автордың кітабын онлайн тегін оқу The Propaganda for Reform in Proprietary Medicines, Vol. 1 of 2
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THE PROPAGANDA FOR REFORM —IN— Proprietary Medicines
Part I.
Council Reports
Part II.
Laboratory Contributions
Part III.
Contributions from the Journal: Nostrums
Part IV.
Contributions from the Journal: Miscellany
[Ninth Edition]
REPRINTED FROM THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
PREFACE
From time to time The Journal of the American Medical Association has published the reports of the Council on Pharmacy and Chemistry and the Chemical Laboratory, as well as other matter on proprietary medicines. Repeated requests for some of the matter have led to the compilation of “The Propaganda for Reform in Proprietary Medicines,” which, in the present volume, attains its ninth edition.
The seventh, eighth and ninth editions have been compiled on slightly different principles from their predecessors. The therapeutic reform work of The Journal and of the Association’s Chemical Laboratory was at first confined almost entirely to the criticism and analysis of the so-called ethical proprietaries. This was right; the medical profession owed it to the public to combat the nostrum evil within its own ranks.
As the more flagrant evils of the “ethical proprietary” question were mitigated, the Association has turned the light on the more widespread and dangerous “patent medicine” evil. The articles devoted to “patent medicines” or quackery being naturally of greater interest to the general public than to the medical profession, the number of inquiries from laymen regarding various quacks and nostrums has steadily increased. It has been thought best, therefore, to publish separately1 all of the matter from The Journal relative to quackery and to those nostrums exploited only or chiefly to the public, and to include in the Propaganda for Reform practically none of the matter that is of direct interest primarily to laymen. In one or two instances in which the subjects were of equal interest to the profession and to the public matter that has already appeared in “Nostrums and Quackery” is also given here; but as a general rule the contents of the ninth edition of “The Propaganda for Reform” are of strictly professional interest. Those physicians who are desirous of obtaining in convenient form the matter dealing with “patent medicines” should order the book “Nostrums and Quackery” or the various pamphlets on the same subjects that have been issued since “Nostrums and Quackery” came from the press.
The ninth edition of “Propaganda for Reform” contains a number of new articles, greatly increasing the size of the book. It also contains one novel feature which greatly enhances its value. The index includes references not only to articles in the book, but also to matter on proprietaries not accepted by the Council on Pharmacy and Chemistry which appeared in The Journal of the American Medical Association and elsewhere. This index makes of this edition of “Propaganda for Reform” a very full work of reference on proprietaries which are undeserving of recognition. It should be understood, however, that not all articles indexed are condemned; some are merely discussed and compared.
TABLE OF CONTENTS
PART I: COUNCIL REPORTS
PAGE
Acetanilid Mixtures
9Agar-Lac
10Anasarcin and Anedemin
11Maignen Antiseptic Powder
19Tyree’s Antiseptic Powder
21Apergels
26Aseptikons
26Betul-Ol
27Peacock’s Bromides and Chionia
28Bromidia
31Cactus Grandiflorus
36Calcreose
40Campho-Phenique
40Celerina, Aletris Cordial and Kennedy’s Pinus Canadensis, Light and Dark
43Cineraria Maritima
49Hagee’s Cordial of the Extract of Cod Liver Oil Compound
51Wampole’s Perfected and Tasteless Preparation of an Extract of Cod Liver
52Waterbury’s Metabolized Cod-Liver Oil Compound
54Waterbury’s Compound
57Colchi-Sal
58Cypridol Capsules
59Cystogen, Cystogen Aperient and Cystogen-Lithia
60Cysto-Sedative
61Taka-Diastase and Liquid Taka-Diastase
62Digalen Omitted from N. N. R.
68Dioradin Refused Recognition
73Echinacea
79Echtisia, Ecthol and Echitone
81Ergoapiol
82Erpiol (Dr. Schrader)
83False Unicorn (Helonias)
84Formurol
85Gastrogen Tablets
87Glyco-Heroin, Smith
88Glyco-Thymoline
92Glycozone
95Gardner’s Syrup of Hydriodic Acid
97Hyperol
100Ingluvin
101Intestinal Antiseptic W-A
103Bannerman’s Intravenous Solution
105Iodalia
106Iodex
107Iodia
108Burnham’s Soluble Iodine
110Iodotone
113Iosaline
113Nourry Wine
115Labordine
115Lactobacilline Omitted from N. N. R.
120Reexamination of Lactopeptine
121Meat and Beef Juices
123Valentine’s Meat Juice
129Medicinal Foods
131Migrainin
135Neurilla
136Neurosine, Dioviburnia, Germiletum and Palpebrine
139Oxychlorine
147Pam-Ala, Another Worthless Quinin Substitute
149Papayans Bell
151Passiflora and Daniel’s Concentrated Tincture of Passiflora
156Liquid Combinations Containing Pepsin and Pancreatin
157Pepto-Mangan (Gude)
159Liquid Petrolatum or “Russian Mineral Oil”
161Clinical Experience with Liquid Paraffin (Liquid Petrolatum)
167Angier’s Emulsion
169Phecolates, Phecolax, Phecozymes and Phecotones
174Phenol Sodique
175Phytin and Fortossan
178Prunoids
178Sal Hepatica
179Sanmetto
182Secretogen
185Sinkina
188Somnos
193Succus Alterans
195Sulpho-Lythin
196Taurocol
198Tri-Iodides, Three Chlorides and Maizo-Lithium
198Thialion
205Unguentum Selenio Vanadic (V. Roemer)
207Unicorn Root, Wild Yam and Wild Indigo
208Proprietary Vanadium Preparations
209Venarsen
212Venodine
214Veracolate
216Hayden’s Viburnum Compound
218Vin Mariani
221Virol
225PART II: CONTRIBUTIONS FROM THE CHEMICAL LABORATORY
Anusol Hemorrhoidal Suppositories
227Aromatic Digestive Tablets
229Burnham’s Soluble Iodin
233“Hydrocyanate of Iron-Tilden”
235Hymosa
238Micajah’s Medicated Uterine Wafers
240Noitol and Anadol
245Pix Cresol
247Saliodin
249Theobromin Sodium Salicylate Versus “Diuretin”; The Economical Aspect
251Unguentine
254Uricedin
256Uriseptin
256Zemacol
259Zyme-Oid
261PART III: CONTRIBUTIONS FROM THE JOURNAL:
NOSTRUMS
Alleotone
264Baume Analgésique Bengué
267Antidiabeticum-Bauer
267Antikamnia
268Anusol Suppositories
280Aspiro-Lithine
281Bell-Ans (Pa-Pay-Ans, Bell)
282Biosol
284Bromin-Iodin Compound
285Calmine
286Camphenol
287Chologen
288Hagee’s Cordial of Cod-Liver Oil
289Waterbury’s Compound Once More
291Collyrium-Wyeth
292Diatussin
293Enteronol
294Expurgo (Sanol) Anti-Diabetes
299Formamint
303Gomenol
304Headache Cures
305Hectine
308Hydronaphthol
308Hydrozone
309Hypoquinidol
310Iodonucleoid
310Iridium
312Iron Tropon
313Kutnow’s Powder
314Lymph Compound R-H and Orchitic Fluid Tablets
317Lysol—The Evolution of a Proprietary
318Thompson’s Malted Food Company
319Manola
323Mercol
326Midol and Nurito
327Mu-col
329Narkine
329Papine
330Pasadyne
332Pas-Avena
333Pertussin
334Phenalgin—A Typical Example
335Pheno-Bromate
343Phenolphthalein
343Mixed Vaccine and Phylacogens
346The Danger in Protonuclein, a Preparation Containing Thyroid
348Purgen
349Pyo-Atoxin
350Resinol
352Resor-Bisnol
353Robinol and Sevetol
353Salacetin
356Sal-Codeia-Bell
357Sanatogen
358 Sanatogen: a Scientific Investigation of Its Alleged Actionon the Recuperating Powers of the Blood
378 The Feeding Value of Sanatogen Compared with Commercial Caseinwith Respect to Maintenance and Growth
385Poehl’s Spermin in Arteriosclerosis
395Syrup of Cocillana Compound
396Aubergier’s Syrup of Lactucarium
399Tartarlithine
401Thoxos
402Trypsogen
403Tyree’s Antiseptic Powder
404Vapo-Cresolene
408Vasogen and Iodovasogen
408Viburnum Compound—and other Nostrums
409Wheeler’s Nerve Vitalizer
411Zymotoid
412PART IV: CONTRIBUTIONS FROM THE JOURNAL:
MISCELLANEOUS MATTER
Acetphenetidin and Phenacetin—Their Relative Purity
414Clean Advertising
418Lippincott’s Magazine
419Medical Journal Advertising
422Medical Journals and the Great American Fraud
426The Army and Navy Medical Record
432The Medical Times Advertisements
438Cause for Optimism
440The Comparative Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials
442Diabetic Foods Offered for Sale in the United States
446The Jireh Diabetic Food Company
451The Name “Epinephrin” Versus the Name “Adrenalin”
454The Hord Sanitarium
456The German Propaganda for Reform
458The German Council on Pharmacy and Chemistry
459Grand Prix and Gold Medals for Sale
462The Hypophosphite Fallacy
464Buffalo Lithia Water
467Meat Extracts and Meat Juices
470Pharmaceutical Manufacturers and the Great American Fraud
474Dowd’s Phosphatometer
476Amorphous Phosphorus
478THE PROPAGANDA FOR REFORM IN PROPRIETARY MEDICINES
PART I
COUNCIL REPORTS
ACETANILID MIXTURES[A]
Report of the Council on Pharmacy and Chemistry
To the Council on Pharmacy and Chemistry:
In response to the request of your chairman we have investigated the below-mentioned preparations and report as follows:
Specimens of the articles were bought in different cities in the open market, and in original sealed packages, and were analyzed by some of us or under our direction. Each article was examined by at least two chemists, and some were subjected to several analyses. While certain of the preparations are represented as being chemical compounds, the specimens examined were all found to be mixtures, the principal ingredient being acetanilid. The percentage proportions of acetanilid given below are the minimum obtained by any of the analysts.
Soda and ammonia, combined with carbonic acid, are calculated and reported as sodium bicarbonate and as ammonium carbonate (U. S. P.) respectively. Salicylic acid is calculated and reported as sodium salicylate. Diluents and other constituents than those reported were not determined.
AMMONOL
According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:
Acetanilid.
Sodium Bicarb.
Ammonium Carb.
50.
25.
20.
ANTIKAMNIA[B]
According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:
Acetanilid
Caffein
Citric Acid
Sodium Bicarb.
68.
5.
5.
20.
KOEHLER’S HEADACHE POWDERS
According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:
Acetanilid
Caffein
76.
22.
ORANGEINE
According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:
Acetanilid
Sodium Bicarb.
Caffein
43.
18.
10.
Other constituents said to be present were not determined.
PHENALGIN[C]
According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:
Acetanilid
Sodium Bicarb.
Ammonium Carb.
57.
29.
10.
Certain packages of phenalgin were purchased which on analysis did not show ammonium carbonate.
SALACETIN[D]
According to the analyses of the contents of the original sealed packages as purchased, this was found to be a mixture, and to contain the following ingredients approximately in the proportions given:
Acetanilid
Sodium Bicarb.
Sodium Salicylate
43.
21.
20.
We recommend that this report be printed in The Journal of the American Medical Association.
Respectfully submitted,
J. H. Long, M.S., Sc.D.,
Committee on Chemistry,
Council on Pharmacy and
Chemistry of the A. M. A.
W. A. Puckner, Ph.G.,
S. P. Sadtler, Ph.D.,
J. Stieglitz, Ph.D.,
H. W. Wiley, M.D., Ph.D.,
(From The Journal A. M. A., June 3, 1905).
AGAR-LAC
Report of the Council on Pharmacy and Chemistry
Agar-lac, said to be the product of “Agar-lac, Inc.,” is sold by E. Fougera and Company, New York. The following “formula” for Agar-lac is published:
“Agar-Agar with Lactic Ferments
Grs.4
1⁄
2Phenolphthalein
Grs. 1⁄
2”
Regarding the “lactic ferment,” the identity of which is not declared by the manufacturer and for the viability of which no precautions appear to be taken, the Council’s expert on lactic acid ferments reported that Bacillus bulgaricus was present in small numbers only and that there were at least two other bacteria present, one of which is a gas-former of the Bacillus coli type.
The Council found that the amount of agar-agar in Agar-lac and the identity of the “lactic ferment” are not declared; that the name “Agar-lac” is blown in the glass and that the method of its exploitation will lead laymen to use it to their detriment; that the claims that it “facilitates assimilation of proteids” and that it is of value as an aid to “gastro-intestinal digestion” give a false value to the mixture and that the claims emphasize the action of agar-agar when from the composition it is evident that the phenolphthalein action will predominate; that the name does not indicate its predominating constituent, phenolphthalein, and that the use of a ready-made combination of cathartic drugs, such as agar-agar and phenolphthalein with lactic acid ferments, is unscientific. The Council therefore refused recognition to Agar-lac.—(From The Journal A. M. A., Nov. 14, 1914.)
1 This matter appears in “Nostrums and Quackery,” a 700-page book, and also in various pamphlets. Write for the descriptive price-list of publications dealing with the nostrum evil.
Of the six physicians located in Winchester, three (50 per cent.) are engaged in the dropsical cure business. Poor Winchester! Aside from their connection with these two nostrums, these physicians may be estimable and worthy citizens, but where, pray, did they find the extensive clinical facilities and pharmaceutical knowledge necessary for their wonderful and epoch-making discovery? Were they aided in their scientific work by the four lawyers connected with the Anedemin Company or by the insurance solicitor who is a director of the Anasarcin Company? Did the 1,500 inhabitants of the town furnish the vast clinical material necessary for discovering and working out the formulas of these two preparations? If so, we fear that dropsical affections are much more prevalent in Winchester than in any other known spot on the globe. This matter should be investigated. Without doubt the vital statistics of Franklin County would be most interesting and we commend them to the special attention of the medical profession in Tennessee.—(From The Journal A. M. A., May 4 and 11, 1907.)
For years Mr. Tyree has been misleading physicians by making false statements regarding the composition of his powder and regarding its value as a therapeutic agent. When exposed he tries to defend himself and his business by statements and excuses that are worthy of a schoolboy trying to get out of a bad scrape. We would respectfully suggest to him that he either take his wonderful powder off the market, or—which would probably amount to the same thing—tell the truth, and the whole truth, about it.—(From The Journal A. M. A., May 18, 1907.)
The second interesting phase of this “ethical” proprietary is that it illustrates another point, i. e., that many of these articles are supplied to our profession by those who are not legitimate manufacturing pharmacists. The Campho-Phenique Company of St. Louis, according to all reports, is owned and controlled by a gentleman named Ballard. This “company” supplies the medical profession with the preparations under consideration and also with Chloro-Phenique and Scrofonol. We are informed that this same Mr. Ballard is the principal owner, if not the sole owner, of quite a number of “patent-medicine” companies, such as Ballard-Snow Liniment Co., Brown’s Iron Bitters Co., Mayfield Medicine Mfg. Co., Smith Bile Beans Co., Swain’s Laboratory, and several others. We learn from the wholesale drug trade lists that these various “companies” make and sell, besides the Campho-Phenique preparations, Ballard-Snow Liniment, Ballard’s Herbine, Brown’s Iron Bitters, Dr. Herrick’s Pills, Richardson’s Life-Preserving Bitters, Smith’s Bile Beans, Swain’s All Healing Ointment, and several other “patent medicines.”
The Council has previously expressed the opinion19 that the preponderance of evidence indicates that whatever therapeutic value cod liver oil may have depends chiefly, if not entirely, on its fat (oil). There never was any evidence or scientific authority for the theory that the therapeutic value of cod liver oil was independent of its fat content. The fact that the fat is the growth-promoting element has already been shown, and J. P. Street, chemist for the Connecticut Agricultural Experiment Station (The Journal A. M. A., Feb. 20, 1915, p. 638), in a series of experiments on a number of the so-called extracts of cod liver or cod liver oil (including Hagee’s Cordial) has conclusively demonstrated that the growth-promoting properties of the oil are not to be found in the extracts. Street placed rats on a ration not sufficient to maintain normal nutrition and growth for an extended period. After the rats had been on this ration for some time and a failure to maintain weight was indicated, an amount of dealcoholized Hagee’s Cordial was substituted for a portion of the lard contained in the ration. Later Hagee’s Cordial was replaced by cod liver oil.
The results of the examination are briefly as follows: The total quantity of acids isolated amounted to about 0.3 per cent., and of this amount about two-thirds was salicylic acid. Thus it appears from the examination of the specimens bought on the open market that the preparation contains at most but 0.1 per cent. of the fatty acids from cod-liver oil, a totally insignificant quantity.
Colchi-Sal is typical of unscientific ready-to-take proprietaries. It was held ineligible for New and Nonofficial Remedies because of its secret composition, viz., the unknown nature of the “active principle of Cannabis indica” (Rule 1); because the circular in the package and the name blown in the bottle constitute advertisement to the laity (Rule 4); because the claim that cannabis indica removes the gastro-intestinal irritation, and the claim of the superiority of methyl salicylate are unwarranted therapeutic claims (Rule 6); because the name does not indicate the presence of the habit-forming cannabis indica, and because of its unscientific composition (Rule 10).—(From The Journal A. M. A., March 20, 1915.)
Rule 4: The dosage, price, etc., on the label, and the name “Cypridol” blown in the bottle, all tend to a direct self-prescribing by the public. In addition to the objectionable statements on the bottle itself, the preparation is put up in patent medicine style and is accompanied by a circular giving full directions for the use of this and of other proprietaries for the treatment of syphilis in all of its stages. The circular states that “a 1 per cent. solution of bin-iodide of mercury in an aseptic oil” is “An Improved Specific in the Treatment of Syphilis,” and after lauding the virtues of Cypridol, gives full directions for the treatment of syphilis in its various stages by means of Capsules of Cypridol augmented, during periodical cessation of treatment, by “small doses of iodide of strontium (Paraf-Javal’s standard solution, thirty grains to the ounce).” Further, the circular expounds the need of “a toning up of the general system” and by means of obsolete theories and obviously untrue assertions recommends “Chapoteaut’s Wine [another of their proprietary preparations], each ounce of which contains 10 grains of phospho-glycerate of lime. This is a delicious, nutritive tonic. A pint bottle costs $1.00.”
Cystogen is the therapeutically suggestive name applied to hexamethylenamin by the Cystogen Chemical Company. While investigation has shown that hexamethylenamin yields formaldehyd only in the presence of an acid and consequently can produce an antiseptic effect only in the gastric juice and in the urine, it is claimed that Cystogen is an “intestinal antiseptic” and that it “bears its disinfectant and antitoxic qualities into well-nigh every important bodily cavity.”
“In formulating Cysto-Sedative each drug entering into its composition was subjected to careful study clinically to determine the exact proportion required when combined to increase their efficiency as a whole. Cysto-Sedative is scientifically prepared, the proportion of each individual drug being so finely adjusted as to increase their therapeutic action in the conditions for which they are intended, forming a preparation always reliable and of the very highest medicinal activity.”
The Dioradin Company submits considerable clinical data in favor of Dioradin. It must be remembered that most favorable opinions have been published, from time to time, about scores of “consumption cures,” which have mysteriously lost their efficiency when their novelty wore away. There is no more reason to doubt the good faith of those who are enthusiastic about Dioradin than of those who have been enthusiastic about other “cures.” There appear to be features in the course of tuberculosis which make the judgment of therapeutic measures peculiarly difficult. It is possible that impartial clinical trials of Dioradin by tuberculosis experts appointed by the Council might facilitate judgment as to the actual efficiency of Dioradin. The referee doubts, however, whether this would advance the Council very much toward the acceptance of the substance. Such an investigation would be so lengthy that it should not be undertaken until the Dioradin Company itself has offered at least presumptive evidence in this direction, especially in view of the adverse report recently made by Cecil Wall.45 Ten tuberculous patients were treated by Wall in strict accordance with the method outlined to him by Bernheim, yet Wall concludes that none of the cases, though treated accurately in accordance with the instructions, can be quoted to justify any of the claims for the therapeutic efficiency of Dioradin. The Council cannot undertake lengthy investigations of this character until it is put in possession of data which would show to its satisfaction that such investigations would probably be fruitful.
These absurd claims of an evidently ignorant man have passed into the more recent proprietary advertising matters and into much of the eclectic writings. Indeed, the seemingly impossible had been attained by even surpassing Meyer’s all-but-all-embracing claims. Not content with endorsing echinacea as a positive and speedy “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia, later enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus and exophthalmic goiter, and with the power of retarding the development of cancer.
Echtisia (Wm. S. Merrell Chemical Co.), Ecthol (Battle and Co.) and Echitone (Strong, Cobb and Co.) are proprietary preparations each of which is alleged to contain echinacea as its chief constituent. In 1909 the Council examined into the claims made for echinacea. This drug has been claimed to be a “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia. Enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus, and exophthalmic goiter and with power of retarding the development of cancer. Of course there is no reliable or trustworthy evidence to substantiate these claims. Echinacea is not often prescribed under its own name, but is employed as an ingredient in proprietary preparations mixed with other little-used or obsolete substances. Thus Echtisia is said to contain echinacea, wild indigo, arbor vitae and poke root; Ecthol, to have echinacea and arbor vitae; Echitone, to consist of echinacea, pansy and blue flag. Naturally the manufacturers of such proprietaries make use of all available optimistic reports in promoting their sale, while each manufacturer ascribes special and peculiar virtues to the combination represented in his particular preparation. The Merrell Chemical Company claims that baptisia (wild indigo) is a “destroyer” of devitalizing elements in the blood “a vitalizer of the blood as well”; that thuja (arbor vitae) is a “perfect antiseptic and a generator of vital force in disorganized tissues,” and that a long list of diseases, including diphtheria, syphilitic sciatica and gonorrheal rheumatism, “are all more or less amenable to full doses” of phytolacca (poke root). Strong, Cobb and Co. maintain that Iris versicolor (blue flag) is “one of the most powerful excitants of the biliary, salivary and pancreatic secretions,” and that the “principal sphere of action of Viola tricolor [pansy] is in the gastro-intestinal canal and the skin.”
In consequence of the more thorough scrutiny now given by the Council to the therapeutic value of the remedies admitted to New and Nonofficial Remedies, the Council has reconsidered Erpiol (Dr. Schrader), previously accepted for New and Nonofficial Remedies. Erpiol (Dr. Schrader) is the name applied to capsules containing apiol, ergotin and gossypin, which are sold as an emmenagogue. The first two ingredients have a recognized value in the treatment of diseases of the female generative organs. The third, gossypin, is a preparation from cotton-root bark, belonging to the somewhat indefinite class of pharmaceutical preparations known as resinoids.
There is practically no reference to this drug in reliable medical literature, and as there is no evidence worthy of credence to support the claims made for it, the drug was not considered deserving of a place in the Pharmacopeia. Hence, it may be regarded as a drug not worthy of attention of physicians.—(From The Journal A. M. A., Nov. 27, 1909.)
While these recommendations sound as if they were addressed to the public, Gastrogen Tablets are advertised in medical publications and hence come within the scope of the Council. Gastrogen Tablets are said to be composed of pepsin, calcium carbonate, calcium phosphate and “aromatics.” As each tablet, according to the label, contains 7 grains of calcium carbonate (chalk), the recommended dosage would in most cases be sufficient to neutralize the gastric fluids in the stomach and would thus tend to prevent the pepsin from exerting its digestive effects. The means adopted to relieve one symptom of dyspepsia, in other words, defeats the action of the means for relieving the indigestion. The fact is that patients who need an antacid do not need pepsin, while those who need pepsin will be harmed by the administration of an antacid. Gastrologists hold that, except in rare cases, the evidence tends to show that wherever there is a sufficiency of hydrochloric acid there is a sufficiency of pepsin. When pepsin is lacking it should be administered along with hydrochloric acid to make it effective. The Council voted that Gastrogen Tablets be refused recognition.—(From The Journal A. M. A., Dec. 12, 1914.)
The following is another illustration of the vague statements made: After asserting that Glycozone is hygroscopic and that it will deteriorate by absorption of water unless securely corked, it is stated that “Its healing properties increase with age.” Whatever mysterious ingredient there may be present in this mixture to justify the statement that the healing properties increase with age can only be conjectured. To humbug the patient further, the circular advises him to use only a “silver, glass or hard rubber spoon.”—(From the Journal A. M. A., June 5, 1909.)
The fallacies attending the use of digestive ferments in most stomach diseases have been previously noted in The Journal.53 In most digestive disorders a deficiency of the digestive ferment has not been proved. In cases in which pepsin is lacking, its administration is valueless unless it is combined with large doses of hydrochloric acid, and it is doubtful whether this combination is either necessary or conspicuously useful. There is, however, something so alluring about medication by digestive ferments which are assumed to supply a physiologic need, that since their discovery they have formed a fertile field for the activity of the manufacturer of proprietaries. As by scientific laboratory tests, it is possible to determine whether a given preparation has digestive power, the manufacturers of Ingluvin avoid this point by claiming that the remedy acts, not on the food, but on the stomach itself. That remedies may exist which act as stimulants to the digestive secretions can not be denied, although at the present time this power has not been satisfactorily demonstrated. The proprietors of Ingluvin, finding that proteolytic activity is not to be attributed to this preparation of chickens’ gizzards, announce a new therapeutic fact in the claim that “the natural glycocholic acid in Ingluvin is the active principle and the most efficient agent in the treatment of all stomachic and enteric disorders. According to the report made to the Council there is no glycocholic acid in this preparation, nor is it possible, from the anatomic arrangements of the fowl’s digestive apparatus, for it to get there. By all the tests which can be applied to determine its value this preparation is of much less value in digestive disorders than saccharated pepsin, which was discontinued in the Pharmacopeia because of its inferiority to the other forms of the ferment.
The testimonials contained in the advertisements cannot be considered as serious evidence. None present any indication of accurate record or proper control of conditions, or of the performance of control observations. They are superficial impressions, to which little or no weight can be attached.
Iodex is advertised as beneficial in muscular soreness, sprains, sciatica, neuritis, chronic rheumatism, enlarged glands, orchitis, epididymitis, gout, burns and dermatomycoses. It is also said to be “Indicated in Glandular Enlargements, Inflammatory Conditions, Various Joint Diseases, Rheumatism, Skin Diseases, Chilblains, etc., etc.”
