The red mixture

BMJ 2008; 336 doi: (Published 24 April 2008) Cite this as: BMJ 2008;336:937
  1. Suresh Kumar Pathak, retired general practitioner, Romford
  1. skpathak137{at}

I was born and brought up in a small town near Agra in India. A small hospital, the Civil Hospital, served the 45 000-strong population of the town and surrounding rural area. The Civil Hospital had large grounds, used by the dhobiwalah (laundryman) to dry his washing and by the local lads to play cricket. In the early 1950s the hospital was well appointed and, as with many buildings constructed during the Raj, was quite imposing.

It had a central hall, which was the outpatient department. On one side was the surgical section, where a male nurse known as the “compounder” (etymology obscure) ran a small, very clean and airy room. He was kept busy dressing wounds, and was competent to do minor surgery. On the other side of the hall was a room of similar size, the dispensary. Mixtures from large bottles were dispensed there, along with small packets of powders and a few tablets, mainly for malaria or diarrhoea. Behind the hall was an operating theatre, with facilities for such procedures as appendicectomy, hernia repair, and bladder calculus removal and facilities for manipulation under anaesthetic for uncomplicated closed fractures. When the medical officer performed any operation in the theatre it was the talk of the town. On either side was a 10 bedded inpatient ward, males on one side and females on the other. Behind the hospital was the x ray department, which was used rarely. Separated from the main hospital was the isolation ward, consisting of four rooms, used infrequently by patients with cholera, typhoid, tetanus, and other communicable diseases. The outpatient department, surgical dressing room, and dispensary were in constant use but were never overcrowded.

I was a frequent visitor to the dispensary. My innumerable elders would invariably have indigestion after Indian festivals, having consumed large amounts of ghee (clarified butter) and various sweets. They would request (rather, order) me to go to the dispensary and get the “Red Indigestion Mixture.” This was called Mixture Carminative, a deep red coloured liquid. I would leave home with a clean white medicine bottle, but with no cork as the hospital would provide one. I would present myself to the outpatient department and request the Red Indigestion Mixture. A prescription would be issued (no questions asked), and I would take the small brown note to the dispensing area, where the dispenser would take the bottle, wash it thoroughly and make a dose level using a piece of specially cut white paper which was stuck to the bottle to measure each dose. I would then return home with the potion to relieve my relatives’ bloating, burping, and dyspepsia, to make them ready for the next round of ghee and sweets.

Once, an aunt complained that the red mixture would not do any good as it was not red enough. So I returned to the hospital on my bicycle, the dispenser took the bottle, went to the large metal cupboard and took out a small bottle. He measured a drachm of “Tincture Card. Co.” (I know that now, not at the time) in a tiny measuring jar and added it to my bottle. As if by magic, the pale mixture suddenly became scarlet red. My aunt was delighted to see this unction, and pronounced that she now needed no more than half the dose.

When I entered general practice here in England in the early 1970s I remember prescribing “Mist. Carminativa” with satisfactory results. The mid-70s saw the introduction of cimetidine. Since then, expensive H2 antagonists and proton pump inhibitors have made the red mixture obsolete.

On my last visit to India I revisited the Civil Hospital. There was no dispensing room, the whole area had been reconstructed to house a modern MRI Scanner.

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