Another gift from around this time was "Paregoric as Directed Dr. Wilder" (22016).
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When I talked to Johns about this painting, he said that Dr. Wilder had prescribed paregoric for a particularly nasty case of diarrhea and that it took effect almost immediately.
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Nobody else seems to want this lurching hulk of a city, headed to the honor farm like a former star given to paregoric and shoplifting, so it has de facto been ceded to us self-appointed guttersnipes, and maybe someday we will rule it, although for now we're content to pick at its scabs.
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In 1944, two clinicians who evaluated the expectorant action of Paregoric, concluded: > The survival of paregoric through the centuries, and particularly through > recent critical decades, is probably due to keen clinical observation and > stubborn adherence to the clinical deduction that paregoric is useful in > certain types of cough.
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Paregoric is sometimes confused with Laudanum, because their chemical names are similar: Camphorated Tincture of Opium (Paregoric) vs. Tincture of Opium (Laudanum). However, Laudanum contains 10 milligrams of morphine per milliliter, 25 times more than Paregoric. Confusion between the two drugs has led to overdose and death in patients.
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During the twentieth century its use declined as governments regulated its ingredients (opium is a controlled substance in many countries.) Beginning in late 2011, there was a period in which paregoric was not being manufactured in the United States. , however, the manufacture of paregoric has resumed.
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In the United States, opium tincture contains 10 mg per mL of anhydrous morphine. By contrast, opium tincture's weaker cousin, paregoric, also confusingly known as "camphorated tincture of opium", is 1/25th the strength of opium tincture, containing only 0.4 mg of morphine per mL. A 25-fold morphine overdose may occur if opium tincture is used where paregoric is indicated. Opium tincture is almost always dosed in drops, or fractions of a mL, or less commonly, in minims, while paregoric is dosed in teaspoons or tablespoons.
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For example, in the United Kingdom the formula for Paregoric, B.P. is tincture of opium 5 ml, benzoic acid 500 mg, camphor 300 mg, anise oil 0.3 ml, alcohol (60%) to 100 ml, and contains about 1/30th grain of anhydrous morphine in 60 minims, which is 25% stronger than Paregoric, U.S.P.
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Until 1970, paregoric could be purchased in the United States at a pharmacy without a medical prescription, in accordance with federal law. Federal law dictated that no more than two (2) ounces of paregoric be dispensed by any pharmacy to the same purchaser within a 48-hour period. Purchasers were also required to sign a register or logbook, and pharmacies were technically required to request identification from any purchaser not personally known to the pharmacist. Some states further limited the sale of paregoric, or banned over-the-counter sales entirely.
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In France, paregoric was available without prescription until 1986; nowadays, it is used to wean infants born to opiate-addicted women.
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Other popular medicines, based on opium, included Paregoric, a much milder liquid preparation for children; Black-drop, a stronger preparation; and Dover's powder.
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The principal active ingredient in Paregoric is powdered opium. In the United States the formula for Paregoric, U.S.P. is tincture of opium 40 ml, anise oil 4 ml, benzoic acid 4 g, camphor 4 g, glycerin 40 ml, alcohol 450 ml, purified water 450 ml, diluted alcoholDiluted alcohol is a mixture of equal portions of purified water and 190 proof alcohol (95% alcohol by volume). to 1000 ml, and contains the equivalent of 0.4 mg/ml of anhydrous morphine; one ounce of paregoric contains 129.6 mg (2 grains) of powdered opium, or the equivalent of 13 mg of anhydrous morphine.The Extra Pharmacoepia Martindale, Vol.
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B&O; Supprettes was unique in the United States because they were the only drug containing opium that is for suppository use sold in the US and, in fact, one of the very few medications that contains opium in any form in the US along with paregoric and opium tincture (laudanum).In November 2009, manufacturers of Paregoric (Camphorated Tincture of Opium) and Laudanum (Tincture of Opium) were notified in writing that there were was no FDA approval on-file for either preparation, and as-such, their manufacture and distribution may be in violation of federal (USA) laws.
