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Remington
The Science and Practice of Pharmacy
Remington
The Science and Practice of Pharmacy

23rd Edition

Editor-in-Chief
Adeboye Adejare
Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy,
University of the Sciences, Philadelphia, PA, United States
Department of Chemistry and Biochemistry, Misher College of Arts and Sciences,
University of the Sciences, Philadelphia, PA, United States

Section Editors
Purnima D. Amin
Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Mumbai, India
Grace L. Earl
School of Pharmacy and Health Sciences, Fairleigh Dickinson University, Florham Park, NJ, United States
Simon Gaisford
UCL School of Pharmacy, University College London, London, United Kingdom
Islam M. Ghazi
Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA, United States
Zhiyu Li
Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy,
University of the Sciences, Philadelphia, PA, United States
David J. Newman
Newman Consulting LLC, Wayne, PA, United States
Michael S. Saporito
Intervir, LLC, Philadelphia, PA, United States
Jeff Talbert
Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, United States

Chair of the Board


Edward F. Foote
Dean, Philadelphia College of Pharmacy, University of the Sciences,
Philadelphia, PA, United States
Academic Press is an imprint of Elsevier
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525 B Street, Suite 1650, San Diego, CA 92101, United States
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The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom
Copyright © 2021 University of the Sciences in Philadelphia. Published by Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying,
recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission,
further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and
the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research
methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, com-
pounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others,
including parties for whom they have a professional responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to
persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or
ideas contained in the material herein.

British Library Cataloguing-in-Publication Data


A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress

ISBN: 978-0-12-820007-0

For Information on all Academic Press publications


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Publisher: Andre Gerhard Wolff


Acquisitions Editor: Erin Hill-Parks
Editorial Project Manager: Barbara Makinster
Production Project Manager: Sreejith Viswanathan
Cover Designer: Matthew Limbert
Typeset by MPS Limited, Chennai, India
Publication history
First edition, 1886 Sixteenth edition, 1980
Second edition, 1889 Chairman, Editorial Board
Third edition, 1897 Arthur Osol
Fourth edition, 1905 Editors
Joseph P. Remington Grafton D. Chase Robert E. King
Fifth edition, 1907 Alfonso R. Gennaro Alfred N. Martin
Sixth edition, 1917 Melvin R. Gibson Ewart A. Swinyard
Joseph P. Remington Assisted by C. Boyd Granberg Gilbert L. Zink
E. Fullerton Cook Stewart C. Harvey
Seventh edition, 1926
Editors Seventeenth edition, 1985
E. Fullerton Cook Chairman, Editorial Board Managing editor
Charles H. LaWall Alfonso R. Gennaro John E. Hoover
Eighth edition, 1936 Editors
Editors Associated editors Grafton D. Chase Thomas Medwick
E. Fullerton Cook Ivor Griffith Ara H. DerMarderosian Edward G. Rippie
Charles H. LaWall Adley B. Nichols Stewart C. Harvey Joseph B. Schwartz
Arthur Osol Daniel A. Hussar Ewart A. Swinyard
Ninth edition, 1948
Tenth edition, 1951 Gilbert L. Zink
Eighteenth edition, 1990
Editors
Chairman, Editorial Board Managing editor
E. Fullerton Cook
Alfonso R. Gennaro John E. Hoover
Eric W. Martin
Editorial assistant
Eleventh edition, 1956
Editors Bonnie Packer
Editors Associated editors
Eric W. Martin E. Emerson Leuallen Grafton D. Chase Edward G. Rippie
E. Fullerton Cook Arthur Osol Ara H. DerMarderosian Joseph B. Schwartz
Linwood F. Tice Stewart C. Harvey Ewart A. Swinyard
Clarence T. Van Meter Daniel A. Hussar Gilbert L. Zink
Twelfth edition, 1961
Thomas Medwick
Editors Assistant to the editors
Eric W. Martin John E. Hoover Nineteenth edition, 1995
E. Fullerton Cook Chairman, Editorial Board Managing editor
E. Emerson Leuallen Alfonso R. Gennaro John E. Hoover
Arthur Osol Editorial assistant
Linwood F. Tice Bonnie Packer
Clarence T. Van Meter Editors
Grafton D. Chase Edward G. Rippie
Thirteenth edition, 1965 Ara H. DerMarderosian Joseph B. Schwartz
Editor-in-Chief Managing editor Glen R. Hanson H. Steve White
Eric W. Martin John E. Hoover Daniel A. Hussar Gilbert L. Zink
Editors Thomas Medwick
Grafton D. Chase Robert E. King
Herald R. Cox E. Emerson Leuallen Twentieth edition, 2000
Richard A. Deno Author Osol Chairman, Editorial Board Managing editor
Alfonso R. Gennaro Ewart A. Swinyard Alfonso R. Gennaro John E. Hoover
Stewart C. Harvey Clarence T. Van Meter Editorial assistant
Bonnie Packer
Fourteenth edition, 1970 Editors
Chairman, Editorial Board Managing editor Ara H. DerMarderosian Roger L. Schnaare
Arthur Osol John E. Hoover Glen R. Hanson Joseph B. Schwartz
Editors Thomas Medwick H. Steve White
Grafton D. Chase Robert E. King Nicholas G. Popovich
Richard A. Deno Alfred N. Martin
Twenty-first edition, 2006
Alfonso R. Gennaro Ewart A. Swinyard
Paul Beringer Pardeep K. Gupta
Melvin R. Gibson Clarence T. Van Meter
Ara H. DerMarderosian John E. Hoover
Stewart C. Harvey
Linda Felton Nicholas G. Popovich
Fifteenth edition, 1975 Steven Gelone William J. Reilly, Jr.
Chairman, Editorial Board Managing editor Alfonso R. Gennaro Randy Hendrickson, Chair
Arthur Osol John E. Hoover
Twenty-second edition, 2013
Editors
Editor-in-Chief Chairman, Editorial Board
John T. Anderson C. Boyd Granberg
Loyd V. Allen, Jr Lisa A. Lawson
Cecil L. Bendush Stewart C. Harvey
Editors
Grafton D. Chase Robert E. King
Adeboye Adejare Yvonne Perrie
Alfonso R. Gennaro Alfred N. Martin
Shane P. Desselle Nicholas G. Popovich
Melvin R. Gibson Ewart A. Swinyard
Linda A. Felton Kenneth M. Shermock
Anthony C. Moffat Donna S. Wall
Dedication

I would like to dedicate this book to the Philadelphia College of Pharmacy (PCP) family, including, but not limited to
students, faculty, staff, and alumni. As the first school or college of pharmacy in North America, it can be argued that
we are really the home of pharmacy and pharmaceutical sciences in North America! From great educators like Joseph
P. Remington to helping to bring the United States Pharmacopeia to fruition to industrial giants like Eli Lilly, the con-
tributions of PCP to the profession continues to be very significant. The Remington Honor Medal is the highest honor
bestowed by the American Pharmacists Association. I am extremely grateful and proud to be part of this family as a
faculty member. Finally, I would like to dedicate the book to my greatest teacher, I. Abiola Adejare, none other than
my father. Though you have moved on to where the Yorubas say “ibi agba re” (where elders go), the seeds that you
sowed continue to bear great fruits. Your grandson is now a PCP alum!

Adeboye Adejare
Professor, Philadelphia College of Pharmacy
Editor-in-Chief
Contents

List of contributors xix 2.7. Integrated approach to drug


Foreword—Remington 23rd edition xxiii nomenclature 38
Preface to the first edition xxv 2.8. Conclusion 39
Preface to the 23rd edition xxvii Acknowledgment 39
Acknowledgments xxix References 39

Section 1 Section 2
Introduction Natural Products
David John Newman
1. History of pharmacy 3
Gregory J. Higby and Benjamin Y. Urick 3. Botanical dietary products 45
1.1. The drug-taking animal 3 Esperanza J. Carcache de Blanco and
1.2. Prehistoric pharmacy 3 A. Douglas Kinghorn
1.3. Antiquity 4
1.4. The Middle Ages 5 3.1. Botanical dietary supplements 45
1.5. The Renaissance and Early Modern Europe 6 3.2. Botanicals standardization and quality
1.6. American pharmacy 8 evaluation 48
1.7. Antebellum America: Pharmacy finds 3.3. Quality control and quality assurance
its niche 10 of botanicals 50
1.8. The search for professionalism 11 3.4. Potential toxicity of botanical dietary
1.9. Legislation 11 supplements 51
1.10. Transition to a modern profession 12 3.5. Kratom (Mitragyna speciosa), a
1.11. The era of Count and Pour 13 controversial psychoactive plant 52
1.12. The emergence of clinical pharmacy 14 3.6. Concluding remarks 53
1.13. The conflicting paradigms of References 54
pharmaceutical care and managed care 15
4. Natural products and derivatives as
1.14. The promise of a new century 15
1.15. The future 16 human drugs 59
1.16. History as a discipline 16 David J. Newman
1.17. Bibliographic notes 16
1.18. A chronology of pharmacy 20 4.1. Introduction 59
4.2. Agents against pain 59
2. Integrated approach to drug 4.3. Antiinfectives (antibacterial, antiparasitic,
nomenclature 23 and antiviral) 62
4.4. Anticancer agents 70
Amos O. Abioye 4.5. Conclusion 72
2.1. Introduction 23 References 72
2.2. The changing face of drug nomenclature 25
5. Medicinal Cannabis: an overview for
2.3. Principles of drug nomenclature 26
2.4. Types of drug nomenclature 28 health-care providers 75
2.5. Global cooperation on harmonization of Jason Wallach
drug nomenclature 29
2.6. The challenges of selecting INN 5.1. History of Cannabis use 75
for biologics 32 5.2. Clinical indications 77

ix
x Contents

5.3. Cannabis subjective effects 78 7.6. In silico prediction of protein ligand


5.4. “Stimulation versus couch lock?” 78 binding affinities by free energy methods 144
5.5. Formulations 78 7.7. Machine-learning approaches 147
5.6. Routes of ingestion 78 References 150
5.7. Product labeling 81
5.8. The endocannabinoid system 81 8. Pharmaceutical profiling 155
5.9. Pharmacology of phytocannabinoids 82
5.10. Mechanisms of action 84 Taiwo Olayemi Elufioye and Adeboye Adejare
5.11. ( 2 )-trans-Δ9-Tetrahydrocannabinol 86
8.1. Introduction 155
5.12. Cannabidiol 86
8.2. Pharmaceutical profiling in drug
5.13. Cannabinol 87
discovery 155
5.14. ( 2 )-trans-Δ8-Tetrahydrocannabinol 87
8.3. Profiling of active pharmaceutical
5.15. Propyl, butyl, and heptyl
ingredients and drug products’
phytocannabinoid homologs 88
degradants 156
5.16. Phytocannabinoid acids 90
8.4. Pharmaceutical profiling in drug
5.17. Terpenes 90
development 157
5.18. Additional small molecule components
8.5. Pharmaceutical profiling in
in Cannabis 91
pharmacokinetics and
5.19. The entourage effect 91
pharmacodynamics 158
5.20. Adverse effects 93
8.6. Pharmaceutical profiling in toxicology
5.21. Pharmaceutical cannabinoid products 94
and adverse drug reactions 158
5.22. Conclusion 95
8.7. Methods in pharmaceutical profiling 159
References 95
8.8. Absorption, distribution, metabolism,
and excretion prediction models
Section 3 and methodologies 161
Pharmaceutical Chemistry 8.9. Methods in toxicity prediction 162
Adeboye Adejare 8.10. Automation in pharmaceutical profiling 162
8.11. Concluding remarks 162
References 162
6. Pharmaceutical chemistry 105
Anush Abelian, Michael Dybek, Jason Wallach, 9. Prodrugs 169
Boyenoh Gaye and Adeboye Adejare
Zeynep Ates-Alagoz and Adeboye Adejare
6.1. Introduction 105
9.1. Introduction 169
6.2. Functional groups 105
9.2. Prodrug approaches based on drug
6.3. Acids and bases 110
delivery 170
6.4. Salts 119
9.3. Prodrug approaches based on functional
6.5. Structural determinants of drug action 121
groups 171
6.6. Intermolecular forces of attraction 123
9.4. Prodrug approaches for anticancer drugs 173
6.7. Quantitative structure activity
9.5. Summary 182
relationship studies 125
References 182
6.8. Inorganic pharmaceutical chemistry 127
6.9. Drugs 127
6.10. Excipients 128 10. Fundamentals of medical
References and further reading 128 radionuclides 187
7. Structure activity relationships and Jeffrey P. Norenberg
drug design 129 10.1. Applications of radionuclides in medicine
Eleonora Gianti and Randy J. Zauhar and pharmacy 187
10.2. Radioactivity and radiation 188
7.1. Introduction 129 10.3. The atom 189
7.2. Analog approach 130 10.4. Radioactive decay 191
7.3. Chemical space 132 10.5. Production of radionuclides 195
7.4. Quantitative structure activity 10.6. Radiolabeling of compounds to prepare
relationships 139 radiotracers and radiopharmaceuticals 199
7.5. Molecular docking for virtual screening 142 Bibliography 204
Contents xi

Section 4 14. Model-informed drug development


Pharmacokinetics/Pharmacodynamics and discovery: an overview of current
Islam M. Ghazi practices 263
Mohamed Elmeliegy and Oliver Ghobrial
11. The science of pharmacokinetics: an
overview and applications 207 14.1. Current drug-development challenges 263
14.2. Model-informed drug development:
Islam M. Ghazi and Michael J. Cawley virtual reality meets drug discovery
and development 264
11.1. Introduction 207
14.3. Model-informed drug development
11.2. Evolution of pharmacokinetics 207
tools and approaches 265
11.3. Drug-development concepts 212
14.4. Applications of model-informed drug
11.4. Clinical application 214
development tools in different phases
11.5. Future developments 215
of drug development 272
11.6. Conclusion 215
Acknowledgments 277
References 215
Disclosures 277
References 277
12. Principles of pharmacokinetics and
pharmacodynamics 219
Section 5
Brian R. Overholser and Kevin M. Sowinski Pharmaceutics
12.1. Introduction 219 Simon Gaisford
12.2. Drug concentration versus time profile 219
12.3. Rates and orders of reactions 221 15. Preformulation 283
12.4. Intravenous bolus with instantaneous
distribution 221 Simon Gaisford
12.5. Intravenous bolus with noninstantaneous 15.1. The concept of preformulation 283
distribution 224 15.2. Physicochemical properties 283
12.6. Continuous input 227 15.3. Solubility 283
12.7. Multiple-dose administration 228 15.4. Partitioning 289
12.8. Noncompartmental analysis following 15.5. Dissolution rate 291
instantaneous input 228 15.6. Powder properties 293
12.9. Statistical moments 229 15.7. Compaction 294
12.10. Pharmacokinetic parameters derived 15.8. Summary 294
from statistical moments 229 References 294
12.11. Absorption 230
12.12. Organ-specific clearance 232 16. Powder characterization 295
12.13. Protein binding 235
12.14. Dose- and time-dependent Asma Buanz
pharmacokinetics 236 16.1. Introduction 295
12.15. Stereochemical considerations 237 16.2. Particle shape 295
12.16. Kinetics of pharmacologic effect 238 16.3. Particle diameter and particle-size
References 241 distribution 296
Further reading 242 16.4. Particle size analysis methods 298
16.5. Powder properties 301
13. Therapeutic drug monitoring 243 References 304
James M. Kidd, Tomefa E. Asempa and 17. Salt selection 307
Kamilia Abdelraouf
Simon Gaisford
13.1. Rationale for therapeutic drug
monitoring 243 17.1. The need for pharmaceutical salts 307
13.2. Practical considerations for therapeutic 17.2. The chemistry of salt formation 307
drug monitoring 244 17.3. Selection of a salt former 309
13.3. Drugs for which therapeutic drug 17.4. Salt screening 311
monitoring is performed 245 17.5. Salt solubility 311
References 259 17.6. Solubility of basic salts 311
xii Contents