It is generally accepted that in certain stages of syphilis the only hope of success lies in efficient iodin medication. The exploiters of Iodia state that a dose of the nostrum contains 21⁄2 grains of potassium iodid; actually it contains only 11⁄2 grains. To urge physicians and the public to depend on this product for efficient iodid medication constitutes an unwarranted therapeutic exaggeration (Rule 6) which approaches criminality. The reason Iodia does not produce iodism is that, in the doses recommended, the iodin action is extremely feeble.
Iosaline, therefore, appears to be a solidified, watery-alcoholic solution of soap containing potassium iodid, menthol and methyl salicylate. Physiologic tests carried out by rubbing the preparation on the skin and afterward testing the saliva and the urine for an iodid indicated that none of the potassium iodid is absorbed. Since Iosaline is claimed to contain 70 per cent. of alcohol and 5 per cent. of iodin, the alcohol content is but 68.7 per cent. and the iodin content but 85 per cent. of the amounts claimed. The phrase “combined iodin” is evidently meant to mislead, and adds the element of mystery on which preparations of this class rely so largely.—(From The Journal A. M. A., March 15, 1913.)
This is a fair sample of nostrums and of the methods of exploiting them. The bitterly humiliating fact about the whole business is that a preparation, advertised under such palpably misleading claims, could actually be advertised in medical journals, even in journals of a supposedly high scientific standard, and could be bought and prescribed for years by supposedly intelligent and conscientious physicians. It is not supposed that every physician should be enough of a chemist to detect the ridiculous discrepancies between the published formula and the therapeutic claims made for such a mixture. But that members of a supposedly learned profession should fail to have enough interest in the preparations they prescribe for their confiding patients to find out that acetanilid is being masked under an obsolete and little used name, that under an imposing polysyllabic designation is hidden saccharin, that the so-called “active principle Process-Laborde” (whatever that may be), is equivalent only to one-third grain of salicylic acid in a 5-grain tablet, and that the advertising matter sent out for years by this company contained absolute falsehoods regarding the composition and therapeutic benefits of its preparation, is certainly just cause for shame and humiliation. If a physician, knowing the composition of Labordine, wishes to prescribe it and prescribes it intelligently, he has a perfect right to do so. If he wishes his patient to have 2 grains of acetanilid, 1⁄20 of a grain of quinin, and 1⁄3 of a grain of salicylic acid, and considers a mixture of ground celery seed, starch and milk sugar as a proper vehicle for this medication, no one will question his right to administer it. No physician, however, has any right, either moral or professional, to prescribe a preparation, concerning the ingredients of which he knows absolutely nothing.
The Franco-American Ferment Company has advised the Council on Pharmacy and Chemistry that, in advertising its products, it will no longer conform to the rules of the Council. This is evident. The Franco-American Ferment Company has distributed circulars in which the public is informed that auto-intoxication is the cause of innumerable ills ranging all the way from arteriosclerosis, rheumatism and gout to chronic headache, odorous perspiration, nervous disorders and melancholia; that the Bulgarian bacillus “is a wonderful corrective or remedy” for all these conditions, and that the Lactobacilline products are the only preparations of Bulgarian bacillus “to be had in America which bear his [Professor Metchnikoff’s] personal endorsement”—by inference, the only reliable products. In view of the action of the Franco-American Ferment Company, and of the tendency of their advertising to cause the public to exaggerate slight ailments into alarming conditions, the Council has voted that the several Lactobacilline products of this concern be deleted from New and Nonofficial Remedies.—(From The Journal A. M. A., April 17, 1915.)
[Editor’s Note.—The difference between meat extracts and meat juices was fully discussed in the previous report of the Council, Meat “juices” are made by the cold expression of meat with subsequent evaporation, in such a way that the nutritious coagulable proteins remain in solution. In making meat “extracts,” heat is used which almost completely removes the coagulable proteins and thus renders it practically devoid of nutrient qualities.
There is likewise another point of considerable importance to consider in this connection. The terms peptone and albumose include bodies of very uncertain composition, and their suitableness as food substances depends largely on how they are prepared. Animal experiments have shown that nitrogen equilibrium may be maintained, for a time at least, by use of enzymic hydrolytic products of the proteins, even where the hydrolysis has been carried far beyond the so-called peptone stage, but it appears to be likewise true that the mixtures secured by acid or high temperature steam hydrolysis have no such value. Some of these, indeed, may exhibit a toxic behavior. This is true in particular of some of the commercial varieties of peptone, and until more is known of the source of the bodies of protein character employed in the makeup of these “predigested” mixtures it is unwise to assume anything concerning the food value of the nitrogen compounds found in them by analysis or even to dignify them by the name of foods.—(Abstracted from The Journal A. M. A., May 11, 1907.)
In recent advertising matter issued by Koechl & Co., “phenozon-caffein citrate” is given as a synonym for Migrainin, one circular stating that “Migrainin is phenozon-caffein citrate,” etc. In the same circular the following also appears: “In the treatment of migraine with phenacetin or antipyrin, the attack is delayed, while with Migrainin it is usually permanently stayed.” This will, no doubt, lead physicians to infer that Migrainin is not a mixture of antipyrin and caffein citrate, but that it is some new compound. While the firm disclaims any intention to mislead, it does not offer to withdraw or modify this circular. It is recommended, therefore, that the approval of Migrainin be rescinded and that it be omitted from New and Nonofficial Remedies.—(From The Journal A. M. A., June 5, 1909.)
[Editorial Note.—The four nostrums mentioned above have been grouped together for publication to call attention to one phase of the proprietary business. A fact not mentioned in the Council’s report is that these nostrums are manufactured and promoted by a concern that belongs to a type we have often designated “pseudo-chemical” companies. By this is meant companies that are not in the legitimate business of pharmacy or chemistry, but organized to exploit one, two or in some instances half a dozen proprietaries. “Patent medicines” are exploited by this class of “companies.” The Dios Chemical Company is not a chemical company, except in name. J. H. Chambers, the founder so far as we can learn, never claimed any special knowledge of chemistry, pharmacy or medicine. The officers at the present time are: J. H. Chambers, president; M. E. Chambers, vice-president; Leslie T. Chambers, treasurer, and Arthur Chambers, secretary. M. E. is the wife of J. H., and Leslie T. and Arthur are sons.
Surely these people must have access to physiologic and chemical authorities not found in modern medical libraries, or else their esoteric researches into the mysteries of life must have carried them far beyond the ken of our most advanced workers along these lines. The scientific world would receive with great interest information as to how a mixture of potassium chlorate, sodium nitrate and boric acid oxygenates blood, maintains nutrition and causes healing without scar formation. A mixture which will destroy micro-organisms and yet will not destroy a living cell certainly shows a fine sense of selection and discrimination not heretofore expected of a combination of chemicals or of a chemical compound. How like the wonderful elixir of medieval times, which was to the Christian a tonic and to the heathen a poison!
The writer of the second testimonial is reported to have written that he tried Pam-ala “on a most pronounced case of malarial spleen with the most excellent results” and that he “also tried Pam-ala on a case of Malarial Cystitis and Hematuria, with entire satisfaction.” In reply to inquiry this physician admits that he was “very favorably impressed with the preparation at the time.” He states that at that time he was also trying out Sinkina and that after six months he “discontinued the use of both as the results did not warrant further investigation.” He concludes:
Extravagant and inconsistent claims are made for Daniel’s concentrated tincture of passiflora in the advertising literature, where it is recommended for such a wide range of diseases as asthma, typhoid fever, convulsions and paralysis.
In the reports, one clinician noted no differences that were not negligible. Another was slightly in favor of No. 2 (heavy Russian) as regards taste. A third reporter did not make comparative tests. A fourth is slightly in favor of “B” (heavy Russian) as regards taste and general suitability. All of the findings of this investigation are based on hospital cases. A fifth reporter favored No. 1 (light Russian petrolatum). He considered it the most prompt in its effect, the most uniform in results, and the most prone to give a satisfactory admixture of the oil with the other materials. The difference, however, from the other oils was not marked. Another reporter noted no special differences.
“The abuse of saline cathartics by the public is an evil deserving of serious attention. Rightly or wrongly, the laity fear constipation and naturally take what they are taught to believe is the cheapest and simplest course for its relief, self-drugging by means of saline cathartics or the extensively advertised purgative mineral waters. This habit is responsible for much of the distressing spastic constipation that exists, and its accompanying neurasthenia. The advertisement and sale to the laity of such a nostrum as “Sal Hepatica” can only increase these evil results and the physician who aids and abets the evil by using the preparation should reflect whether he is thereby not only encouraging a fraud on the public but also, what is even worse, helping to impair the public health.”
The physician who prescribes Sanmetto prescribes a secret medicine for conditions which he is presumably competent to treat with simple remedies of which he knows the origin and action and which he can vary to suit the needs of the individual.
The G. W. Carnrick Company introduces a number of testimonials as to the value of Secretogen. These testimonials are similar to all testimonials. They include no evidence of careful diagnosis, and present an uncritical estimate of the results. They show that the writers have given Secretogen Elixir or Tablets indiscriminately in almost the whole range of digestive disorders, in nephritis, neuralgia, liver disease and gallstones, exophthalmic goiter, neurasthenia, epilepsy, etc. As dependable evidence, these testimonials are not worthy of consideration.
Case 10.—This was in a child of 8 years which was treated by the investigator’s confrère and gave similar negative results. Blood examination showed numerous parasites. The child was placed on 1 ounce of Sinkina three times a day and kept on it for two weeks. The clinical picture remained unaltered, and parasites could be detected in numbers whenever examinations were conducted. A gradually increasing enlargement of the spleen was also noted. At the end of two weeks quinin was substituted, and the child went on to a rapid and uneventful recovery.
To sum up our results on the physiologic action of Somnos: We have been completely unable to verify the claims of the manufacturers that Somnos is less toxic than hydrated chloral, or that it has a less depressing effect on temperature, respiration or circulation. On the contrary, the physiologic effects are indistinguishable from those of hydrated chloral, doubtless because the action of Somnos is simply the action of hydrated chloral. We can see nothing in the animal experiments or in the chemical composition which would suggest that Somnos would possess therapeutic advantages over an elixir of hydrated chloral of corresponding strength.88
The recommendations of the subcommittee were adopted by the Council and in accordance therewith the report is published with comments, substantially as follows: The formula means that it is a solution of well-known salts, some of them under partially disguised names. Every one knows what Glauber’s salts are good for. Disodium hydrogen phosphate is ordinary common sodium phosphate. Sodium thiosulphate is familiar as sodium hyposulphite, the “hypo” of the photographers. Every one knows, of course, that sodium chlorid is common salt. Examination and analysis of various specimens of this product demonstrated that its composition is not always the same. As an indication of the ignorance of the promoters of this nostrum it is interesting to note that the label on one of the bottles purchased states that it is a “sulphophosphate” instead of a sulphophosphite. Extravagant claims are made for this simple mixture of laxative salts, and these with the methods of using it are printed on the labels, and while it is claimed to be only advertised to the profession, the physician is repeatedly advised in the advertisements to “order always an original (six ounce) bottle to prevent substitution.” The natural result of this would be, of course, to put the patient in the way of prescribing it for himself and to spread the advertisement of the drug among the public. Difficulty has been experienced in finding out who the promoters of this nostrum are and the correspondence in regard to it is published. They seem to prefer to be known by their corporate title of Laine Chemical Company only. It is a sample of many other so-called ethical proprietary drugs, most of which are simple mixtures of well-known drugs which physicians are using every day and which require no skill in their compounding. Their proprietors not only presume to sell and advertise medicines but also to tell the physicians how to treat their patients.—(Abstracted from The Journal A. M. A., Dec. 8, 1906.)
[Editorial Note.—When the Council on Pharmacy and Chemistry was started we announced that we did not see any clear line of demarcation between “patent medicines” and many so-called “ethical proprietaries.” Time has not caused us to change our opinion. As we have already shown, and as we shall have occasion to show in the future, not a few of the “ethical proprietaries” offered to physicians are being advertised by those who are pushing the rankest of “patent medicines.” The three preparations mentioned above are sold—and presumably manufactured—by Mr. Ballard, of St. Louis. Mr. Ballard is the promoter of Ballard’s Snow Liniment, Brown’s Iron Bitters, Herbine, Dr. Herrick’s Vegetable Liver Pills, Swaim’s Panacea, Renne’s Pain Killing Oil, etc. He is also the promoter of Campho-Phenique, exposed in The Journal some eight years ago.89 The spectacle is not an edifying one. A manufacturer with one hand offers the public a profusion of cure-alls, while with the other he endeavors to foist on the medical profession preparations which are just as fraudulent. Some day our profession will awake to the disgrace of it all. It will also awake to the fact, which should have been evident ere this, that the nostrum business would cease if physicians would refuse to accept into their offices, even as a gift, the nostrum-promoting medical journals that live off this trade. Fraudulent “patent medicines” will continue to thrive just so long as newspapers will publish “patent medicine” advertisements; fraudulent “ethical proprietaries” will continue to exist just so long as medical journals will advertise such proprietaries. As the better class of newspapers are rejecting “patent medicine” advertising on their own volition, so are the better class of medical journals rejecting advertisements of fraudulent proprietaries. Some newspapers will continue to carry nostrum advertising until their subscribers raise a protest that will cause the business department to take notice; so, too, some medical journals will continue to share the profits with the nostrum exploiters until an outraged medical profession repudiates such publications.]—(From The Journal A. M. A., Feb. 6, 1915.)
But there are hundreds of other so-called “new chemical” compounds among the “ethical” proprietaries on the market aside from the acetanilid mixtures. These wonderful compounds, by the mysterious union of their ingredients, possess therapeutic properties different from, or more powerful for good than the drugs from which they are made. At least, this is what we are told, and this is what many believe or they would not sell so well.
Unguentum Selenio Vanadic (v. Roemer) is an ointment manufactured by A. von Roemer, Brooklyn, N. Y., and put on the market by Schering and Glatz, New York. It is claimed to contain 1 per cent. of selenium oxycyanid and 1 per cent. of vanadium chlorid “so prepared and incorporated into a modified lanolin base as to insure complete absorption.” The preparation is recommended in the later stages of inoperable carcinoma, sarcoma, epithelioma and other malignant tumors, as a substitute for morphin and other narcotics to control pain, as a modifying (ante-operative) treatment in the middle stage of malignant cases presenting the characteristics of being inoperable, and as a prophylactic treatment of recurrences and metastases following excision of malignant tumors. It is also recommended for use in slow-healing surgical wounds, abscesses, tuberculous and mixed septic and gangrenous processes, etc., in lupus, acne, eczema, psoriasis, scabies, erythemata, adenomata, angiomata, papillomata, etc. The use of the ointment is further recommended by systemic inunction in septicemia, pneumonia, erysipelas, cerebrospinal meningitis, septic rheumatism, septic neuritis, etc. The Council voted that the preparation be not accepted for inclusion with New and Nonofficial Remedies because no evidence has been submitted that the vanadium and selenium are absorbed or that they produce any of the effects claimed.
5. Whisky has the same alcoholic content (50 per cent.) as Hayden’s Viburnum Compound; the dangers in the use of whisky are well known and its value as a therapeutic agent is being questioned more and more every year.
Can we blame the layman for using Peruna, Wine of Cardui, etc., simply because they are advertised, when there are physicians who, for the same reason, prescribe concoctions that are just as quackish and just as useless? And can editors of medical journals consistently find fault with newspapers for carrying advertisements of fraudulent “patent medicines” when they themselves admit to their pages advertisements of nostrums that are no less fraudulent and of no more value?
Saccharated pepsin, which was formerly official, was required to digest 300 times its own weight of moist egg albumin, while the pepsin that is now official is required to digest ten times that amount, or 3,000 times its own weight. It is evident, therefore, that the tablets should contain sufficient pepsin to digest appreciable amounts of protein. No intelligent physician would prescribe these tablets simply for the pepsin they contain or are supposed to contain; if he wanted to give pepsin he would prescribe the drug in the simple form.
Examination.—Hymosa as purchased on the market is a dark brown liquid with an odor of sassafras and a rather sweetish taste, reacting acid to litmus. Qualitative tests having indicated the presence of salicylate, iodid, sodium, potassium, alcohol and some organic matter, presumably sugars and some plant extractives, these were determined quantitatively.96 It was found that a part of the salicylate was present as free salicylic acid and part in a combined form. The sodium determinations indicated that all the salicylate, excepting that in the form of free salicylate acid, was present as sodium salicylate. From the results of the potassium estimations, it was evident that the iodin was present in the form of potassium iodid.
[Editorial Note: The chemical investigations reported above emphasize once more the need of such an institution as the Association’s laboratory and again demonstrates the value of its work. At first sight it seems disheartening to find that physicians are so easily humbugged. Yet when it is remembered that it is impracticable for physicians either to analyze such products themselves or to go to the expense of having chemists do it for them, it is evident that the fault lies not so much with the physicians as with the conditions that make the exploitation of such frauds possible. It is on the public that the burden ultimately falls, for it is the layman who has to pay two dollars for a few cents’ worth of medicine. But—and this is far more serious—that the physician should be urged to dose his patient with an insidiously dangerous drug to a point far beyond the limits of safety, is little less than criminal. Yet so long as unknown medicinal products are prescribed just so long will this danger be a very real one.]—(From the Journal A. M. A., May 21, 1910.)
The results of the above analysis, together with advertising matter regarding Zemacol, were submitted to Dr. William Allen Pusey, professor of dermatology and clinical dermatology, College of Physicians and Surgeons, Chicago, and past chairman of the Section on Dermatology of the American Medical Association, with the inquiry whether or not there was any record of investigations regarding the therapeutic value of an extract of the rete mucosum of the sheep and whether in his opinion the claims made for Zematol would be warranted. The following reply was received:
Ludwig Bauer,104 the manufacturer of “Antidiabeticum,” inserted advertisements in daily papers asserting that for his “humanitarian efforts” the society “Opera Educativa pacifica” in Rome had granted him a diploma and placed his publications in the celebrated “Bibliotheca Marciazzi.” Dr. Kantor, editor of the Gesundheitslehrer, declared that, according to information received from the German Consulate in Rome, no such society existed there, and the library referred to probably was the Bibliotheca Marciana in Florence, which, like other public libraries, accepts all donations without critical examination. To offset these exposures, the promoter of Antidiabeticum published advertisements libeling Dr. Kantor and attacking the Society for Suppression of Quackery. This resulted in suits and counter-suits for libel between Dr. Kantor and the directors of the antiquackery society on the one side and the promoter of Antidiabeticum on the other. As a result of the recent combined trial, the court declared that Dr. Kantor’s charges had been substantiated and the manufacturer of Antidiabeticum was fined 600 marks or forty days’ imprisonment, while apparently on purely technical grounds Dr. Kantor was fined 50 marks or five days’ imprisonment. The costs were divided between Bauer and Dr. Kantor in the proportion of 11 to 1. As Bauer in the course of the trial made further libelous charges, Dr. Kantor has lately started new proceedings against Bauer. The incessant persecution of Dr. Kantor was described in an editorial in The Journal, May 20, 1911, p. 1486.
We had hoped that the time had passed for reputable houses to employ such time-worn methods, but probably they will not stop so long as physicians encourage them by continuing to use such preparations. Acetysalicylic acid is a good drug, whose value is pretty well known. It is further known that lithium salts do not possess any great medicinal virtue. Just what acid citro-tartrate of lithium may be is hard to tell, for chemistries do not recognize such a substance. The name presumably is intended to hide the real nature of the preparation.
“It removes flatulence, vertigo, weakness and other symptoms of indigestion quickly and pleasantly.”
“It relieves vomiting in pregnancy, alcoholism, seasickness and cholera morbus....”
“To promote appetite, digestion and the elimination of toxic and waste material prescribe the Bell-ans....”
“... prevent eruptions, nausea, vertigo, pain, etc. ...”
“... remove distention, pain, weakness, depression, etc. ...”
“There is no derangement of the digestive organs upon which the proper dose of Bell-ans (Pa-pay-ans, Bell) will not act quickly, pleasantly and favorably....”
H. Hille, once of Heidelberg, now of Oak Park, Ill., having reached the conclusion that mineral starvation is the cause of all diseases, devoted his talents to finding a remedy. He claims to have found it and calls it “Biosol.” He published his discovery in a pamphlet entitled “Facts of Modern Science,” and recently published an article in the Medical Record giving his ideas on this mineral point of view. Biosol is an indescribable mixture of alcohol, carbohydrates, and many and various mineral bodies—ranging all the way from sodium, potassium, calcium and magnesium to silicon, copper, uranium and thorium—the amount of each being in most cases extremely minute. It is said to be a valuable food as well as medicine. A dose of this food might keep a rabbit alive for several hours, and a man who could stand the expense and escape death from delirium tremens might live on three quarts of the mixture per day. Human beings have little occasion to fear mineral starvation, and may obviate whatever danger there may be with a drink of milk. Like other living creatures, we may be thankful that we are furnished in our own bodies with a living bioplasm which can use the minerals of the waters and the rocks and which has its own laboratory in which to prepare organic compounds to suit its needs.—(From The Journal A. M. A., March 8, 1913.)
This “hypodermic treatment of phthisis” was widely advertised in the late nineties by the Bromin-Iodin Chemical Co, Binghamton, N. Y., and was but one of the innumerable “treatments” for pulmonary tuberculosis that have risen, had their day and, more or less gracefully, retired. It was first sold “to physicians only” for hypodermic administration. In 1906, however, physicians were told by the company that “if we find it impossible to secure your cooperation ... we will be compelled to do business with the druggists in your locality ...” Apparently they found such cooperation impossible, because a leaflet was issued to the laity and the statement was made that they intended to advertise “all over North America in publications of national and international circulation, as well as in local newspapers ...” Naturally the laity couldn’t be expected to administer this treatment by the hypodermic method and it is not surprising to read that “experiment has proved that the same solution can be taken internally.” In addition to the advertising leaflet, the public also was provided with a “pocket calendar good for 200 years” which contained numerous testimonials from physicians laudatory of the “bromin-iodin” treatment. The layman who received one of the leaflets was told that if he was suffering from “asthma, bronchitis, colds, consumption, coughs, eczema, goiter, hay fever, neuralgia, rheumatism ... also constipation and kidney troubles,” and his recovery was “not as rapid as it should be,” should, moreover, his physician refuse to use the bromin-iodin compound “it might not be a bad idea to discharge him” and get a physician who would!
A really satisfactory hypnotic and sleep-inducer, which Calmine certainly seems to be, has been awaited expectantly for many years. Of course, we have always had agents of this sort—a new one has come out at frequent intervals—but none of them have “filled the bill”; they have been prescribed only because there was nothing better to be had.
Hagee’s Cordial of Cod-Liver Oil Compound is said to “represent 33 per cent. of pure Norwegian cod-liver oil,” with other ingredients, in perfect solution. It is also claimed, according to the advertising pamphlet, that “in this preparation we have every beneficial constituent of the best and purest Norwegian cod-liver oil.” Put to the above three tests, however, Hagee’s cordial of cod-liver oil is not, 1, an emulsion of cod-liver oil; 2, is not a saponification of cod-liver oil; and, 3, does not contain fatty acids. It therefore contains no cod-liver oil. The only nutrients in the mixture, revealed by analysis, are sugar, alcohol and glycerin, none of which is contained in cod-liver oil.
According to an advertising circular, issued by E. Bischoff & Co, purporting to be a “reprint from the Munich Medical Weekly,” Diatussin is “... a dialysate of Herbæ Thymi and Pinguiculae.” The latter is said to be known in the Alps as “blue fatweed.” The only further information as to the composition of this preparation is the statement that “the dialysate of this blue fatweed is said by the manufacturer to contain a proteolytic ferment.” The writer of the article recounts how, after trying a host of remedies, he finally had such success in the treatment of whooping-cough that “... a whole procession of mothers with children affected by whooping-cough came to me from a neighboring village, only because several children from this place had been quickly cured by the dialysate.” Nevertheless, while the “procession of mothers” appears to have been impressed by the virtues of Diatussin, the writer of the article, rather modestly for contributors of this sort, admits that “I am, of course, well aware, that the small number of cases under my observation allows of no decisive conclusion; it is only the object of these lines to interest a wider circle in tests.”—(From The Journal A. M. A., May 17, 1913.)
Formamint tablets have recently been put on the American market by the same concern that exploits Sanatogen, the “food tonic” or “tonic food”—according to whether one reads European or American newspapers. Formamint tablets are being introduced to the American public by that cheapest of all methods of advertising “patent medicines,” through the medical profession. It is not advertised in American newspapers or lay magazines—at present. For some years this product has been advertised in newspapers and other periodicals in Europe under such claims as the following:
Gomenol is apparently a volatile oil. It is a proprietary said to come from France, and to be prepared from a species of cajuput (Melaleuca viridiflora, Gaertn.). This plant is closely related to the cajuput tree or swamp tea-tree (Melaleuca leucodendron, Linné) from which the official oil of cajuput is obtained. The oils from these two plants are very similar in composition and presumably in therapeutic properties. The oil of the first-named plant appears not to be marketed except in the form of the proprietary, Gomenol. It probably has no advantage over the official oil of cajuput, while in the form of Gomenol it costs about four times as much. The following are some of the claims made for Gomenol in the advertising circulars. They need no comment.
From this we would not wish to give any bias to Dr. Boone’s statistics. We hardly expect, however, that such will be the case. Dr. Boone’s name appears as the author of an article entitled “A Therapeutic Study of Antikamnia and Heroin Tablets”—an article that has been very extensively “quoted” and has been sent out in its entirety by the Antikamnia Chemical Company. Under these circumstances we may be forgiven if we venture the opinion that Dr. Boone is not likely to be unduly prejudiced against “headache tablets” in general and fake “synthetic” coal-tar mixtures in particular. We await with breathless interest the appearance of Dr. Boone’s “exhaustive article” and we must confess to some degree of curiosity regarding the name of the “leading medical journal” in which these valuable data will appear.—(Modified from The Journal A. M. A., Aug. 14, 1909.)
Hydronaphthol thus furnishes one more illustration of the fact that most proprietary medicines for which the most extravagant claims are made are but old and well-known remedies sold under a fancy name at a price far in advance of that charged for the constituent or constituents. The exploiters are extremely positive in their statements regarding the non-toxic character of the preparation. Yet, as a matter of fact, betanaphthol is by no means harmless; it has been absorbed by the diseased skin with injury to the kidney and with fatal results. In some cases injury to the eye has also occurred. These toxic actions should be known to the practitioner. From 3 to 4 gm. (1 dram) applied to the skin has produced death (Stern: Therap. Monatshefte, 1900, p. 165). When a manufacturer advertises a preparation which possesses potentialities for harm, and especially when he puts it out under a name which conceals its identity, it is incumbent on him to warn the customer of possible injurious or inconvenient actions instead of proclaiming that the preparation is harmless.—(From The Journal A. M. A., Sept. 3, 1910.)