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In the very early 18th century, Jakob Le Mort (1650–1718), a professor of chemistry at Leiden University, prepared an elixir for asthma and called it "paregoric". The word "paregoric" comes from the Greek word "paregoricon" which was originally applied to oratory - to speak, but, more accurately, talk over, soothe, and finally came to have the same meaning as "anodyne". Le Mort's elixir, consisted of "honey, licorice, flowers of Benjamin, and opium, camphor, oil of aniseed, salt of tartar and spirit of wine," became official as "Elixir Asthmaticum" in the London Pharmacopoeia of 1721. Its ingredients were assembled out of the obsolete humoral philosophy and quasi-scientific reasoning of the Renaissance.
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However, Paregoric was characterized as "a needlessly complex pharmacopeial mixture... of a former day" by a 1966 study. In the 21st century its two main uses have been largely supplanted by minimally psychoactive cough-suppressant drugs (such as dextromethorphan) and non-psychoactive antidiarrheal drugs (such as loperamide).
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This episode features an alternate, jazzier arrangement of the opening theme music. Trapper makes a pun during the poker game comparing a "pair of twos" with paregoric. B movies referred to are Love Life of a Gorilla (1940), Bride of the Gorilla (1951) and Bonzo Goes to College (1952).
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The medicine was similar to paregoric; a tincture of opium and camphor. To this was added catechu together with anise flavouring and a colouring agent. Over the years there were several different formulas. Bateman’s Drops were advertised as being intended for infants and adults and was dosed accordingly.
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Thus, an order for opium tincture containing directions in teaspoons is almost certainly in error. To avoid this potentially fatal outcome, the term "camphorated tincture of opium" is avoided in place of paregoric since the former can easily be mistaken for opium tincture. In 2004, the FDA issued a "Patient Safety" news bulletin stating that "To help resolve the confusion [between opium tincture and paregoric], FDA will be working with the manufacturers of these two drugs to clarify the labeling on the containers and in the package inserts." Indeed, in 2005, labels for opium tincture began to include the concentration of morphine (10 mg/mL) in large text beneath the words "Opium Tincture".
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"1 oz. making 8 ozs. Tr. Opii Camphorated U.S.P (Paregoric)" for $2.00 per pint; (3) Opium, Concentrated (Deodorized and Denarcotized) "Four times the strength of tincture, Used when Tinct. Opii U.S.P. is contraindicated" for $9.50 per pint, and (4) Opium (Aqueous), U.S.P., 1890, "Tr. (assayed) Papayer Somniferum" for $2.25 per pint.Frank S. Betz Co. 1915 Catalog No. N-15. Second edition.
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In Eastern culture, opium is more commonly used in the form of paregoric to treat diarrhea. This is a weaker solution than laudanum, an alcoholic tincture which was prevalently used as a pain medication and sleeping aid. Tincture of opium has been prescribed for, among other things, severe diarrhea. Taken thirty minutes prior to meals, it significantly slows intestinal motility, giving the intestines greater time to absorb fluid in the stool.
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After plying de Groote with Cognac laced with Paregoric and prying Napoleon's troop movements out of him, his wife arrives brandishing pistols. The ensuing altercation injures de Groote, disabling him and attracting the attention of the police. Jardineaux proposes to next have Jacky serve as a camp follower, trailing Napoleon's men. Jacky, offended, decides to dress as a man, this time joining Napoleon's messengers, granting her ready access to military documents.
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Never one to waste a trip, Tubman gathered another group, including the Ennalls family, ready and willing to take the risks of the journey north. It took them weeks to safely get away because of slave catchers forcing them to hide out longer than expected. The weather was unseasonably cold and they had little food. The children were drugged with paregoric to keep them quiet while slave patrols rode by.