17.7. Solubility of acidic salts 312 21.7. Semisolids 384


17.8. The importance of pHmax 312 21.8. Biphasic semisolids 386
17.9. Dissolution of salts 313 21.9. Packaging and labeling 387
17.10. Effect of excipients on pHm 313 21.10. Other dosage forms for application to
17.11. Partitioning of salts 313 the skin and its appendages 388
17.12. Summary 314 21.11. Rectal, vaginal, and urethral routes
References 314 of administration 389
References 392
18. Physical form 315
Gareth R. Williams
Section 6
18.1. Introduction 315
18.2. Particle size and shape 316
Biopharmaceutics
Zhiyu Li
18.3. Crystalline materials 316
18.4. Amorphous materials 324
18.5. Characterization 327 22. Biotechnology and drugs 397
18.6. Summary 332
Michelle Parker and Zhiyu Li
References 332
22.1. Biotechnology 397
19. Solid oral dosage forms 333 22.2. Biopharmaceuticals 401
Atheer Awad, Sarah J. Trenfield and 22.3. Biopharmaceutical research and
Abdul W. Basit development 408
22.4. Remarks 413
19.1. Introduction 333 References 413
19.2. Tablets 333
19.3. Types of tablets 334
19.4. Tablet compression 342
23. Therapeutic antibody discovery 417
19.5. Tablet excipients 343 Jaclyn M. Hoover, Elisabeth G. Prinslow,
19.6. Tablet formulation examples 347 Jeffrey E. Teigler, Matthew D. Truppo and
19.7. Tablet characterization 349 Sherry L. La Porte
19.8. Capsules 351
19.9. Capsule characterization 356 23.1. Introduction 417
References 356 23.2. Antibody generation 419
23.3. Hit and lead generation 423
20. Liquid dosage forms 359 23.4. Antibody lead optimization 427
23.5. Lead selection 432
Atheer Awad, Christine M. Madla, 23.6. Future directions 432
Francesca K.H. Gavins, Nour Allahham, Disclosure 432
Sarah J. Trenfield and Abdul W. Basit
References 433
20.1. Introduction 359
20.2. Monophasic liquids 360
24. Therapeutic antibody development—
20.3. Biphasic liquids 367
20.4. Quality control 374 Remington chapter 437
20.5. Applications 374 Brian Geist, Songmao Zheng and Yan Xu
References 377
24.1. Introduction 437
21. Medicated topicals 381 24.2. Background of therapeutic
antibodies 437
Purnima D. Amin, Bahijja Tolulope Raimi-Abraham,
24.3. Nonclinical development of therapeutic
Devanshi S. Shah and Sharda Gurram
antibodies 444
21.1. Introduction 381 24.4. Clinical development of therapeutic
21.2. Skin as a site for drug delivery 381 antibodies 453
21.3. Drug delivery to the skin: basic 24.5. Conclusion/future direction 457
principles 382 Acknowledgments 458
21.4. Topical drug classification system 383 Disclosure 458
21.5. Formulation considerations 383 Abbreviations 458
21.6. Formulation of topical dosage forms 384 References 458
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Contents xiii

25. Gene and cell therapy 463 28.7. Intravitreal injections/implants 571
28.8. Juxtascleral injections 572
Jieni Xu, Bing Wang and Song Li 28.9. Intracameral injections 572
25.1. Preface 463 28.10. Iontophoresis 572
25.2. Gene therapy 464 28.11. Subconjunctival injections 572
25.3. Cell therapy 478 28.12. Retrobulbar injections 572
25.4. Ethical issues 485 28.13. Ophthalmic preparation characteristics 573
25.5. Marketing and funding 486 28.14. Packaging 573
25.6. Progress and perspective 487 28.15. Antimicrobial preservatives 573
References 487 28.16. Summary 574
References 574
26. Protein drug production and
29. Parenteral preparations 577
formulation 489
Mangal Shailesh Nagarsenkar and
Izabela Gierach, Jackelyn M. Galiardi, Vivek Vijay Dhawan
Brian Marshall and David W. Wood
29.1. Introduction 577
26.1. Biologics versus synthetics—basic 29.2. Advantages of parenteral route and
definitions and history 489 formulations 577
26.2. Complexity and regulatory 29.3. Concerns with parenteral route and
considerations 490 formulations 577
26.3. Biologics manufacturing processes 524 29.4. Considerations for formulation
26.4. Special notes on biosimilars 540 development of parenterals 578
References 545 29.5. Formulation components 578
29.6. Containers and closures 581
Section 7 29.7. Pyrogens (endotoxins) and
depyrogenation 586
Pharmaceutical Materials and 29.8. General considerations—production
Devices/Industrial Pharmacy facilities 587
Purnima Dhanraj Amin 29.9. Personnel 591
29.10. Environmental control evaluation 591
27. Coating of pharmaceutical dosage 29.11. Process simulation testing by media fill 592
forms 551 29.12. Manufacturing of parenteral product 592
29.13. Quality assurance and control 600
Stuart C. Porter References 602
Further reading 603
27.1. Introduction 551
27.2. Evolution of coating processes 551
27.3. Pharmaceutical coating processes 552
30. Pulmonary, Nasal, and Topical Aerosol
27.4. Film coating of oral solid dosage forms 552 Drug Delivery Systems 605
27.5. Coating procedures and equipment 557 Mala Menon, Richard N. Dalby, Isha Naik,
27.6. Coating pans 558 Hemali Savla and Kaveri Kalola
27.7. Fluidized-bed coating equipment 560
27.8. Recent trends in film-coating processes 562 30.1. Introduction 605
References 564 30.2. Modes of drug delivery to the
respiratory tract 606
28. Ophthalmic preparations 565 30.3. Important considerations in the design
of pulmonary aerosol systems 606
Furqan A. Maulvi, Ketan M. Ranch,
Ankita R. Desai, Ditixa T. Desai and 30.4. General aerosol formulation principles 607
Manish R. Shukla 30.5. Aerosol formulation components 614
30.6. Manufacture of pressurized aerosol
28.1. Introduction 565 products 618
28.2. Bioavailability 565 30.7. Product testing 619
28.3. Types of ophthalmic dosage forms 568 30.8. Human factors 620
28.4. Drug administration 570 30.9. Future of aerosols and inhaled
28.5. Irrigating solutions 571 drug therapy 622
28.6. Intraocular injections 571 Further reading 622
xiv Contents

31. Nanotechnology 623 Section 8


Varsha Pokharkar and Krutika Khanderao Sawant Topics in Translational Research
Michael S. Saporito
31.1. Introduction toward a definition 623
31.2. Types of nanomaterials 623
31.3. Manufacturing technologies 625
35. Translational research—from basic
31.4. Characterization of nanoparticles 627 science to an approved
31.5. Applications of nanoparticles in therapeutic—an overview 663
medicine 627
Michael S. Saporito
31.6. Toxicity of nanoparticles 630
31.7. Regulatory aspects of nanoparticles 630 35.1. Introduction to translational research 663
References 630 35.2. Drug discovery—hit to lead to optimized
drug candidate 666
32. Pharmaceutical excipients 633 35.3. Drug testing in humans 672
35.4. Case studies 674
Heeshma Shah, Ankitkumar Jain, 35.5. Summary 678
Geetanjali Laghate and Divya Prabhudesai References 679
32.1. Introduction to excipients 633
32.2. Solid oral dosage forms 633 36. Translation of gene therapies 683
32.3. Liquid oral dosage forms 637
Richard Thomas Layer
32.4. Parenteral dosage forms 638
32.5. Ophthalmic and otic dosage forms 639 36.1. Introduction 683
32.6. Nasal 640 36.2. Mechanisms of action 683
32.7. Inhalation 640 36.3. Delivery vector 684
32.8. Topical 641 36.4. Adeno-associated virus 685
32.9. Rectal and vaginal 642 36.5. Mode of delivery 687
32.10. Medical devices 643 36.6. Proof of concept studies 688
32.11. Conclusion 643 36.7. Preclinical safety evaluation 688
References 643 36.8. Quality and manufacturing
considerations 689
33. Hot-melt extrusion: a versatile 36.9. Clinical trials 690
36.10. Examples of successful gene therapy
technology 645
translation programs 691
Mohammed Maniruzzaman and Jaywant Pawar 36.11. Summary 696
References 696
33.1. Introduction 645
33.3. Hot-melt extrusion Instrumentation and 37. Large-scale molecular profiling
other details 646
33.4. Applications of hot-melt extrusion 648 approaches facilitating
33.5. Conclusion 652 translational medicine: genomics,
References 652 transcriptomics, proteomics, and
metabolomics 699
34. Process validation in pharmaceutical
manufacturing 655 Felix W. Frueh and Michael E. Burczynski

Pirthi Pal Singh 37.1. The concept of forward and reverse


translational medicine studies, and the
34.1. Introduction 655 relevance of OMIC technologies 699
34.2. Background 655 37.2. Drug development tools (such as
34.3. Approach to process validation 655 biomarkers) can be identified with
34.4. Documentation 659 OMIC technologies 700
34.5. Conclusion 659 37.3. Translational medicine principles for
Disclaimer 659 enhancing drug development probability
References 659 of success 701
Contents xv

37.4. A brief introduction to OMIC technologies 40.2. Role of the medication safety leader 749
of the central dogma: 40.3. Medication safety analysis 749
DNA-RNA-protein-(metabolite) 703 40.4. Error-reduction strategies 752
37.5. Systems biology: creating context by 40.5. Medication safety practices 753
putting the “OMES” together 715 40.6. Patient Safety and Medication
37.6. A final word—considerations regarding Safety Organizations 756
publicly available OMICS data in silico 716 40.7. Conclusion 757
37.7. Summary 716 References 757
References 717
41. Substance use disorders 759
38. Neurobiologic correlates of depression:
illustration of challenges in bench-to- Daniel J. Ventricelli and Andrew M. Peterson
bedside translation 719 41.1. Introduction 759
41.2. Definitions 760
Bruce Edward Jones
41.3. At-risk populations 761
38.1. Introduction 719 41.4. Addressing the problem 762
38.2. Defining the patient population 720 41.5. Specific substance use 763
38.3. Cultural impact on defining 41.6. Pharmacists role 766
neuropsychiatric disease 720 41.7. Conclusion 767
38.4. Hurdles to basic and translational References 767
research 721
38.5. Models of neuropsychiatric disease 721 42. Global trends in pharmacy practice 769
38.6. Genomics in depression 727
Claire Anderson
38.7. Antidepressant targets beyond serotonin 729
38.8. Summary 731 42.1. Introduction 769
References 731 42.2. Primary care and universal health
coverage 770
Section 9 42.3. Prevention 775
42.4. Pharmacists role in disease management 775
Pharmacy Practice 42.5. Pharmacist prescribing 777
Grace L. Earl
42.6. Collaborating with other health
professionals 777
39. Pharmacy and patient centered 42.7. Public health roles 777
care 737 42.8. Competency and credentialing to
provide services and advance practice 778
Kimberly A. Galt 42.9. Advancing community pharmacy
39.1. What is patient centered care? 737 globally 778
39.2. Why is patient-centered care needed? 737 References 779
39.3. History of patient centered care 738 Further reading 780
39.4. Future trends in the United States 738
39.5. Considerations affecting pharmacists 43. Value-based payment models
provision of patient-centered care 738 involving pharmaceutical services 781
39.6. Barriers and gaps 741
39.7. Patients, pharmacists, and settings Jing Yuan and Laura T. Pizzi
where patient-centered care is practiced 742 43.1. Introduction 781
39.8. Education and training 746 43.2. Approaches toward improving
39.9. Conclusion 747 health-care value 781
References 747 43.3. Approaches toward improving
health-care value 784
40. Medication safety and medication References 787
error prevention 749
44. Role of the pharmacist in research 789
Michael Claro Dejos
Lisa E. Davis and Sandipan Bhattacharjee
40.1. State of medication safety and
recent advances 749 44.1. Introduction 789
xvi Contents

44.2. What constitutes research? 789 48. Specialty pharmacy services 829
44.3. Roles for pharmacists in research 790
44.4. Implementation science 796 Vivianne K. Celario and Pinal Mistry
44.5. Preparing for careers in research 796 48.1. Practice models and services 830
44.6. Tips for success in pursuing research 797 48.2. Trends and impact 832
44.7. Tips for conducting and assessing 48.3. Stakeholders 832
outcomes research 798 48.4. Technology 833
44.8. Conclusion 798 48.5. Barriers and challenges 833
References 799 48.6. Organizational oversight 834
48.7. Education and training 834
45. Trends in nutrition practice 801 48.8. Resources 835
Diana M. Solomon and Angela L. Bingham 48.9. Conclusion 835
References 835
45.1. Introduction 801
45.2. Overview 801
45.3. Nutrition practice models 802 49. Pharmacy involvement in medical
45.4. Evidence-based medicine 803 missions 837
45.5. Factors leading to transformation
and innovation 804 Mary J. Ferrill
45.6. Oversight by relevant organizations 805
45.7. Education and training 805 49.1. Introduction 837
45.8. Barriers and gaps 806 49.2. Planning logistics 837
45.9. Resources 809 49.3. Health-care logistics 839
45.10. Conclusion 809 49.4. Integrating medical missions into
References 809 pharmacy education 844
49.5. Conclusion 847
46. Medication disposal 811 References 847