Iodonucleoid, then, seems to be another one of the many iodin “substitutes” which have been put on the market. Other iodin substitutes are Iodalbin, manufactured by Parke, Davis & Co.; Iodipin manufactured by E. Merck & Co., and Sajodin, manufactured by the Farbenfabriken of Elberfeld Co. As these products have been examined by the Council and found eligible for inclusion with New and Nonofficial Remedies, physicians who wish to use substitutes for potassium iodid would do well to use them instead of a product presented under a misleading name. Physicians should understand, however, that these organic iodin compounds are non-irritating because the iodin is held in such combination that it is much less active. It seems probable that they are therapeutically active only to the extent that the iodin content is dissociated from the organic compound and concerted into ionic iodin.
A few statements quoted from the circular will show that the person who wrote it knows nothing about medicine and cannot correctly use the English language: “The qualifications of Medicinal Iridium are its simplicity, purity, harmless under prolonged use, easily borne by the stomach.” “It has been observed that when Medicinal Iridium acts as a laxative, it will regulate the same.” “Called the family group, Iridium and Osmium are destined to become the world’s benefactors in medicinal properties, thereby creating a new chapter in medical science.” The circular quotes some supposed “excerpts from hundreds of letters on file, written by physicians, in the hope that they may attract your attention,” which bear marks of having been written by the same person who wrote the circular. Note the quality of the following statements: “Iridium has a power, purity and simplicity that pleases me; now I can make progress.” “I say to you frankly, Iridium is my standard. I can get results and make progress. I am confident it aids the fibrin in the blood.” “Dr. X is pushing Iridium on five or six cases.” It is not explained who Dr. X is, but it has this to say about him: “Dr. X is an eminent practitioner. He has made a remarkable record with Iridium and has so far never failed on cases of Jacksonian epilepsy; experimental tests have shown that Iridium increases blood-corpuscles.”
The manufacturers state in their later “literature” that Iron Tropon is a tonic and a food; that it is a compound of the food albumin tropon, 2.5 per cent. of iron in its most assimilable form, and enough chocolate to flavor it agreeably. It will be noted that they now make no claim for pepsin, nor do they state that it contains iron in organic form. In the dose recommended, a teaspoonful three times a day for an adult, the patient gets something over a grain of iron, and he might as well take an equivalent quantity of Blaud’s mass, the value of which has been proved.
One wonders whether a large experience in the advertising world, and especially his membership in the Proprietary Association of America, has unconsciously led Mr. Kutnow to assume that muzzling the press is one of the perquisites of the large purchasers of advertising space.—(From The Journal A. M. A., Aug. 31, 1907.)
“The treatment of a case of chronic parenchymatous nephritis is a task requiring the best judgment and the greatest knowledge that the physician can command. From the first his aim should be to do no harm, and with this in view he will recognize that since we do not know the cause of this disease, and since we are unable to influence the essential process in the kidney, the administration of a remedy capable of doing harm should be undertaken only under the clearest indications. It is probable that the remedy proposed, containing, it is asserted, a mixture of foreign proteins, might injure healthy kidneys, to say nothing of sick ones. It is well known that foreign proteins, such as the white of egg, if they enter the circulation unchanged, are excreted by the kidney and are liable to produce serious irritation, which in the case of parenchymatous nephritis might easily aggravate the existing condition and frustrate all other efforts at a cure. More especially is it imperative to do no harm when, as in the case reported by our correspondent, the patient appears to be in good health. Two questions should be raised in that case. First, is there any evidence that the occasional excretion of a few casts, whatever may be their variety, is actually doing the patient any harm? And second, since there are no symptoms, what possible improvement could be expected from treatment? It is admitted that we have no remedy which can affect an essential change in the condition of the diseased kidney. What must be done in such a case is to spare the kidney—to require of it the minimum of functional activity. In such a case, the physician who introduces an animal protein, foreign to the human system, would be taking a serious responsibility. The chances are that it would do harm; how great, no one can tell. If the physician can really make up his mind to experiment at the risk of the life of his patient, this case appears to be one unusually favorable to the manufacturer of the serum. There are chances that the diagnosis may be incorrect and that such a condition of the urine does not indicate a serious condition of the kidney. It is frequently the case after an acute infection, or some similar irritation, that the kidney continues for some time to excrete albumin and casts, but the condition eventually clears up. In such a case, if the serum did no harm it would be given the credit of curing the patient, who recovers in spite of it. It is a little unfortunate, however, for the purpose of such demonstration that the patient is said to feel well. If only he could be persuaded that he has a serious disease so that he might be somewhat depressed mentally, the effect of the cure would be more remarkable!
Regarding certain proprietary preparations and their equivalents found in the pharmacopeias or other standard works of reference, it is often questioned whether the proprietary is the original and the official preparation the imitation, or vice versa. As a general proposition, medicinal compounds and preparations are not born but evolved, as in the case of epinephrin, in which the credit of discovery belongs to no one person, but to several.108 So it is often the case that the proprietary and official preparations may be based one on the other, while both are usually based on some preparation which antedates them. This is well illustrated by the proprietary preparation Lysol, the practical equivalent of which—liquor cresolis compositus—is official in the United States Pharmacopeia. After the discovery of phenol (carbolic acid) and the recognition of its germicidal value, it was gradually learned that other phenolic compounds occurring in the crude distillates from tar and wood were more efficient and less poisonous than phenol (carbolic acid). When this was discovered, attempts of course were made to utilize these higher and more efficient phenols, which meant that their insolubility in water had to be overcome. In these attempts there were efforts to form new compounds as well as a search for simple solvents. While the first failed, because these compounds were less efficient than the phenol from which they were made, a simple solvent was found in soap. The first attempt to utilize the solvent power of soap gave creolin, a mixture of the so-called crude carbolic acid (really containing but little phenol and consisting largely of higher phenols along with inert hydrocarbons) with soap. This was followed in 1884 by Schenkel’s discovery that a portion of this “crude carbolic acid” could be made soluble in water by treatment with soap. Schenkel was refused a patent on the ground that any soap manufacturer should be permitted to add phenol to his soap, but in 1889 a patent for a cresol-soap solution was granted to Damann, who used cresol, a constituent of “crude carbolic acid.” The preparation was put on the market and has since been widely advertised under the proprietary name “Lysol.”109 It is thus seen that Lysol is a good example of the way in which manufacturers appropriate the discoveries of others, develop them and turn them to proprietary use.
Manola is a light amber colored liquid having the odor and taste of sherry wine. The above analysis indicates that it is nothing more than wine, fortified with alcohol and a slight amount of medicinal substances added. The non-volatile matter appears to be nearly all sugar, glycerin, or some similar substance and the presence of less than one gram of ash to 100 c.c. excludes the presence of more than a small amount of organic salts. From the amount of phosphorus found there appears to be about one dose of phosphoric acid to a twenty-ounce bottle. Arsenic is present in such small amounts that the ordinary hydrogen sulphid test failed to show its presence and the delicate Gutzeit’s test had to be used to detect it.—(Modified from The Journal A. M. A., April 2, 1910.)
From these statements the incautious physician might be led to infer that Papine is a preparation analogous or similar to the official tincture of deodorized opium. Formerly in the manufacture of the latter preparation, in addition to removal of the odorous substances, narcotin, then thought to be the principal convulsive alkaloid,110 was also removed. By the process for the manufacture of this tincture, which is now official in the United States Pharmacopeia, most of the narcotine is found in the finished preparation. While it is a comparatively simple matter to remove the narcotin from opium and its preparations, thus eliminating most of the commonly reputed “convulsive elements,”111 to remove the “narcotic elements” from opium would result in destroying the integrity of the product. The reasons for this are that morphin is the most powerful narcotic substance found in opium, and it is present in the largest proportion of any of the alkaloidal constituents. Its removal from an opium preparation would, therefore, render that preparation practically valueless.
“Chloral and the bromids, before the recognition and advent into medicine of Pasadyne (Daniel’s Concentrated Tincture of Passiflora Incarnata), were widely employed in all turbulent states of the psyche and, notwithstanding their many untoward, even sometimes dangerous effects, were held in high favor by physicians. For that matter, they still retain some of their old-time popularity, but since the superior value of Pasadyne (Daniel’s Concentrated Tincture of Passiflora Incarnata) has been demonstrated to the profession’s satisfaction, the erstwhile high esteem in which chloral and the bromids were held, is fast waning and ere long Pasadyne will have crowded them out.”
Substitution of anilpyrine for somnalgesine gives little more information. Chemists may recognize this as a name applied to a mixture said to be formed by the fusion of two molecules of antipyrin and one molecule of acetanilid. To physicians, however, the name carries with it the same mystery as did somnalgesine. Attention is directed to the fact that by publishing the guarantee under the pure food laws the company presumes to disperse all doubt and criticism, assuming that the majority of physicians will be satisfied with the guarantee as it stands. Inasmuch as the preparation contains acetanilid and antipyrin, however, the manufacturers are disregarding that part of the Food and Drugs Act which requires that the name of the parent substance—in this case acetanilid and antipyrin—be put in parenthesis. The laws are so well defined that physicians appear to be content to do nothing, firmly believing that they are safe from the defrauding methods of unscrupulous manufacturers.—(Abstracted from The Journal A. M. A., March 7, 1908.)
“Every time an unbroken protein is introduced into the body it carries with it, and as a part of it, a poison. From the very careless, rash, and unwarranted way in which ‘vaccines’ of most diverse origin and composition are now used in the treatment of disease, this matter certainly cannot be understood or its danger appreciated by those who subject their patients to such risk. It should be clearly understood that all proteins contain a poisonous group—a substance which in a dose of 0.5 mg. injected intravenously kills a guinea-pig. This poison is present in all the so-called ‘vaccines’ now so largely used, and it is not strange that death occasionally follows the use of ‘Phylacogen’ or similar preparations. Not only do these proteins contain a poison, but when introduced parenterally the poison is set free, not in the stomach, from which it may be removed, but in the blood and tissues. It is possible that vaccine therapy may become of great service in the treatment of disease. Even now there are occasional brilliant results which are reported while the failures and disasters are not so widely advertised.”
The report of a case of poisoning by Purgen (phenolphthalein) is the occasion for some pertinent observations by Dr. G. Brasch as to the proper introduction of such remedies to the medical profession (Ztschrift für Medizinalbeamte, Abst. in Apotheker-Zeitung, No. 59, 1906). He agrees with Best that all such remedies should first receive a thorough trial in an institution subject to state supervision, before they are advertised to the medical profession, so that their harmlessness in appropriate doses may be ascertained by a method free from liability to error. The manner in which the manufacturers introduced Purgen to the profession and the laity is to be condemned, and probably led to the symptoms of poisoning exhibited in the case of Dr. Best and tends to discredit a remedy which is harmless and efficient if used in proper doses. The manufacturer of such a preparation is inclined, for obvious reasons, to put the dose of his preparation much too high. The most important point, however, is the objectionable character of the names given to such articles. The organic compound phenolphthalein has been known for a long time and has been widely used as an indicator. Accidentally it was discovered that phenolphthalein possessed laxative properties and thereon it was proposed (1901) as a medicine under the name “Purgen.” It is sold in tablets containing 0.05, 0.1 and 0.5 grain phenolphthalein mixed with sugar and flavored with vanilla. The author says: “But it is very desirable—and I regard this as the most important part of my communication—that phenolphthalein should be received into the materia medica under its own name. The addition of vanilla and sugar is to the highest degree superfluous and the arbitrary dosage in three strengths with the ridiculous designations, ‘baby,’ ‘for adults,’ ‘for patients confined to bed,’ are merely calculated to prejudice the physician who is accustomed to individualize in his prescriptions, against a remedy which is in itself an excellent one.”
The exploitation of Sevetol is but one more case of turning to commercial account an exploded theory. Isn’t it about time that our profession demanded that the purveyors of medicinal products tell the truth? And isn’t it time, too, that we cease taking our pharmacology and therapeutics from proprietary manufacturers?—(From The Journal A. M. A., July 4, 1914.)
Salacetin is free from Toluodine and produces no harmful cyanosis. In the treatment of Acute Bronchitis, Grippe, Influenza, Tonsillitis, Lithemic Headaches, Rheumatism and Neuralgias, it relieves pain, reduces inflammation and abnormal temperature, and eliminates uric acid more quickly and thoroughly than the salicylates, and without causing depression or stomachic or renal irritation.
Have personally interviewed thousands of physicians, including every prominent one in the East, and can honestly state that we have never known of anything at once so efficient and so unobjectionable in the removal of rheumatic and neuralgic pain and other symptoms of the uric-acid accumulation.... In La Grippe and Acute Bronchitis it relieves pain and coughing, reduces inflammation and temperature, makes the patient comfortable, and checks the progress of the disease. In Tonsillitis its action is specific.... In Acid Cystitis, it neutralizes acidity, reduces inflammation and removes irritation.... In Dysmenorrhea it relieves pain and congestion with no hallucinations, constipation or danger of a drug habit.
In Dysmenorrhea and Ovarian Neuralgias try Sal-Codeia—Bell. It will relieve the pain as well as morphia. It will not check any secretions, induce any habit, cause any depression or inconvenience of any kind.
According to the Committee on Chemistry of the Council on Pharmacy and Chemistry of the American Medical Association, whose report was published in The Journal of the American Medical Association June 3, 1905, p. 1791, “Salacetin” is a mixture of acetanilid, salicylate of sodium and bicarbonate of sodium. Sal-Codeia (Salacetin-Codein) therefore would be the same as above with codein added. Of course, acetanilid and codein will relieve pain (it could not do otherwise) and consequently make a very good combination in certain conditions, if not used too often and if used with care. Although the continued use of codein is not likely to produce a drug habit, it, as well as acetanilid, does so sometimes, and it must be remembered that codein is a motor paralysant, and is not the best combination to be used with acetanilid. For those who wish to give a combination of acetanilid, salicylate of sodium and codein, the following prescription is suggested:
How many intelligent physicians really believe that there is the slightest basis of fact for the claims we have quoted? Yet it is by means of these claims that Sanatogen is being foisted on a public that looks to the medical profession for enlightenment and truth. And every quotation in this article is taken from advertising matter issued during the current year, 1913!
As our correspondent correctly states, the drug from which the name (not the action) of the preparation is derived comes from Bolivia and has properties similar—but evidently inferior—to ipecac. That it possesses but little therapeutic value is perhaps best evidenced by the fact that, in spite of the propaganda made for it by Parke, Davis & Co., neither the drug nor any preparation of it is listed, so far as we know, by any other large pharmaceutical house, with one exception. Besides cocillana the preparation contains two other obsolete drugs, wild lettuce and euphorbia pilulifera. The activity of the “cough syrup,” it is needless to say, depends in the main on the drug which is more or less buried in the published formula: heroin hydrochlorid. At one time Parke, Davis & Co. admitted that the preparation owed its chief value to heroin. In a letter to the Council on Pharmacy and Chemistry the firm said:
One of the advantages claimed for ready-made prescriptions over the made-to-order variety, or even over pharmacopeial preparations, is that they are more elegant in appearance and less offensive to the nostrils and palate. This is the common experience of physicians who, having prescribed some ready-made mixture, wish to change the dose of one of its constituents and write a prescription or ask their pharmacists to prepare a similar preparation. The inability of the pharmacist to prepare a preparation even approaching the original in appearance, color or taste usually leads to increased confidence in the skill of the manufacturer of the proprietary and a correspondingly decreased belief in the pharmacist’s professional attainments. But these conclusions, although natural, are based on false premises. As the proprietary did not have the composition declared on the label, a mixture based on the formula differed more or less widely from the proprietary it was expected to resemble.—(From The Journal A. M. A., Nov. 9, 1912.)
Tartarlithine was examined by two chemists whose reports indicate that it is an effervescing preparation composed approximately of 20 per cent. of carbonate of lithium and about 80 per cent. of tartaric acid. Thus it is simply another of the hundreds of lithia preparations on the market offered for the cure of rheumatism. This in spite of the fact that scientific investigation and clinical experience have demonstrated that lithia is of very little use in the treatment of that disease. While the advertisement carries the idea that Tartarlithine is a product of the Tartarlithine Company, and that McKesson and Robbins are simply selling agents, we are informed that the business is owned by McKesson and Robbins, who under this style manufacture a remedy for rheumatism.—(Abstracted from The Journal A. M. A., April 23, 1907.)
While great claims have been made for Trypsogen and while it has been most widely advertised, it is the consensus of opinion of the most eminent students of the question that pancreas is not really efficacious in diabetes. Were it of any value in this disease, it would have won world-wide recognition for itself ere now, in view of the great enthusiasm with which the discovery of the relation of the pancreas to diabetes was received and of the enormous amount of clinical, as well as animal, experimentation that followed. As the conditions of experiment in this question are extremely complex, it is not surprising that occasionally apparently positive results should have been obtained. Were it really useful, it should have yielded positive results much more uniformly.
Iodovasogen, recommended for external application as a substitute for tincture of iodin, was examined by Zernik in 1905, who found that the iodin existed not as a free iodin, but chiefly as ammonium iodid. The therapeutic character of the preparation is thus entirely different from that to be inferred from the labels and elsewhere, since the counter-irritant effects of free iodin are of course absent in ammonium iodid. Pearson & Co. now claim that when Zernik’s findings were published they immediately modified their statements on the label in accordance with the truth. This is denied by Dr. Lungwitz, the editor of the Therapeutische Rundschau (Apotheker Zeitung, 1908, p. 900), who vigorously criticizes the misrepresentation made by Pearson & Co. in regard to Iodovasogen. He calls attention to the fact that, while Zernick’s results were published over three years ago, the labels which are in use today still bear the statement that Iodovasogen consists of Vasogen 90 parts and resublimed iodin 10 parts, and Vasogen 94 parts and resublimed iodin 6 parts, respectively.
Unless the pharmacist happens to know that the physician in writing the prescription desired the Bayer brand, he would be justified in dispensing acetphenetidin, U. S. P. As a general thing, physicians use the word “phenacetin” without intending to prescribe any particular brand or make, simply because they are familiar with this word and are not familiar with the official term “acetphenetidin.” They will doubtless continue to use the term “phenacetin” and we know of no sufficient reason for doing otherwise. During the life of the patent the word “phenacetin” became a familiar one, and the product became generally known by this term. But a coined name for a patented article loses its proprietary character and becomes the common name of the article when the patent expires. In other words, when the patent expires, not only the product but also the name itself becomes common property. This principle has been recognized by the courts. Those who formerly controlled the product and the name “phenacetin” evidently recognized this principle, for they have taken no steps to prosecute a firm in this country which sells the product openly under the name “phenacetin.” It might be added that the preparation is official in most foreign pharmacopeias under the name “phenacetin.” In agreement also with this principle the Council on Pharmacy and Chemistry (The Journal, April 27, p. 1298) lists in New and Nonofficial Remedies such products as “lanolin,” “phenacetin,” “sulphonal” and “trional” as non-proprietary names applied to Adeps lanæ hydrosus, U. S. P., Acetphenetidinum, U. S. P., Sulphonmethanum, U. S. P., and Sulphonethylmethanum, U. S. P., respectively.
Within the past few months The Journal has had brought to its attention a good example of what may be accomplished by personal effort in cleaning up the advertising pages of a fraternal publication. The Royal Neighbor, official organ of a fraternal organization, until comparatively recently, carried numerous fraudulent medical advertisements. Fake liquor cures, rheumatism cures, tapeworm expellers, tobacco-habit cures, asthma and hay-fever cures, epilepsy cures, etc., disgraced its advertising pages. These called forth protests from Dr. E. A. Hall, Henry, Ill., who addressed letters to the official physicians of the fraternal order that the Royal Neighbor represents, objecting to such advertisements. These letters in turn reached the advertising manager, and it was not long before the board of managers took the matter up for consideration and decided to eliminate this class of advertising from their official organ. By December, 1913, the Royal Neighbor came to its readers clean. There is no doubt that the same results can be duplicated in similar cases. Whether they are will depend on the amount of active work done by individuals interested in the question of clean advertising.—(From The Journal A. M. A., Feb. 14, 1914.)
Before leaving the subject, we are constrained to refer to Lippincott’s medical publication, the Annals of Surgery. We begin to realize now why that journal offers a welcome haven to such products as Sal Hepatica, Bromidia, Papine, Gray’s Glycerin Tonic, Fellows’ Syrup of Hypophosphites, et al. Presumably the same “custom” obtains in the acceptance of advertising for the Annals of Surgery as for Lippincott’s, namely that the Lippincott Company does “not verify the claims of advertisers.” Possibly the Annals of Surgery is afraid that, should it reject the Sal Hepatica advertisement, for instance, it might he haled into court! Let us trust, for their peace of mind, that the publishers of the Annals of Surgery do not receive an advertisement from Old Doc Hartman for a full page display of Peruna. The mental anguish they would undergo in reluctantly accepting this advertisement—under the fear that Hartman would “claim damages” if it were rejected—is painful to contemplate.—(From The Journal A. M. A., Feb. 7, 1914.)
In another letter on the same subject its writer says: “I think the time has arrived when we have a right to expect real leadership from the ‘big men’ of the profession.”—(From The Journal A. M. A., Nov. 22, 1913.)
We have frequently referred to the inquiries that are received by this office from newspaper and magazine editors asking for information about products whose advertisements they have been offered. One of the greatest difficulties in the way of accomplishing the good that such inquiries otherwise might lead to is the lack of uniform action on the part of the medical press of the country. A specific instance may be given. A layman wrote to a high-glass{sic} weekly magazine published in New York City protesting against an advertisement of Sanatogen which the magazine was carrying, and sending a reprint of The Journal’s article on this product. The advertising manager of the magazine in question wrote back that he had seen The Journal’s article, but had sought further information regarding the preparation from the editor of a medical journal in his city. The medical editor recommended that the magazine accept the Sanatogen advertisement, so the advertising manager said, and in view of this, the manager suggested that possibly the article published by the American Medical Association in its journal was inspired by some “personal prejudice.” Giving weight to the probability that the advertising manager went for his information to a source that he knew would be favorable to the acceptance of the advertisement, the fact remains that it is a disgraceful state of affairs when editors of medical journals will give vicious advice in matters on which they are supposedly competent to pass. The probability is, of course, that the medical journal whose editor was questioned contained the self-same advertisement that the lay magazine was carrying. And the advertising manager of the magazine was willing to accept—because such information coincided with his wishes—information that on its face must be biased, and rejected advice—that did not meet his approval—because of a purely supposititious “personal prejudice.” It is probably asking too much to expect advertising managers not to go to sources that are likely to be favorable for information about products whose advertisements are offered to them. But we have a right to expect that physicians, editors of medical journals, should no longer be participes criminis in the furtherance of the great American fraud. If our strictures on Sanatogen are unfair, if the Council on Pharmacy and Chemistry rejected the product in mere pique, if the opinions of such men as Billings, Cabot, Hektoen and Lusk are to be brushed aside as “personal prejudice,” if this mixture of cottage cheese and glycerophosphates really is the marvelous product which its exploiters claim—then indeed not only have the editors of medical journals a right to praise it, but it is also their duty to proclaim these wonders in their editorial pages. If, on the other hand, this much-vaunted preparation is a very ordinary mixture sold at an extraordinary price, if indigent consumptives and others are being inveigled into spending dollars for a preparation whose food value could be duplicated for a few cents—then in the name of humanity and common decency let the editors of medical journals proclaim these facts, and not let their scientific judgment be blinded by the glitter of advertising contracts.—(Modified from The Journal A. M. A., Jan. 18, 1913.)
Phenalgin,134 twin brother to the Antikamnia fraud, shouts its inferential falsehoods in a half-page display. Micajah’s Wafers,135 the alum-borax mixture long advertised as a cure for gonorrhea, endometritis, etc., may also be found, as well as many other preparations exposed at various times by The Journal. For example: Anasarcin,136 Campho-Phenique,137 Papine,138 Bromidia,139 Cactina Pillets,140 Pluto Water,141 Prunoids,142 Sanatogen143 and Sal Hepatica.144
“We will pay you $25 for each patient that you bring or send us.” Thus, to physicians, writes the Hord Sanitarium of Shelbyville, Indiana, and continues: “We have a perfect and an absolute cure for all liquor and drug addictions.” Fearing doubtless that those to whom these offers are made may be disgusted with the first proposition and will realize the evident falsity of the second, the concern encloses a list of references “showing the high moral and professional standing of our sanitarium.” The Hord Sanitarium emphasizes further that it does a strictly “no cure no pay” business. Suspiciously similar is the offer made by the Mizer Sanatorium of Coshocton, Ohio, Blake V. Mizer, manager. Not many months ago Mr. Mizer was running the Hord Sanitorium (the concern’s own spelling), which at that time advertised “the only guaranteed cure.” Now, Mr. Mizer hurls invectives at those concerns that make “unreasonable guarantees” and adds virtuously that “we resort to no such unethical and pretended guarantee in order to do business.” Nevertheless, in small type in the northwest corner of his stationery, Mr. Mizer admits that his “proposition” is no cure no pay. The fees of the Mizer Sanatorium “are $125 to $250, depending on the room.” The physician’s rake-off is “20 per cent. of the above.” “This,” explains Mr. Mizer blandly, “is simply a matter between ourselves and does not concern the patient in any way.” Of course not. All the patient has to do is to pay the bills. And the Mizer Sanatorium is “conducted along ethical ... lines”—Mr. Mizer says so. The Mizer Sanatorium has odd ideas of what constitutes ethics, medical or otherwise, for not long ago it advertised, in such medical journals as would accept its “copy,” that “medical ethics prevents the statement here of the whole truth about the Mizer treatment.” Of course medical ethics never prevented truthful statements of any kind. A dirty business; no other words express it. When the Hord Sanitarium and the Mizer Sanatorium claim to cure all cases of drug or liquor addiction, they make claims that are false—cruelly false. When these concerns try to drum up trade by offering secret commissions to physicians they insult an honorable profession. The fact that they send out this sort of advertising matter is presumptive proof that there are some physicians who will patronize them. Such as do so are unfair to their patients and untrue to the ideals of medicine.—(From The Journal A. M. A., Jan. 31, 1914.)