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Paregoric was classified as an "Exempt Narcotic", as were other medical products containing small amounts of opium or their derivatives.Section 6 of the 1914 Act did not apply "to the sale, distribution, giving away, dispensing or possession of preparations and remedies which do not contain more than two grains of opium, or more than one- fourth of a grain of morphine, or more than one-eighth of grain of heroin, or more than one grain of codeine, or any salt or derivative of them, in one fluid ounce, or, if a solid or semisolid preparation, in one avoirdupois ounce; or to liniments, ointments, or other preparations which are prepared for external use only, except liniments, ointments, or other preparations which contain cocaine or any of its salts." In 1929-30, Parke, Davis & Co., a major United States drug manufacturer based in Detroit, Michigan, sold "Opium, U.S.P. (Laudanum)" as Tincture No. 23 for $10.80 per pint (16 fluid ounces), and "Opium Camphorated, U.S.P. (Paregoric)" as Tincture No. 20, for $2.20 per pint. Concentrated versions were available.
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Codeine is used to treat mild to moderate pain and to relieve coughing. It is also used to treat diarrhea and diarrhea-predominant irritable bowel syndrome, although loperamide (which is available without a prescription for milder diarrhea), diphenoxylate, paregoric, or even laudanum are more frequently used to treat severe diarrhea. Weak evidence indicates that it is useful in cancer pain, but it is associated with increased side effects. The American Academy of Pediatrics does not recommend its use in children due to side effects.
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"Opium Camphorated, for U.S.P. Tincture: Liquid No. 338" was "exactly 8 times the strength of Tincture Opium Camphorated (Paregoric) [italics in original], U.S.P.", "designed for preparing the tincture by direct dilution", and cost $7 per pint. Similarly, at a cost of $36 per pint, "Opium Concentrated, for U.S.P. Tincture: Liquid No. 336," was "four times the strength of the official tincture", and "designed for the extemporaneous preparation of the tincture".1929-1930 Physicians' Catalog of the Pharmaceutical and Biological Products of Parke, Davis & Company, pages 87-88." The catalog also noted: "For quarter-pint bottles add 80c.
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Antimotility agents are drugs used to alleviate the symptoms of diarrhea. These include loperamide (Imodium), diphenoxylate with atropine (Lomotil), and opiates such as paregoric, tincture of opium, codeine, and morphine. In diarrhea caused by invasive pathogens such as Salmonella, Shigella, and Campylobacter, the use of such agents has generally been strongly discouraged, though evidence is lacking that they are harmful when administered in combination with antibiotics in Clostridium difficile cases. Use of antimotility agents in children and the elderly has also been discouraged in treatment of EHEC (Shiga-like toxin producing Escherichia coli) due to an increased rate of hemolytic uremic syndrome.
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Raw opium may be sold to a merchant or broker on the black market, but it usually does not travel far from the field before it is refined into morphine base, because pungent, jelly-like raw opium is bulkier and harder to smuggle. Crude laboratories in the field are capable of refining opium into morphine base by a simple acid- base extraction. A sticky, brown paste, morphine base is pressed into bricks and sun-dried, and can either be smoked, prepared into other forms or processed into heroin. Other methods of preparation (besides smoking), include processing into regular opium tincture (tinctura opii), laudanum, paregoric (tinctura opii camphorata), herbal wine (e.g.
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The abbreviation "DTO," traditionally used to refer to Deodorized Tincture of Opium, is sometimes also erroneously employed to abbreviate "diluted tincture of opium." Diluted tincture of opium, also known as Camphorated Tincture of Opium (Paregoric) is a 1:25 mixture of opium tincture to water prescribed to treat withdrawal symptoms in newborns whose mothers were using opioids while pregnant. The United States Pharmacopeia and FDA recommend that practitioners refrain from using DTO in prescriptions, given this potential for confusion. In cases where pharmacists have misinterpreted DTO, and given "deodorized tincture of opium" when "diluted tincture of opium" was meant, infants have received a massive 25-fold overdose of morphine, sometimes resulting in fatalities.
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They were available over-the-counter without a prescription in many states until the early 1990s, at which time the FDA banned the sale of anti-diarrheal drugs containing kaolin and pectin; also, Donnagel-PG contained tincture of belladonna, which became prescription-only on January 1. 1993. Paregoric is currently listed in the United States Pharmacopeia. Manufacture of the drug was discontinued for several months beginning in late 2011; however, production and distribution resumed in 2012, so the drug is still available in the United States by prescription. Thus, it is unclear as to whether the lapse in manufacture actually resulted in a shortage of the drug at any time, since prescription drugs are often still available for many months after manufacture has been discontinued.