Annette McFarland and Amy Sutton Peak


50. Pharmacists’ role in infectious
46.1. Introduction 811
46.2. Hazardous waste 811 pandemics: illustration with
46.3. Household disposal of medications 812 COVID-19 849
46.4. Minimization of pharmaceutical waste 814
Grace Earl, Lisa M. Cillessen,
46.5. Conclusion 814
Heather Lyons-Burney, Paul O. Gubbins,
References 815
Andrew W. Mina, David M. Silverman,
Further reading 815 Carmela M. Silvestri and Maria Leibfried
47. Pharmacist use of point-of-care testing 50.1. Introduction 849
to improve access to care 817 50.2. Pharmacists’ response to
COVID-19 850
Lisa M. Cillessen, Heather Lyons-Burney and 50.3. Pharmacy scope of practice 851
Paul O. Gubbins 50.4. Pharmacists’ response in the
community 851
47.1. Introduction 817
50.5. COVID-19 treatments and medication
47.2. Community pharmacy based
safety 853
CLIA-POCT services 818
50.6. Pharmacists’ role in point-of-care
47.3. Pharmacy-based CLIA-POCT testing in
testing for COVID-19 855
the ambulatory care setting 821
50.7. Pharmacists’ response in critical care
47.4. Cost-effectiveness of pharmacist-
and healthcare systems 860
provided CLIA-POCT testing 823
50.8. Pharmacists’ response in long-term
47.5. Future ways pharmacist-provided
care settings 867
CLIA-POCT testing can improve
50.10. Conclusion 872
access to care 824
References 873
References 826
Contents xvii

Section 10 54. Pharmacoeconomics 915


Pharmaceutical Outcomes and T. Joseph Mattingly II
Policy 54.1. Overview 915
Jeff Talbert
54.2. Perspectives 917
54.3. Designing an economic analysis 917
51. Health policy and pharmacy 879 54.4. Measuring costs 919
54.5. Measuring health effects 919
Nathan Pauly and Amie Goodin
54.6. Analysis considerations 921
51.1. Section 1: Introduction to health policy 54.7. Reporting and interpreting results 922
in pharmacy 879 54.8. Discussion 926
51.2. Section 2: Pharmacist participation in References 926
the policy process—vaccinations and
the advancement of the profession 881 55. Laws governing the practice of
51.3. Section 3: The pharmacists’ role in pharmacy 929
substance use disorder policy 882
Karl G. Williams
51.4. Section 4: Opioid use disorder
policy levers 883 55.1. Relationship between state and
51.5. Conclusion 886 federal law 929
References 887 55.2. Definitions 931
55.3. Rules and regulations 932
52. Implementation and evaluation of 55.4. Entry-level competence: licensing
pharmacy services 889 exams 932
55.5. Transfer of an existing license:
Jacob T. Painter and Geoff Curran “reciprocity” 933
55.6. Nuclear pharmacy 933
52.1. Introduction 889
55.7. Pharmaceutical care 933
52.2. Implementation of pharmacy services 889
55.8. Remote pharmacy practices 934
52.3. Evaluation of pharmacy services 893
55.9. Prescription drug order 934
52.4. Conclusion 897
55.10. Transfer of a prescription drug order 935
References 897
55.11. Product selection by the pharmacist 935
55.12. Hypodermic needles and syringes 935
53. Pharmacoepidemiology and 55.13. Pharmacy licensing and regulation 936
pharmacovigilance 899 55.14. Pharmacy licensing and facilities 936
55.15. Pharmacy supervision 936
Chris Delcher, Daniela Moga, Yan Li, 55.16. Compounding 936
Monica Muñoz, Minji Sohn and 55.17. Outsourcing facilities 937
Jungjun Bae
55.18. Federal laws 938
53.1.Introduction 899 55.19. Historical background of the act 938
53.2.Common study types 902 55.20. Drug approval process 940
53.3.Randomized controlled trial 903 55.21. Liability under the Food, Drug, and
53.4.Cohort studies 903 Cosmetic Act 943
53.5.Case control study 905 55.22. Recordkeeping under the Food, Drug,
53.6.Cross-sectional and ecological and Cosmetic Act 944
studies 905 55.23. Prescription labeling 944
53.7. Measurements 906 55.24. Package inserts/professional product
53.8. Bias 908 labeling 944
53.9. Confounding 909 55.25. Patient package inserts or (“PPI”) 945
53.10. Communicating change 911 55.26. Unit-dose labeling 946
53.11. Summary 911 55.27. Regulation of dietary supplements 946
References 911 55.28. Drug recalls 947
Additional resources 913 55.29. Prescription Drug Marketing Act 949
xviii Contents

55.30. Misbranding and adulteration 950 56. Drug distribution system 967
55.31. Misbranded drugs 951
55.32. Poisons 952 Minji Sohn
55.33. The Comprehensive Drug Abuse 56.1. Health-care delivery and third-party
Prevention and Control Act of 1970 954 payers 967
55.34. Prescriptions 960 56.2. Drug distribution and pharmacy
55.35. Miscellaneous controlled substance reimbursement 971
issues 963 References 973
55.36. Liability for negligent acts 963
Further reading 965 Index 975
List of contributors

Kamilia Abdelraouf, Center for Anti-Infective Research Sandipan Bhattacharjee, Health Outcomes Division,
and Development, Hartford Hospital, Hartford, CT, College of Pharmacy, The University of Texas at
United States Austin, Austin, TX, United States
Anush Abelian, Department of Chemistry and Angela L. Bingham, Philadelphia College of Pharmacy,
Biochemistry, Misher College of Arts and Sciences, University of the Sciences, Philadelphia, PA, United
University of the Sciences, Philadelphia, PA, United States States
Amos O. Abioye, Lloyd L. Gregory School of Asma Buanz, School of Pharmacy, University College
Pharmacy, Palm Beach Atlantic University, West Palm London, London, United Kingdom
Beach, FL, United States Michael E. Burczynski, Department of Pharmacology,
Adeboye Adejare, Department of Pharmaceutical University of Pennsylvania, Philadelphia, PA, United
Sciences, Philadelphia College of Pharmacy, University States
of the Sciences, Philadelphia, PA, United States; Esperanza J. Carcache de Blanco, Medicinal Chemistry
Department of Chemistry and Biochemistry, Misher and Pharmacognosy, College of Pharmacy, The Ohio
College of Arts and Sciences, University of the State University, Columbus, OH, United States
Sciences, Philadelphia, PA, United States
Michael J. Cawley, Philadelphia College of Pharmacy/
Nour Allahham, UCL School of Pharmacy, University University of the Sciences, Philadelphia, PA, United States
College London, London, United Kingdom
Vivianne K. Celario, Pharmacy, Walgreens and Rutgers
Purnima D. Amin, Department of Pharmaceutical University, New Brunswick, NJ, United States
Sciences and Technology, Institute of Chemical
Technology, Mumbai, India Lisa M. Cillessen, University of Missouri-Kansas City,
School of Pharmacy at Missouri State University,
Claire Anderson, Division of Pharmacy Practice and Springfield, MO, United States
Policy, School of Pharmacy, University of
Nottingham, Nottingham, United Kingdom Geoff Curran, Center for Mental Healthcare &
Outcomes Research, Central Arkansas Veterans
Tomefa E. Asempa, Center for Anti-Infective Research Healthcare System, Little Rock, AR, United States;
and Development, Hartford Hospital, Hartford, CT, Departments of Pharmacy Practice and Psychiatry,
United States Center for Implementation Research, University of
Zeynep Ates-Alagoz, Department of Pharmaceutical Arkansas for Medical Sciences, Little Rock, AR,
Chemistry, Faculty of Pharmacy, Ankara University, United States
Ankara, Turkey; Department of Pharmaceutical Richard N. Dalby, Department of Pharmaceutical
Sciences, Philadelphia College of Pharmacy, Sciences, School of Pharmacy, University of
University of the Sciences in Philadelphia, Maryland, Baltimore, MD, United States
Philadelphia, PA, United States
Atheer Awad, UCL School of Pharmacy, University Lisa E. Davis, Pharmacy Practice & Science, University
College London, London, United Kingdom of Arizona, Tucson, AZ, United States; Pharmacy,
Jungjun Bae, Institute for Pharmaceutical Outcomes and Banner University Medical Center, Tucson, AZ,
Policy, College of Pharmacy, University of Kentucky, United States
Lexington, KY, United States Michael Claro Dejos, Department of Patient Safety,
Abdul W. Basit, UCL School of Pharmacy, University Methodist Le Bonheur Healthcare, Memphis, TN,
College London, London, United Kingdom United States

xix
xx List of contributors

Chris Delcher, Department of Pharmacy Practice and Eleonora Gianti, Department of Chemistry and
Science, College of Pharmacy, University of Biochemistry, Swarthmore College, Swarthmore, PA,
Kentucky, Lexington, KY, United States United States; College of Science and Technology,
Ankita R. Desai, Maliba Pharmacy College, Uka Temple University, Philadelphia, PA, United States
Tarsadia University, Surat, India Izabela Gierach, Protein Capture Science, LLC, Dublin,
Ditixa T. Desai, Maliba Pharmacy College, Uka Tarsadia OH, United States
University, Surat, India Amie Goodin, Department of Pharmaceutical Outcomes
Vivek Vijay Dhawan, IPA-MSB’s Bombay College of and Policy, University of Florida, Gainesville, FL,
Pharmacy, Mumbai, India United States; Center for Drug Evaluation and Safety
(CoDES), Gainesville, FL, United States
Michael Dybek, Department of Chemistry and
Biochemistry, Misher College of Arts and Sciences, Paul O. Gubbins, University of Missouri-Kansas City,
University of the Sciences, Philadelphia, PA, United States School of Pharmacy at Missouri State University,
Springfield, MO, United States
Grace Earl, Fairleigh Dickinson University, School of
Pharmacy and Health Sciences, Florham Park, NJ, Sharda Gurram, Department of Pharmaceutical
United States Sciences and Technology, Institute of Chemical
Technology, Mumbai, India
Mohamed Elmeliegy, Pfizer, Inc., San Diego, CA,
United States Gregory J. Higby, School of Pharmacy, University of
Wisconsin-Madison, Madison, WI, United States;
Taiwo Olayemi Elufioye, Faculty of Pharmacy, American Institute of the History of Pharmacy,
University of Ibadan, Ibadan, Nigeria; Department of Madison, WI, United States
Pharmaceutical Sciences, Philadelphia College of
Pharmacy, University of the Sciences, Philadelphia, Jaclyn M. Hoover, Biologics Discovery, Janssen
PA, United States Research and Discovery, LLC., Spring House, PA,
United States
Mary J. Ferrill, College of Pharmacy, Taipei Medical
University, Davenport, FL, United States Ankitkumar Jain, Signet Excipients Pvt. Ltd, Mumbai,
India
Felix W. Frueh, Opus Three, Del Mar, CA, United
States Bruce Edward Jones, Research and Development, CSO
Score Pharma Inc., Exton, PA, United States
Simon Gaisford, UCL School of Pharmacy, University
College London, London, United Kingdom Kaveri Kalola, Department of Phamaceutics, Bombay
College of Pharmacy, Mumbai, India
Jackelyn M. Galiardi, Department of Chemical and
Biomolecular Engineering, The Ohio State University, James M. Kidd, Center for Anti-Infective Research and
Columbus, OH, United States Development, Hartford Hospital, Hartford, CT, United
States
Kimberly A. Galt, School of Pharmacy and Health
Professions, Creighton University, Omaha, NE, United A. Douglas Kinghorn, Medicinal Chemistry and
States Pharmacognosy, College of Pharmacy, The Ohio State
University, Columbus, OH, United States
Francesca K.H. Gavins, UCL School of Pharmacy,
University College London, London, United Geetanjali Laghate, Signet Excipients Pvt. Ltd,
Kingdom Mumbai, India

Boyenoh Gaye, Department of Pharmaceutical Sciences, Sherry L. La Porte, Biologics Discovery, Janssen
Philadelphia College of Pharmacy, University of the Research and Discovery, LLC., Spring House, PA,
Sciences, Philadelphia, PA, United States United States
Richard Thomas Layer, Research & Development,
Brian Geist, Biologics Development Sciences, Janssen
Ganglion Therapeutics, New York, NY, United States
Research and Development, LLC., Spring House, PA,
United States Maria Leibfried, Fairleigh Dickinson University, School
of Pharmacy and Health Sciences, Florham Park, NJ,
Islam M. Ghazi, Philadelphia College of Pharmacy/ United States
University of the Sciences, Philadelphia, PA, United States
Song Li, Center for Pharmacogenetics, Department of
Oliver Ghobrial, Teva Branded Pharmaceuticals R&D, Pharmaceutical Sciences, School of Pharmacy,
West Chester, PA, United States University of Pittsburgh, Pittsburgh, PA, United States
List of contributors xxi

Yan Li, Department of Pharmaceutical Outcomes and David J. Newman, Newman Consulting LLC, Wayne,
Policy, College of Pharmacy, University of Florida, PA, United States
Gainesville, FL, United States; Division of Jeffrey P. Norenberg, Chemistry, Invicro—A Konica
Pharmacovigilance I, Office of Surveillance and Minolta Company, Boston, MA, United States; Pharmacy
Epidemiology, Center for Drug Evaluation and and Anesthesiology, University of New Mexico Health
Research, U.S. Food and Drug Administration, Silver Sciences Center, Albuquerque, MA, United States
Spring, MD, United States
Brian R. Overholser, Department of Pharmacy Practice,
Zhiyu Li, Department of Pharmaceutical Sciences, College of Pharmacy, Purdue University, West
Philadelphia College of Pharmacy, University of the Lafayette and Indianapolis, IN, United States; Division
Sciences, Philadelphia, PA, United States of Clinical Pharmacology, Department of Medicine,
Heather Lyons-Burney, University of Missouri-Kansas School of Medicine, Indiana University, Indianapolis,
City, School of Pharmacy at Missouri State University, IN, United States
Springfield, MO, United States Jacob T. Painter, Division of Pharmaceutical Evaluation
Christine M. Madla, UCL School of Pharmacy, & Policy, Department of Pharmacy Practice,
University College London, London, United Kingdom University of Arkansas for Medical Sciences, Little
Mohammed Maniruzzaman, Pharmaceutical Engineering Rock, AR, United States; Center for Mental Healthcare
and 3D Printing (PharmE3D) Labs, Division of & Outcomes Research, Central Arkansas Veterans
Molecular Pharmaceutics and Drug Delivery, College Healthcare System, Little Rock, AR, United States
of Pharmacy, University of Texas at Austin, Austin, Michelle Parker, Thermo Fisher Scientific, Waltham,
TX, United States MA, United States
Brian Marshall, Department of Chemical and Nathan Pauly, Office of Health Affairs, West Virginia
Biomolecular Engineering, The Ohio State University, University, Morgantown, WV, United States
Columbus, OH, United States Jaywant Pawar, Department of Pharmaceutical Sciences
T. Joseph Mattingly II, University of Maryland School and Technology, Institute of Chemical Technology
of Pharmacy, Baltimore, MD, United States Mumbai, Mumbai, India
Furqan A. Maulvi, Maliba Pharmacy College, Uka Amy Sutton Peak, College of Pharmacy and Health
Tarsadia University, Surat, India Sciences, Butler University, Indianapolis, IN, United States
Annette McFarland, College of Pharmacy and Health Andrew M. Peterson, Philadelphia College of
Sciences, Butler University, Indianapolis, IN, United States Pharmacy, University of the Sciences in Philadelphia,
Mala Menon, Department of Phamaceutics, Bombay Philadelphia, PA, United States
College of Pharmacy, Mumbai, India Laura T. Pizzi, Center for Health Outcomes, Policy, and
Andrew W. Mina, St. Michael’s Medical Center, Staten Economics (HOPE), Ernest Mario School of Pharmacy,
Island, NY, United States Rutgers University, Piscataway, NJ, United States