The movement for reform, Wohlfahrt und Wirtschaft goes on to explain, is not exclusively a medical one. It is a part of the reaction of “economic common sense” against a too individualistic commercial system which leads to overproduction. In other words, it is a reaction against the system of making things because they can be sold rather than because they are needed. The interests of producers need to be harmonized with those of consumers, not merely in the drug trade alone, but throughout the commercial world. Wohlfahrt und Wirtschaft quotes with unqualified approval the ArzneimittelKommission’s statement of its position: An industry which serves the science of healing must be guided by that science. (Eine Industrie die der Heilwissenschaft dient, hat sich nach der Heilwissenschaft zu richten.)
“It should be made perfectly clear,” Heubner insists, “that we are concerned with questions of importance for the standing and influence of the medical profession among the people, and, consequently, for the conditions of its future existence. But even now the consequences of the prevailing indifference to the traffic in nostrums are making themselves felt. The prevalence of self-medication, which was lately recognized by a Berlin court as the normal for ‘slight’ affections and which has already been made an argument against the extension of the compulsory prescription law, is merely a result of the great evil based on the loss of control by the medical profession of the remedies it employs. Only centralized and energetic measures on the part of the organized profession can secure a reformation of the intolerable conditions that prevail in the field of modern industry in medicine and foodstuffs. The American Medical Association and the German Arzneimittelkommission have shown that a little sacrifice and energy can secure a condition in which the medical profession becomes a powerful factor, able to dictate in the field of the trade in medicine instead of letting itself be dictated to.”—(From The Journal A. M. A., April 18, 1914.)
The manufacturer of proprietaries having settled on a plausible theory on which to sell his products has no further need for science. Thus, while these theories are no longer to be found in accredited text-books, they are still preached by the proprietary interests. An elaborate pamphlet on “Iodine and Phosphorus,” containing statements which are known to be false, is one firm’s text-book supplied to physicians to-day, and contains long quotations from Dr. Churchill’s writings of sixty years ago. This book contains no intimation that these theories have been overthrown. It is poor economy to waste money in changing literature when the old theories and the old plausible reasoning will sell goods just as well. Consequently the old errors are drummed into those physicians who are willing to read their physiology from the neat monographs of proprietary literature and to sit at the feet of glib salesmen who expound to them the proprietary theory of therapeutics.—(From The Journal A. M. A., April 25, 1914.)
Bovinine, another widely advertised meat preparation, which, according to statements on “The Bovinine Co.’s” letter head, is “a concentrated beef juice” and “the only perfect food in the world” was analyzed and found below the standard set for meat juices, since it contains only 3.38 per cent. of coagulable proteids. Yet in spite of this discrepancy, the manufacturers of Bovinine persist in exploiting it as a food, stating it to be “... a concentrated easily assimilable, nitrogenous food,” and in another place it is stated that Bovinine “is an ideal food.” As it is deficient in coagulable proteids and thus below the requirements as a food, it is misbranded when called a food of any sort, for to quote again the Bulletin, page 55: “... meat extracts ... must not be looked on as representing in any notable degree the food value of the beef or other meat from which they are derived”; and, again: “They are not, however, concentrated foods, having, on the contrary, but comparatively little nutritive value.”
The Nutriola Company of Chicago was declared fraudulent by the postal authorities and a full account of the methods of this fake medical concern appeared in The Journal, April 28, 1906. Nutriola was advertised as:
[A] See also Labordine, p. 115; Headache Cures, p. 305; Anadol, p. 244; Phenalgin, 335.
[B] See also Antikamnia, The Nostrum and Its Method of Exploitation, page 268.
[C] See also Phenalgin—A Typical Example, p. 335.
[D] See also Salacetin, p. 356.
ANASARCIN AND ANEDEMIN
Reports of the Council on Pharmacy and Chemistry and Comments Thereon
The following reports were submitted to the Council by the subcommittee to which these articles were assigned:
ANASARCIN
To the Council on Pharmacy and Chemistry:—Your subcommittee to whom Anasarcin (Anasarcin Chemical Co., Winchester, Tenn.) was assigned, herewith submits its report:
This remedy is offered in two forms: “Anasarcin Tablets,” a pretended combination of the active principles of oxydendron arboreum, sambucus canadensis, and urginea scilla; and “Anasarcin Elixir,” said to contain the active principles of oxydendron, sambucus, hepatica and potassium nitrate. The advertisements of these articles conflict with the rules of the Council as follows:
With Rules 1 and 2: The composition of these articles is kept secret, in that the proportion of the ingredients is not furnished. The statement that it contains the “active principles” is misleading, since these are for the most part unknown.
With Rule 6: The description of the pharmacologic action of Anasarcin agrees practically with that of squill. No material part of its effects can be attributed to the other ingredients. Nevertheless, the advertisement studiously cultivates the impression that Anasarcin has no relation whatever to the digitalis group in which scilla is commonly placed. The claims are therefore misleading. The claim of its infinite superiority to digitalis, the claims that it cures neurasthenia, eliminates uric acid in rheumatism, and is useful in obesity, cystitis, lumbago and eclampsia, dyspepsia and asthma, and that it works wonders in exophthalmic goiter, appear exaggerated or false.
The recommendation of its indiscriminate use in nephritis, for lowering the blood-pressure and the statement (contradicted in the firm’s own literature) that it is not depressing, are actually dangerous.
It is recommended that the articles be refused recognition, and that the report, with explanations, be published.
ANEDEMIN
To the Council:—Your subcommittee to whom Anedemin (Anedemin Chemical Co., Winchester, Tenn.) was assigned herewith submits its report:
Anedemin is an evident imitation of Anasarcin. It is marketed as tablets, said to contain the isolated active principles of strophanthus, apocynum, squill and sambucus, chemically combined. The quantities are not stated. The therapeutic claims are copied almost literally from the Anasarcin circulars and are equally false. Anedemin, therefore, conflicts with Rules 1, 5, 6 and 7.
It is recommended that this report be published, with comments.
The reports were adopted by the Council and are herewith published.
W. A. Puckner, Secretary.
Anasarcin
This wonderful remedy, Anasarcin, has already been exposed in these columns (The Journal A. M. A., Jan. 27, 1906), but it deserves additional mention, as it teaches several important lessons of general application. It is a typical example of the revival, under a new name and a thin disguise, of an old, time-worn article, squill, presumably because experience has demonstrated its general inferiority to other drugs. Anasarcin further illustrates the dangers involved in the use of semi-secret nostrums. It also shows how a short experience with a widely advertised but little understood drug is apt to lead to conclusions which more extensive experience demonstrates to be entirely fallacious.
The first lesson is, that formulas are not always what they seem. A hasty glance at the formula of Anasarcin tablets, the basis of the Anasarcin dropsy cure, creates the impression that it is a non-secret remedy; for it is said to represent a combination of the active principles of oxydendron, sambucus and scilla. As a matter of fact, it is a secret nostrum of the insidious kind. A formula which omits the quantities of its potent ingredients means very little. Further than this, we do not hesitate to charge that the claimed composition is a deliberate deception. The circulars emphasize the claim that Anasarcin consists of the isolated principles, and not of the crude drugs. Now, the isolated active principles of sambucus and oxydendron are not on the market, for the good and sufficient reason that no active principles have ever been isolated. Are we to believe that the Anasarcin Company has surpassed the accredited chemists and has discovered such principles and is isolating them? We shall have more to say on this subject presently; but any one in the least familiar with the difficulties attending the isolation of organic principles knows such an idea to be preposterous. Indeed, it is absolutely incompatible with the exhibition of ignorance of the elementary facts of pharmaceutical chemistry which is given by these people when they call the active principles of digitalis and squill “alkaloids.”
It is an axiom that the effects of a mixture can only be understood if the action of its components are known. So far as we know, the physiologic effects of oxydendron and sambucus have never been scientifically investigated, for the simple reason that they are too slight and indefinite to promise results. Both are credited with some slight, obscure diuretic action. Oxydendron, the sour wood or sorrel tree, is a small tree of the heath family, the acid leaves of which are said to be chewed by hunters for their pleasant taste and for the relief of thirst. Sambucus is the common elder. It is most unlikely that these two innocuous substances should play any part in the claimed powerful effect of Anasarcin; they are evidently put in the formula, we do not say in the preparation, to obscure the fact that Anasarcin is composed principally of squill. That this is so can be gathered unmistakably from a study of the pharmacologic action of Anasarcin as described by its promoters:
Acting primarily on the heart and arterial systems through the nerve ganglia, a natural physiologic balance is established between the arterial and venous systems, whereby effusions ... are eliminated.... Coincident with this action there is a noteworthy slowing of the pulse.... If the remedy is pushed, can be brought down to 20 or 30 beats per minute.... Its physiological action is to stimulate the cardiac motor-ganglia through the cardiac plexus of the sympathetic system and at the same time exert an inhibitory influence upon the cardiac fibers of the pneumogastric, thereby dilating the arterioles, slowing the heart’s action, and increasing the force of the systole.... The prolonged diastole allows the ventricle time to completely fill, and the more forcible contraction causes the mitral valve to close more thoroughly and at the same time increases pressure in the coronary arteries, serving thereby the double purpose of relieving pulmonary engorgement and increasing heart nutrition.
Anasarcin will nauseate some persons.
To appreciate fully the meaning of this description of the actions of Anasarcin, it should be compared with the effects of the digitalis group, to which squill belongs. The following account is quoted literally from a recent text-book of pharmacology (Sollmann):
The phenomena of the therapeutic stage of digitalis action are said to be:
1. Slowing of the heart, with systole and diastole both lengthened.
2. Increased strength of beat, leading to greater efficiency of the individual contractions, and to an increase in the total efficiency.
3. A tendency to the systolic phase.
4. A rise of blood-pressure, due mainly to the increased action of the heart, but partly also to a vasoconstriction.
The therapeutic action may be explained, in part, as follows:
A larger amount of blood will be thrown into the aorta and coronary circulation. The first effect will be an improved nutrition of the heart.... The tonic action ... narrows the ring of the valves, brings them together, narrows the orifice.... The venous congestion will tend to be relieved. This relief ... will fall in the first place on the lungs.... The lowering of the venous pressure will tend to cause absorption of the effusions.
The nauseant action of squill, which is alluded to in connection with Anasarcin, is too well known to require more than a mention.
In brief, then, it appears from the statements of the Anasarcin Company that the action of the remedy is that of squill and that the other ingredients are a mere blind. It is, of course, well known that squill can be used as a substitute for digitalis in cardiac dropsy, although it is generally considered very inferior to the latter drug. Rose Bradford, for instance, states: “Squill is not used to any extent in the treatment of cardiac disease and cardiac dropsy, digitalis being a far more efficient and less toxic substance.” However, it has been frequently observed that digitalis occasionally fails, and it may then be replaced successfully by another member of the group. At all events, it is very likely that squill is a fairly efficient substitute for digitalis, especially when it is supplemented by a very free course of Epsom salts and by potassium nitrate (the active ingredient of Anasarcin Elixir), both of which are stated to be essential adjuvants to the Anasarcin (or squill) tablets. There can be no objection to the use of squill when it is indicated; but any one who wishes to use it should do so with his eyes open, knowing what substance he is using and how much (which he does not in Anasarcin); knowing also that it has the same indications and limitations as digitalis. He should not be misled by such statements as the following:
“Does what dropsy medicaments have hitherto failed to accomplish.”
“Superior to digitalis, strophanthus, scoparius, squills, acetate of potash and the hydragogue cathartics all put together.”
“The only known relief [how modest!] and permanent cure of dropsies.”
“Unrivaled heart tonic.” “The most powerful agent known.”
Any one wishing to use squill should take the trouble to acquaint himself with the results obtained by competent and independent observers, and not rely on it in eclampsia, septicemia, “vices of civilization,” all forms of neurasthenia, as “an active eliminator of uric acid in rheumatism,” in hepatic cirrhosis, dyspepsia, asthma, obesity, cystitis (!), lumbago, exophthalmic goiter, etc.
He should also learn the contra-indications to the use of squill, deducible from the fact that it causes vasoconstriction and raises the blood-pressure (prohibiting its use in Bright’s disease and arteriosclerosis), and that it produces marked gastric irritation, consequently nausea and depression, that it is a very toxic agent, and that the dangers of cumulative action must be borne in mind. In respect to these the advertisements of the Anasarcin people are little short of criminal, for these state:
“Safe in administration.” “Non-toxic as ordinarily administered.” “Will nauseate some persons,” but “the reaction from the temporary depression is prompt.” “In Bright’s disease, both the interstitial and parenchymatous forms of nephritis, acute or chronic, no remedy ... to equal it in efficacy.” “Without increasing the debility of the patient or interfering with nutrition by producing loss of appetite....” “This treatment is to be continued without cessation until all symptoms of dropsy have disappeared.”
Physicians who are inclined to disregard this warning, and who follow the advice of the Anasarcin people, should remember that their patients—or their friends—will put the blame for the results, which are bound to follow sooner or later, on the prescribers, and not on the deceptive advertisements of the Anasarcin Chemical Company.
There is another little matter which throws an illuminating side-light on the Anasarcin Company. They take every occasion to say that Anasarcin is “not offered to the laity,” “never sold to the laity,” etc.; but witness the following, which was found in the Retail Druggist of May, 1906, p. 179. The italics are ours.
CURE FOR DROPSY.
“As every druggist knows, dropsy has been one of the incurable diseases when caused either from heart, liver or kidney trouble. A pharmacist in Winchester, Tenn., has worked out a remedy called Anasarcin, which he is exploiting to the physicians, and his remedy is showing itself as possessing great merit. Several hopeless cases have been treated as a last resort by Anasarcin and in a very short time the patient has shown marked improvement and has effected permanent cures.
“The result of the cases as handled by the physician with the aid of Anasarcin has been so easily and quickly cured that physicians of Tennessee and the southern states are high in their praises of the remedy. The company which now manufactures and sells it is known as the Anasarcin Chemical Co., of Winchester, Tenn. Any druggist who knows of a case of dropsy would be conferring a favor on the patient and mankind in general by telling the party or his physician of the southern pharmacist, and we have no doubt but what a prompt relief and permanent cure would be affected.” [Probably means effected.—Ed.]
Anedemin
If we are disposed to doubt the vaunted scientific ability of the Anasarcin Company, we are forced to admire their business methods, at least, if there is any truth in the saying that imitation is the seal of success. Anasarcin has had this rather undesirable compliment paid to it, for its native town of Winchester has given birth to another remedy, Anedemin, which looks like a fair-haired twin brother. The Anedemin Company has adopted Anasarcin almost bodily. The name—“opposed to edema”—is about as close as the copyright laws permit. The pharmacologic and therapeutic claims agree almost literally with those of Anasarcin and contain the same exaggerations and dangerous misstatements. There is the same emphasis on free purgation with Epsom salts. The dose is the same. Both are marketed at $2.00 for a box of 100—only the Anedemin people have adopted the prize package device of throwing in 20 or 30 tablets extra, for good measure, and give a discount of 75 cents or so.
Laboratory and Warehouse of the Anasarcin Chemical Company, Winchester, Tenn.
In short, the Anedemin Company has appropriated all of Anasarcin which they considered of any value. It is, therefore, rather suggestive that they drew the line at the formula. Anasarcin is said to contain squill, sambucus and oxydendron; Anedemin discards the oxydendron and reinforces the squill with strophanthus and apocynum. Notwithstanding this material change in composition, the actions are described as identical; this is again rather suggestive.
The Anedemin Company, like the Anasarcin Company, scorns crude drugs and claims to use only the isolated principles. It was saved the trouble of discovering active principles for strophanthus and apocynum, for these are known; but it managed to find some scope for its inventive genius, “both drugs being so chemically treated and disposed as to absolutely eliminate all objectionable and disagreeable properties and effects” so as to convert a vasoconstrictor action into a dilator action; so as to render them non-toxic and non-cumulative; so as to deprive apocynum of its characteristic nauseant effect. Who can say that the days of miracles are past? Even this is not the limit of Anedemin alchemy; if we are to believe their claims, they have succeeded in forcing strophanthin, apocynum, scillain, etc., to combine with each other: “It is a definite chemical compound of the active principles” of these drugs! This makes the achievements of Emil Fischer in synthesizing sugars and proteids appear as mere child’s play.
Since the formulas were completed, however, clinical reports have been numerous enough—almost too numerous, if we are to believe them. Anedemin has been on the market for less than three years; the circulars emphasize that testimonials and endorsements are not solicited. Nevertheless, we are told that it is “endorsed by over fifty thousand clinicians throughout the United States.” Since the total number of physicians in the United States and Canada is only about 128,000, this means that nearly every second physician has endorsed Anedemin. The Anasarcin Company solicits endorsements and they seem to do the larger business. Hence the majority of physicians of the United States must have written an endorsement of either Anedemin or Anasarcin, or both. Or is this statement another “invention”? It is a little peculiar that nearly all the endorsements come from small towns in sparsely settled districts; practically none from the centers of population. Does this mean that dropsy is more common in the rural communities than in the cities?
THE INVENTORS OF ANASARCIN AND ANEDEMIN
Even the newspapers, when they tax our credulity with pretended scientific “discoveries,” feel the moral obligation of justifying themselves by telling us something of the personality and experience of the discoverers. We may ask, therefore, who are these expert pharmaceutic and synthetic chemists, these manufacturers of active principles, these skilled clinicians of wide experience, who have “intelligently built up the formula by wide application”? What are we told of these men who ask us to believe, on their mere assurance, in miracles and feats of magic; who tell us that they have converted neutral principles into alkaloids, that they have effected definite chemical compounds between these neutral principles, that they have discovered principles that do not exist, that they have changed the actions of these principles to suit their wishes, that, in short, they have reversed the laws of Nature?
These companies are located in Winchester, Tenn., a town of about 1,500 inhabitants, situated in an agricultural country. The town boasts of neither scientific schools, colleges, universities nor laboratories. The Anasarcin Company was organized in 1902, the incorporators and directors being Dr. John W. Grisard and his sons, Dr. John P. Grisard, B. A. Grisard, and A. F. Grisard, and Will E. Walker, all of Winchester. Dr. John W. Grisard seems to be the originator and promoter of Anasarcin. W. E. Walker is an insurance solicitor of Winchester and is not actively identified with the business. We are informed that he owns but a single share of stock having a face value of $100, and that he was added to the company in order to comply with the laws of Tennessee, which require five directors for any corporation. Dr. John W. Grisard, the father, has practically retired, but still has a general supervising interest in the business. There is no regularly licensed pharmacist or chemist connected with the company. The office is in the rear of a jewelry store in the business part of Winchester and on the second floor above. According to our reporter, an office force of about ten stenographers and clerks handles the correspondence and labels and sends out the preparation which is made in a crude frame building located on a side street and without laboratory equipment. According to our reporter, the work is done by the Grisards and a colored man.
The Anedemin Chemical Company was organized in 1905 with a capital of $20,000, the incorporators and directors being Dr. T. B. Anderton, Floyd Estill, J. J. Lynch, J. M. Littleton and I. G. Phillips, all residents of Winchester, and all lawyers with the exception of Dr. T. B. Anderton. A Mr. Gordon, a clerical employee of the company, is reported to have active charge of the business, to prepare the medicine and conduct the correspondence. The office headquarters, laboratory and complete outfit of the Anedemin Company comprises two rooms over the law office of Estill & Littleton. No one connected with the company is a regularly licensed pharmacist or graduate chemist.
Of the six physicians located in Winchester, three (50 per cent.) are engaged in the dropsical cure business. Poor Winchester! Aside from their connection with these two nostrums, these physicians may be estimable and worthy citizens, but where, pray, did they find the extensive clinical facilities and pharmaceutical knowledge necessary for their wonderful and epoch-making discovery? Were they aided in their scientific work by the four lawyers connected with the Anedemin Company or by the insurance solicitor who is a director of the Anasarcin Company? Did the 1,500 inhabitants of the town furnish the vast clinical material necessary for discovering and working out the formulas of these two preparations? If so, we fear that dropsical affections are much more prevalent in Winchester than in any other known spot on the globe. This matter should be investigated. Without doubt the vital statistics of Franklin County would be most interesting and we commend them to the special attention of the medical profession in Tennessee.—(From The Journal A. M. A., May 4 and 11, 1907.)
MAIGNEN ANTISEPTIC POWDER
Report of the Council on Pharmacy and Chemistry
The report which appears below was submitted by a referee and after adoption by the Council was sent to the manufacturer for comment, in accordance with the Council’s regular procedure in such cases. The manufacturer’s comments were transmitted to a second referee, who reported that after a careful consideration of the manufacturer’s reply he saw no valid reason for a modification of the report. The referee also reported that a visit to the Maignen Institute further served to convince him of the viciousness of the treatment as given and that the records made by the persons in the employ of the institute were too inadequate to serve as clinical evidence. On the referee’s recommendation, the report as originally adopted was reendorsed by the Council and authorized for publication.
W. A. Puckner, Secretary.
Maignen Antiseptic Powder is marketed by the “Maignen Institute for the Study of Bacterial Diseases,” Philadelphia. It is claimed to be a mixture of calcium hydroxid, sodium carbonate, aluminum sulphate and boric acid, but no statement as to the amount of the several constituents is furnished. Its action depends on the sodium hydroxid which is formed when the powder is treated with water, 1 Gm. of the powder as now submitted to the Council yielding 0.32 Gm. of sodium hydroxid (NaOH) and a specimen obtained a year ago yielding 0.28 Gm. Its promiscuous use is recommended both to physicians and to the public with claims which are extravagant, preposterous and even dangerous.
A pamphlet, clearly intended for the laity, entitled “What Is Catarrh?” gives direction for the “sterilization” of the nose, throat, stomach, lungs, eyes, gums, mouth and the genito-urinary tract. The following, taken from this pamphlet, illustrates the absurdity of the claims made for Maignen Antiseptic Powder:
“STERILIZATION OF THE STOMACH
“Take of the Maignen Antiseptic Powder half the quantity raised on a dime, scant.
“ADD to a tumbler of water, preferably warm, and stir.
“Drink slowly.
“This is what may happen:
“1). Belching may be the first indication of the sterilization of the stomach.
“2). The excess of acidity is corrected.
“3). The fermentation is stopped.
“4). The sterilization extends to the Intestinal Tract.
“5). The bowels are regulated without purgation.
“6). The whole metabolic process is improved.
“When and how often to drink the antiseptic solution.
“a). For Indigestion, whenever distressed, before or after meals.
“b). For Constipation, half an hour before breakfast or last thing at night.
“c). For Gastro-Intestinal troubles, such as Typhoid Fever, Dysentery and Cholera, which are the most serious forms of catarrhal inflammation, take half a tumbler or a whole tumbler of hot water with half the quantity of Powder raised on a dime every hour, and between times a glass of generous [sic] wine.
“Remarks
“The sterilization recommended here is a plain disinfecting process which does not interfere with medical treatment. It is, on the contrary, of great assistance to it.
“It has been found very effective in breaking up the cigarette habit. It does away with the craving by removing the morbid irritation of the mucous membrane.”
Eighty-eight disorders are listed in a pamphlet entitled “Antiseptic Therapeutics” all of which are reported as having been treated with success. The dangerous character of the Maignen “sterilization” propaganda is illustrated by a pamphlet “First Aid to Baby-Sick” and by the recommendation on the trade package:
“To prevent Blood Poisoning, Lockjaw, Hydrophobia and Infectious Diseases.”
The legend on the trade package and the advertising matter contained in it are likely to lead the public to place dependence on a weak sodium hydroxid solution as a means of preventing blood-poison, lockjaw, hydrophobia and infectious diseases. The pamphlet “First Aid to Baby-Sick” recommends its use in sore eyes, teething and sore mouth, sore throat, running ears, running nose, sore chest, summer complaint, skin troubles and infection after vaccination; if any trust is put in these claims, they are bound to lead to the sacrifice of many infants through neglect of proper treatment.
Patent No. 1,086,339 has been granted on this powder to P. J. A. Maignen of Philadelphia by the U. S. patent office on the following specification of claim made in the application:
“1. A process for destroying microorganisms on living tissue, without injuring the latter ... whereby the growth of such organisms is inhibited and their substance dissolved without deleterious effect upon contiguous healthy tissue.”
With brazen assurance this grant has been twisted by the unscrupulous promoters into a government endorsement of the preparation. It, of course, means nothing of the sort, as, no doubt, in accordance with legal routine the patent was granted without any investigation by the patent office to determine the effectiveness of the powder for the purpose claimed.
In view of the dangerous, unwarranted and absurd claims made for Maignen Antiseptic Powder the referee recommends that it be refused recognition, and that the Council declare its agreement with views expressed in the article “Maignen Pulv.” published in The Journal, Feb. 15, 1913, p. 537, particularly the following:
“The germicidal powers of strong alkalies have long been known, but the inconvenience of their application to tissues and mucous membranes has prevented their use. That they will be of service when sufficiently diluted not to irritate the tissues is improbable, for the antiseptic power of such solution is slight and the disinfectant value practically nil.”
Because the Maignen Institute has twisted the granting of U. S. patent No. 1,086,339 into a quasi-endorsement of the claims made for Maignen Antiseptic Powder it is recommended that a copy of this report be sent to the Commissioner of Patents as a protest against the present law, which authorizes the granting of patents on unproved and improbable medical claims.—(From The Journal A. M. A., Nov. 14, 1914.)
TYREE’S ANTISEPTIC POWDER[E]
Report of the Council on Pharmacy and Chemistry with Comments
Tyree’s antiseptic powder was assigned for examination to a subcommittee of the Council, which made the following report:
To the Council on Pharmacy and Chemistry:—Your subcommittee, to whom was assigned Tyree’s Pulv. Antiseptic Comp., marketed by J. S. Tyree, Washington, D. C., reports as follows: The label on the package states: “This preparation is a scientific combination of borate of sodium, alumen, carbolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha, in the form of a powder,” etc.
The statement that the powder contains the crystalline principles of thyme, eucalyptus, gaultheria and mentha is vague and misleading, since the chief medical constituents of eucalyptus and gaultheria are liquids, but it tends to convey the impression that the powder contains the essential constituents of these drugs, namely, thymol, oil of eucalyptus or eucalyptol, oil of wintergreen, or methyl salicylate, and menthol.
