physician may be able to fit the medicament to suit the case, and that the pharmacist may not be forced to carry in stock a large assortment of these more or less perishable goods.

In view of these exacting requirements, it may seem remarkable that over fifty different medicaments are at present available for administration in the form of sweet tablets. This has been accomplished by taking advantage of the fact that some medicines are practically tasteless; that modern synthetic chemistry has enriched our resources in this direction by the production of a large number of tasteless, or almost tasteless, and yet active substances; and that many of the isolated active principles of drugs are easily disguised. In some cases a chemical trick is successful, e. g., using a little alkali or a little acid to render the substance less soluble in the mouth. Some of the bitterest alkaloids, e.g., strychnine, have been rendered available for candy medication by the use of finely powdered fuller's earth, or of Lloyd's Reagent, to be described later. Quite a number of almost insoluble substances of slight but lingering taste can be made perfectly pleasant by saccharinization.

CHAPTER III.. The Uses of Sweet Tablets.

THE USES OF SWEET TABLETS.

IT MAY seem strange that modern pharmacy which boasts of so many elegant and palatable preparations suitable for adults, has thus far done so little to render medicine more acceptable to children; and yet attractiveness and palatability are even more important for the little ones than for the grown-ups. Syrups have hitherto been our chief aids in making medicines more pleasant for children. Unfortunately, however, many a child has had its palate offended by liquid medicines to such a degree that it abhors spoon-medicine of any kind, and will struggle even against the most palatable. When one witnesses the struggling of the average child against the average medicine, one cannot but wonder whether at times the struggle does not do more harm than the medicine can do good, and wish that we had other means of administering medicines to the little ones. As all children love candy, this would seem the form most desirable for them. For one who has not used candy medication there is a revelation in store in the positive enjoyment and eagerness with which children take these sweet tablets. And many a petted child that has grown up into a sensitive woman, who believes she cannot swallow a pill, also cannot and will not take medicine. It so happens that just these are often excessively fond of candy and will take candy medicine. Another use for candy medication is in the treatment of the insane, who frequently will not take medicine, but may take it in candy form.

It may be of interest to see how many indications may be met, confining oneself entirely to the list of candy medicaments:

1. For effect upon the alimentary tract:

Absorbent: Charcoal.

Antacid: Chalk. Magnesia. Sodium Bicarbonate.

Emetics: Apomorphine. Tartar Emetic. Emetine.

Antiemetics: Cocaine. Anaesthesine. Morphine. Bismuth Subnitrate or subcarbonate. Chalk. Cerium Oxalate.

Antidiarrheal: Bismuth Subnitrate or Subcarbonate. Tannalbin. Morphine. Chalk.

Cathartics: Calomel. Mercury with Chalk. Phenolphthalein. Elaterin. Resin of Podophyllum. Resin of Jalap. Senna. Sulphur.

Antispasmodic: Atropine.

Intestinal Antiseptic: Magnesium salicylate. Mercurials. Lactic acid ferment.

Anthelmintic: Santonin.

2. For effect upon the respiratory system:

Expectorants: Apomorphine. Emetine. Terpin hydrate. Sajodin.

Antitussic: Heroine. Morphine. Sabromin.

Antispasmodic: Atropine.

3. For effect upon the circulatory system:

Circulatory Stimulants: Digitalis. Strophanthin. Atropine. Strychnine. Caffeine.

Circulatory Depressant: Aconitine.

Vaso-Dilator: Nitroglycerin.

4. For effect upon genito-urinary system:

Diuretic: Diuretin. Caffeine.

Urinary Antiseptic: Hexamethylenamine.

5. For effect upon skin:

Diaphoretic: Pilocarpine. Dover's Powder.

Anhydrotic: Atropine.

6. For effect upon nervous system:

Depressants: Morphine. Hyoscine. Sabromin. Sulphonmethane. Adalin.

Stimulants: Atropine. Cocaine. Strychnine. Caffeine.

7. Antipyretics:

Acetphenetidin. Antipyrin. Acetylamidosalol (Salophen). Aconitine. Aristochin.

8. Hematinics:

Iron, Reduced Iron, Iron carbonate, saccharated. Arsenic.

9. Tonics:

Iron, quinine, strychnine.

10. Specifics:

In Malaria: Aristochin. Saloquinine. Arsenic.

In Syphilis: Mercurials. Sajodin.

In Rheumatic Fever: Acetylsalicylic acid (Aspirin). Acetylamidosalol (Salophen). Magnesium salicylate.

In Myxedema: Thyroid.

Of course, a large variety of combinations of these could be elaborated.

It, therefore, seems established that we have, in candy medication, a method of fairly extensive applicability; an almost complete therapeutic armamentarium of the greatest possible value in the treatment of children. For the tiny infant this method is, of course, unsuitable as well as unnecessary. As soon, however, as the youngster commences to know what candy is, it is ready for candy medication. It is particularly during the ages of from three to ten that this form of administration is indicated.

Several objections have been raised against this method. Perhaps the most serious one lies in the danger of poisoning, from the fact that children enjoy these tablets so much that they are likely to eat a large number of them at one time, should the mother be careless enough to leave them within reach. The only way to prevent such an occurrence is not to prescribe more tablets than would constitute a safe dose should all of them be taken at one time. It is better to have the patient get a new supply daily than to have a single case of death or serious disturbance occur from this source.

Another objection that has been raised is that the dose of some of the medicines is very small. In the case of such remedies as sulphur and chalk the author admits that the dose is perhaps too small to be of practical importance. In the case of most other medicaments, however, the smallness of dose is of advantage rather than of disadvantage, in that it necessitates administration at short intervals. If the administration of small doses frequently repeated until the desired effect is obtained is a good principle in practice, it is particularly so in pediatrics. For are not all the vital processes of the child much more rapid than those of the adult; are not its bowel movements, its urinations more frequent, does it not need nourishment more often? Then why not medicine?

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