Pinal Mistry, Pharmacy Revenue Integrity, Corporate Varsha Pokharkar, Department of Pharmaceutics,
Pharmacy Services, OhioHealth, Columbus, OH, Poona College of Pharmacy, Bharati Vidyapeeth
United States (Deemed University), Pune, India
Daniela Moga, Department of Pharmacy Practice and Stuart C. Porter, Pharmaceutical R&D, PPT Pharma
Science, College of Pharmacy, University of Technologies, Hatfield, PA, United States
Kentucky, Lexington, KY, United States;
Divya Prabhudesai, Signet Excipients Pvt. Ltd,
Epidemiology, College of Public Health, University of
Mumbai, India
Kentucky, Lexington, KY, United States
Elisabeth G. Prinslow, Biologics Discovery, Janssen
Monica Muñoz, Division of Pharmacovigilance I, Office Research and Discovery, LLC., Spring House, PA,
of Surveillance and Epidemiology, Center for Drug United States
Evaluation and Research, U.S. Food and Drug
Administration, Silver Spring, MD, United States Bahijja Tolulope Raimi-Abraham, Institute of
Mangal Shailesh Nagarsenkar, IPA-MSB’s Bombay Pharmaceutical Science, School of Cancer and
College of Pharmacy, Mumbai, India; VES College of Pharmaceutical Sciences, King’s College London,
Pharmacy, Mumbai, India London, United Kingdom

Isha Naik, Department of Phamaceutics, Bombay Ketan M. Ranch, Maliba Pharmacy College, Uka
College of Pharmacy, Mumbai, India Tarsadia University, Surat, India
xxii List of contributors

Michael S. Saporito, Intervir, LLC, Philadelphia, PA, Benjamin Y. Urick, Practice Advancement and Clinical
United States Education (PACE), University of North Carolina
Hemali Savla, Department of Phamaceutics, Bombay Eshelman School of Pharmacy (UNC ESOP), Chapel
College of Pharmacy, Mumbai, India Hill, USA

Krutika Khanderao Sawant, Department of Pharmacy, Daniel J. Ventricelli, Philadelphia College of Pharmacy,
Faculty of Pharmacy, The Maharaja Sayajirao University of the Sciences in Philadelphia,
University of Baroda, Vadodara, India Philadelphia, PA, United States

Devanshi S. Shah, Department of Pharmaceutical Jason Wallach, Department of Pharmaceutical Sciences,


Sciences and Technology, Institute of Chemical Philadelphia College of Pharmacy, University of the
Technology, Mumbai, India Sciences, Philadelphia, PA, United States; Substance
Use Disorders Institute, University of the Sciences,
Heeshma Shah, Signet Excipients Pvt. Ltd, Mumbai, India Philadelphia, PA, United States
Manish R. Shukla, Maliba Pharmacy College, Uka Bing Wang, Department of Orthopaedic Surgery, School
Tarsadia University, Surat, India of Medicine, University of Pittsburgh, Pittsburgh, PA,
David M. Silverman, Prime Healthcare, Newark, NJ, United States
United States Gareth R. Williams, UCL School of Pharmacy,
Carmela M. Silvestri, Med-Therapy Consults LLC, University College London, London, United Kingdom
Flemington, NJ, United States Karl G. Williams, Professor of Pharmacy Ethics
Pirthi Pal Singh, Associate Vice-President & Head R&D, and Law, St John Fisher College, Rochester, NY,
Differentiated Formulations, Proprietary Products, Dr. United States; Adjunct Professor of Pharmacy
Reddy’s Laboratories Ltd., Hyderabad, India Ethics and Law, Bernard J. Dunn School of
Pharmacy, Shenandoah University, Winchester, VA,
Minji Sohn, College of Pharmacy, Ferris State
United States
University, Big Rapids, MI, United States; Department
of Pharmaceutical Science, College of Pharmacy, David W. Wood, Protein Capture Science, LLC, Dublin,
Ferris State University, Big Rapids, MI, United States OH, United States; Department of Chemical and
Biomolecular Engineering, The Ohio State University,
Diana M. Solomon, Cooper University Hospital,
Columbus, OH, United States
Camden, NJ, United States
Jieni Xu, Center for Pharmacogenetics, Department of
Kevin M. Sowinski, Department of Pharmacy Practice,
Pharmaceutical Sciences, School of Pharmacy,
College of Pharmacy, Purdue University, West
University of Pittsburgh, Pittsburgh, PA, United States
Lafayette and Indianapolis, IN, United States; Division
of Clinical Pharmacology, Department of Medicine, Yan Xu, Clinical Pharmacology & Pharmacometrics,
School of Medicine, Indiana University, Indianapolis, Janssen Research and Development, LLC., Spring
IN, United States House, PA, United States
Jeffrey E. Teigler, Biologics Discovery, Janssen Jing Yuan, Center for Health Outcomes, Policy, and
Research and Discovery, LLC., South San Francisco, Economics (HOPE), Ernest Mario School of Pharmacy,
CA, United States Rutgers University, Piscataway, NJ, United States
Sarah J. Trenfield, UCL School of Pharmacy, Randy J. Zauhar, Department of Chemistry and
University College London, London, United Kingdom Biochemistry, University of the Sciences, Philadelphia,
PA, United States
Matthew D. Truppo, Biologics Discovery, Janssen
Research and Discovery, LLC., Spring House, PA, Songmao Zheng, Biologics Development Sciences,
United States Janssen Research and Development, LLC., Spring
House, PA, United States
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Foreword—Remington 23rd edition

There is arguably no textbook that has been more influen- introduced preparations of the age.” Even more so than
tial on the profession of pharmacy than Remington: The the late 19th century, the profession continues to rapidly
Science and Practice of Pharmacy. First Authored by evolve and Remington continues to serve us as both a
Joseph Remington in 1885, an eminent pharmacist and valuable reference text and a record of pharmacy’s prog-
long-serving faculty member and the second dean of ress over the last 135 years. Our profession is unique
Philadelphia College of Pharmacy (PCP), the textbook among the sciences and health-care arenas in that it is
has been published continuously since then and as such, I truly a science and practice profession. The original sec-
am proud to introduce the 23rd edition of Remington. As tions of Remington detailing the pharmaceutical apparatus
an alumnus of PCP (now part of University of the and the listings of inorganic and organic chemical sub-
Sciences) and it’s 16th dean, I am particularly delighted stances of the day, which may seem irrelevant and foreign
that the newest edition of Remington is being edited once to the contemporary pharmacist, have been replaced with
again by a PCP faculty member, Dr. Adeboye Adejare chapters such as therapeutic antibodies and molecular pro-
who “moved mountains” to bring Remington to fruition. filing. In Remington’s time (and for many years thereaf-
Remington: The Science and Practice of Pharmacy ter) the practice of pharmacy was much closer aligned to
will be forever tied to the legacy of PCP and the profes- a shopkeeper than a health-care provider. The ever-
sion of pharmacy. Joseph Remington was profoundly changing role of pharmacists in the direct care of patients
influenced by William Proctor Jr—another PCP faculty is elucidated in chapters such as point-of-care testing and
member—and considered by many to be the father of the role of the pharmacist in the COVID-19 pandemic.
American Pharmacy. Further, Remington is being pub- This truly is a marvelous and comprehensive textbook!
lished to coincide with the 2021 bicentennial of the For many seasoned pharmacists, Remington was the
founding of PCP, the first college of pharmacy in the pharmacy textbook. We no longer carry this massive
nation and often considered the birthplace of American tome under our arms, but the book (in particular the elec-
Pharmacy. There can be no better tribute to our tronic version!) will continue to inspire generations of stu-
profession. dents, pharmacists, and pharmaceutical scientists for years
I found it profound that Professor Remington, in the to come.
Preface to the first edition (a reproduction which is
Edward F. Foote
included in this edition!), wrote, “The rapid and substan-
Dean, Philadelphia College of Pharmacy,
tial progress made in Pharmacy within the last decade has
University of the Sciences,
created a necessity for a work treating of the improved
Philadelphia, PA, United States
apparatus, the revised processes, and the recently

xxiii
Preface to the first edition

The rapid and substantial progress made in pharmacy Pharmacopoeia, the National authority, which is now so
within the last decade has created a necessity for a work thoroughly recognized.
treating of the improved apparatus, the revised processes, In order to suit the convenience of pharmacists who
and the recently introduced preparations of the age. prefer to weigh solids and measure liquids, the official
The vast advances made in theoretical and applied formulas are expressed, in addition to parts by weight, in
chemistry and physics have much to do with the develop- avoirdupois weight and apothecaries’ measure. These
ment of pharmaceutical science, and these have been equivalents are printed in bold type near the margin, and
reflected in all the revised editions of the pharmacopoeias arranged so as to fit them for quick and accurate
which have been recently published. When the author was reference.
elected in 1874 to the chair of Theory and Practice of Part III treats inorganic chemical substances.
Pharmacy in the Philadelphia College of Pharmacy, the Precedence is of course given to official preparation in
outlines of study which had been so carefully prepared for these. The descriptions, solubilities, and tests for identity
the classes by his eminent predecessors, Prof. William and impurities of each substance are systematically tabu-
Proctor, Jr. and Prof. Edward Parrish, were found to be lated under its proper title. It is confidently believed that
not strictly in accord, either in their arrangement of the by this method of arranging the valuable descriptive fea-
subjects or in their method of treatment. Desiring to pre- tures of the Pharmacopoeia will be more prominently
serve the distinctive characteristics of each, an effort was developed, read reference facilitated, and close study of
at once made to frame a system that should embody their the details rendered easy. Each chemical operation is
valuable features, embrace new subjects, and still retain accompanied by equations, while the reaction is, in addi-
that harmony of plan and proper sequence which are tion, explained in words.
absolutely essential to the success of any system. The carbon compounds, or organic chemical sub-
The strictly alphabetical classification of subjects stances, are considered in Part IV. These are naturally
which is now universally adopted by pharmacopoeias and grouped according to the physical and medical properties
dispensatories, although admirable in works of reference, of their principal constituents, beginning with simple bod-
presents an effectual stumbling block to the acquisition of ies such as cellulin and gum and progressing to the most
pharmaceutical knowledge through systematic study; the highly organized alkaloids, etc.
vast accumulation of facts collected under each head Part V is devoted to extemporaneous pharmacy. Care
arranged lexically, they necessarily have no connection has been taken to treat the practice that would be best
with one another, and thus the saving of labor effected by adapted for the needs of the many pharmacists who con-
considering similar groups together, and the value of the duct operations upon a moderate scale, rather than for
association of kindred subjects, are lost to the student. In those of the few who manage very large establishments.
the method of grouping the subjects which is herein In this, as well as in other parts of the work, operations
adopted, the constant aim has been to arrange the latter in are illustrated, which are conducted by manufacturing
such a manner that the reader shall be gradually led from pharmacists.
the consideration of elementary subjects to those which Part VI contains a formulary of pharmaceutical pre-
involve more advanced knowledge, while the groups parations which have not been recognized by the pharma-
themselves are so placed as to follow one another in a copoeia. The recipes selected are chiefly those which
natural sequence. have been heretofore rather difficult of access to most
The work is divided into six parts. Part I is devoted to pharmacists, yet such as are likely to be in request. Many
detailed descriptions of apparatus and definitions and private formulas are embraced in the collection, and such
comments on general pharmaceutical processes. preparations of the old pharmacopoeias, that have not
The Official Preparations alone are considered in Part been included in the new edition, but are still in use, have
II. Due weight and prominence are thus given to the been inserted.

xxv
xxvi Preface to the first edition

In conclusion the author ventures to express the hope Mr. George M Smith for their valuable assistance in revis-
that the work will prove an efficient help to the pharma- ing the proof sheets and to the latter especially for his
ceutical student as well as to the pharmacist and the phy- work on the index. The outline illustrations, by Mr. John
sician. Although the labor has been mainly performed Collins, were drawn either from the actual objects or from
amidst the harassing cares of active professional duties, photographs taken by the author.
and perfection is known to be unattainable, no pains have
been spared to discover and correct errors and omissions
in the text. The author’s warmest acknowledgments are JPR
tendered to Mr. A B Taylor, Mr. Joseph McCreery, and Philadelphia, October, 1885
Preface to the 23rd edition
The 200th year anniversary of the founding of the
Philadelphia College of Pharmacy edition

It is indeed an honor and a career high to be able to lead fundamentals remain same. To quote the first paragraph
the development of the 200th year anniversary of the of the 1885 Preface, “The rapid and substantial progress
founding of the Philadelphia College of Pharmacy (PCP) made in Pharmacy within the last decade has created a
edition of Remington: The Science and Practice of necessity for a work treating of the improved apparatus,
Pharmacy. It is also the 23rd edition of Remington. This the revised processes, and the recently introduced pre-
fruition did not come without significant challenges and parations of the age.” That statement is true of the new
obstacles. The first challenge was to truly examine Remington and topics of this “age” are “treated.” There
whether or not there is need for a compilation of this are indeed chapters dealing with new formulation and
nature and what such might look like, especially given the manufacturing techniques, translational research, and nat-
easy access to information for free on the internet. ural products including medicinal cannabis. There are
Another task was to carefully examine reasons why the also chapters dealing with modern issues including phar-
22nd edition was not well received. After consulting with maceutical chemistry, prodrugs, biotechnology, protein
appropriate stakeholders, the findings were clear and formulation, therapeutic antibody, specialty pharmacy,
pointed to marching forward with this edition and we substance use disorders, and health policy. As the work
decided to do so. A major development along the way was rounding up, the pandemic of 2020 [Coronavirus
was ability to recruit one of the largest publishers, SARS-CoV-2, Coronavirus Disease 2019 (COVID-19)]
Elsevier, Inc. to partner with us on the new Remington. became a reality and is thus addressed.
This fact is significant not just in the global availability of With PCP as anchor, we have been able to recruit edi-
the book but also in ability to utilize modern publishing tors and authors from all over the world consistent with
technologies, giving access to the whole book or just a the mission of Remington. I indeed hope that you find the
chapter, electronic or hard copy. The resulting book is compilation useful.
indeed true to Remington!
Adeboye Adejare
The Preface to the first edition in 1885 is reproduced
Philadelphia College of Pharmacy,
above for historical and relevance purposes. It is impor-
University of the Sciences, Philadelphia,
tant to note that while there have been many develop-
Pennsylvania, United States
ments in the profession of pharmacy and the underlying
sciences in over a century between then and now, the October 2020

xxvii
Acknowledgments

I would like to gratefully acknowledge all those who have played roles in making this edition possible. I thank the edi-
tors and authors for a phenomenal job in spite of dealing with the current pandemic (COVID-19) and many other duties.
I thank the Dean of PCP, who also happens to be an alum of PCP, Dr. Edward Foote who has been very encouraging
on this journey; as well as my colleagues. I would also like to thank Kristine Jones for bringing me to the Elsevier fam-
ily as an author. With the success of the book “Drug Discovery Approaches for the Treatment of Neurodegenerative
Disorders: Alzheimer’s Disease,” there was no doubt in my mind as to where to go once deliberations about the new
edition of Remington began. I would like to thank the many colleagues at Elsevier, especially Barbara Makinster, Erin
Hill-Parks, and Sreejith Viswanathan. It has been great working with you and I hope that we get to do it again!
I would like to acknowledge the support for my career in academia and for this book granted by my family, starting
from my lovely wife, Adekemi, to our children Adeboye Jr. (AJ), Adekunle (PCP alum), Aderonke, and Adeola. I
would also like to thank many people who have been helpful in one way or another, with special thanks going to my
mother, Ayoola Adejare.