The literature supplied to physicians claims its composition to be: “Parts, sod. bor., 50; alumen, 50; ac. carbol., 5; glycerin, 5; the cryst. principles of thyme, 5; eucalyptus, 5; gaultheria, 5, and mentha, 5.”
The composition, therefore, might be expressed as follows:
Sodium borate (borax)
50 parts, or38.46
per cent.
Alum
50 parts, or38.46
per cent.
Phenol (carbolic acid)
5 parts, or3.85
per cent.
Glycerin
5 parts, or3.85
per cent.
Thymol
5 parts, or3.85
per cent.
Oil of eucalyptus or eucalyptol
5 parts, or3.85
per cent.
Oil of gaultheria (or methyl salicylate)
5 parts, or3.85
per cent.
Menthol
5 parts, or3.85
per cent.
Analysis of specimens purchased from different sources in the open market were made under our direction. The reports of the chemists show that Tyree’s antiseptic powder contains no borax, or mere traces only, and that it contains no alum, or mere traces only. Instead, the analyses show that boric acid and zinc sulphate are the essential constituents. The amounts of carbolic acid, thymol, menthol, etc., contained in the powder, if present, were far below the quantities indicated by the formula. The presence of glycerin could not be demonstrated, and, if present, the amount must be very small.
One chemist reports: The result of analysis shows that different samples differ slightly in composition, but that the following indicates the average composition of the product:
Per Cent.
Zinc sulphate, anhydrous
15.56Boric acid
81.26Volatile matter at 100° C. for four hours
0.45The undetermined portion consists of salicylic acid, carbolic acid, menthol and eucalyptol; possibly other antiseptic agents may be present in very minute quantities.
From the above findings we conclude that Tyree’s antiseptic powder is a mixture of boric acid and dried zinc sulphate and antiseptic bodies, such as menthol, salicylic acid and carbolic acid, eucalyptol, etc. From this it can be readily seen that the label, which is supposed to set forth the composition of Tyree’s antiseptic powder, is not in accord with the facts. The powder does not contain either borate of sodium or alum, and the presence of glycerin could not be established. The antiseptic agents, exclusive of the boric acid, are present only in small amounts.
The report of another analysis concludes as follows:
It evidently contains less than the amount stated of the principles of thyme, eucalyptus, wintergreen and mint. It also contains a very small amount indeed of carbolic acid, much less than that stated. We have been unable to identify certainly the presence of glycerin, and it is doubtful if it be present.
From the result of the analysis we feel confident that the preparation is to all intents and purposes a mixture of boric acid and sulphate of zinc.
The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present, are present only in sufficient amount to give the compound a satisfactory odor.
In view of the fact that J. S. Tyree has given wide publicity to a formula which the preceding report has shown to be a deliberate misrepresentation of facts, it is recommended that the article be refused recognition by the Council on Pharmacy and Chemistry, and that this report be published in The Journal of the American Medical Association.
The recommendation of the subcommittee was adopted by the Council in accordance with which the report is published.
W. A. Puckner, Secretary.
Mr. Tyree, in a letter to Dr. Simmons (which he states he writes at the request of Dr. Kebler of the Drug Laboratory of the Department of Agriculture, though he is under no moral or financial obligation to do so), says that it has been his intention to inform the medical profession of his reasons for changing the formula of Tyree’s Antiseptic Powder from an alum and borax base to a boracic acid and zinc base. He states that this change was made at the suggestion of prominent physicians connected with hospital clinics on nose and throat, venereal and other conditions and that he has had in contemplation the omission from the label of the various conditions to which the preparation is applicable.
Mr. Tyree, it will be seen, assumes the right to sell to physicians a preparation with a descriptive formula which he acknowledges is false, and he presumes to use his own pleasure as to the time when he will inform them of its true composition.
Mr. Tyree does not state when he changed the formula. We do not know whether it was a year ago, five years ago or ten years ago, but we do know that the package which was used in making the first analysis was purchased as early as last February, and the first chemist’s report was submitted to the Council March 5, 1906. On April 4 Mr. Tyree was notified by the Council that the composition of Tyree’s Antiseptic Powder did not correspond to the formula published by him.
Whether or not Mr. Tyree is justified in offering our profession a preparation as composed chiefly of borax and alum when in reality it is chiefly composed of boric acid and zinc sulphate, we leave physicians to judge.
Discrepancies Between Facts and Claims—Unfortunate
Attempts of Mr. Tyree at Explanation
A report from the Council on Pharmacy and Chemistry on Tyree’s Antiseptic Powder appeared in The Journal, Oct. 20, 1906. This showed that the preparation, advertised as a “scientific combination of borate of sodium, alumen, carbolic acid, glycerin and the crystallized principles of thyme, eucalyptus, gaultheria and mentha, in the form of a powder.” was essentially a mixture of boric acid and sulphate of zinc—approximately four-fifths of the former to one-fifth of the latter. “The carbolic acid, thyme, eucalyptus, wintergreen, etc., if present, are present only in sufficient amount to give the compound a satisfactory odor.” As will be remembered, in the correspondence published at that time, Mr. Tyree attempted to explain the discrepancies between his statements and the proved facts by intimating that he had recently changed the formula, and that it was his intention “on or about the first of February to state to the medical profession his reasons for changing the formula,” and that the change had been made “a short time ago, at the suggestion of several prominent gentlemen.” Since that time, through circulars and other advertisements, Mr. Tyree has attempted to explain the matter in various ways. In his latest circular letter he seems to make a deliberate attempt to mislead our profession and to misrepresent facts to a degree that makes it almost impossible to believe that the circular came from a man who claims to be honorable.
First, however, we shall take this opportunity to publish some matter which we have had in reserve since the first exposé was made last October. When it was realized that Mr. Tyree intended to defend himself by claiming that a change had recently been made in the powder, we took occasion to try to secure some of the preparation that had been on the market for a long time. In this we succeeded very well. From a Chicago druggist one package was bought which had been in the store at least since July, 1902—how much longer is not known. The druggist from whom the powder was obtained bought the drug store in July, 1902, and this powder was on hand at that time, none having been bought since. This particular powder was analyzed by a chemist, who found the composition practically the same as that given in the Council’s report, this chemist estimating that it contained approximately 81 per cent. boric acid and 14 per cent. anhydrous zinc sulphate. Bearing in mind that for at least four years and ten months Tyree’s Powder has been essentially the same as it is today, this letter is very interesting: (The comments in brackets are, of course, ours.)
“J. S. TYREE,
“Chemist,
“WASHINGTON, D. C.
“April 16, 1907.
“Dr. ————,
“——,
“My Dear Sir:—Doctors and medical publications of extreme and prejudicial minds often hold and express opinions in honorable faith, but like all critics, they are not always familiar with the conditions composing their opinions, and are often given to expressing them without knowledge of the true motives and facts in the case.
“If you will read an article that appeared in one of the medical weeklies some time ago [The Journal of the American Medical Association, of course] and which has been copied by several of its offsprings [not many we regret to say] relating to Tyree’s Antiseptic Powder, you will see that I had previously informed the editor as well as his council of investigators, that at the suggestion of prominent physicians, extensive clinical experimenting [sic] were being made with some slight [! ! !] changes in my powder, the object being to develop and extend its usefulness in new lines [It had already been recommended for about everything2] and at the same time make it more acceptable to the general run of the profession. I also notified this editor that these investigations would not be completed until the first of the present year, after which time these slight [! ! !] changes in the formula of Tyree’s Powder would be announced. [It is now the middle of May; when and where were the changes announced?3]
“There is nothing new, startling or dangerous in such changes in formulas. The Pharmacopeias and national books of authority are continuously improving their formulas. It is the same with every preparation on the market. [Mr. Tyree, as a nostrum maker, is in a position to know. His plea evidently is: “I am no worse than others.”] The apparent difficulty in my case is caused by my exceptional frankness [“exceptional frankness” is good under the circumstances] with the profession in telling them [when and where?] about this improvement before I was ready to announce full details and particulars, or place my improved [sic] powder on the market.
“Yours very truly,
“J. S. Tyree.”
For years Mr. Tyree has been misleading physicians by making false statements regarding the composition of his powder and regarding its value as a therapeutic agent. When exposed he tries to defend himself and his business by statements and excuses that are worthy of a schoolboy trying to get out of a bad scrape. We would respectfully suggest to him that he either take his wonderful powder off the market, or—which would probably amount to the same thing—tell the truth, and the whole truth, about it.—(From The Journal A. M. A., May 18, 1907.)
APERGOLS[F]
Abstract of Report of the Council on Pharmacy and Chemistry
Apergols, put out by H. K. Wampole Co., Inc., is alleged to be a “Uterine Stimulant.” Apergols is apparently an inversion of the name Ergoapiol and the preparation appears to have essentially the same formula, namely:
Apiol
5 min.Oil Savine
1⁄2 min.Ergotin
1gr.
Aloin
1⁄8gr.
Aromatics
q. s.
As in Ergoapiol, the constituent referred to in the formula as “Apiol” appears to be oleoresin of parsley-seed instead of the definite substance apiol described in New and Nonofficial Remedies. In general the claims made for Apergols are the same as those made for Ergoapiol (see p. 82). The Council refused admission to Apergols because they are advertised indirectly to the public, because of unwarranted therapeutic claims, because of the non-descriptive name and because the product is unscientific.—(From The Journal A. M. A., Dec. 12, 1914.)
ASEPTIKONS
Report of the Council on Pharmacy and Chemistry
Aseptikons are vaginal suppositories sold by the Chinosol Co. of New York. Each suppository is said to contain:
Ac. Salicylici
2
gr.Ac. Borici
10
gr.Quin. purae (Alkal.)
1
gr.Chinosol
2
gr.But. Cacao
60
gr.The following claims appear in advertisements:
[E] See also Tyree’s Antiseptic Powder, p. 404.
2 From the circular accompanying a package bought over a year ago, we find the powder recommended for the following conditions: “For Leucorrhea, Gonorrhea, Vaginitis, Pruritus, Ulcerated conditions of the mucus membrane.... Scrofulous, Syphilitic and Varicose Ulcers ... for Spraying the Nose and Throat,... for immediate deodorizing and disinfecting ... for prickly heat, poison oak, squamous eczema and other conditions of similar nature.... As a deodorant and prophylactic in dental work,... for disinfecting offensive cavities ... for profuse and offensive perspiration, swelling, soreness and burning of the body and feet.... As a delightful toilet preparation after the bath and shaving.”
3 Last January the national Food and Drugs Act went into effect; one of its provisions is that the label must not lie. This is not the exact verbiage, but it means the same thing. So, instead of repeating the old false statements, the new label of Tyree’s antiseptic powder contains nothing whatever about the composition; the law does not require that it should—unless the preparation contains certain specified drugs. Why is the formula omitted?
[F] For abstract of report on Ergoapiol see p. 82; for the unabridged report of the Council’s action on Apergols, see Reports Council Pharm. and Chem., 1914, p. 64.
Echtisia (Wm. S. Merrell Chemical Co.), Ecthol (Battle and Co.) and Echitone (Strong, Cobb and Co.) are proprietary preparations each of which is alleged to contain echinacea as its chief constituent. In 1909 the Council examined into the claims made for echinacea. This drug has been claimed to be a “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia. Enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus, and exophthalmic goiter and with power of retarding the development of cancer. Of course there is no reliable or trustworthy evidence to substantiate these claims. Echinacea is not often prescribed under its own name, but is employed as an ingredient in proprietary preparations mixed with other little-used or obsolete substances. Thus Echtisia is said to contain echinacea, wild indigo, arbor vitae and poke root; Ecthol, to have echinacea and arbor vitae; Echitone, to consist of echinacea, pansy and blue flag. Naturally the manufacturers of such proprietaries make use of all available optimistic reports in promoting their sale, while each manufacturer ascribes special and peculiar virtues to the combination represented in his particular preparation. The Merrell Chemical Company claims that baptisia (wild indigo) is a “destroyer” of devitalizing elements in the blood “a vitalizer of the blood as well”; that thuja (arbor vitae) is a “perfect antiseptic and a generator of vital force in disorganized tissues,” and that a long list of diseases, including diphtheria, syphilitic sciatica and gonorrheal rheumatism, “are all more or less amenable to full doses” of phytolacca (poke root). Strong, Cobb and Co. maintain that Iris versicolor (blue flag) is “one of the most powerful excitants of the biliary, salivary and pancreatic secretions,” and that the “principal sphere of action of Viola tricolor [pansy] is in the gastro-intestinal canal and the skin.”
“These suppositories are indicated in cervicitis, leucorrhea, specific and non-specific vulvo-vaginitis and in all cases where complete vaginal antisepsis is desired.”
“Non Toxic, Non Irritating; No Damage to Membranes. Yet a More Powerful Antiseptic than Bichloride.”
The Council decided that the foregoing claims in the absence of evidence must be held exaggerated and likely to mislead, and also that the claim “Stronger than Bichloride” which appears on the box is misleading.
The position of the Council is that “In the case of pharmaceutical preparations or mixtures the trade name must be so framed as to indicate the most potent ingredients.” The name Aseptikons does not give any indication of the ingredients of the product.
The Council holds that “The combination of two or more remedies in a mixture must be considered contrary to scientific medicine unless a distinct reason exists for such combination.” No evidence has been submitted to establish the value of the combination in Aseptikons.
On the basis of the evidence submitted the Council voted that Aseptikons be refused recognition because unwarranted and misleading therapeutic claims are made, because the name does not indicate its potent constituents, and because the combination of two or more remedies in a mixture is considered contrary to scientific medicine unless a distinct reason exists for such combination.—(From The Journal A. M. A., Nov. 14, 1914.)
BETUL-OL[G]
Abstract of Report of the Council on Pharmacy and Chemistry
Betul-ol (E. Fougera and Co., New York) is a methyl salicylate preparation advertised to physicians (and indirectly to the public) as an external analgesic and anti-rheumatic. The statements regarding its composition are vague, misleading and, as shown by examination in the Chemical Laboratory of the American Medical Association, untrue. The therapeutic claims are based on discarded theories. Although the alleged superiority of natural over synthetic salicylates has been disproved, physicians are urged to use Betul-ol because it contains, or is alleged to contain, a natural salicylate. Another discarded theory is pressed into service in the claim that the chloral in the mixture will be absorbed and converted into chloroform in the blood. The recommendations for the use of Betul-ol in rheumatism are likely to lead the public to the self-treatment of rheumatism. In view of the serious complications and sequelae of rheumatic fever this recommendation is utterly unjustifiable and a danger to public health—even if the external application of this mixture in uncertain doses were as effective as a proper internal use of salicylates—a theory contrary to experience and unsupported by adequate evidence.
The Council therefore refused recognition to Betul-ol.—(From The Journal A. M. A., Dec. 12, 1914.)
PEACOCK’S BROMIDES AND CHIONIA
Reports of the Council on Pharmacy and Chemistry
The Council has authorized publication of the following reports on Peacock’s Bromides and Chionia, sold by the Peacock Chemical Company, St. Louis.
W. A. Puckner, Secretary.
PEACOCK’S BROMIDES
This is another nostrum of the ordinary mixture type. Of the various statements concerning composition furnished by the company, the following gives as much information as any:
“In Peacock’s Bromides it is designed to unite fifteen grains of the purest bromides of Potassium, Sodium, Ammonium, Calcium and Lithium, in such proportion as to insure the bromine equivalent of potassium bromide. Each fluid drachm about equals, in medicinal strength, fifteen grains of potassium bromide.”
The label on the trade package indicates the presence of 10 per cent. of alcohol. It will be observed that the proportions of the different bromids are not stated. Hence, the assertion of the Peacock Chemical Company that “there is nothing secret in this compound” cannot be true. A physician prescribing it cannot know how much of each ingredient he is giving; it may be 141⁄2 grains of potassium bromid and 1⁄8 grain each of sodium, ammonium, calcium and lithium bromid, or any other of an enormous number of possible permutations of the proportions.
While the theoretical basis of bromid medication is not yet fully settled, the weight of the best pharmacologic authority and clinical experience is decidedly against the dogmatic claim of the Peacock Chemical Company that “the best result is obtained by prescribing a combination of bromides.” And if there were any advantage in prescribing such a combination, the physician ought to regulate the proportions.
The following quotations are from the advertising matter:
“Being uniform in purity and therapeutic power, it can be relied upon to produce clinical results which it is believed cannot be obtained from the use of commercial bromide substitutes.”
“The purity, quality and constant uniformity of this high grade product have long made it a standard bromide preparation.”
These claims are unfounded. The analyses published in the concern’s own advertising “literature” show a variation of 8 per cent., in the bromid content, which certainly indicates a sufficient lack of uniformity.
Again quoting:
“In order to insure the best results the bromides must be pure, i. e., free from alkalies and almost free from chlorides. The U. S. P. allows three per cent. of chlorides. Peacock’s Bromides contains the least possible amount of this impurity. Bromism is therefore less frequent in those cases in which this preparation is employed.”
In view of the claim of low chlorid content, it is interesting to note that the analyses above referred to show that the chlorid content is actually higher than that of some other bromid preparations on the market.
The claim of merit on the ground of freedom from chlorids is, of course, absurd, and must be regarded as an attempt to play upon the credulity of the doctor. As a matter of fact, the average individual takes with his food many times the amount of chlorid he could possibly take in contaminated bromid. The 10 per cent. of alcohol would undoubtedly have a greater disturbing influence on the bromid action than the amount of chlorid that might be present in any bromid on the market.
Then we have the statement that, owing to this freedom from chlorids:
“Bromism is therefore less in those cases in which the preparation is employed.”
Sodium chlorid, even as an impurity, would retard rather than favor the development of bromism; sodium chlorid is even used as an antidote in bromid poisoning.
The therapeutic claims lay stress on the value of the bromids in sleeplessness, epilepsy, sexual excitement, tetanus, infantile convulsions, chorea, delirium tremens, the climacteric, migraine, headache due to pelvic conditions, ovarian neuralgia, etc. These and other claims, while too vague to be branded as falsehoods, are misleading and not in accordance with modern teaching or practice; the latter recognize the limitations of bromid therapy as well as its scope and advantages. For instance, in epilepsy the company asserts that:
“Large doses must be given if we expect to control the convulsions. We are to be guided by the frequency and the severity of the seizures, the saturation of the system by bromides and by the age of the patient. The rule is ‘large doses for long periods but with occasional periodic monthly or quarterly omissions.’ When we have succeeded in controlling the convulsions in so far as greatly diminishing the frequency and severity of the attacks we may then attempt to decrease the dose, but the results must be carefully watched. Increase in frequency of convulsive seizures is a sign that the bromides must again be pushed as before.”
The best modern clinical teaching concerning the treatment of epilepsy is that bromids should be avoided except as a last resort. Bromids do not cure, and the amount necessary to control the convulsions may produce a degree of mental hebetude that is a greater evil than the disease itself.
It is recommended that the preparation be held ineligible for admission to N. N. R., because of its conflict with Rules 1, 4, 6 and 10 of the Council, and that this report be published.
CHIONIA
Chionia, according to the statement of the Peacock Chemical Company, which exploits the product, contains 19 per cent. alcohol and is “A Preparation of Chionanthus Virginica.”4
This preparation is advertised particularly as “a potent hepatic stimulant” and special claims are made for it in various disturbances of the liver:
“Chionia is very well adapted in the treatment of hepatic congestion owing to its specific action in depleting the portal circulation.”
In passive congestion of the liver, the manufacturers would have us believe
“... we have a drug in Chionia that will stimulate the circulation of the blood and lymphatics of the liver as well as stimulate its physiological activities and instead of the patient vomiting the blood an internal depletion of the liver occurs.”
“... in cases of simple jaundice due to circulatory (congestive) changes in the liver, Chionia is the drug ‘par excellence’ that will rapidly cause a disappearance of this symptom.”
As a prophylactic against eclampsia, if a history of torpidity of the liver is obtained:
“CHIONIA should be used during the major portion of child-bearing period because it acts directly on the liver stimulating its functional activity.”
Chionanthus virginica has never been shown to have the slightest pharmacologic activity and no evidence is presented that its offspring, Chionia, has any therapeutic value whatever in any disturbance of the liver. The promoters themselves indicate a lack of faith in their own preparation, for they advise the use of old and efficient forms of treatment along with Chionia—heart tonics and laxatives in passive congestion of the liver, mercurial purge or podophyllin and sodium phosphate in “biliousness,” and quinin in malaria. Finally, with delightful English and elaborate insouciance, they advise in the treatment of eclampsia:
“In all cases the uterus should be emptied as quick as possible. (Version of Cæsarian Section.)”
The physician who prescribes Chionia promotes a fraud.
The Council held Chionia ineligible for admission to N. N. R.
[Editorial Comment: In Peacock’s Bromides and Chionia the Peacock Chemical Company has, for a third of a century, been foisting on the medical profession nostrums composed of drugs that are easily combined in any proportion that the physician may want to prescribe. The company has been inflicting on the unthinking physician pseudo-scientific rubbish in the form of advertising literature that should long ago have been regarded as an insult to the intelligence of the medical profession. The following medical journals are carrying advertisements of Peacock’s Bromides and Chionia:
Alienist and Neurologist
Medical Fortnightly
American Journal of Surgery
Medical Herald
American Medicine
Medical Record
Archives of Pediatrics
Medical Review of Reviews
Atlanta Journal-Record of Medicine
Medical Sentinel
Buffalo Medical Journal
Medical Standard
Charlotte Medical Journal
Medical Summary
Chicago Medical Recorder
Medical Times
Denver Medical Times and Utah Medical
Journal
Medical World
Nashville Journal of Medicine and Surgery
Eclectic Medical Journal
New Orleans Medical and Surgical Journal
Ellingwood’s Therapeutist
New York Medical Journal
Indianapolis Medical Journal
Pacific Medical Journal
International Journal of Surgery
Southern Practitioner
Lancet-Clinic
Texas Medical Journal
Louisville Monthly Journal of Medicine
and Surgery
Texas Medical News
Therapeutic Gazette
Maryland Medical Journal
Wisconsin Medical Recorder
Medical Brief
Woman’s Medical Journal]
—(
From The Journal A. M. A., April 3, 1915.)
BROMIDIA
Report of the Council on Pharmacy and Chemistry
The following report was submitted to the Council by a member of its Committee on Therapeutics, with the recommendation that publication be authorized. This recommendation was adopted.
W. A. Puckner, Secretary.
Bromidia (Battle & Co., St. Louis) at once suggests bromids; yet Bromidia is essentially a chloral rather than a bromid preparation. This nostrum illustrates the need of the provision in the Council’s Rule 8 under which recognition is refused pharmaceutical mixtures whose names do not indicate their most potent ingredients. While the chloral content of Bromidia has been given considerable publicity, yet the preparation is used both by physicians and by the public without due consideration of its potent ingredient. This fact is attested not only by the fatal results which have followed its use but also by the many reports of habit formation. As long ago as in 1887 a fatal case of poisoning was reported5 to the medical society of the District of Columbia due to an overdose taken by a Bromidia addict. The physician who reported this case also gave his experience with another patient who had the Bromidia habit. In the discussion of the paper a number of cases were reported by others present in which Bromidia had been taken without a physician’s advice and with more or less grave symptoms of poisoning.
In the report of a death of one who had been a slave to Bromidia it was said:6 “When the body was found, there were eleven one-ounce Bromidia bottles about the room or on his person. Nine were entirely empty and the other two were about half full. None of these bottles indicated that they had been purchased on a physician’s prescription, only the druggist’s label marked ‘Bromidia’ being on them.”
Dr. Horatio C. Wood, Jr., gave7 a striking illustration of how preparations like Bromidia come to be used even by physicians without consideration of their constituents:
“Within an hour after his father, a Brooklyn physician, had given him a dose of bromid, H.G.P., a prodigal son, died yesterday at his father’s home in Brooklyn. Two years ago, when he appeared to have sown his wild oats, the father made him superintendent of his country place, near Grants Mills, Delaware County. A week ago the son left his place, and at 1 o’clock yesterday morning appeared at his father’s Brooklyn home. He was nervous, and at 9 a. m. begged for a sedative.
“‘I prescribed the usual quantity of bromidia,’ the young man’s father told a reporter. ‘He was weak and had suffered from weak heart and kidney trouble for some time.’
“An hour later the father found the son dying and administered restoratives, but to no avail.”
A circular, “The Advantages of Bromidia,” makes it plain how physicians come to use a preparation like Bromidia without consideration of its potent constituent. In this circular the presence of chloral is at first frankly admitted, then it is suggested that in the combination the evil effects of chloral are completely eliminated and in the end the impression is left that Bromidia is practically innocuous. Thus at the beginning while arguing that Bromidia is better than extemporaneous preparations the chloral content is plainly acknowledged:
“In the untoward effects so frequently attending the use of extemporaneously prepared mixtures of chloral and the bromides, may be found the reason for BROMIDIA’S preference when the need for a hypnotic agent arises. Were it not for the well known disadvantages of these drugs which become still more marked with their continued use, there could be no special need for such a preparation as BROMIDIA (Battle), for the therapeutic powers of chloral and the bromides are among the most positive facts in medicine.”
Again:
“It was to meet the growing professional demand for a combination of chloral and the bromides with their evil effects eliminated, that led to the manufacture of BROMIDIA (Battle).”
Then, suggesting the indiscriminate use of Bromidia—as an entity as Dr. Wood suggests—the claim is made that:
“... its constituents have been chosen with a view of enabling Bromidia to meet every requirement for an agent of its class.”
“Owing to the exceptional purity of its component parts and its freedom from untoward effects when continued over long periods, this product will be found of the highest utility in epilepsy.”
“... its action is that of chloral and the bromides minus their evil effects.”
Finally Bromidia becomes a simple bromid preparation. Thus an advertisement reads:
“Bromidia’s (Battle) Marked Sedative and Antispasmodic Qualities eminently fit it for the treatment of Maniacal Excitement, Epilepsy, Spasmodic Asthma, Convulsive Seizures of Reflex Origin, Sexual Neuroses, and other disorders attendant upon nervous irritability.
“Through its exhibition, the fullest therapeutic power of the bromides may be secured with a minimum of their evil effects; a feature of the greatest service when the necessity for continued treatment becomes necessary.”
In addition to the general invitation to use Bromidia in epilepsy and various nervous disorders, a circular also recommends its use in typhoid, a recommendation, which, if followed, may turn the scale in favor of a fatal result. The circular states:
“As a soothing agent in the extreme restlessness and irritability of typhoid fever and other infectious diseases, BROMIDIA (Battle) is a therapeutic weapon of definite service. Relief of the headache of typhoid may also be secured through the use of BROMIDIA (Battle). By means of its administration for the above purposes, the patient’s strength is conserved and as a result he is much better prepared to stand the force of the infection.”