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Today, however, the drug is often processed to remove all or most of the noscapine (also called narcotine) present as this is a strong emetic and does not add appreciably to the analgesic or antipropulsive properties of opium; the resulting solution is called Denarcotized Tincture of Opium or Deodorized Tincture of Opium (DTO). Laudanum remains available by prescription in the United States and theoretically in the United Kingdom, although today the drug's therapeutic indications are generally confined to controlling diarrhea, alleviating pain, and easing withdrawal symptoms in infants born to mothers addicted to heroin or other opioids. Recent enforcement action by the U.S. Food and Drug Administration (FDA) against manufacturers of paregoric and opium tincture suggests that opium tincture's availability in the U.S. may be in jeopardy. The terms laudanum and tincture of opium are generally interchangeable, but in contemporary medical practice the latter is used almost exclusively.
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Dallek was able to consult a collection of Kennedy-associated papers from the years 1955–1963, including X-rays and prescription records from the files of White House physician Dr. Janet Travell. According to Travell's records, during his presidential years Kennedy suffered from high fevers; stomach, colon, and prostate issues; abscesses; high cholesterol; and adrenal problems. Travell kept a "Medicine Administration Record," cataloguing Kennedy's medications: "injected and ingested corticosteroids for his adrenal insufficiency; procaine shots and ultrasound treatments and hot packs for his back; Lomotil, Metamucil, paregoric, phenobarbital, testosterone, and trasentine to control his diarrhea, abdominal discomfort, and weight loss; penicillin and other antibiotics for his urinary-tract infections and an abscess; and Tuinal to help him sleep." Years after Kennedy's death, it was revealed that in September 1947, while Kennedy was 30 and in his first term in Congress, he was diagnosed by Sir Daniel Davis at The London Clinic with Addison's disease, a rare endocrine disorder.
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Codeine is probably Robiquet's most important contribution, that prevails still today with a very strong presence and impact on daily life; in effect, until the beginning of the 19th century, raw opium was used in diverse preparations known as laudanum (see Thomas de Quincey's "Confessions of an English Opium-Eater"), paregoric elixirs (a number of them, very popular in England since the beginning of the 18th century), and health or even death hazards to users from improper preparation or improper use were frequent. The isolation of codeine by Robiquet from opium's several active components while working on refined morphine extraction processes, opened the path to the elaboration of a new generation of specific antitussive and antidiarrheal potions of much safer use, based on codeine only, which became immediately extremely popular. Codeine is nowadays by far the most widely used opiate in the world and very likely even the most commonly used drug overall according to numerous reports over the years by organizations such as the World Health Organization and its League of Nations predecessor agency and others. It is one of the most effective orally-administered opioid analgesics and has a wide safety margin.
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The name codeine is derived from the Ancient Greek (, "poppy head"). The relative proportion of codeine to morphine, the most common opium alkaloid at 4% to 23%, tends to be somewhat higher in the poppy straw method of preparing opium alkaloids. Until the beginning of the 19th century, raw opium was used in diverse preparations known as laudanum (see Thomas de Quincey's Confessions of an English Opium- Eater, 1821) and paregoric elixirs, a number of which were popular in England since the beginning of the 18th century; the original preparation seems to have been elaborated in Leiden, the Netherlands around 1715 by a chemist named Lemort; in 1721 the London Pharmacopoeia mentions an Elixir Asthmaticum, replaced by the term Elixir Paregoricum ("pain soother") in 1746. The progressive isolation of opium's several active components opened the path to improved selectivity and safety of the opiates-based pharmacopeia. Morphine had already been isolated in Germany by in 1804. Codeine was first isolated in 1832 in France by , already famous for the discovery of alizarin, the most widespread red dye, while working on refined morphine extraction processes.
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