Adeboye Adejare
Professor, Philadelphia College of Pharmacy
Editor-in-Chief

xxix
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which he noisily refused to be ejected in the morning to permit of other
guests turning the room to its proper uses—raise their prices to absurd
heights, and when the season suddenly collapses, the managers still
endeavour to screw from their lingering guests as near an approach as
possible to the season’s prices. Montevideo hotels that three or four years ago
were charging from $3.50 to $4.00 per day (the Uruguayan dollar is worth
two cents more than the American) now demand in the season from seven to
nine dollars for accommodation which consists of one small room, with full
board, half a dollar extra having to be paid for each bath taken on the
premises! When I protested against this extra charge for baths, the hotel-
keeper said that under no circumstances was he prepared to deduct it, as
water in Montevideo was “dearer than wine,” because a maldita English
company owned the waterworks, and made the poor townspeople pay dearly
for the privilege of keeping themselves clean. Under the circumstances, my
wife and I were quite willing to substitute the cheaper wine for the water, but
even this condescension on our part did not meet with his approval.
Certain it is that, although Buenos Ayres cannot really maintain the proud
claim to be the most expensive city in the world—for I defy you to beat the
record of four dollars paid by an acquaintance of mine in Rio de Janeiro for
one cake of Pears’ soap, a small packet of tooth-powder, and four ounces of
tobacco, all bought in the same shop!—it is in all conscience one of the most
remarkably easy places in the world for getting rid of money quickly. Mr.
Punch’s immortal Scotsman who wasn’t in London half an hour before “bang
went saxpence” would assuredly have had an apoplectic fit within a quarter of
an hour of arriving in Buenos Ayres. Fortunately, the preliminary shocks,
which ought to be the severest, are the least felt, for one takes some little
time to become familiarised with the relative values of the money, and not
until one can instantly figure the American or English values of the Argentine
notes he is paying away does he quite realise how rapidly his hard-earned
cash is slipping from him.
The real unit of value in most transactions is the paper peso,—these notes
are usually so dirty that they are in very truth “filthy lucre”—and as the
exchange stands about 11.4 to the English sovereign (the standard
throughout South America), it will be seen that a peso is value for about 42
cents. Many English residents, in endeavouring to regulate their expenditure,
follow the somewhat simple plan of reckoning a peso as a shilling. This
method certainly saves worry, though it is extremely bad finance, and worse,
when it is known that, even reckoned as a shilling, the peso can purchase
nothing that is the equivalent of a shilling’s worth in England. Thus bad
begins, but worse remains behind, for,—as we shall all too surely find,—not
only have we often to spend three times, and sometimes four times the value
of English money to secure what the English unit would have obtained at
home, but the article so bought will often prove to be falsificado,—a shoddy
imitation!
But what most strikes the observer at first is the seeming negligence with
which the Buenos Ayrian throws his money about, and the brazen audacity of
the shopkeeper, as illustrated by the price he places upon his wares. The one
is, of course, a resultant of the other, though, obviously, there must be other
forces at work to inflate prices. Mainly, we have to bear in mind that in this
great city, perhaps the most cosmopolitan in the world, with a population of
nearly a million and a half gathered from the ends of Earth, a motley
multitude of money grubbers, money is the only standard of value. Thus, an
art dealer who placed a statue in his window and ticketed it at a reasonable
figure, leaving to himself a fair profit after importing it at a fair price, would
not long continue to thrive in Buenos Ayres. A very large percentage of the
spending class are people who have come by their money easily, and, lacking
all knowledge alike of commercial values and intrinsic worth, can judge only
that a thing is good or bad according as the seller prices it. It is a happy state
of affairs this, which cannot last forever, and already there are signs that the
Golden Age is passing. In October of 1912, for instance, I witnessed a
portentous demonstration, in which a hundred thousand citizens took part, to
petition the Government and Municipality for some immediate legislative
action to lessen the cruel burden of the common people, to whom high wages
and brisk trade mean absolutely nothing, in view of the excessive prices for
the merest necessaries of life. To this I shall make further reference in the
present chapter.
I remember how impressed I was in one of my earliest walks, window
gazing in Calle Florida, by the curious care certain shopkeepers had taken to
display articles which in New York would have been heaped in tray-loads and
ticketed, “Anything in this basket 20 cts.” In fancy goods dealers’, for example,
insignificant little purses and common pencil-holders, cheap fountain pens and
little desk calendars, paper knives, and all the familiar odds and ends which
are classed under the generic head of “fancy goods,” were not crowded into
the window, as with us, suggesting overflowing richness of stock, but were
each disposed in solitary state at respectful distance from one another, much
as though they were valuable jewels, and indeed when one noted the prices,
they might have been precious stones, for a leather purse which would sell in
New York for a dollar would there be ticketed relatively at $3. I paid exactly
$3.15 for a small loose-leaf pocket book, an exact copy of which I had
previously bought in London for $1.30.
The chief disparity between English and South American prices is found in
articles of clothing, which, fortunately for most temporary residents, is a
matter that does not greatly trouble them, as it is always possible to take
sufficient clothing to last one for a considerable period. But certainly when
you see an ordinary straw hat, that would sell in the Strand, London, for
$1.25 ticketed somewhere around $4 you are inclined to catch your breath.
The common “bowler,” that sells in London at $1.50 will cost you anything
from four to five dollars; while the average price for a suit of clothes made to
measure in Buenos Ayres, equivalent in all respects to a suit costing twenty
dollars in London, is fifty dollars. Consequently, many Argentines have their
measure taken by a London tailor, who, charging them thirty dollars for a suit
(thus leaving an unusual margin of profit to himself) enables the purchaser,
after paying $10 import duty, to wear an actual London made suit for 20 per
cent. less than he can get one of inferior quality made in Buenos Ayres.
To give anything like an exhaustive list of the excessive prices charged for
the simplest necessities in the way of personal clothing might be to lay
oneself open to the charge of exaggeration, except that, fortunately, I have
preserved several newspaper advertisements as evidence of the bona fides of
any statements I have made, should these ever be called in question. So far
as clothing is concerned, I shall limit myself to the further statement that on
the day of my leaving Buenos Ayres for travel further afield, I bought one
dozen pairs of common socks, which in London sell for 40 cts. a pair, and paid
for these exactly forty pesos, or $1.40 per pair. This was one of the few
occasions, during my stay in South America, when I found it necessary to
purchase any articles of personal wear, and afterwards on looking at the
prices in New York and London stores, I congratulated myself very heartily
that I went forth to my adventures in South America well stocked. I
remember an English traveller, whose business takes him to Buenos Ayres for
three months of every year, stating in the most emphatic manner that he
would rather walk down Florida in his shirt tail than commit the economic
crime of purchasing a stitch of clothing in the town,—and he was not a
Scotsman!
It might be thought that the Gringo was a legitimate object of prey for the
harpy shopkeepers of Buenos Ayres, but it is not so. The present writer, being
not only competent to ask for anything in the native language, but, when
occasion serves, to engage in heated and lengthy discussion in that delightful
tongue, never found it possible to secure better terms than were granted to
any Gringo who could not utter a sentence of Spanish. It is not a case of one
tariff for the native and, another for the foreigner, as we find in Paris and
other European resorts. The native pays as highly—and, from long practice,
much more cheerfully—for all that he buys, as the stranger.
In proof of this, I cannot quote a better example than that afforded by an
incident in which the silk hat of my native secretary figured somewhat
eminently. He had been wearing it one Sunday at some special function—for
the “stove pipe” is throughout Latin America the symbol of importance and of
special occasions, as it used to be in England—and, happening to be caught in
a heavy shower, he required to send it round to the hatter’s for ironing next
morning. His wife, also a native, speaking only Spanish, called in and took the
hat back home (errand boys are at a premium). The charge made for merely
ironing the hat was 4 pesos ($1.68). The good lady had no idea whether this
was much or little, but her husband considered it a trifle excessive, as he,
having lived some little time in New York, and having found it possible to have
a hat ironed there for 10 cents went round to the Buenos Ayres hatter, and
after much argument succeeded in recovering two pesos, or 50 per cent. of
the charge from that gentleman, who was quite indifferent to the business,
and told him to keep his old hat at home, as he had no wish to iron anybody’s
hats!
That is the spirit in which all repairing business is done. If you want
anything repaired, you have got to pay so much that it is about as cheap to
buy a new article. One day my watch stopped: the spring was not broken, and
evidently it was only some slight fault, requiring, probably, a speck of oil. I left
it with the watchmaker and asked him to regulate it. Calling next day, the
watch was ready and going perfectly well, but to my surprise I was asked to
pay eight pesos ($3.35) for the craftsman’s skill and labour in putting it right.
The Luxurious Domestic Architecture of Buenos Ayres.

The immense building seen in the background of the


upper illustration is the home of the Paz family in the Plaza
San Martín; the lower view shows a typical “quinta,” or
country house of an Argentine magnate in the suburbs.

“Oh, evidently the mainspring was broken when you charge so much,” I
remarked.
“No, sir, the mainspring was not broken,” he replied.
“Then surely one of the jewels must have fallen out, or there was
something to replace, to justify so heavy a charge.”
“No, none of the jewels was missing, but it was quite a difficult little job,
and, besides, we do not like to repair watches,”—which was all the satisfaction
I was able to secure for parting with eight pesos!
On mentioning my experience that afternoon to an Englishman of longer
residence in the city, he remarked that these were the sort of things that
never could happen to one after two or three years, because one soon
discovered it was cheaper to buy, as you can, a good useful 5 peso American
watch, and whenever it goes out of order, throw it away and buy another.
There is a perfectly reasonable explanation of this. Workmanship, artisan
skill, labour of all sorts, are the commodities at highest premiums in Buenos
Ayres. People are making their money, reaping fortunes, not from honest,
productive workmanship and exercise of creative skill, as in North American
and in other settled industrial countries, but merely from sale and exchange.
The men who grow rich are the agents, the middle-men, and it is the middle-
men who are taking back as quickly as they can from the wage-earners the
high salaries which the latter can easily obtain but not so easily retain. The
stationer, for instance, who sold me for ten pesos a mechanical pencil
sharpener, which my office boy immediately broke by carelessly inserting the
point of the pencil, charged five pesos to repair the little machine. His
business was to sell at a profit what he had imported from Europe, but not to
supply skill and labour to put anything right.
As rather an inveterate smoker, and one with a preference for cigars, I
recall how disappointed I was to be told by the captain of the ship on which I
sailed to the River Plate, that there was probably no place in the world where
cigars were so bad or so expensive as in Buenos Ayres. I cherished for a time
some faint hope that this was perhaps a sweeping generalisation founded on
unfortunate experience, but I must bear witness to its general accuracy. The
cigar shops are many of them most beautifully appointed, fitted up with a
luxury rare even in London or New York. In not one of them is there a
smokable cigar to be had at less than 60 centavos (roughly 25 cts.) and in
order to enjoy something approximating to the pleasure of a fine Cuban cigar,
which would sell in New York for 40 cts., you will have to disburse at least 3
pesos, or $1.25. It is a custom among the Argentines, who are notably
abstemious, to invite a friend to smoke a cigar, under circumstances where an
American or Englishman would ask him to “have a drink.” Often I have noticed
at the tobacconist’s a gentleman taking in a friend to “stand” him a cigar, and
seldom, if he is a gentleman who values his self-respect and reputation in the
community, will he offer a friend anything less than a cigar that cost three
pesos. It is naturally a biggish cigar, and it will certainly have a very wide
band, with a good splash of gilt on it, and it will probably smoke not quite so
well as a 25-ct. cigar sold in Broadway. So far as I could discover, the moist
atmosphere deteriorates the imported Havannas. Locally made imitations are
concocted from Brazilian tobacco, packed up in disused Havanna boxes and
hawked among the offices by men who pretend to have smuggled them into
the country without paying duty. Admirably “faked” as to outward appearance
—for the art of falsification is one of the few local industries that flourish in
Buenos Ayres—these cigars can deceive no one after the first puff, but
thousands of boxes are annually sold to ready buyers, who, unable to afford
the shop prices, at least make a pretence of smoking Havannas, though they
know quite well they are being fobbed off with cheap Brazilian tobacco. Cigars
are sold at all sorts of prices, from 20 centavos upwards, and occasionally it is
possible to smoke one sold at 50 centavos, as I had frequently to do at my
hotel, where I was charged one peso for a cigar, on the band of which 50
centavos was printed. Representing to the manager that 42 cents seemed a
good deal to pay for a 21-cent cigar, the value of which in New York would not
have exceeded ten cents, he blandly assured me that they always charged a
peso for a 50 centavo cigar in the hotel!
Hotel prices are naturally in excess of all shop prices in Buenos Ayres, as
elsewhere, and of course there are degrees even among the hotels. At one
hotel where some of the modern comforts common to the better class of
hotels in London or New York may be obtained, the tariff is so formidable that
even an Argentine millionaire whose acquaintance I made, and who had been
making the hotel his headquarters for a year or two instead of living in a town
house, told me that he would have to quit, as he felt it was little short of
sinful to pay the weekly bill with which he was presented. Another gentleman,
the manager of a very large industrial concern in England, whose market is
mainly in the Argentine, was spending several months in Buenos Ayres during
my stay, and left the palatial hotel in question to come to the more modest
establishment where we two Gringos put up. In talking over the relative
charges with me, he said that while we had to pay enough in all conscience
for what we received (and for which no praying could have made us “truly
thankful”!), there was at least the difference between paying excessively for
very common fare and having your money literally “taken away from you.” Yet
the hotel in question, thanks to the extraordinary difficulty of obtaining
competent assistants at reasonable wages, and to the famine prices which
must be paid for every domestic commodity, as well as the immense capital
that has to be invested in steel frames, reinforced concrete, and furnishings, is
no very profitable business for those who conduct it. I doubt if they could
charge less than they do! This was often my experience when I came to
inquire into what seemed altogether unreasonable prices: to find that those
who seemed to be imposing on one were really asking no more than the
circumstances warranted.
All the same, a knowledge of the economic conditions does not greatly help
you to look with approval upon a charge of $2.35 for placing a bunch of about
six roses and half-a-dozen other flowers in a bowl on your table at dinner
when you are entertaining a couple of guests, especially if, as you happen to
know for certain, the said flowers have been left over from a wedding
celebration in the hotel the evening before. On several occasions this was the
charge which appeared on our weekly bill for decorating our little table in the
gorgeous manner described. Myself, having scant use for alcoholic beverages,
my main expenses on liquids touched “soft drinks.” Certainly the prices were
hard enough. I have retained some of our hotel bills as reminders. From these
I extract the following interesting items: One bottle of San Pellegrino Water,
55 cts.; Salus Water, 70 cts.; Small Apollinaris, 35 cts.; Schweppe’s Soda, 58
cts.; Vichy, 55 cts.; Small Perrier, 35 cts. As most visitors make it a point never
to drink the water of the town, and can easily dispose of several bottles of
Perrier or Schweppe’s Soda per day during the hot weather, the reader can
figure what proportions the weekly bill for mineral waters will reach, and it
must be borne in mind that the figures given are those charged at a hotel of
an extremely modest character. Nor would these prices appear so excessive if
each bottle contained what was indicated on the label. There is no security
that such is the case, and I know that many a time have I had to accept some
local concoction put forth in the guise of an imported European mineral water.
I also find some notes as to alcoholic drinks in our hotel bills, which will
give some notion of the casual expenses of entertaining friends. For a bottle
of Guinness’ Stout, 45 cts.; for a glass of Tonic Water and Gin, 50 cts.; for a
bottle of Chandon, $5.30; the same for a bottle of Veuve Clicquot; Chateau
Lafitte, $3; and so on. It will be noticed that the disparity between American
and Argentine prices in the matter of alcoholic drinks is less glaring than in
the case of mineral waters. But I find an occasional item in these weekly bills
which probably touches the high water mark of imposition. Under the heading
of “Alcohol,” we were charged from time to time 75 cts. for a pint bottle of
methylated spirits for use in a small spirit lamp!
Apart altogether from the normal excessive charges in the ordinary hotels,
which one comes to accept without demur simply because they are universal,
a further stage of imposition is to be noted in the swindling propensities of
restaurant employees. Thus, I have a note that I was once made to pay $1.05
for one glass of tonic water and gin which I “stood” a friend, and on various
occasions I was charged 63 cts. for a glass of whisky and soda, while I had
myself consumed frequent glasses of hot water with half-a-lemon squeezed
therein and a spoonful of sugar added, at a charge of 27 cts., before I realised
that a portion of these casual expenses was finding its way into the pocket of
the gentleman with the shifty eyes who presided over a certain “bar” where
the drinks were obtained. But the hotel charge of 62 cts. for half an hour’s
game of billiards, which conformed in every particular to that imagined by W.
S. Gilbert as the punishment of the billiard sharper,—