Particularly vicious is the recommendation that it be given to children. Thus, in a pamphlet entitled “Effective Drugs Effectively Combined”:
“Another point of advantage to be found in bromidia is the ease with which it is borne by children. Owing to this tolerance, it is of distinct service in a considerable list of disorders of childhood. Thus, of course, employed with care and an understanding of its potency, bromidia has a field of usefulness in chorea, laryngismus stridulus, and whooping-cough. In other nervous disorders of childhood—those attending acute infections, for instance—bromidia is a definitely indicated therapeutic aid, owing to the soothing influence exerted by even a moderate dose and the absence of untoward effects. More specifically, the correcting influence of bromidia in the night-terrors of children may be mentioned.”
Formerly advertisements asserted that each fluidram of Bromidia contained:
“Chloral hydrate
15grains
“Potassium bromid
15grains
“Extract of Cannabis indica
1⁄8grain
“Extract of henbane
1⁄8grain”
This formula also appears on the label of a sample package sent through the mails during 1914. A recent circular contains a somewhat different formula. Instead of “1⁄8 gr. each of gen. Imp. Ext. Cannabis Ind. and Hyoscyam.” as was formerly claimed, each fluidram of Bromidia is now said, not to “contain” but to “represent,” not the extracts but the far less potent drugs “Cannabis indica 1⁄8 grain, Hyoscyamus 1⁄8 grain,” thus:
“Chloral hydrate
15grains
“Pot. brom.
15grains
“Cannabis indica
1⁄8grain
“Hyoscyamus
1⁄8grain”
Furnishing still greater variety, the labels on a recently purchased bottle of Bromidia, where under the Food and Drugs Act the presence of narcotic drugs must be declared, read:
“Alcohol 10 per cent., Chloral Hydrate, 91 grs. per ounce. Cannabis indica indeterminate in finished product.”
“In the manufacture of BROMIDIA to each drachm of fluid used are added 15 grains of pure chloral hydrate and purified brom. pot., and 1⁄8 grain each of gen. imp. ext. cannabis ind. and hyosciam.”
These various statements as to the composition of Bromidia leave one very much “in the air.” As chloral and potassium bromid are easily determined and since lying on the labels of widely exploited proprietaries has become somewhat risky recently, it is probable that the statements on the trade package are to be depended on and that each fluidram of Bromidia contains something like 12 grains each of chloral and potassium bromid and not 15 grains as the medical profession has been and is being told.
Pharmacists who have attempted to put up a nonproprietary preparation similar to or, more correctly, having the alleged composition of Bromidia have found it practically impossible to do so. The reason is that extract of cannabis indica is almost insoluble in a menstruum such as that found in Bromidia. The National Formulary, first edition, listed Mistura Chlorali et Potassii Bromidi Composita of which it was said: “Each fluidram contains 15 grains each of Chloral and of Bromid of Potassium, and 1⁄8 grain each of Extract of Indian Cannabis and Extract of Hyoscyamus.” In this the pharmacists attempted to incorporate the cannabis indica by using the tincture of the drug and suspending it by the addition of tincture of soap bark. In the present edition of the National Formulary, the preparation is made by triturating the extract of cannabis indica with pumice stone and then filtering the finished product. This gives an “elegant” preparation—but one from which the cannabis indica is filtered out! A sad commentary on the National Formulary. It should not be supposed, however, that the manufacturers of Bromidia have solved the problem that has baffled the pharmacists; not at all. Bromidia probably contains no more cannabis indica than does its National Formulary prototype. The statement on the present trade packages, that the amount of cannabis indica in Bromidia is “indeterminate,” is but a tardy acknowledgment of the fact that the stuff has not, and never had, the amount of cannabis indica claimed for it for so many years.
The “indications” named on the Bromidia labels are, in common with nostrums of this type, but suggestions for self-drugging. They will appeal to the layman who has purchased, either by prescription or otherwise, an “original package” of Bromidia and who may imagine he suffers from “nervousness,” “sleeplessness,” “headache” or “neuralgia.”
But while the manufacturers in their advertising matter have on the whole not disguised the presence of chloral so much as they have attempted to make it appear that the chloral has been robbed of its dangers—for all hypnotics if used thoughtlessly are dangerous—after all the name has created the false impression that Bromidia is a bromid preparation. It is because of this false impression carried by its name, that Bromidia came to be used indiscriminately by the profession and in the course of time still more indiscriminately and recklessly by the public. Bromidia is a vicious chloral preparation masquerading under a misleading name. That physicians have been impressed by the claims of its harmlessness and by the mystery connected with the formula is not a credit to the intelligence of our profession. There is no doubt but that physicians are responsible for the use and abuse of this chloral preparation by the public.
There is no scientific or rational excuse for a ready-made preparation of this sort. When chloral or a bromid is indicated the proper dose of each of these, if they are to be combined, should be determined for each patient. Potassium bromid and chloral hydrate both are readily soluble in water, syrup or elixirs and it is a simple matter to prescribe the required dose of chloral and of bromid dissolved in some aromatic water like cinnamon-water (Aqua Cinnamomi), in some syrup like syrup of orange (Syrupus Aurantii) or in an elixir like the aromatic elixir (Elixir Aromaticum) or adjuvant elixir (Elixir Adjuvans). If this mixture is prescribed thus the physician is alive, alike to the dangers and the limitations of the drugs; if it is prescribed under a misleading proprietary name, the physician endangers his patient, stultifies his profession and tends to perpetuate the great American fraud.
[Editor’s Note.—A list of some of the medical journals that advertise Bromidia:
Texas Medical News
Southern Practitioner
Nashville Journal of Medicine & Surgery
New Orleans Medical & Surgical Journal
Medical Brief
Therapeutic Gazette
Annals of Surgery
Medical Herald
Charlotte Medical Journal
Medical Times
Medical Sentinel
Texas Medical Journal
Memphis Medical Monthly
Wisconsin Medical Recorder
Laryngoscope
International Journal of Surgery
Medical World
Vermont Medical Monthly
Medical Review of Reviews
Atlanta Journal-Record of Medicine
Louisville Monthly Journal
St. Paul Medical Journal
Indianapolis Medical Journal
Hospital Bulletin of the University of Maryland
Monthly Cyclopedia & Medical Bulletin
Denver Medical Times
Journal of Nervous & Mental Diseases
Buffalo Medical Journal
Maryland Medical Journal
Medical Review
Merck’s Archives
Ellingwood’s Therapeutist
Iowa Medical Journal
Eclectic Medical Journal
Medical Standard
Massachusetts Medical Journal]
—(
From The Journal A. M. A., May 16, 1914.)
CACTUS GRANDIFLORUS
Report of the Council on Pharmacy and Chemistry [H]
The Council voted that cactus grandiflorus should not be accepted for New and Nonofficial Remedies, and that a statement be prepared for The Journal giving the reasons for this action. Accordingly the following report has been adopted by the Council and its publication authorized.
W. A. Puckner, Secretary.
Cactus Grandiflorus
The therapeutic value of this plant has been variously estimated by different observers. Experimental evidence as to its action is scanty and no complete chemical examination has ever been made.
Reputable men have testified that some of the plants of the cactus family contain very active principles, but so far experiments seem to prove that cactus grandiflorus has neither the action of digitalis nor that of strychnin. The principal contributions, clinical and experimental, for and against the drug, are set out below.
EXPERIMENTAL EVIDENCE
O. H. Myers8 worked with a product which he calls cactina and which he regards as the active principle of the drug. (As no such substance as cactina is described in any materia medica, it is impossible to state what Myers really used.) He found that it had a strychnin-like action and raised the blood-pressure.
Hatcher comes to the conclusion: “Either Myers’ work was a pure fabrication or he was dealing not with cactin but with a substance similar to the pellotin of Heffter, the action of which resembles that of strychnin to a certain extent.”
E. Boinet and J. Boy-Teissier9 experimented with an aqueous extract, an alcoholic extract, and with an alkaloid which they call “cactine.” They concluded from three sets of experiments on frogs that extract of cactus produces, in ten minutes, a temporary increase in the heart’s action which frequently repeated doses are required to maintain; and that large doses slow the heart and produce arrhythmia.
L. E. Sayre10 experimented with a preparation of cactus, made from the stem of the plant, by injecting it into the dorsal lymph space of the frog. There was seemingly an increase in the amplitude of the heart’s action and an indication of a strengthened beat or increased force.
R. A. Hatcher11 states that it is possible that cactus grandiflorus, under certain conditions, may contain a principle with a strychnin-like action. But Hatcher made ten experiments on frogs, four on cats, six on dogs, two on rabbits, and one on a guinea-pig, with Cactina pillets of the Sultan Drug Company and the Cactin of the Abbott Alkaloidal Company. From 1 to 15 pillets in frogs and up to 25 in dogs were used at each dose. In no single instance was there any evidence of a digitalis-like or strychnin-like action, or, in fact, of any decided action of any kind whatever.
Gordon Sharp12 was unable to obtain either alkaloid or glucosid from the plant, but found a series of resins that caused contraction of the blood-vessels of a frog. This was not a digitalis-like contraction, but depended, he believed, on simple acidity. On the heart of the frog the resins have little or no effect, comparisons being made with digitalis in the same animals. There is no proof that cactus grandiflorus itself shortens diastole, or in fact, that it has any special action on the heart muscle at all. Sharp experimented on himself with large doses of an extract made with alcohol 1 to 5, but got no noticeable results. He thinks that the plant may have some slight diuretic action.
Sayre submitted the preparation which he used in his experiments for more careful testing to E. M. Houghton, who reported that it had practically no action on the heart.
In commenting on Houghton’s results, Reid Hunt said that they were confirmed by his own experiments. He did not deny, however, that the drug might have some therapeutic effect and that, in very large doses, it did affect the kidneys.
S. A. Matthews13 found one preparation of cactus (cactin—Abbott) absolutely inert so far as any effect on the heart is concerned. He found that cactina (Sultan Drug Co.) in very large doses depressed both the circulation and respiration. In this regard it differs from strychnin, and it has no resemblance to the action of digitalis, strophanthus or any of the heart stimulants. A dose of from 10 to 12 pillets administered intravenously to a 10 to 12 kg. dog exerted little or no influence on the heart or circulation; the larger dose may cause a slight fall in blood-pressure. When 70 or more pillets were administered within two and a half hours the animal generally died.
The work of Boinet and Boy-Teissier also has been criticized by Hatcher on the ground that their most positive results were obtained with an alkaloid which no one at this day is able to prepare. The results quoted in this report, however, were obtained by the use of extracts of cactus so that it does not seem that they should be entirely rejected, whatever their value may be.
CLINICAL EVIDENCE
Clinical observations have been more abundant than exact, and a favorable action of the drug in some organic diseases of the heart has been reported; other observers would limit its use to functional arrhythmia, insisting that it is not a substitute for digitalis or aconite, but that it occupies a place distinct from either of those remedies.
P. W. Williams14 recommends cactus for functional heart disease, but, as a rule, found it useless in organic disease. He thinks it one of a class of remedies which act on the accelerator nerves and sympathetic ganglia, shortening the diastole and stimulating the spinal vasomotor nerve centers. Williams apparently relied on Myers for his knowledge of the pharmacologic action, and his paper is a fair example of the clinical studies of cactus.
Ellingwood15 claims that cactus is a cardiac tonic, acting on the accelerator nerves and heart ganglia, increasing muscular force and arterial tension. He recommends it in both organic and functional diseases.
Boinet and Boy-Teissier found that therapeutic doses of 40 drops of tincture of cactus were without effect on the normal heart. In patients with noisy asystole (asystolie bruyante) the same dose produced no appreciable effect. In the period of latent non-compensation of true cardiac patients, from 80 to 100 drops a day increased the force of the failing heart. In patients with secondary heart disease with arrhythmia of nervous origin, daily doses of 80, 100 and 120 drops of the tincture were well tolerated for weeks; they seemed to increase the fulness of the pulse and regulated its rhythm. In spite of such large doses, these observers never noticed any symptoms that could be attributed to a cumulative action. It must be remembered that the precise preparation of cactus which they used is not known.
Aulde16 recommends it as a cardiac tonic free from cumulative effects.
Gordon Sharp says: “The therapeutics of the subject, I think, are clear enough. Cactus grandiflorus cannot be included in our list of cardiac drugs. It is not even a simple stomachic tonic and at most all one can say is that it has small diuretic action.”
Hatcher says: “Clinical testimony is so conflicting that between the extreme views of Gordon Sharp and those of Ellingwood there is room for an honest difference of opinion concerning cactus grandiflorus.”
Matthews himself took 100 granules of cactin (1⁄67 gr.—1 mg. each), 25 every four hours, without experiencing the least effect.
CONCLUSIONS
Reliable conclusions regarding the therapeutic use of cactus grandiflorus are rendered difficult on account of several factors.
1. It is uncertain what part of the plant contains the active principle if one exists; and its nature is unknown. The National Standard Dispensatory states that its “activity must be confined to the flower in some special stage of its development or to a certain part of it or to some parts gathered with it.” This uncertainty may explain the negative results obtained by some observers, but it makes the drug one that cannot be generally relied on and gives an excellent opportunity for the exploitation of proprietary preparations.
2. Some of the experimental work and much of the clinical evidence has been obtained and published under proprietary auspices. For this reason many of the therapeutic claims made for the drug must be viewed as merely the reflection of the exaggerated statements made by the advertisers of proprietary preparations.
3. The value of clinical evidence when unsupported by an animal experimentation is much diminished by the tendency of enthusiastic and untrained observers to attribute to the drug given the effect really due to general remedial measures, psychic suggestion and so forth. While it must be admitted that valuable remedies may exist whose therapeutic properties cannot be revealed by animal experimentation, yet in the absence of such experimental evidence conclusions should be drawn with extreme caution.
Bearing these conditions in mind, the following statements seem to be justified: (a) The botanical, chemical and pharmaceutical properties of cactus are not sufficiently determined to make any available preparation a reliable remedy. (b) There is some evidence that cactus may be capable of affecting the animal heart and nervous system, but its action is not that ordinarily attributed to it. It does not increase the force of the heart-beat. (c) While there is some clinical testimony as to its usefulness in functional diseases of the heart, the indications for its administration are at present too uncertain to afford a safe basis for recommending it.
4. While the drug may be deserving of further experimental and clinical investigation, this should be carried on in reliable pharmacologic laboratories and in clinics provided with facilities for exact observation.—(From The Journal A. M. A., March 12, 1910.)
CALCREOSE
Report of the Council on Pharmacy and Chemistry
In response to inquiries and in view of the extensive advertising propaganda, the Council, on Dec. 19, 1913, took up for consideration Calcreose (Maltbie Chemical Company, Newark, N. J.). Examination showed that the preparation contained, in loose combination, approximately equal weights of creosote and lime. The claims made in the advertising “literature” were extravagant and uncritical, and the Council therefore held Calcreose ineligible for New and Nonofficial Remedies.
In June, 1914, at the request of the Maltbie Chemical Company, the Council undertook a reconsideration of the preparation. The advertising claims were now found more conservative. Before the existing claims could be judged, however, the Council deemed it necessary to require from the company satisfactory proof (1) that the large doses of Calcreose recommended and administered actually furnish large amounts of creosote to the blood, and (2) that patients taking these large doses do not suffer from digestive disturbances, loss of nutrition, albumin in the urine or phenol urine, as claimed. The Council accordingly advised the company of this requirement, at the same time stipulating that nothing in the report should be interpreted as indicating a belief on the part of the Council that enormous doses of creosote are necessary for, or will promote a cure of tuberculosis.
The Maltbie Chemical Company has not up to the present date furnished this proof, but has evinced a disposition to make the Council’s holding Calcreose under advisement appear in the guise of a quasi-approval. It is therefore recommended that Calcreose be refused recognition for conflict with Rule 6.—(From the Journal A. M. A., June 26, 1915.)
CAMPHO-PHENIQUE
Report of the Council on Pharmacy and Chemistry and Some Comments Thereon
The following report was submitted to the Council on Pharmacy and Chemistry by the subcommittee to which Campho-Phenique had been assigned:
To the Council on Pharmacy and Chemistry:—Campho-Phenique, sold by the Campho-Phenique Co., St. Louis, Mo., is claimed to be composed of phenol 49 per cent., and camphor 51 per cent.
Examination of specimens, purchased in the open market, made under our direction, demonstrates that the statements made in regard to the composition are not true. Instead of containing 49 per cent. of phenol (carbolic acid), the analysis showed that it contains not more than 20 per cent. Instead of containing 51 per cent. of camphor, the analysis demonstrates that the amount of camphor is not more than 38 per cent. Besides phenol and camphor, a third substance was found which proved to be liquid petrolatum and to be present to the extent of 38 per cent. or more.
Since the statements made in regard to the composition of Campho-Phenique are deliberate misrepresentations of the facts, it is recommended that the article be not approved.
Besides Campho-Phenique, the above-mentioned firm also sells a preparation labeled Campho-Phenique Powder. While no statement in regard to the composition of this product is made on the label or in the literature, such expressions as “Campho-Phenique in a powdered form” and “Powdered Campho-Phenique” lead to the inference that it has essentially the same composition as that stated for the liquid preparation. An examination of a specimen of Campho-Phenique Powder purchased in the open market showed that 92 per cent. of it was a talcum-like inorganic substance. The remaining 8 per cent. consisted chiefly of camphor with a small amount of phenol.
In view of the fact that Campho-Phenique Powder contains very little phenol, but instead consists chiefly of an inorganic talcum-like substance, its name is misleading and deceptive. It having been shown that Campho-Phenique Powder corresponds to a camphorated talcum powder, the claims that it “has no equal as a dry dressing,” that it is “absolutely superior to iodoform,” and that it has “all the excellent properties of aristol and iodoform,” are unwarranted. It is recommended that the article be not approved, and that this report be published.
The recommendations of the subcommittee were adopted by the Council, and in accordance therewith the above report is published.
W. A. Puckner, Secretary.
Campho-Phenique
The above report on a much advertised “ethical” proprietary medicine is worthy of the thoughtful consideration of the members of the medical profession, as it illustrates admirably some of the conditions connected with this proprietary medicine business.
THE FORMULA A FAKE
First, it illustrates the fact that the published formulas of the “ethical” proprietaries are not always reliable. The Campho-Phenique Company has been very willing to give out a formula, purporting their product to be 51 per cent. camphor and 49 per cent. phenol (carbolic acid). Now, these two drugs will make a liquid mixture, and any druggist can make it, and the mixture will have about the same consistency and appearance as Campho-Phenique. But its effect differs decidedly from that of Campho-Phenique. Some months ago a very intelligent physician, in discussing the proprietary medicine business, said that in some cases physicians could not get druggists to make preparations which were as satisfactory as those which could be bought ready-made. He cited Campho-Phenique as an illustration. He said that he had used this preparation for burns, etc., but as he did not like to use preparations put up by companies about which he knew nothing, he asked his druggist to make the mixture in accordance with the published formula. The druggist’s preparation was not satisfactory; it had a decidedly different effect from Campho-Phenique, and so he tried another druggist. This druggist also followed the published formula, but his results, too, differed materially from the proprietary article.
The various analyses that have been made show why the preparations put up by the druggists did not resemble that made by the company; since, according to the analyses, Campho-Phenique consists of 40 per cent. liquid petrolatum, which is an inert but soothing diluent, while instead of 49 per cent. of carbolic acid, as claimed, it really contains less than 20 per cent. This is an entirely different proposition. Now, if the physician referred to above will have his druggist make a mixture of 20 per cent. of carbolic acid, 40 per cent. of camphor and 40 per cent. of liquid petrolatum, and will then compare this resulting compound with Campho-Phenique, he will find that there is not much difference. Furthermore, he will realize that there is nothing either new or wonderful about the preparation. Camphorated oil and carbolized oil are both in common use. Campho-Phenique is apparently simply a mixture of the two.
THE POWDER STILL WORSE
So much for the liquid. The powder seems to be something entirely different, for, according to the chemist’s report, over 90 per cent. of it is inert, absorbent, talcum-like material. There is enough camphor and carbolic acid to give the powder an odor and thus mislead physicians, especially those who are in the habit of taking for granted that whatever statements nostrum manufacturers make are true. Perhaps it is a fairly good dressing for wounds—at least it will do no harm—but its name is misleading and deceptive. For all practical purposes it is essentially a camphorated talcum powder.
COMPANY A “PATENT-MEDICINE” CONCERN
The second interesting phase of this “ethical” proprietary is that it illustrates another point, i. e., that many of these articles are supplied to our profession by those who are not legitimate manufacturing pharmacists. The Campho-Phenique Company of St. Louis, according to all reports, is owned and controlled by a gentleman named Ballard. This “company” supplies the medical profession with the preparations under consideration and also with Chloro-Phenique and Scrofonol. We are informed that this same Mr. Ballard is the principal owner, if not the sole owner, of quite a number of “patent-medicine” companies, such as Ballard-Snow Liniment Co., Brown’s Iron Bitters Co., Mayfield Medicine Mfg. Co., Smith Bile Beans Co., Swain’s Laboratory, and several others. We learn from the wholesale drug trade lists that these various “companies” make and sell, besides the Campho-Phenique preparations, Ballard-Snow Liniment, Ballard’s Herbine, Brown’s Iron Bitters, Dr. Herrick’s Pills, Richardson’s Life-Preserving Bitters, Smith’s Bile Beans, Swain’s All Healing Ointment, and several other “patent medicines.”
It is hardly necessary to make any further comments. The whole business is nauseating to those who know the actual conditions of this nostrum business and how our profession is being deluded. The Campho-Phenique matter is not an exception; it is simply another illustration of these conditions.
The majority of “ethical” proprietaries are foisted on our profession, either without any formula accompanying them, or with a “formula” that is a fake. The majority of the “ethical” proprietaries are manufactured and supplied to physicians, with instructions regarding their use, by men who bear the same relation to legitimate pharmacy that the veriest quack that ever swindled a credulous public bears to scientific medicine.—(From The Journal A. M. A., April 20, 1907.)
CELERINA, ALETRIS CORDIAL AND KENNEDY’S PINUS CANADENSIS, LIGHT AND DARK
Report of the Council on Pharmacy and Chemistry
The following reports on products of the Rio Chemical Company have been submitted by a referee. The Council recommends that they be published, as the preparations discussed are glaring instances of nostrums exploited through physicians on unscientific claims and false representations.
W. A. Puckner, Secretary.
Celerina
Celerina belongs to what Samuel Hopkins Adams calls the “bracer” type of nostrum. According to the label it contains 42 per cent. alcohol (whisky contains about 50 per cent.). The other ingredients of Celerina are declared to be as follows:
[G] For the unabridged report of the Council’s action on Betul-ol, see Reports Council Pharm. and Chem., 1914, p. 62.
4 Of Chionanthus Virginica or fringe-tree, the Council on Pharmacy and Chemistry in its 1912 report on “Some Unimportant Drugs” said: “The drug is much used by eclectics and homeopathists, especially as a depurant in hepatic and syphilitic disorders.... The claims for this remedy are not supported by experimental evidence and clinical reports of its use fail to show indications of discriminating critical observation. It is not noticed by most pharmacologic authorities.”
5 The Journal A. M. A., July 9, 1887, p. 55.
6 The Journal A. M. A., April 21, 1906, p. 1220.
7 The Journal A. M. A., April 21, 1906, p. 1220.
[H] A reprint of various articles discussing Cactus Grandiflorus, Cactin—now called Cactoid—(Abbott Alkaloidal Company) and Cactina Pillets (Sultan Drug Company) will be sent on receipt of a 2-cent stamp.
8 New York Med. Jour., 1891, liii, 681–683.
9 Bull. gén. de thérap., 1891, cxxi, 343–349.
10 Am. Pharm. Assn., 1906, liv, 405.
11 The Journal A. M. A., Sept. 21, 1907, pp. 1021–1024.
12 Practitioner, London, 1894, iii, 444–446.
13 The Journal A. M. A., March 21, 1908, pp. 956–958.
14 Practitioner, London, 1891, xlvii, 266–273.
15 Med. Rec., New York, 1905, lxvii, 857.
16 Practitioner, London, xlvii, 223; Therap. Gaz., 1890.
“Each fluidounce represents Forty grains each Kola, Viburnum, Forty-eight grains Celery, Twenty grains Cypripedium, Sixteen grains Xanthoxylum and Aromatics.
“Dose—1 or 2 teaspoonfuls 3 times a day.”
Kola contains a very small percentage each of caffein and theobromin. It is impossible for the infinitesimal amounts of these alkaloids in an ordinary dose of Celerina to produce any physiologic effect.
Viburnum has been called a “uterine sedative,” whatever that may be. Its only real activity is the psychic one due to its taste and odor.
Celery at one time was credited with being both an antispasmodic and a nerve stimulant—a remarkable combination of opposing qualities! Scientific investigation has failed to show that celery has any physiologic or therapeutic activities. If it had the slightest medicinal value, the rational course would be to prescribe it in its fresh and natural state. The small dose contained in a teaspoonful of Celerina is inappreciable and not even equivalent to that contained in a stalk of celery.
Ladyslipper, more imposing under the Latin name of “cypripedium,” is a flowering plant with a legendary reputation as an “antispasmodic and nerve stimulant.” It has been in the therapeutic scrap-heap for years. It contains a little tannic acid, gallic acid and a volatile oil. Even a tannic acid action cannot be expected from a teaspoonful of a preparation containing 20 grains of ladyslipper to the ounce.
Prickly ash (xanthoxylum) has never been shown to have any activity other than that of a local irritant, especially to mucous membranes. The slight “bite” from this drug would be entirely covered up by the alcohol in Celerina. Any stimulating effect which this drug may have on the stomach is greatly inferior to that produced by a very small glass of ordinary ginger ale.
In short, there is no ingredient in Celerina, except the alcohol, that has any recognizable activity; and the alcohol content is nearly as great as that of ordinary whisky. Some of the claims and recommendations for this nostrum are:
“Celerina (Nerve Tonic), for Nervousness, Hysteria, Insomnia, Nervous Indigestion, Languid and Debilitated Conditions, Recovery from Alcoholic Excess.”
Think of prescribing an alcoholic nostrum four times a day to promote recovery from alcoholic excess!
“NEURASTHENIA: The bane of the general practitioner; the puzzle of the neurologist; the juicy fruit of the quack and faddist; the opportunity of the intelligent therapist.... For the medical treatment CELERINA is the preparation of wide utility.”
