READING OLD PRESCRIPTIONS
Reading Old Prescriptions
The prescription at the top of this article was written in 1903 (3-23-03). Both the doctor and the patient have long since left our society on this side of the counter, so I'm sure neither will mind if we examine this prescription together.
Today, electronic prescribing is rapidly contributing to the extinction of the written prescription. The doctor's orders are typed into the computer, iPad or other handheld device and off they flow through the invisible Internet to the local drugstore's digital device.
What modern medicine has gained in efficiency it has lost in art. The old, handwritten, carefully crafted prescription order seemed to carry a certain measure of healing in the shear beauty and mystery of it's composure. As a pharmacist, a prescription like this carries a certain measure of intrigue and challenge. It is a thin window into pharmaceutical and medical history. On this fading piece of paper a bit of the past is preserved for us to ponder. The medication, as well as the patient for that matter, have long since expired...but the prescription lives on. So in this brief article I want to walk you through what is written here and conclude with a guess as to what it was being used for.
This article will cover, therefore, 3 aspects of this prescription:
- The ingredients named on the prescription.
- The Latin abbreviations and quantities of each ingredient indicated.
- The best guess as to what it was used for.
The prescription is for a single medication, an elixir, which is to contain 3 ingredients.
1. Codeine Sulfate
3. Aromatic Syrup of Yerba Santa (written as "Syrupi Yerba Sant. arom")
I suppose the "Codeine" ingredient needs little introduction. Codeine continues to play a very important part in pharmacotherapy today. It is used primarily for pain, but also is in several prescription cough suppressants (e.g. Robitussin AC).
Sanguinaria - more commonly known as "blood-root." A flower that blooms in late April and May. The extract, according to an old pharmacy textbook, contains an alkaloid similar to morphine.
Syrup of Yerba Santa - literally "holy or sacred herb" in Spanish. Historically this herb was used for its expectorant properties (loosens phlegm) and also imparts a pleasant flavor to liquid compounds.
THE LATIN ABBREVIATIONS AND QUANTITIES
The following is my interpretation of the symbols and abbreviations on this prescription:
1. Codeine Sulf. "gr. IV" The "gr. IV" refers to 4 grains. Grains? Yep, that's right. The old Apothecary System of measurement consisted of weighing substances in pounds, ounces and grains. In the modern metric system, 1 grain is approximately equal to 65 milligrams (mg). Sometimes regular strength aspirin is still referred to as "5 grain" aspirin (meaning 325mg of Aspirin). So 4 grains of Codeine is about 260mg of codeine powder that would have to be weighed out by the pharmacist.
2. Ext. Sanguinaria "Fl. z IV" The designation following the word sanguinaria means "4 fluid drams." A dram was a unit of measurement for both weight and volume. In this case, it is being used for volume, thus "fluid drams." A dram is a little less than a teaspoonful. 4 fluid drams is about a tablespoonful of liquid.
3. Syrup of Yerba. Sant. Arom. "ad zz iV." The funny squiggle I am representing with "zz" for convenience. It means "ounces" and the designation "ad" means "up to." So the prescription is telling the pharmacist to add this syrup to the other ingredients so that the total volume in the end is 4 ounces.
4. The instructions to the patient follow the abbreviation "sig." Sig is short for "signature" from the Latin for "mark." In other words, the physician is telling the pharmacist to "mark' the prescription with these instructions. Specifically the instructions listed mean "Take 1/2 to 1 teaspoonful when necessary as directed."
WHAT WAS THIS USED FOR?
So now for the million dollar question: What is it? What was it used for?
At best we are guessing. The prescription itself contains no specific indication as to the purpose of the compound. Two possibilities exist:
1) It is possible this is a prescription for pain, due to the codeine content and the morphine alkaloid. However, 1 teaspoonful of this prescription would contain only about 10mg of codeine. This is a pretty light dose for pain.
2) More likely I think this was being prescribed to treat a cough. Codeine was commonly used in prescription cough suppressants in the early 1900s. And even today, 10mg of Codeine is about the dose typically used in commercially available prescription cough suppressants. The expectorant (yerba santa) would also support this suggestion.
So there you have it. Time to break out my mortar and pestle and see if I can make up a batch of this stuff tonight!