“On a cloth untrue, with a twisted cue,


And elliptical billiard balls,”—

seemed to me at once an insult and an injury.


Mentioning petty swindling on the part of employees reminds me that the
favourite dodge is to return the change of a five peso bill when a ten peso bill
has been presented. My patience, though seared by many tiny swindles
mutely borne, was never equal to taking the five-pesos-for-ten trick “lying
down.” I first became acquainted with it, soon after my arrival, at Retiro
station, when taking out a ticket for Hurlingham, the British suburban resort.
Presenting a ten peso bill at the booking office, the clerk hastily handed me
my ticket and the change of a five peso bill, which fact I discovered only on
examining my change after leaving the window. But even at that early period
of my stay, my command of the language was good enough to enable me to
return to the window and hold up the entire crowd of would-be ticket-buyers,
by informing the clerk that I intended to stay there until he handed me
another five pesos. He brazenly denied that I had presented a ten peso bill,
but on my stoutly asserting that I intended remaining in front of his window
till I received another five pesos, he forthwith met my demand, and thereby
advertised himself to the entire company the thief he undoubtedly was. I do
not exaggerate when I state that on dozens of occasions I had to draw the
attention of shop assistants and waiters (especially on dining cars) to the fact
that they had made this slight error in my change. When it is remembered
that five pesos is no less a sum than $2.10, it will be understood that some
slight knowledge of the language is desirable when one goes a-shopping
among the petty swindlers of Buenos Ayres.
Perhaps the very apex of audacity in the matter of excessive prices is
reached by the chemists, who ought surely to be the richest trades people in
all South America. It was our unfortunate experience, as indeed it is the
experience of most Northerners who have to live for any length of time in
these parts, to be fairly frequent patrons of the drug shop. But no amount of
experience reconciled us to the prices that were exacted. Nor do I think the
natives ever purchased anything without an inward or outward protest, as I
was frequently present at disputes between customer and chemist. I recall
particularly a youth who had been sent by his employer to fetch some
medicine that had been dispensed for him, and on offering all the money his
employer had given him to pay for the medicine, he was found to have
brought less than half the price demanded by the chemist.
It was my wife’s unfortunate fate to have to consume a large number of
cachets, prescribed by a Porteño doctor, and these I had to purchase weekly
at a well-known drug store, paying $2.10 for thirty, the price of which in
London would have been 60 cents. Out of curiosity, after two or three weeks,
I took the prescription to another chemist—as there is one at every other
street corner, the choice is ample—and was supplied with precisely the same
articles at $1.05. But the following week, when I returned for a new supply, I
was charged $2.10, as at the other chemist’s! On my protesting that I had
only paid half that price the previous week, I was informed that as they had a
somewhat limited supply of a certain drug used in the prescription, they were
forced to charge an increased price, and had therefore added 100 per cent. to
the first charge! These prices are typical of everything sold in the chemists’
shops; from soap to chest protectors, there is not a single item that will not
cost the purchaser from three to five times the price at which it may be
bought in the stores of New York or London.
It will thus be seen that it is a somewhat expensive business to be ill in
South America, and as most people, natives included, seem to be in a
continual state of recovering from illness (so much so that a familiar greeting
among the natives is “Buenas días, y como le pasa su estómago?”—“Good
morning, and how’s your stomach?”), the harvest of the chemist fails less
frequently than that of the agriculturist. The commonest class of doctor
charges a fee of $4.15 if you call upon him for a few minutes’ consultation
and are fortunate enough to be admitted before his two hours of work are
over, as you will usually find a roomful of patients awaiting his attention. If
you indulge in the luxury of inviting a visit from him at your house, his charge
will be $8.30, which must be paid on the nail, while payment for a
consultation at his rooms is either made to an attendant before entering, or to
the doctor himself on leaving. A simple operation, such as that for
appendicitis, will cost you anything from $250 to $1000.
Returning again to the smaller items of daily expense which help to drain
your earnings away from you as quickly almost as you receive them, I find I
have a few further notes worthy of record. At the hotel where we lived, two
English servants suddenly appeared. They had been attracted to Buenos Ayres
as the new Eldorado, and wages of forty pesos a month had seemed to them
the beginning of fortune, especially when they estimated the possibilities of
“tips.” But one of them, requiring to buy a new hat after her first fortnight in
the city, and being charged twenty-three pesos for the same (about $10),
which in London she would have considered fairly expensive at $1.70, she and
her companion very speedily made up their minds to return home, prepared
to be a little more contented with the conditions they had so lately despised.
A peso and a half (63 cts.) was a common charge for hair-cutting—a simple
haircut, no shampoo or singeing included, mark you.
As for theatre charges, the opera save in the gallery—where anybody who
has any reputation to maintain in the town can not afford to be seen—is
possible only to the wealthy, and consequently it is seldom visited by English
residents, except when honoured by an invitation from some Argentine friend.
A seat in the pit of the commonest theatre costs about $1.30. There is a
curious system of paying for your seat and afterwards paying a peso for the
privilege of entering the theatre! The cinematographs, which are relatively as
numerous as in New York or Chicago, have a uniform charge of 85 cts. for an
entertainment that compares badly with those that charge a quarter in New
York. Some of them are run on a system of three sections per evening, the
admission being 25 cts. to each section, but these are of the cheaper class.
In short, there is no necessity or luxury of life for which one has not to pay
many times more in Buenos Ayres or in Montevideo than in any North
American or European city. Every instance I have taken from my personal
experience, and beyond these there are doubtless hundreds of examples quite
as remarkable, or perhaps still more noteworthy, for various newcomers with
whom I came into touch, who were settling in the city and under the
necessity of furnishing flats or houses, were uniformly aghast at the prices
they were asked to pay for the most modest items of furniture, while house
rents would have turned a Fifth Avenue landlord green with envy. I had
personally to buy many items of office furniture, the prices of which I do not
recall, with the exception of a polished oak table of North American
manufacture, which in London would not have fetched more than $15, but
which cost me exactly $70. I also remember that a none-too-ostentatious
writing-desk of similar origin cost me upwards of $125.

Terminus of the Southern Railway at Plaza Constitucion, Buenos Ayres.

No wonder such conditions of life should be pressing heavily on the resident


population, with whom la carestía de la vida has become an all-absorbing
topic of conversation. During my stay, as I have already mentioned, a strong
movement was initiated by the popular journal La Argentina, in the hope of
bringing about some easing of the terrible burden, with what ultimate success
I know not. But it is interesting to quote here a few passages from the leading
English daily (the Standard), which, like all the Buenos Ayres journals, native
and foreign alike, is seldom severely critical of the economic conditions of the
country, being, I suppose, nervously afraid of saying anything that might
place the Argentine in an unfavourable light to foreign critics:

For some years past the Press has been urging upon the
National and Municipal authorities the necessity of adopting
measures for improving the condition of the working-classes
by reducing the cost of the necessaries of life and by providing
convenient and hygienic dwellings for workmen and their
families, but hitherto, the people having remained patiently
submissive to the economic state of things which counteracts
the higher remuneration obtainable for labour, the authorities
have failed in their duties to promote, to the utmost of their
power, the well-being of the mass of the population of this
great city. Congress has voted lavishly the resources for the
embellishment of the city, for the construction of monumental
buildings and monuments, for the acquisition of useless
warships, for the granting of hundreds of pensions to persons
who have no claim to public charity, for the sending of
representatives to congresses held in foreign countries upon
subjects in which this Republic is not interested, and special
embassies and commissions under different excuses, to enable
favoured individuals to make the tour of Europe with their
families at the expense of the public, but there is never any
surplus revenue to permit the diminution of the duties and
taxes which weigh most heavily upon the shoulders least able
to bear the burden....
The place of meeting was in the Congress plaza, to which,
in spite of the threatening state of the weather, the people
flowed from all parts of the city and suburbs, and at the
appointed time marched in orderly procession to the Plaza
Mayo. A deputation, headed by Mr. Adrian Patroni, a member
of the staff of La Argentina, was received in the Government
House by the Minister of Finance, Dr. Perez, who was
accompanied by his private secretary and by the Administrator
of the Custom House. Mr. Patroni presented to the Minister a
petition, together with numerous lists of thousands of
signatures in support of the petition, which asks, among other
things, for the reduction of the import duties on the
necessaries of life; for a diminution of the cost of transport of
articles of general consumption; for the erection of 10,000
houses for workmen and their families; for the grant of
sufficient funds for paving all the streets of the suburbs in
order to give work to the unemployed as well as to improve
the hygiene of the city; for the prohibition of races on working
days, and for the closing of the hippodromes (race-courses)
within five years....
Numbers of people in the procession carried placards upon
which were inscribed the requirements of the proletariat,
including, besides those mentioned in the petition, demands
for the concession of the public land, with facilities for the
payment of the same, to those who are willing to cultivate it;
for personal security for all the inhabitants of the provinces
and territories; for the improvement of the roads; for the
suppression of trusts and monopolies; for severe legislation
against usury; for regulations of the auctioneers’ profession;
for issuing bonds for 100,000,000 pesos for pavement in the
suburbs; for the reduction of license taxes on the vendors of
articles of consumption; for establishing free fairs in all
sections of the municipality; for permission to introduce the
carcasses of animals slaughtered outside the boundaries of
the Municipality.