The sang froid with which the exploiters of this nostrum refer to other “quacks and faddists” as reaping “juicy fruit” from neurasthenics would command admiration were it not so pitiful.
“Celerina has substantial endorsement in nervous disorders characterized by Aphonia (nervous).”
Of course, the disappearance of nervous aphonia might follow the application of any treatment whatever, be it Eddyism, Chiropractic, Peruna or Celerina.
In
“CLIMACTERIC (the Menopause) flattering results have been reported from a combination of equal parts Celerina and Aletris Cordial Rio.”
“Teaspoonful doses after meals and upon retiring have proven efficacious [in “dyspepsia”] when other remedies have failed.”
Here is a good example of proprietary-house therapeutics: Such widely different conditions as digestive trouble and the climacteric are to be treated with a combination of alcohol, simple bitters and aromatics! Why not order a cocktail under its own name? It would be equally efficacious, less mysterious and its dangers might be better realized!
“A teaspoonful or two in three tablespoonfuls of boiling hot water [for insomnia] upon retiring.”
Any other hot toddy at bedtime (and it need not cost a dollar a bottle) might give relief; but the intelligent physician to-day recognizes the danger of prescribing alcohol in such conditions.
“In the case of brain workers who suffer from nervous excitability and mental fatigue, the administration of Celerina in teaspoonful doses, three times a day and at bedtime, rapidly controls the condition and increases mental capacity.”
And the same effect follows its use:
“In cases involving worry, anxiety, overwork, and excesses of various kinds....”
Moreover:
“Celerina is the most prompt and efficient of remedies for devitalized or broken-down constitutions—doses four times a day.”
The statement made by its manufacturers that this preparation is free from narcotics or habit-forming drugs is not true. Alcohol is both a narcotic and a habit-forming drug.
As in the case of other nostrums containing no potent drugs but alcohol, Celerina is recommended for various diseased conditions in combination with a familiar form of treatment by drugs of more or less value. The physician who thoughtlessly prescribes one of these combinations will without doubt unthinkingly attribute any subsequent improvement to the Celerina. Thus, for malaria, a prescription of quinin and Celerina is advised; for chorea in children, arsenic with Celerina; in “Convalescence from La Grippe,” strychnin sulphate, Fowler’s solution, and Celerina; for impotence, nux vomica, dilute phosphoric acid and Celerina. In none of these conditions would Celerina affect favorably anything except the pockets of the exploiters; in some, as in the chorea of children, the alcohol would be positively detrimental. Of course, the value of such prescriptions (so far as they have any apart from the fictitious value lent by the alcohol) resides altogether in the standard drugs prescribed with Celerina.
There is no possible excuse for writing a prescription for Celerina, either in original package or mixed with well-known or valuable drugs. The sooner it is realized that this preparation has no place in medicine, should never be prescribed by physicians and is essentially nothing but alcohol and bitters exploited under a fancy name, the better for the public health and the science of medicine. The continued sale and use of Celerina is a disgrace to the medical profession.
Aletris Cordial
Aletris Cordial is a nostrum containing therapeutically worthless drugs in alcohol (28 per cent.).
The “formula” on the label reads:
“Each fluidounce represents ten grains Aletris, thirty grains Helonias and thirty grains Scrophularia.”
At one time these drugs had some vogue, chiefly as domestic remedies. They have been discarded as valueless by modern scientific medicine.
Aletris, or unicorn root (Aletris farinosa), contains a bitter principle and starch. The remarkable uterine tonic properties formerly ascribed to it have not been confirmed by reliable observers. It is practically worthless.17
Helonias, or false unicorn (Chamaelirium luteum), is asserted to be a hemostatic and uterine tonic. No trustworthy evidence has ever been offered in support of the claims made for this drug; reliable medical literature contains no reference to it; it has no valid claim on the attention of physicians.18
Scrophularia, or figwort (Scrophularia marilandica), contains a principle which has a digitalis-like action on the heart. Its activity is so slight in comparison with that of digitalis, however, that there was nothing to be gained by studying it. The drug is consequently little known and is not mentioned in critical works on pharmacology. If the drug were therapeutically active in the quantities used, another danger would be added to that of the alcohol content of Aletris Cordial. Since the recommended dose (a teaspoonful) contains, if the formula be correct, only about 4 grains of figwort, this drug too may be regarded as practically inert in this preparation.
Not one of these drugs has been deemed worthy of mention in the Pharmacopeia. The Council has previously discussed them and declared them valueless (Reports Council Pharm. and Chem., 1909, p. 146; 1910, p. 10; 1912, p. 42).
In Aletris Cordial, then, there is no ingredient capable of producing any other effect than the alcohol stimulation and such psychic effect as may be due to the bitter taste. Yet physicians are asked to believe that
“Probably no remedy is so uniformly successful in the prevention of threatened miscarriage as ALETRIS CORDIAL Rio.”
“HABITUAL MISCARRIAGE can be effectually overcome by the systematic use of Aletris Cordial Rio.”
“... regulates the local circulation and imparts normal tone and strength to the uterine muscle.”
“The use of Aletris Cordial Rio throughout pregnancy goes far to assure normal, uncomplicated labor.”
Such claims as these, when made for a mixture containing no therapeutically active constituent except alcohol, are absolutely preposterous. It should be noted that the declared alcohol content of Aletris Cordial is much higher than that of the strongest wines, and, in the light of medical experience, quite high enough to promote the formation of the alcohol habit in a steady user. The following recommendation, taken from the company’s “Budding into Womanhood” circular, therefore, is outrageous:
“Many medical practitioners recommend to mothers the use of Aletris Cordial Rio for their growing daughters, ranging in age from twelve to eighteen years....”
It is to be hoped that no medical practitioner is so heedless of consequences as to prescribe for adolescent girls a worthless nostrum capable of creating a craving for alcohol. The temperance societies might with profit take steps to inform laymen, especially women, concerning the worthlessness of this nostrum, the risk involved in taking it, and the outrageous character of the recommendations made for it by the manufacturers.
Kennedy’s Pinus Canadensis, Light and Dark
(Abican and Darpin)
Kennedy’s Pinus Canadensis, Light (recently renamed “Abican”) and Dark (renamed “Darpin”) are also exploited by the Rio Chemical Company. Although they have been on the market some thirty or forty years they appear to have achieved no marked degree of commercial success. Yet they have been imitated by most of the pharmaceutic houses. They are of interest chiefly through the barefaced fraud involved in their exploitation.
COMPOSITION CLAIMED
Apparently the dark preparation (“Darpin”) was first put on the market; then the light one (“Abican”) was offered, to be used only “as an injection and externally.” The reason for the existence of the light preparation evidently was the objectionable property of the dark, which stained linen. The two preparations are both said to be extracts of Pinus Canadensis or hemlock bark. A circular issued some years ago contained the following statement:
“Pinus Can. (Ken.)—Dark—A non-alcoholic extract of Pinus Canadensis, to each fluidounce of which is added 0.48 grains Thymol.
“Pinus Can. (Ken.)—Light—A non-alcoholic extract of Pinus Canadensis, to each fluidounce of which is added 24 grains each of pure Alum Potash and Sulphate of Zinc and 0.48 grains of Thymol.”
The labels on the packages of the light and dark preparations sent out to-day bear, respectively, only the following references to composition, the first on the dark and the second on the light:
“Each fluidounce also contains 0.48 grains Thymol.”
“A non-alcoholic preparation of Pinus Canadensis, to which is added twenty-four grains each pure alum potash and sulphate of zinc and 0.48 grains thymol to the fluidounce.”
ACTUAL COMPOSITION
“Darpin” or Kennedy’s Pinus Canadensis, Dark, does contain tannin, but, as the simplest of chemical tests demonstrate, Pinus Canadensis, Light, does not contain tannin. It might as truthfully be called maple syrup or beef tea.
It is almost a work of supererogation to discuss the therapeutic claims made for preparations sold under false pretenses as to composition. It is enough to mention that Kennedy’s Pinus Canadensis, Dark or Light, is recommended in
Albuminuria Hemorrhage from the Nose Diarrhea-Dysentery Uterine Hemorrhage Fetid Perspiration Leucorrhea Endometritis Nasal and Pharyngeal Catarrh Fissures Piles Fistula Sore Throat Gonorrhea Ulceration of the CervixThe intelligent physician of to-day knows that his forefathers in the days of the stage-coach employed tannic acid in its crude form and treated intestinal disease in a very unsatisfactory manner; he knows, further, that advances in our knowledge of pathology have rendered the use of tannic acid in gastro-intestinal therapeutics largely unnecessary and that when it is used it should be in some form that will pass the stomach unchanged. So far as its use as local application is concerned, he knows, without need of instruction from the Rio Chemical Company, when tannin is indicated, and the Pharmacopeia furnishes a suitable preparation for the physician so that he need not resort to an unscientific nostrum like Darpin.
The physician who is competent to treat a case of gonorrhea does not need to be told that alum and zinc sulphate may be useful in such conditions, and he does not want them palmed off on him for something else under the name of Pinus Canadensis, Light, Abican or what not. Also, he prefers to use them, when they are needed, singly and in strength suited to the conditions of the individual case.
[Editorial Comment.—Celerina, Aletris Cordial and Kennedy’s Pinus Canadensis, Light and Dark, appear to be the entire output of the Rio Chemical Company, which was one of the earliest of the various companies organized by James J. Lawrence of Medical Brief fame. The business was moved from St. Louis to New York City in 1901. According to what we believe to be reliable information, the Rio Chemical Company is now composed of James P. Dawson, president; William W. Conley, vice-president and treasurer; and E. D. Pinkerton, secretary. These also constitute the directors. It appears that James P. Dawson is a member of the law firm of Dawson and Garven, St. Louis; E. D. Pinkerton is said to be Miss Effie D. Pinkerton, stenographer for Dawson and Garven. We know little concerning William W. Conley except that he appears to be in charge of the establishment in New York. We find no evidence that he is either a chemist or a pharmacist; his name does not appear in the membership list of the American Chemical Society or of the American Pharmaceutical Association, nor can we discover that he has published anything in the way of chemistry or pharmacy. As a matter of fact, the Rio Chemical Company is another of the pseudo-chemical companies created to exploit one or more proprietaries—in this instance Celerina, Aletris Cordial and Pinus Canadensis. The following medical journals carry advertisements of the Rio products (or did late in 1914): American Journal of Surgery, American Medicine, Denver Medical Times and Utah Medical Journal, Eclectic Medical Journal, International Journal of Surgery, Interstate Medical Journal, Massachusetts Medical Journal, Medical Brief, Medical Century, Medical Council, Medical Review of Reviews, Medical Sentinel, Medical Standard, Texas Medical Journal and Woman’s Medical Journal.].—(From The Journal A. M. A., Feb. 13, 1915.)
CINERARIA MARITIMA
Report of the Council on Pharmacy and Chemistry
Occasional inquiries in regard to the therapeutic value of Cineraria maritima caused the Council to consider the drug with reference to its fitness for inclusion in N. N. R. among non-official, non-proprietary remedies. The following report, having been submitted to the Council by a subcommittee, was adopted and its publication authorized.
W. A. Puckner, Secretary.
To the Council:—The juice of a plant referred to as Cineraria maritima was at one time supposed to be of value in the treatment of cataract and certain other affections of the eye. No scientific evidence is available to show that the drug is therapeutically active, and its value is no doubt correctly estimated by Dr. Casey Wood, who (“Ophthalmic Therapeutics,” p. 446; Cleveland Press, Chicago, 1909) says:
“Still, a few respectable names have been associated with its [Cineraria maritima] employment in that capacity and it only remains to be said that the instillation into the conjunctival sac of a preparation of this or any other member of the Senecio family has about as much effect on the resolution or dispersal of opacities due to organic changes in the lens as pouring the same down the back of the patient’s neck!”
The plant from which Cineraria maritima juice is claimed to be prepared is commonly referred to in literature as Cineraria maritima, but is more correctly described as Senecio cineraria, D. C.
It may be considered a matter of indifference whether a remedy like this be advertised for the treatment of such diseases as cataract, providing its application could do no harm, but it must be remembered that it is recommended also for other diseases of the eye in which its use, by postponing efficient treatment, would be the means of serious damage or even loss of vision.
Since there is no evidence to show that this drug is of any therapeutic value, it is recommended that it be not admitted to the list of non-official, non-proprietary remedies in N. N. R., and that the Council formally expresses its opinion that the drug, as judged by the evidence which is available, is without value in the treatment of cataract or similar diseases of the eye.
[Editorial Comment.—Cineraria maritima would long since have been relegated to the limbo of discarded and discredited drugs had it not been given a semiproprietary character by a St. Louis nostrum house—the Walker Pharmacal Company—which, like the Manola Chemical Company, is, we understand, practically a subsidiary concern of the Luyties Homeopathic Pharmacy Company. The Walker concern exploits this drug under the name Succus Cineraria Maritima (Walker). Its method of exploitation consists in publishing testimonials, which it dignifies with the name “clinical reports,” from men whom it designates as “representative physicians.” As indicative of what constitutes representative physicians, we find that of the seven testimonials given in their pamphlet the names of three of the signers are not to be found in any medical directory.
The exploitation of Succus Cineraria Maritima (Walker) is the oft-repeated story of the resurrection of discarded and worthless drugs for the purpose of creating proprietorship in a nostrum. Cineraria maritima is worthless; its therapeutic value is nil. By the prodigal use of printers’ ink, the medical profession—and through it the public—has been humbugged into believing that it possesses curative value.]—(From The Journal A. M. A., Nov. 11, 1911.)
HAGEE’S CORDIAL OF THE EXTRACT OF COD LIVER OIL COMPOUND [I]
Report of the Council on Pharmacy and Chemistry
This is one of the “oilless” cod liver cordials. Like other manufacturers of such extracts, the Katharmon Chemical Company, St. Louis, which owns Hagee’s Cordial, attempts to trade on the reputation long enjoyed by cod liver oil as a promoter of growth and nutrition. The following is the statement of composition furnished by the company:
“Each fluid ounce of Hagee’s Cordial of the extract of Cod Liver Oil Compound represents the extract obtainable from 1⁄8 fluid ounce of Cod Liver Oil (the fatty portion being eliminated), 6 grs. Calcium Hypophosphite, 3 grs. Sodium Hypophosphite, 1⁄2 gr. Salicylic Acid (made from Oil Wintergreen), with Glycerin and Aromatics.”
And here are some of the therapeutic claims:
“Tonic, Stimulant, Alterative, Reconstructive, Nutritive and Digestive.”
“Useful in phthisis pulmonalis, scrofula and all chronic pectoral complaints, coughs, colds, brain exhaustion, nervous debility, palsy, chronic cutaneous eruptions and impaired digestion.”
Of course, these absurd claims hark back to the time of the prevalence of the now discarded theory that the valuable properties of cod liver oil reside, not in the fat, but in certain nitrogenous, alkaloid-like constituents present in infinitesimal amounts. Further “playing up” this theory:
“The prescriber may know that in our preparation he is getting, in easily assimilable and palatable form, the very properties that make cod liver oil the best of reconstructives.
“When you prescribe cod liver oil you are after the active principles—why not give the active principles themselves.”
Proprietary manufacturers usually ignore scientific investigations which establish facts adverse to proprietary claims; but the same proprietary manufacturers are quick to seize on any theory that can be twisted into support of their interests. Thus, recent investigations having shown that cod liver oil, like butter and egg yolk, possesses certain growth-promoting properties not found in some other fats, the promoters of Hagee’s Cordial claim these properties of cod liver oil for their extract. They assert:
“Recent Chemical Investigations of Cod Liver Oil show that the active principles contain the nutritive qualities attributed to the whole oil.”
The Council has previously expressed the opinion19 that the preponderance of evidence indicates that whatever therapeutic value cod liver oil may have depends chiefly, if not entirely, on its fat (oil). There never was any evidence or scientific authority for the theory that the therapeutic value of cod liver oil was independent of its fat content. The fact that the fat is the growth-promoting element has already been shown, and J. P. Street, chemist for the Connecticut Agricultural Experiment Station (The Journal A. M. A., Feb. 20, 1915, p. 638), in a series of experiments on a number of the so-called extracts of cod liver or cod liver oil (including Hagee’s Cordial) has conclusively demonstrated that the growth-promoting properties of the oil are not to be found in the extracts. Street placed rats on a ration not sufficient to maintain normal nutrition and growth for an extended period. After the rats had been on this ration for some time and a failure to maintain weight was indicated, an amount of dealcoholized Hagee’s Cordial was substituted for a portion of the lard contained in the ration. Later Hagee’s Cordial was replaced by cod liver oil.
Street says:
“None of the four rats did well on Hagee’s Cordial; in fact, they lost 1.2 to 15.4 gm. during feeding periods of from seven to fourteen days.”
“The rats failed so quickly when put on Hagee’s Cordial that in two cases the animals did not recover even when put on the full cod liver oil ration.”
“... the four rats during the Hagee period, instead of gaining the normal 24 gm., actually lost 36.2 gm., while during the cod liver oil period instead of gaining 114 gm., they gained 156.4 gm.”
“The inferiority of Hagee’s Cordial as a reconstructive and a nutrient compared with ordinary cod liver oil is apparent.”
Hagee’s Cordial of the Extract of Cod Liver Oil Compound has neither the nutritive qualities nor the reconstructive efficacy of cod liver oil. This mixture is worthless for the conditions for which it is advertised, and is marketed under misleading and unwarranted claims. It is recommended that Hagee’s Cordial be held ineligible for New and Nonofficial Remedies.—(From The Journal A. M. A., April 10, 1915.)
WAMPOLE’S PERFECTED AND TASTELESS PREPARATION OF AN EXTRACT OF COD LIVER [J]
Report of the Council on Pharmacy and Chemistry
Wampole’s Preparation is another of the oil-free “extracts” of cod liver. The following formula (which, be it observed, is non-quantitative and therefore practically worthless) is published by the owners, Henry K. Wampole & Co., Inc.:
“Contains a solution of an extractive obtainable from fresh cod livers, the oily or fatty portion being afterward eliminated. This extractive is combined with Liquid Extract of Malt, Fluid Extract of Wild Cherry and Compound Syrup of Hypophosphites (containing Calcium, Sodium, Potassium, Iron, Manganese, Quinin and Strychnin).”
An alcohol content of 17 per cent. is declared on the label. The following claims are typical of those made for the preparation:
“This grease, or oil, is not present in Wampole’s Preparation of the Extract, which is palatable and, at the same time, very efficient as a stimulant to the centers of nutrition and assimilation. It is unsurpassed as a reconstructive tonic ...”
“[Cases] with a marked tendency to pulmonary troubles,... if a timely impulse be given them will easily shake off the impending evil. Wampole’s Preparation gives that timely impulse ...”
In the Council’s opinion, as previously expressed,20 such therapeutic value as there may be in cod liver oil is chiefly, if not altogether, due to the fat (oil). Lately, the investigations of J. P. Street of the Connecticut Agricultural Experiment Station have definitely disproved the claims made for the Wampole’s and similar preparations. In Street’s experiments, rats were placed on a ration insufficient for normal nutrition and growth. After the rats had been on the ration for a time long enough for inability to maintain weight to become evident, dealcoholized Wampole preparation was substituted for a portion of the lard contained in the ration. Later the Wampole preparation was replaced by cod liver oil. From these experiments it appears that, although the Wampole preparation is said to contain malt extract and sugar, it does not show the advantage over ordinary cod liver oil as a source of nutriment which is claimed for it by the manufacturers. Street emphasizes that the Wampole preparation does not possess to any marked degree the reconstructive properties of cod liver oil, butter fat and egg yolk, on which foods rats gain weight rapidly and steadily after having been on a deficient diet. Street calls attention to the fact that the amount of alcohol consumed daily by the user of the Wampole preparation (the equivalent of 0.7 fluidounces of whiskey) explains to a considerable extent the asserted tonic virtues of the preparation.
Though offered as an efficient substitute for cod liver oil, Wampole’s “Perfected and Tasteless Preparation of an Extract of Cod Liver” lacks both the nutritive and the reconstructive properties and is marketed under an indefinite name and unwarranted and untrue claims. It is recommended that Wampole’s Preparation be held ineligible for New and Nonofficial Remedies.—(From The Journal A. M. A., April 10, 1915.)
WATERBURY’S METABOLIZED COD-LIVER OIL COMPOUND [K]
Report of the Council on Pharmacy and Chemistry and Laboratory Contribution on Which It Is Based
The following report has been adopted by the Council and its publication directed
W. A. Puckner, Secretary.
To the Council:—Your committee on pharmacology has read with interest the contribution from the Association’s laboratory on Waterbury’s Metabolized Cod-Liver Oil Compound. The report shows that misleading and false statements are made in regard to the composition of the product and also that exaggerated and unwarranted claims are made for its therapeutic value. In view of the attempt of the Waterbury Chemical Co. to create a false impression in regard to the therapeutic value of the composition of its product, it is recommended that the following report be adopted and published:
The Council believes that there is a preponderance of evidence to indicate that whatever therapeutic value cod-liver oil has, that value depends chiefly, if not entirely, on its fat (oil). In the opinion of the Council, the word cod-liver oil should not be used in connection with any preparation unless it consists to a large extent (25 per cent. or more) of cod-liver oil. Since Waterbury’s Metabolized Cod-Liver Oil Compound contains no appreciable quantity of cod-liver oil, the name is incorrect and misleading, and as a cod-liver oil preparation it is believed to be wholly valueless. The Council has previously voted that Waterbury’s Cod-Liver Oil Compound be refused recognition because of conflict with Rules 1 and 6.—(From The Journal A. M. A., Oct. 9, 1909.)
[Contribution from the Chemical Laboratory of the American Medical Association]
Waterbury’s Metabolized Cod-Liver Oil Compound
W. A. Puckner and L. E. Warren
A full page advertisement of Waterbury’s Metabolized Cod-Liver Oil Compound appeared in the Iowa Medical Journal, March 15, 1909, in the form of a letter purporting to give the results of an analysis of the product made for the firm by a Chicago chemist. In this letter-advertisement the chemist states at the outset that the results of his examination “are somewhat at variance with the statements made in The Journal.” These statements he quotes as follows:
1. It is a clear liquid and no globules of oil are seen under the microscope. It is therefore not an emulsion.
2. It is of acid reaction when mixed with water and remains clear when strongly acidified. Hence it does not contain a soap, and is not a saponification of fat.
3. It mixes with water without precipitation, hence, it can not contain more than traces of a fatty acid.
The chemist admits in his letter to the firm that his analyses verify statements 1 and 3, but regarding statement 2 he says: “I find that your preparation is acid in reaction, but when strongly acidified gives a distinct turbidity within 10 minutes and a voluminous precipitate within 1 hour. This precipitate is shown to consist of fatty acids of cod-liver oil, which are thrown down by the splitting of the soaps, on acidifying either with sulphuric or hydrochloric acid.” From these results he states that to him it seems that the “preparation does not deserve the statement that it contains no soap, as there is no question whatever of the presence of cod-liver oil.”
While in the letter published in this advertisement the chemist claims to have demonstrated the presence in the product of “saponified cod-liver oil,” he omits to mention the quantities of the soap present. In the article that originally appeared in The Journal (Oct. 13, 1906), in addition to the three paragraphs quoted by the chemist, the following statements were made:
“By these simple tests a physician is easily able to demonstrate that the preparation does not contain cod-liver oil. It is therefore valueless for the purpose of nutrition for which we give the oil. More careful analysis confirms the results of these tests and shows that it contains no fat or fatty acids (except the merest traces)....”
At the time these statements were published in The Journal, the St. Paul Medical Journal, October, 1906, contained an advertisement for Waterbury’s Metabolized Cod-Liver Oil Compound, which contained this statement:
“The only tasteless preparation on the market which contains Cod-Liver Oil in its entirety. The metabolized product is obtained by the action of digestive ferments on pure Cod-Liver Oil.”
In the Ohio Medical Journal of Feb. 15, 1907, there appeared in the form of an advertisement what purported to be an analysis of Waterbury’s Metabolized Cod-Liver Oil Compound by Prof. C. N. Kinney of Drake University. While Professor Kinney made a quantitative analysis of the preparation, the quantities were omitted from the analysis as published. A footnote added by the Waterbury Chemical Company called attention to this fact and closed as follows:
“Any physician who is not satisfied with the analysis we will be only too glad to furnish the complete analysis by our representatives.”
If this weirdly constructed sentence meant anything, it meant that the complete analysis would be furnished on request. Such requests to the company, however, from various sources failed to elicit the information required nor was the “complete analysis” forthcoming. The inference to be drawn is fairly plain.
In a circular accompanying the product as sold at present, this statement occurs:
WATERBURY’S METABOLIZED COD LIVER OIL COMPOUND With Creosote and Guaiacol or Plain
DOES CONTAIN COD LIVER OIL DOES ALLAY FERMENTATION DOES AID DIGESTION DOES ASSIST ASSIMILATION BUT DOES NOT DISTURB THE STOMACH
As previous examination disclosed only the merest traces of cod-liver oil in the product though claims were made that it “represents cod-liver oil in its entirety,” and in view of the fact, too, that present advertisements emphatically declare that cod-liver oil is present in the preparation as now sold, it was thought best to examine some of the preparation with especial reference to the quantities of fatty acids from cod-liver oil.
OLD LABEL
NEW LABEL
It is interesting in this connection to note that this product is no longer being sold under the name “Metabolized Cod Liver Oil Compound.” See the illustrations of the old and new labels.
The results of the examination are briefly as follows: The total quantity of acids isolated amounted to about 0.3 per cent., and of this amount about two-thirds was salicylic acid. Thus it appears from the examination of the specimens bought on the open market that the preparation contains at most but 0.1 per cent. of the fatty acids from cod-liver oil, a totally insignificant quantity.
Notwithstanding the protestations by the manufacturers, in the form of published analyses and circulars, it is seen that the statements published in The Journal, Oct. 13, 1906, p. 1207, are essentially substantiated; it is further evident that the product does not deserve to be designated as a cod-liver oil preparation. To obtain a medicinal dose of cod-liver oil the patient would be compelled to swallow the contents of a bottle of this mixture, and as the product contains 11 per cent. alcohol the patient who did so would probably experience a degree of exhilaration not referable to cod-liver oil.—(From The Journal A. M. A., Oct. 9, 1909.)