Now what is the reason for this extraordinary expense of living? It is not a
matter that can be explained in a few sentences, so many factors are at work
to make the conditions what they are. I can at most throw a beam of light on
several of these factors. Visitors are astonished, for instance, to be told that in
a country popularly supposed to be one of the most naturally fruitful in the
world (though there is no greater illusion), that the commonest fruits which in
North America and Europe are within the reach of the very poorest, are only
to be enjoyed in Buenos Ayres by the rich. The country is almost destitute of
native fruit-bearing trees; it is naturally a treeless, bushless, wilderness of
rich, loamy soil, capable of producing enormous crops of grain if properly
cultivated, or of maintaining almost fabulous herds of cattle. The contents of
the orchards and vineyards that do exist must be reckoned as exotics. Few
people, indeed, seem to trouble about the cultivation of fruit or vegetables,
though the vineyards round about Mendoza on the Andine frontier, and Bahía
Blanca in the south of the Province of Buenos Ayres, show what unlimited
possibilities the soil possesses for the vine. Cattle and grain have occupied
(and not unnaturally) the energies of the agriculturists, but fruit-growing has
been comparatively neglected. Even so, it has fallen into the hands of a
vicious “ring,” who, adopting the worst of North American methods, have set
themselves to exploit the public. In the islands of the Tigre, at carting
distance from Buenos Ayres, where fruit and to spare could be grown to
supply the needs of the capital; and across the river, in Uruguay, where there
are ideal conditions for fruit culture, and where peaches, pears, apples, and
other fruits are almost as plentiful as blackberries; this ring has seized control,
and I have been told that thousands of tons of peaches and other fruit have
been thrown into the river in a single season rather than that the harvest, by
its natural abundance, should have been permitted to lower the market prices.
A successful English fruit-grower, attracted by the possibilities of Buenos
Ayres and the crying need for supplies, came out to study the situation, and
found that although he could easily have secured ideal orchard land, and
could have raised enormous crops of apples, pears, peaches, and all sorts of
table fruits, he would have been powerless to have brought his products to
the market in face of this sinister ring. He, therefore, abandoned the project
and returned to England. Thus, within walking distance of orchards laden with
peaches, it would cost you 6 cts. for one, and in Montevideo the conditions
are more outrageous still, as during our summer there we bought hundreds of
Californian apples at a cost of from 16 cts. to 25 cts. each, the local product,
at best inferior to the imported, and nearly as expensive, being then
inaccessible.
One effect of this scarcity of fruit—and the vegetables are only a little less
scarce, the country people seldom tasting them!—is the vogue of English
preserves, which are served as table delicacies. Jams, which the London
workman buys at 12 cts. a pot, are dealt out in the restaurants in spoonfuls at
more than 12 cts. a helping! Dulce inglésa is the line on the menu and when
you ask for it (which you do but once) you find it means a tablespoonful of
common strawberry jam, and you could have had a peche melba for the
money at home! Common 12 ct. pots of marmalade are sold in Buenos Ayres
at 43 cts. In Montevideo we two Gringos were responsible for the
consumption of many a tin of American fruit, such as sells in London at 20
cts. or 25 cts., the uniform price of which in Montevideo was 80 cts.
In the matter of manufactured articles, one naturally expects to pay extra,
since everything has to be imported from Europe or the United States. From
the latter country comes most of the polished oak office furniture, on which
there is an infamous import duty, on top of which again the selling agents
exact large profits. In this way the price swells to four or five times the home
selling cost. Import duties on ready-made clothes and every variety of
household wares are so excessive that the original cost is augmented by 25
per cent. to 50 per cent. before the seller secures possession of the goods.
The seller in turn has such enormous expenses in the shape of high wages to
assistants and iniquitous rentals, that he must clap on another 25 per cent. or
so for handling expenses, and finally, as he himself has heavy outgoings for
his own living and will naturally endeavour to secure some little luxuries from
the limited possibilities open to him, on must go another 25 per cent. or more
for profit.
It is thus one vicious circle, which results in everybody earning far more
money than he can earn anywhere else, and spending four or five times more
to secure about one-half of the comfort or luxury he would expect to enjoy in
any part of Europe or North America. Net result: he is, perhaps, “ahead of the
game,” but I am far from being convinced that the European or the North
American could not equally keep “ahead of the game” in his own country,
earning less, spending less, enjoying more, and saving equally. There is,
however, to some temperaments a certain delight in having money pass freely
through one’s hands, and assuredly that is what happens in the Argentine. If
the money comes easily, it goes with equal ease, and in the getting and the
going there is a certain zest which brings with it a feeling of unusual
prosperity.
CHAPTER XI
SOME PHASES OF SOCIAL LIFE

Here is a subject which every writer on the general life of a town or a


country is expected to deal with, but in the case of Buenos Ayres one is
reminded of the famous, “Story? Lord bless you, there’s none to tell, sir!”
Save, that in being a civilised people, the inhabitants of the Argentine must
needs dwell in communities, “social life,” as we understand it, is difficult to
discover in these communities. Certainly, a teeming city of nearly a million and
a half population, with crowded streets, palatial houses, theatres, lecture
rooms, concert halls, restaurants, would seem to suggest possibilities of
“social life”; but it happens to be a city mainly devoted to money-making,
those who have already made their money maintaining a centre of social life
somewhat remote from the Calle Florida; as far away, indeed, as the Bois de
Boulogne and the Champs Élysées, for is not Paris the social Mecca of the
successful Argentine?
Still they are few indeed thus privileged, in comparison with the multitude
who have to make the best of things as they are in Buenos Ayres. Even during
the terrible months of summer, those who can afford to fly from its stifling
atmosphere to the rustic surroundings of the Hills of Córdoba, to the sea-
washed shores of Mar del Plata, or to the still more attractive riverside
suburbs of Montevideo, constitute a small section of the community.
There is, of course, an important section of the community who annually
quit the city to pass the spring and summer months in the “Camp.” These are
the estancieros, whose wealth comes entirely from their country estates,
where life in the winter months declines to the nadir of dismal dulness and
discomfort, so that they reside for some seven or eight months of the year in
the city, and remove to the country for the warmer season, during which time
the head of the family may inspect and revise the work that has been going
on in his absence under the direction of his mayordomo, while the members
of his family, (which may include what we would consider half-a-dozen
separate “families,” as the patriarchal system of family life still obtains among
the Argentines) will enjoy themselves in a variety of simple and healthy
country pursuits. When residing in Buenos Ayres, the estancieros who have
not placed their affairs entirely in the hands of estate agents, as is the custom
with those who prefer to live in Paris, maintain offices and clerical staffs like
any other business men, for the work of an Argentine estancia entails a vast
amount of organisation.
With the family life of the Argentines, however, I do not for the moment
wish to concern myself, that being a subject of peculiar interest, which I
purpose treating at some length in a later chapter. For the moment, my
endeavour is only to register such evidences of the outward social life of the
people as came within my range of observation during my stay in Buenos
Ayres and my visits to different parts of the country. Conditions in the capital
city differ, of course, in various ways, from those in the larger provincial
towns, such as Rosario, Córdoba, and Mendoza, and still more widely from the
life of the smaller rural communities; but we must always bear in mind in
speaking of the Argentine that more than a fifth—and the most important fifth
—of the entire population is concentrated in the capital, so that while London
is not the embodiment of England, nor New York of the United States, Buenos
Ayres does stand for Argentina.
In previous chapters I have expressed my feelings of surprise and
disappointment at the unlooked-for dulness of the so-called “Paris of South
America.” Never shall I forget the deadness of our first night in Buenos Ayres
—a deadness that struck us like a nipping wind, chilling to the bone all hope
of bright and entertaining evenings. It was an impression which the
succeeding months, when we maintained a hungry and pathetic quest for
social interest, did but little to remove. Perhaps it was due in some degree to
the grossly exaggerated and misleading pictures of the city spread abroad by
writers more intent on flattery and official patronage than on the simple
narration of the truth. Almost alone among the many who have written on the
life of Buenos Ayres, M. Jules Huret has ventured to hint at the appalling
dulness of the social life and the lack of interest, especially for those of the
younger generation.
The most vital factor in determining the social life of any community is,
perhaps, the position of the womenfolk. In this respect, there is probably no
city in the world on which so much has been written, yet concerning which
the untravelled reader entertains more erroneous ideas. For this we have
chiefly to thank the sensational journalism of Europe and North America,
which, on the flimsiest of bases, has built up in the public mind the
conception of Buenos Ayres as the metropolis of Vice, the world’s mart of the
White Slave Traffic. Bearing in mind much of what has been written on this
unsavoury topic, and more that is circulated world-wide in irresponsible
gossip, the visitor might expect to find the outward conditions of New York,
London and Paris reproduced on a many-times magnified scale. Nothing could
be further from the truth. There are no large cities that I have visited in
Europe or North America,—and I have visited most of them—outwardly so
free of social offence as Buenos Ayres and the other great cities of South
America. By comparison, New York, Chicago, New Orleans, even Washington
and Philadelphia, would seem sinks of iniquity. Go to the races at Palermo,
visit any theatre in Buenos Ayres, with two or perhaps three exceptions, dine
at any of the few restaurants where a good meal is obtainable, wander the
streets at any hour of the day or night, and you will never have a moment’s
embarrassment from the social pest which obtrudes itself so flauntingly in
New York or London. This is one of the few things they regulate better in
Buenos Ayres. All places of public resort are barred to the demi-mondaine,
and as she is officially known, this makes for a certain surface cleanliness of
society, which is doubtless a delusion so far as the essential morals of the
people are concerned, and may be written down an organised hypocrisy, but
the outward evidences are as stated and not otherwise.
Furthermore, I know of no cleaner journalism than that of South America.
Even the papers of the Anglo-Saxon world compare unfavourably in this
respect; yes, those we deem highly “respectable”! One might expect to find
among a Latin people something of the Continental levity in the treatment of
this subject, but for propriety and sobriety, I do not believe it would be
possible to better the journals, even of the lighter class, which are published
in Buenos Ayres. They are almost absurdly respectable; the result, it may be,
of a very obvious lack of humour in the people. A further consideration is the
intense devotion of the Argentine to family life, and to family life of an almost
Moorish exclusiveness, so that, with very few exceptions, almost any
publication issuing in Buenos Ayres may safely pass from the hands of the
parents into those of the youngest children.
This will be something of a revelation to many of my readers, but when I
come to deal with “The Argentine at Home,” the factors which make for this
outward cleanliness of social life will become apparent.
On the other hand, the position of the Argentine woman, which so vitally
affects the social life of the country, corresponds in no way to Anglo-Saxon
notions, and explains much of the dulness, artificiality, and insincerity it is my
immediate business to describe. I remember very well reading in the pages of
M. Huret’s admirable work Del Plata á la Cordillera de los Andes:

An Argentine assured me that, on meeting in the street a


lady whom he had known in his youth, and whom he is
entitled to address familiarly (á la cual tutea), he is careful not
to stop and speak to her, lest in doing so he might
compromise the lady.

Indeed, this Argentine informed the French writer that in such a case he
preferred not to notice the lady at all, but to look away from her! Here, surely,
is a suggestive fact. The statement seemed to me so remarkable that I raised
the point with various Argentines, and always had it confirmed, one
gentleman assuring me that he would not even go so far as to pause for a
moment to speak in the street with his sister-in-law if she were
unaccompanied. He thought it was an extremely foolish social custom but
considered it was one to which every gentleman was bound to conform.

Marble Fountain in the Gardens of the Paseo Colón.


Plaza Francia in the Avenida Alvear.

The memorial is an offering of the French “Colony” to the


Argentine on its Centenary in 1910. Various monuments, the
gifts of other “Colonies,” ornament different parts of the
capital city.
It will thus be seen at a glance that one form of social intercourse so
familiar to us does not exist in the Argentine, which country is typical in this of
almost all the South American Republics. How far this must condition the
social life, any one can guess. The women are permitted some measure of
freedom until they become engaged, and may, under strict chaperonage,
attend formal receptions and balls, where the stiffest of starchy manners are
de rigueur. But after marriage, they withdraw to the seclusion of their own
homes and devote themselves to the care of their families, seldom taking part
in any social gaieties, even going very little to the theatre.
One consequence of this is an extraordinary preponderance of men at all
places of amusement. I am probably under-estimating the proportion when I
say that in almost any audience, with the exception of that at the Teatro
Colón, seventy-five per cent. would be men. More, I have often deemed it a
pathetic commentary on the arid life of the place to enter one of the many
cinematograph theatres and note the rows upon rows of men, with no more
than a handful of women sprinkled among them. Often in an audience
numbering probably five hundred, there would not be more than a dozen
ladies and most of these foreigners. It is a condition of things that tends to
perpetuate itself, as my wife, even with me at her side, always felt a little ill at
ease where so few of her sex seemed to be expected, although, without
exception, the entertainments might have been arranged for a party of
Sunday-school children, especially if it contained a number of “Budges” who
revelled in “bluggy” subjects, as hairbreadth escapes and the adventures of
Nick Winter, Sherlock (often rendered “Shylock”) Holmes, and other
preposterous “detectives” were the staple fare.
This tremendous overplus of men in the places of amusement admits of two
explanations. First, we have the unusual social custom which allows of the
husband acting as vicarious pleasure-seeker for wife and family, so that no
Argentine lady complains when her husband goes out alone to the theatre
and winds up the night at his club, returning long after she has been asleep!
Secondly, we have to remember that in all cities populated chiefly by
emigrants, large numbers of single men are to be encountered. It is the
experience of business people in Buenos Ayres who employ considerable
staffs, that a large proportion of their workers are youngish men who seem to
be absolutely without family ties or attachments of any kind, lonely wanderers
from the far lands of Europe.
A further influence militating against the womenkind enjoying such
entertainment as is to be found in Buenos Ayres is the widespread area of the
city. With a population not very much larger than half that of Paris, Buenos
Ayres occupies vastly more space, owing to the system of one-story houses,
which is still universal beyond the congested business area of the town. The
tram service, one of the best regulated in the world, as it is also one of the
cheapest, affords only a very inadequate means of communication between
the further suburbs and the theatre district, in Maipú and Esmeralda, while
the primitive state of the Suburban roadways make travel by coach, or
taxicab, a hazardous and painful experience. So it happens that we find
nowhere those bright and attractive supper restaurants with merry groups of
pleasure-seekers, men and women, discussing the play they have just come
from; but, in their place, many cafés, exclusively occupied by soft-hatted men
smoking and drinking. The most pretentious restaurant in the city shuts its
doors immediately after dinner, and even during dinner the ladies are always
in an insignificant minority. Gaiety, forsooth! Who comes to look for that in
Buenos Ayres has undertaken one of the most barren of pursuits.
As for the character of the resorts, little that is favourable can be said. I
remember with what delight I used to scan the theatre advertisements in the
columns of La Prensa before I sailed for the River Plate, and what pleasures
we promised ourselves, my wife and I, when the day’s work would be done!
Places of amusement there are in abundance, and their advertisements make
a brave showing in the newspapers, but there are rarely more than two, or it
may be three, entertainments that are worthy of a visit. South America is the
happy hunting ground of all sorts of incompetent Spanish actors and draggle-
tailed Spanish dramatic companies. To see “The Merry Widow,” “Casta
Susana,” or “The Count of Luxembourg” performed by a company destitute of
vocal talent, with shabby, misfit scenery, and a wardrobe so poverty stricken
that not a single actor wears a suit of his size (the whole company of them
resembling, in evening dress, a scratch lot of waiters from a Soho chop-
house), the orchestra clad in the motliest mixture of tweed suits, while the
voice of the prompter, whose sweaty shirt sleeves obtrude from his ugly box
in the fore-front of the stage, is heard above that of the actor—to witness this
is by no means a delectable experience; yet such is the manner of the fare
most frequently offered in the theatres of the city.
True, from time to time excellently organised Spanish and Italian companies
do occupy the principal theatres, and once a year there is a visit from some
eminent French actor, with a picked company, but on the whole dramatic
entertainment is pitifully poor, the pieces being staged in a slovenly and
inadequate style. The State-aided Opera, which has its home in the great
Columbus Theatre, is, of course, a national institution, and as such plays a
very important part in the social life of the richer classes, though the bulk of
the people have never seen more than the outside of the building. Opera is
here staged as perfectly as in the finest opera-houses of Europe, and not a
few “stars” first twinkled in Buenos Ayres before their magnitude was
recognised in London or Paris. On the strength of the Opera, Buenos Ayres
enjoys the reputation of being a very musical city. In the paraíso, or gallery,
you might discover a considerable number of Italians who had been attracted
to the Colón out of a genuine delight in the performance, but in most other
parts of the house, and most of all in the highly-priced boxes, the people are
there to see each other: the ladies to study the dresses of the other ladies,
the gentlemen to display in the persons of their wives and daughters the
substantial condition of their banking accounts—or of their credit. Nay, even
during the most dramatic parts of “Aïda,” “Manon Lescaut,” or “Otello,” I have
seen quite as many ladies in the audience with their backs to the stage,
chattering to friends, as there were others following the play. And in the
cazuela (a word which in domestic use signifies a stew, and theatrically a
gallery reserved entirely for ladies—also something of a stew) the chattering
between the fan-flapping occupants is so continuous that on a sudden
lowering of the music one is sure to hear voices from the cazuela ringing out
by contrast. For the rest, the Opera is a function conducted with the most
tremendous gravity, and although the season is comparatively short (and
usually unprofitable to the impresarios), it is not without its uses in enabling
the native community to see a little more of each other than the restrictions of
their social life would otherwise allow. To the stranger, however, it is socially
useless, and to the mere lover of music who could appreciate the excellence
of its representations, it is almost prohibitively expensive, unless he or she is
brave enough to incur the odium of being “spotted” in the five shilling gallery
or paraíso, where no English resident of any position in the town would
condescend to ascend. The consequence is, you will seldom meet an English
resident who has ever been to a performance in the Colón.
Of recent years, a movement in the direction of providing healthier
entertainment of a varied description for the family circle on certain
afternoons of the week, much after the style of the American vaudeville, has
been growing. Thus, on Saturday and Sunday afternoons during our stay, one
used to see many ladies and young children at the Casino, but at night it was
the rarest thing to discover in the whole crowded theatre a respectable
woman. Occasionally, an American or English lady ventured with her husband
to one of the boxes, where it was possible to sit behind a screen and see the
performance without being seen, but every seat in the pit, the circle, and the
galleries was occupied by a man, and invariably there would be at least one
turn that was highly objectionable, and rendered the more so by the conduct
of the audience, who, slow to respond to anything which the Anglo-Saxon
mind recognises as humour, have an ever-ready nose for suggestiveness, and
when that is forthcoming, do not merely laugh at it, but render it the more
offensive by uttering all sorts of obscene noises.
The Casino, the Theatre Royal, the Scala, and the Parisiana, during my stay,
whatever may be the case now, were the evening haunts of the younger men.
The first named was the only one that attempted anything like vaudeville
entertainment, the majority of the artistes being usually American or English,
and the difficulty of maintaining a programme was so great that the
management had to content themselves with what they could get in the
shape of second- and third-rate “turns” from overseas, so that often the
variety was not remarkable, two or three groups of comic acrobats being
included in one programme, and we all know that there is no variety in comic
acrobats. The other three resorts were deplorable imitations of the Parisian
houses that specialise in revues. With the exception of the Casino, these
theatres were all so small that they would not have been considered suitable
in America for more than lecture rooms or “picture” halls. The revues were
usually so stupid, the scenery so contemptible, the performers so inferior, that
I always felt sorry the audience had nothing better to do than waste their
time in such inanity. French was the language of the revues, with occasional
Spanish songs and interludes, and there was only one joke which seemed to
have a universal appeal—some reference to “606.” Examples: A miserable
youth comes on to visit a burlesque doctor. He begins explaining how he had
met a young lady in a restaurant, using words of the most suggestive
character, each sentence containing a pun on a number. “Ah,” says the doctor,
“your case must be treated arithmetically.” As the patient proceeds with his
tale, the doctor seizes on every punning phrase containing a number, jots
these down on a slate, adds the lot up, result 909; but reversing the slate he
exhibits to the audience “606.” Then there is feeble laughter of fools! Or a
young lady has a song of the telephone, and the refrain is “Please give me
number 606.” Faugh! But the spectacle of an English acrobat on the Casino
stage, dressed as a Highlandman, who at certain times pulled a string that
raised the back part of his kilt and displayed “606” painted on the seat of his
“shorts” filled me with disgust. (Perhaps it should be explained that “606” is a
cure for syphilis.)
The music in these revues usually consisted of a rechauffé of such up-to-
date tunes as “Ta, ra, ra, boom de ay!” “A Bicycle Built for Two,” “There are
nice girls everywhere,” and many others that have run their little day in the
“halls” of New York and London. In a word, anything more despicable in the
matter of entertainment could not be conceived, yet in these poor, pitiful play-
houses the young men and older bucks of Buenos Ayres were supposed to be
“seeing life.”
At one of the theatres mentioned, a group of fourteen English girls were
employed as dancers and singers practically all the time I stayed in Buenos
Ayres. They would certainly have found the greatest difficulty in earning a
livelihood in the same way in their own land, and it made me sad to hear their
poor thin voices uttering some drivel about “coons” and “moons” which to me
was only partially intelligible in my native language, and must have been so
much meaningless rubbish to the majority of the audience. The few painted
ladies who frequented those places in the evenings were a sorrowful group of
regular attenders, admitted, I believe, at half price, and gave the final touch
of squalid meanness to the scene.
Prize Bulls at the Agricultural Show in Buenos Ayres.

So much for the “gaiety” of Buenos Ayres! The reader will probably now
begin to realise what an attractive place it is for the young American or
Britisher. Poor young man, there is no one for whom I feel more pity. He is at
his wits’ end for wholesome amusement after business hours, and his case is
even worse than that of the young Frenchman or the Spaniard, who can
occasionally, at least, enjoy some reasonably good performance in his native
tongue, for English dramatic companies cannot possibly find sufficient support
to warrant the expense of the long voyage out and back. When I come to deal
with the life of the British community, I shall describe the straits they are put
to for social amusement and distraction, and the ingenuity with which they
contrive to render their lives a little less unpleasant than circumstances
conspire to make them. But in the general social life of the town, the English
take little or no part, keeping to themselves with their usual exclusiveness,
rendered the greater here by the almost impenetrable barrier which the
criollos, or older native families present to all advances from without.
In this regard, the British are not singular, as the French, German, Spanish,
Italian, and other nationalities all maintain in a very marked degree their racial
sympathies, although assimilating more quickly with the native element in the
matter of language, which remains the great stumbling block of the Anglo-
Saxons. Each community maintains its own clubs, with many sub-divisions
among Italians and Spaniards, the Neapolitans, for instance, having their
meeting-places apart from other Italians—indeed most decent Italians refuse
to recognise the Neapolitans as fellow-countrymen—and, among Spaniards,
the Asturians especially maintaining their local patriotism and racial interests
in this way. These clubs, almost innumerable, afford the men a common
meeting place to discuss their fortunes in the new land of promise and to
recall their old days at home, and as the social side of them includes frequent
concerts, banquets, and balls, the women of the company have also
opportunities for appearing in their best clothes and seeing photographs of
themselves in groups published in Caras y Caretas, the principal illustrated
weekly, whose every issue contains a large number of such items.
The social side of journalism is even more highly developed in Buenos Ayres
and in South America generally than in North America, so that one judging
only by the newspapers and the illustrated periodicals might suppose there
was nowhere in the world such sociability as in these Latin Republics. In
Buenos Ayres and in Montevideo elaborate guías sociales are published
annually, containing lists of “At-home Days” and other information of a
personal character, while La Prensa, La Nacion, El Diario, and all the other
newspapers devote whole columns daily to the movements of the local
nobodies. No possible occasion for a banquete is allowed to pass, and to the
English reader Caras y Caretas is a weekly joy, with its dozens of photographs
of these quaint little functions.
Señor Don Alonso Moreno Martínez (let us say) is going to Rio de Janeiro
on business for two or three weeks. The friends of Don Alonso thereupon ask
him to dine with them at the Sportsman Restaurant, where, in two hours’
time, they will demolish a quite eatable dinner of five or six courses.
Meanwhile, one of the ten or fifteen hosts of Don Alonso has taken care to
warn the photographer of Caras y Caretas, of Fray Mocho, and perhaps of P.
B. T., and these three photographers turn up in the course of the two hours,
make flashlight photographs of the little handful of diners, none of whom will
be in evening dress, the group presenting the oddest assortment of clothes,
and, behold, in the next issues of these widely circulated periodicals, excellent
reproductions of the said photographs, inscribed: “Banquet offered by his
friends to Señor Don Alonso Moreno Martínez, in view of his departure for Rio
de Janeiro, where he will absent himself for a few weeks on affairs of
importance.” It is no exaggeration to say that thousands of these photographs
are published yearly in the pictorial press, and when the honoured guest is a
little more important than my imaginary Don Alonso, then the big daily
newspapers are pleased to publish the photograph, while the provinces send
up to Buenos Ayres scores of them every week. It is all very pathetic, but very
eloquent of the low level of social interest.
Even the Races, so important an institution in Buenos Ayres, are conducted
in a way that almost entirely eliminates the social element. Among the vast
crowd that frequent the splendid course at Palermo on Thursday and Sunday
afternoons, except in the enclosure belonging to the Jockey Club, very few
women are to be seen. The men are there in mobs, not to enjoy the races, in
which they take no genuine sportive interest, but in the hope of making a bit
of money. An American lady said to me she had never been at so quiet a
demonstration before; she considered King Edward’s funeral was altogether a
livelier ceremony! The undemonstrative character of the people is, to us
supposedly phlegmatic Anglo-Saxons, really extraordinary. I have an
impression that it arises from an inborn laziness of character which is not
altogether foreign to their nature. They are chary of giving applause in the
theatre, and they sit dull and motionless before the most exciting films in the
picture palaces. At the Races there is a feeling of sullen determination to get
back twenty pesos or more for the two they have speculated.
With all this lack of wholesome interest in life, outside the brute struggle for
the dollar, it is not surprising that there should be a widespread devotion to
gambling and the card table, most of the social centres already mentioned
being also resorts of gamblers. And with all its veneer of socialness, there is
no genuine public spirit throughout the heterogeneous community. In a minor
way this was illustrated in February of 1913, when, owing to certain
regulations which the Chancellor of the Exchequer imposed upon the shops
selling drugs and perfumes, some 1,340 hairdressers and about 400
drugshops declared themselves “on strike” by temporarily closing their
premises, to the serious inconvenience of the invalids and the dandies. The
action drew forth the strongest denunciation of the Press for its anti-
humanitarian character, but I noticed that quite as much sympathy was
expressed with the male population who would thus be placed under the
painful necessity of shaving themselves for a day or two, as with the suffering
humanity whose need for medicine makes the druggist’s one of the most
successful businesses in the city.
There is truly little humanitarian feeling evident in the social life of Buenos
Ayres, although the organisation of the Asistencia pública is in every respect
admirable and its first aid to the injured and the sick leaves nothing to be
desired. The Hospital organisation into whose care the patient passes after
leaving the hands of the Asistencia is by no means so well conducted, so that
while you may rely on being taken to a hospital in the best possible way,
Heaven help you after you have been left there! While it is true that the
Argentine is far in advance of most of the other republics in its provisions for
public vaccination, and also in its sane policy of making vaccination
compulsory, the official treatment of disease always seemed to me to suggest
a nervous dread of the possibilities, a feverish readiness to test all the latest
European innovations for its suppression. The memory of past plagues is a
potent factor in this; recollections and traditions of the devastations wrought
in Buenos Ayres by Yellow Jack a generation ago do much to spread the
nervousness when there is any whisper of epidemics in other South American
ports.
January 29, 1913, was the second anniversary of the first great epidemic of
yellow fever that decimated the population of Buenos Ayres, and the
anniversary coincided with an outbreak of bubonic plague in the northern city
of Tucumán. The occasion was seized by the very competent and vigorous
writer of “Topics of the Day” in the Buenos Ayres Standard to deliver an
excellent homily on “Disease as a Hygienist.” From this I quote a few
passages which I think worthy of attention, coming as they do from the pen
of an outspoken local critic:

Unfortunately government as an art is not understood to


include or embrace hygiene. Politics concern themselves only
with the passions of the people, and the detriment thereof.
The oft-quoted tag: “the health (sic) of the people is the
supreme law,” is remembered only when an orator is anxious
to display his erudition, or when he feels in a particularly
cynical mood. The “supreme law,” as every one knows, is to
get what you can, when you can, how you can, but get it!
Not merely in the Provinces is hygiene neglected. The big
cities are great culprits in this matter. Some years ago the city
of Rosario was visited by bubonic plague. Instantly it was
placed in a state of siege. Trains from outside were not
allowed to enter, nor were passengers allowed to leave
without “a thorough disinfection.” They and their luggage
were submitted to the process, which gave them a
disagreeable odour, but, unfortunately, gave immunity to no
one. The outbreak was, as a matter of fact, too benevolent to
cause wide alarm in Rosario, but it had a wonderful influence
in stimulating the city authorities. As if by some enchantment,
the old fœtid system of cesspools in the centre of the city was
done away with and modern sanitation installed. Legions of
homeless dogs were summarily caught and mercifully
asphyxiated. The vigorous broom of reform was wielded
unceasingly for a few months, and Rosario smelled sweeter in
consequence. But much still remains to be done in Rosario. In
Buenos Ayres the old problem of sanitation is now in course of
solution, a comprehensive and stupendous scheme being in
course of execution. Still there are places in the outskirts that
would serve as nurseries for exotic disease-germs.
Unfortunately, too, the conventillos are full of children and
adults predisposed by heredity, by malnutrition and
unwholesome surroundings, to fall victims to, and propagate,
any passing epidemic....
The fact is, it is difficult, if not impossible, to find a city,
town or village in Argentina that can boast of adequate
sanitary arrangements. The smaller the place the greater the
problem. But to listen to Argentine orators, in Congress or out
of Congress, it might be thought that this country had
absolutely nothing to worry about but the unsatisfactory
political conditions of the Provinces and the country. Whole
sessions are devoted to a sterile debate upon the alleged
covert intervention of the National authorities in the mean and
pettifogging “politics” of the Provinces. But never a word
about the squalor that is endemic in the cities and towns of
these politician-ridden, quasi-autonomous States. Should
Nemesis come along she will exact heavy retribution for
culpable loss of time and opportunity, sacrificed in order that
glib orators may air their ineffective gifts.

Clearly social hygiene is not yet a strong point in the Argentine, where 62
per cent. of deaths among children born in the country are due to
malnutrition and errors of diet. Think of the folly of it! A land clamouring for
population, inviting immigrants of all races, yet allowing a high percentage of
its new-born citizens to perish owing to the lack of humanitarianism in its
social system. The life of the individual is valued lightly in the Argentine and in
any sort of society where the welfare of the component atoms is deemed of
no importance, the basis upon which to rear the fabric of social well-being is
insecure.

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