Declared Misbranded
This product of the Waterbury Chemical Company, of Des Moines, Iowa, was exposed in The Journal of the American Medical Association, October 9, 1909. In May, 1910, the United States Government issued a notice of judgment in which it was declared that Waterbury’s Metabolized Cod Liver Oil Compound was misbranded. The court rendered its decree of condemnation and forfeiture.—[Notice of Judgment, No. 303.]
WATERBURY’S COMPOUND
Report of the Council on Pharmacy and Chemistry
The Waterbury Chemical Company having requested that the Council reconsider its action of four years ago (see preceding report) on the product then known as Waterbury’s Cod-Liver Oil Compound, now called Waterbury’s Compound, the matter was submitted to a referee. The referee reported that the statement now made as to the composition of this product is as follows:
“Made from Cod Liver Oil, Digestive Ferments, Malt Extract Unfermented, Hypophosphites Comp. Special, Ext. Cherry, Eucalyptus, Aromatics, etc.”
He held that the Waterbury Chemical Company has not submitted satisfactory evidence to indicate that the objections of the Council’s former unfavorable report have been met; that there is no evidence that the product is a substitute for cod-liver oil in any way; and that under the present methods of exploitation it constitutes what is at least an inferential fraud; and recommended that no further consideration be given to Waterbury’s Compound. The report was adopted by the Council.—(From The Journal A. M. A., March 20, 1915.)
COLCHI-SAL
Report of the Council on Pharmacy and Chemistry
Colchi-Sal, said to be made by the Anglo-American Pharmaceutical Co., Ltd., New York, is advertised, sold and “guaranteed” (sic) by E. Fougera and Co., Inc., New York. According to the label of a recently purchased specimen:
“Each Capsule contains Cannabis Indica (Active Principle of) 1-500th Grain (1⁄8 Milligram); Colchicine (Crystallized) 1-250th Grain (1⁄4 Milligram); Methyl Salicylate 20 Centigrams.”
The advertising circular around the bottle adds that the mixture also contains “appropriate aromatic adjuvants.”
It is recommended in “Gouty and Chronic Rheumatic Manifestations,” “acute cases of Gout,” “intestinal auto-intoxication or dyspepsia,” “bilious headaches,” etc. Salicylates are generally recognized as valuable in acute manifestations of acute articular rheumatism; colchicum is useless in these conditions. Both salicylates and colchicum are practically useless in chronic rheumatic and in chronic gouty affections. For dyspepsia, bilious headache, etc., salicylates are distinctly contra-indicated and the drastic purgation produced by colchicum would not be thought desirable. Though methyl salicylate administered internally is not generally considered so efficient as sodium salicylate, it is asserted that the former
“... is found far more effective than salicylate of soda or other salicylic derivatives when given in conjunction with colchicine as Colchi-Sal.”
Further, the highly improbable and unsubstantiated claim is made that “the active principle of Cannabis indica” (whatever that may be) “corrects any tendency of the colchicine to irritate the gastro-intestinal tract” and that the “appropriate aromatic adjuvants” “prevent intolerance of the methyl salicylate.”
Colchi-Sal is put up in a way to appeal to the public; the bottle has the name “Colchi-Sal” blown in the glass; the label gives full instruction for the use of Colchi-Sal, and also the price, suggesting that the preparation may be freely purchased. Wrapped around the bottle is a circular advising its use in various affections.
The physician who acts on the advice that it is well to “insist on the pharmacist dispensing original bottles ...” of the “little green capsules” actually suggests to his patient the use of this preparation of methyl salicylate and colchicum in conditions in which these drugs may do much harm and in which proper treatment is imperative.
Colchi-Sal is typical of unscientific ready-to-take proprietaries. It was held ineligible for New and Nonofficial Remedies because of its secret composition, viz., the unknown nature of the “active principle of Cannabis indica” (Rule 1); because the circular in the package and the name blown in the bottle constitute advertisement to the laity (Rule 4); because the claim that cannabis indica removes the gastro-intestinal irritation, and the claim of the superiority of methyl salicylate are unwarranted therapeutic claims (Rule 6); because the name does not indicate the presence of the habit-forming cannabis indica, and because of its unscientific composition (Rule 10).—(From The Journal A. M. A., March 20, 1915.)
CYPRIDOL CAPSULES
Report of the Council on Pharmacy and Chemistry
Having voted that Cypridol Capsules be refused recognition, the Council directed that for the information of physicians publication of the following report be authorized.
W. A. Puckner, Secretary.
Cypridol Capsules, sold by E. Fougera & Co., New York, are stated to be “Bottled in the New York Laboratories of Vial, late Rigaud and Chapoteaut, Paris,” and to contain, in each capsule, 2 mg. (1⁄32 grain) mercuric iodid (biniodid of mercury) dissolved in a fatty oil. They are claimed to permit the administration of mercury without danger of salivation—an obvious misrepresentation.21 Cypridol Capsules are marketed in a way to appeal to the public. If they are once prescribed, the directions on the bottle and the full instructions for the treatment of syphilis by means of Cypridol and by other proprietaries sold by Fougera & Co. is likely to lead the patient to attempt the treatment of this malady on his own accord, and thus probably to forfeit his chances of cure. Cypridol is a vicious example of the “ready-to-take” proprietaries.
Cypridol Capsules are in conflict with the rules of the Council as follows:
Rule 4: The dosage, price, etc., on the label, and the name “Cypridol” blown in the bottle, all tend to a direct self-prescribing by the public. In addition to the objectionable statements on the bottle itself, the preparation is put up in patent medicine style and is accompanied by a circular giving full directions for the use of this and of other proprietaries for the treatment of syphilis in all of its stages. The circular states that “a 1 per cent. solution of bin-iodide of mercury in an aseptic oil” is “An Improved Specific in the Treatment of Syphilis,” and after lauding the virtues of Cypridol, gives full directions for the treatment of syphilis in its various stages by means of Capsules of Cypridol augmented, during periodical cessation of treatment, by “small doses of iodide of strontium (Paraf-Javal’s standard solution, thirty grains to the ounce).” Further, the circular expounds the need of “a toning up of the general system” and by means of obsolete theories and obviously untrue assertions recommends “Chapoteaut’s Wine [another of their proprietary preparations], each ounce of which contains 10 grains of phospho-glycerate of lime. This is a delicious, nutritive tonic. A pint bottle costs $1.00.”
Rule 6: Whereas it is evident that Cypridol, depending for its effects on mercuric iodid, the ordinary well-known hydrargyri iodidum rubrum of the U. S. Pharmacopeia, must naturally have the properties of a mercuric compound, unwarranted claims such as the following are made:
17 See Unicorn Root, Wild Yam, and Wild Indigo, p. 208.
18 See False Unicorn (Helonias), p. 84.
[I] See also the reports on Wampole’s Preparation and Waterbury’s Compound, following this; also Hagee’s Cordial, p. 289; The Comparative Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials, p. 442.
19 The Journal A. M. A., Oct. 9, 1909, p. 1201.
[J] See also reports on Hagee’s Cordial preceding and Waterbury’s Compound following this; also The Comparative Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials, p. 442.
20 The Journal A. M. A., Oct. 9, 1909, p. 1201. (See following report, this volume.)
[K] See also preceding reports on Hagee’s Cordial and Wampole’s Preparation; also Waterbury’s Compound once more, p. 291; The Comparative Nutrient Value of Cod Liver Oil and Cod Liver Oil Cordials, p. 422.
21 Physicians who desire to use a solution of mercuric iodid in oil should direct their pharmacist to prepare it according to the method suggested by Lemaire (Repert. pharm., xxi, 97–102, from Chem. Abst., 1909, p. 1444), viz.: One gm. of mercuric iodid is dissolved in 50 c.c. sterilized castor oil by warming to about 70 degrees, 3 gm. guaiacol are added and the solution made up to 100 c.c. with sterilized poppy oil. Or according to a later suggestion (Dunning: Proc. Am. Pharm. Assn., 1910, p. 1123): one gm. of mercuric iodid is dissolved in 99 gm. of a mixture of equal parts of sterilized castor and olive oils, by warming on the water-bath.
“CYPRIDOL does not render patients anemic. Ptyalism never follows the administration of the capsules or injections. On the contrary, patients rapidly put on flesh and keep well. There are no diarrhoeas or other symptoms of intolerance even when the dose is pushed.”
Rule 8: The non-informing name “Cypridol” for a mercuric iodid preparation is bound to lead to its use without consideration of the fact that a potent mercury preparation is being used, requiring a careful adjustment of dosage, a consideration of the needs of the individual case, a correct diagnosis, etc. While the advertising propaganda argues that “physicians recognize the advantage of prescribing this solution of mercuric iodide in an aseptic oil under the name of ‘Cypridol,’ because it does not betray to the laity the fact that mercury is being used,” not only the physician but also the patient has a right to know, and ought to know, the potent character of the remedy which is being administered.
It is recommended that Cypridol be refused recognition and that publication of this report be authorized.—(From The Journal A. M. A., Dec. 19, 1914.)
CYSTOGEN, CYSTOGEN APERIENT AND CYSTOGEN-LITHIA [L]
Abstract of Report of the Council on Pharmacy and Chemistry
Cystogen is the therapeutically suggestive name applied to hexamethylenamin by the Cystogen Chemical Company. While investigation has shown that hexamethylenamin yields formaldehyd only in the presence of an acid and consequently can produce an antiseptic effect only in the gastric juice and in the urine, it is claimed that Cystogen is an “intestinal antiseptic” and that it “bears its disinfectant and antitoxic qualities into well-nigh every important bodily cavity.”
As the sale of a simple drug even with the aid of the most extravagant claims probably did not offer sufficient opportunity for an extensive proprietary propaganda, the Cystogen Company has put out two other preparations, Cystogen Aperient and Cystogen-Lithia, and finds it an easy matter by means of extravagant claims, unwarranted assertions and pseudo-scientific arguments to recommend the use of one or another, or often all three, in a well-nigh endless number of diseases.
As the continued patronage of the medical profession cannot be relied on for proprietaries of this sort, the Cystogen Chemical Company takes good care that every Cystogen prescription is likely to spread the Cystogen gospel among the people. The Council has directed publication of its report on the Cystogen products to call attention to the way in which a simple drug of established value may be made the basis of an extensive proprietary propaganda. A conservative discussion of the action of hexamethylenamin appears in the Council’s publication, “Useful Drugs.” The Council therefore refused recognition to Cystogen, Cystogen Aperient and Cystogen-Lithia.—(From The Journal A. M. A., Dec. 12, 1914.)
CYSTO-SEDATIVE
Report of the Council on Pharmacy and Chemistry
Cysto-Sedative is sold by Strong, Cobb and Company, Cleveland, Ohio, with the claim:
“Each fluid ounce represents:
Thuja Occidentalis, 31⁄2 grains.
Pichi, 18 grs.
Saw Palmetto berries, 36 grs.
Triticum Repens, 36 grs.
Hyoscyamus 8 grs.
All inert extractive matter being eliminated.”
The therapeutically active constituents of arbor vitæ, pichi, saw palmetto and couch grass have never been isolated—indeed, it has not been proved that all of these drugs contain any therapeutically active constituents. Yet the absurd claims are made that all inert matter has been eliminated and each lot of drug used in the preparation of Cysto-Sedative is “tested in reference to its medicinal activity.” Equally preposterous is the claim:
“In formulating Cysto-Sedative each drug entering into its composition was subjected to careful study clinically to determine the exact proportion required when combined to increase their efficiency as a whole. Cysto-Sedative is scientifically prepared, the proportion of each individual drug being so finely adjusted as to increase their therapeutic action in the conditions for which they are intended, forming a preparation always reliable and of the very highest medicinal activity.”
Some other extravagant claims made for this complex unscientific mixture are:
“It gives relief in almost every form of cystitis and prostatitis....”
“The best results are obtained in the worst chronic cases of cystitis and prostatitis....”
“In Cystitis, Urethritis, Prostatitis, Inflammation of the Vesicle Neck, complicated with Gonorrhoea, Enuresis, Painful Micturition, the action of Cysto-Sedative is prompt.”
The Council voted that Cysto-Sedative be refused recognition.—(From The Journal A. M. A., Dec. 12, 1914.)
TAKA-DIASTASE AND LIQUID TAKA-DIASTASE
Report of the Council on Pharmacy and Chemistry
Some time ago it was decided that a reexamination should be made of Taka-Diastase and Liquid Taka-Diastase, both of which had previously been rejected, to ascertain whether or not the preparations were in accord with the claims made for them by the manufacturers. Accordingly, the matter was referred to a committee of the Council, and an examination of specimens of these two preparations bought in the market was made. The referee’s report, which appears below, according to the usual procedure, and before final confirmation by the Council, was first submitted to the manufacturers of Taka-Diastase for comment. The report recommends that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand, and that the report be published. Parke, Davis & Co., in their reply, which is given in full below, claim that the report is unjust concerning Liquid Taka-Diastase, because the period of activity of the preparation has been greatly prolonged by reducing the amount of alcohol from 18 per cent. to 10 per cent. and by adding glycerin. They reiterate their claims for the digestive power of Taka-Diastase, but admit that it will not reduce the stated amount of starch to the colorless end-point in ten minutes (the standard method for the valuation of diastase). They further state that they would change the word “digest” on the label to “liquefy.”
The conclusion of the report having been questioned, the entire matter was referred to a member of the Council’s staff of clinical consultants. His report, which, also, is given in full below, states that the material before him was sufficient to decide the matter, and no further tests were necessary. He concludes that the claims of the manufacturers regarding the strength and properties of the material are erroneous and exaggerated; that the literature still sent out by Parke, Davis & Co. is misleading; and that if substitution of the word “liquefy” for “digest” were endorsed by the Council confusion would result which would give an exaggerated and false value to Taka-Diastase. He therefore recommends that the report of the reinvestigation of Taka-Diastase be accepted by the Council and published.
This report of the second referee was referred to Parke, Davis & Co. with the request that they state more definitely the actual amylolytic strength of their preparations. To this they replied that they had no desire to discuss the subject further, or to make any additional statements.
In accordance with the second referee’s recommendations, the Council confirmed its provisional action and voted that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand, and that the report which appears below be authorized for publication.
W. A. Puckner, Secretary.
REFEREE’S REPORT ON TAKA-DIASTASE AND LIQUID TAKA-DIASTASE
Following is the report of the committee to which was referred the reexamination of Taka-Diastase and Liquid Taka-Diastase:
Some time ago a comparison was made of the various methods proposed for the valuation of preparations claimed to have amylolytic power. This work was reported in The Journal,22 and the method proposed for the testing of diastase preparations now appears in New and Nonofficial Remedies.23 In view of the incorrect and exaggerated claims made for Taka-Diastase, the Council in 1908 was obliged to rescind its acceptance and to direct its omission from New and Nonofficial Remedies. The report contained the following reference to Taka-Diastase (Parke, Davis & Company), a product that had been accepted for inclusion with New and Nonofficial Remedies:
“The widest discrepancy between the values as claimed by the manufacturer and those found by actual tests seems to be shown in the case of Taka-Diastase. The liquid preparation has been tested a number of times in different samples and has always been found weak. Some samples, in fact, were quite inert. This ferment appears to lose strength very rapidly in solution, as the manufacturers now concede. The stability of the solid product is also far from satisfactory, and appears to be less than that of the ferment as marketed some years ago. The two samples examined recently were weak.”
More than three years have now elapsed since the publication of the Council’s findings regarding Taka-Diastase—sufficient time, it is believed, for the manufacturers to modify either their claims or the product itself, and thus again make it eligible for inclusion with New and Nonofficial Remedies. With this idea in mind new specimens of Taka-Diastase and Liquid Taka-Diastase were purchased from a Chicago drug house and the preparations reinvestigated. The following is the report of this reinvestigation.
REPORT OF THE REEXAMINATION
In our report on the diastase preparations three years ago, it was recommended that Taka-Diastase be removed from New and Nonofficial Remedies, because the examinations showed that it did not have the digestive strength claimed for it. This was true both for Taka-Diastase itself and for Liquid Taka-Diastase. So far as the latter was concerned, the starch-converting power was practically nil in those preparations which had been in the drug stores for some months.
During the last few weeks new tests have been carried out with several samples of the Taka-Diastase preparations and the results obtained are essentially the same as those obtained in the former examinations. The liquid preparation is still extremely weak in starch-converting power, while we found that Taka-Diastase itself would convert only 16.6 parts of pure anhydrous starch to the colorless end-point in ten minutes, as explained below.
In our method of experimentation we determine the weight of the diastase in question which will convert a given weight of starch in uniform paste to the so-called colorless end-point in ten minutes, that is to the point where it will no longer give any color reaction with a standard iodin solution. The standard starch weight in 50 c.c. always is 1 gm. or 1,000 mg. and to a series of flasks containing this amount of starch, maintained at a constant temperature of 40 C., the diastase dilutions are added. These diastase dilutions are made by dissolving small, accurately weighed amounts of the sample in some small, constant volume of water, usually 5 or 10 c.c. and they are then poured into the starch flasks at the right temperature, and agitated regularly.
Tests are made by taking a few drops from each flask and mixing with the iodin solution. The end-point is reached when a dilution is found which, at ten minutes from the mixing time, gives no color with the iodin reagent. The first set of tests is taken as a general guide, and quite accurate results may be obtained in a second set of dilutions.
We first used a sample of Taka-Diastase bought in the open market. It was found that 140 mg. were required to convert the gram of starch as explained. This is equivalent to a conversion of 7.14 parts of starch by 1 part of the Taka-Diastase.
A new, and possibly fresher, sample was then obtained and the test repeated. With this new sample it was found that 60 mg. were necessary to convert the gram of starch to the colorless end-point in ten minutes, from which it follows that 1 part of the ferment will convert 16.6 parts of starch to the colorless end-point in the same time. With a new sample of Liquid Taka-Diastase obtained simultaneously it was found that 3.5 c.c. were necessary to convert 1 gram of starch to the colorless end-point in ten minutes. As a fluidounce of this liquid is said to contain 20 grains of the solid it will be seen that the results approximately agree with those of the first sample of the solid, and that they are both very low.
In the earlier tests 16 parts of starch converted by 1 part of the ferment was the value found. These results are in close agreement with values reported by Sherman (Jour. Am. Chem. Soc., xxxii, 1073) for a sample of recent purchase. He found a conversion of 51 parts of starch to the colorless end-point in thirty minutes for one sample, while for another he found 66 parts, in the same time. It will be noted that our time limit is ten minutes. It is worthy of note that for a perfectly fresh and specially prepared sample furnished by Dr. Takamine, a conversion of 278 parts in thirty minutes was found by Sherman. Taking the time into consideration, it will be seen that the results are about the same for the market samples as those found by us and much lower than claimed, as well as much lower than for other makes of similar products. The difference in the behavior of fresh specially prepared Taka-Diastase and the market sample is very clearly shown. No one questions the fact that fresh laboratory samples of Taka-Diastase may show a moderate converting power on starch. But we have to deal with the activity of market samples only, and Sherman’s work and our own show the low digesting power of the product as physicians may secure it on the market.
The marked difference in activity between perfectly fresh and ordinary market samples of Taka-Diastase is very clearly shown also in a recent paper published by Wohlgemuth.24 In the digestion of starch paste to the “dextrin” stage Wohlgemuth found in the commercial sample a strength approximately a hundred times less than that observed in a fresh sample sent him by Dr. Takamine.
Wohlgemuth’s results were obtained by a method not essentially different from ours, with this difference, however, that he digested through 24 hours in the cases reported, and carried the reaction to the “dextrin” stage only, in place of to a colorless end-point. Making the proper reductions, it is evident that the actual values found by him for the market samples bought in Germany are not greater than those reported by us.
The reference to the work of Sherman is made because, in a following paper in the same journal, he recommends the use of salt as an activator in finding the strength of certain diastase preparations. It is well known that dialyzed diastase preparations and starch of highest purity have but slight action on each other; a little salt increases the activity greatly, and also increases the activity of commercial diastase preparations. These facts Sherman utilizes in working out a method for valuation of commercial diastases. The facts were well known to us at the time of our former report, but it was not thought best to depart from the general method which had been in use by all analysts following the general scheme of Roberts. Quite recently, I. Bang has published a paper on the investigation of diastase (Biochem. Ztschr., xxxii, 417) in which he studies the behavior of sodium chlorid and other salts on the rapidity of starch conversion, and finds that a much smaller amount of salt than Sherman recommends brings the maximum increase.
The method employed in our former tests is a good comparative method, and this is all that may be claimed at present for any method. By adding salt to our starch solution the activity of Panase and other ferments is likewise greatly increased. For Panase, a preparation possessing rather high starch-converting power, we have recently found an increase of about 30 per cent. in the converting power, with salt present. Working to loss of blue color, merely, it is possible in this way to get a higher value than that claimed by the manufacturer. There is no practical gain in using the salt for our purpose as the methods are at best arbitrary, and the results only comparative.
Taking all the facts into consideration, it is recommended that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand and that, in view of their extensive exploitation, this report be authorized for publication so that physicians may know the facts.
This report was referred to Parke, Davis & Co., and they made the following reply:
“The report submitted in your letter of the 23d is, we contend, erroneous and unjust: first, to our Liquid Taka-Diastase, because over three years ago we changed our formula, reducing the alcohol from 18 per cent. to 10 per cent., increasing the glycerin and thus prolonging greatly the period of activity.
“As for our regular Taka-Diastase, our claim is and has been for years simply that Taka-Diastase will digest or hydrolyze 150 times its weight of starch in ten minutes, under proper conditions. We do not claim, we do not permit our representatives to claim, that Taka-Diastase will completely transform starch, to the colorless end-point, into sugars. Taka-Diastase is used to supplement a deficiency of ptyalin and converts the starch into soluble material with great rapidity, thus giving the gastric fluid immediate access to the proteids.
“If in the enclosed labels the word ‘digest’ were replaced with the word ‘liquefy,’ the claim could not be assailed by the most carping critic. To save any possible question, we shall therefore make this change in our label, having it read: ‘Taka-Diastase will liquefy 150 times its weight of starch in ten minutes, under proper conditions.’ Is there the slightest question in your mind that this statement as just quoted is entirely correct and entirely supported by clinical experience?
“It is our conviction that Taka-Diastase has a very remarkable power to hydrolyze starch either in the test-tube or in the stomach, and that this property is of great utility in clinical work. We do not claim that its conversion of the starch into sugars is complete, to the colorless end-point of the Johnson test; and on this point we have been perfectly frank with the Council, as well as with every physician who has taken sufficient interest to inquire.”
In view of the above protest, the matter was submitted to a second referee, who reported as follows:
“Your referee on the matter of Taka-Diastase has made a careful investigation of the reports and correspondence submitted, and begs to make the following report:
“The question at issue, viz., whether Taka-Diastase should be included in New and Nonofficial Remedies, I believe, can be determined by the material before me, and further tests of the material are not necessary.
“The letter of the makers of Taka-Diastase admits that the early claims regarding the strength and properties of the material were erroneous and exaggerated. Since the product was once admitted to New and Nonofficial Remedies, it may be claimed that as the Council on Pharmacy and Chemistry must have been in error then, it may be now. Your referee does not consider this supposition worth discussing. The conclusion he draws is that the Council was too hasty in accepting the preparation, and that the incident shows how much better it would be in all cases to accept no remedy until sufficient time has been given for conclusive tests.
“The literature still sent out by Parke, Davis & Co. regarding Taka-Diastase is misleading and of a kind more appropriate for a nostrum than a standard chemical substance. What would we think if morphin, quinin or even heroin were advertised in the same way? I cite the statement, ‘Taka-Diastase digests starchy food with vigor and directness.’ It seems to the referee that the proposition to modify the label to indicate the amount of starch which is liquefied rather than the amount which is saccharified, in accordance with the Council’s standard, is bound to lead to confusion and to give an exaggerated and false value to Taka-Diastase.
“Your referee recommends that the report of the reinvestigation of Taka-Diastase which has been submitted to me, be made available to the medical profession, and that the rejection of Taka-Diastase and Liquid Taka-Diastase be allowed to stand.”
This report of the second referee was submitted to Parke, Davis & Co., with the request that they state more explicitly their claims regarding the activity of Taka-Diastase and Liquid Taka-Diastase, in order that, if they decided to revise their claims for the preparations, such revision of claims might be published along with the reports of the Council. They replied:
“Answering your note of the 15th instant: We have no desire to discuss further the subject of your letter of February 24, or to make any statement beyond that set forth in our letter to you of Dec. 27, 1911.”—(From The Journal A. M. A., July 6, 1912.)
DIGALEN OMITTED FROM N. N. R.
Report of the Council on Pharmacy and Chemistry
Digalen is a proprietary said to contain a soluble form (digitoxinum solubile Cloetta) of digitoxin, the chief active principle of digitalis. This preparation was accepted25 by the Council in 1909 for inclusion in New and Nonofficial Remedies. The Council had not at that time determined whether Digalen contained “soluble amorphous digitoxin,” as claimed, or not. The product was accepted merely as a standardized soluble and fairly stable digitalis preparation.
After the acceptance of Digalen, the therapeutic claims made for it by the manufacturers increased in extravagance. Meanwhile, evidence was brought forward by various independent investigators which tended not only to show that these therapeutic claims were unfounded, but also to discredit the claim that Digalen contained a principle chemically identical with digitoxin. In view of the obscurity of the whole subject of the chemistry of the digitalis principles, the latter claim (that Digalen was a solution of “amorphous digitoxin”) had been an academic issue at the time of the acceptance of the product. When, however, the manufacturers of Digalen sought to mislead physicians by increased and unwarranted therapeutic claims, the Council felt that investigation of the whole matter was imperatively demanded to decide whether or not Digalen should be retained in N. N. R.
The questions at issue were: (1) the presence in Digalen of “amorphous digitoxin”; (2) the constancy of composition and reliability of action of Digalen, and (3) the claim that it causes less gastric disturbance than digitoxin. No satisfactory proof has yet been offered that Digalen contains “amorphous digitoxin.” The mass of evidence tends to show that Digalen is not constant in composition or reliable in action, and that, when given in doses corresponding in therapeutic activity, Digalen causes quite as much gastric disturbance as the official galenical preparations of digitalis.
The outcome of protracted negotiations between the Council and the Hoffmann-La Roche Chemical Works may be summed up as follows: 1. The manufacturers promise to hold in abeyance the claim regarding the presence of “amorphous digitoxin.” 2. They refuse to concede the variable composition of Digalen. 3. They reassert the claim that Digalen is superior to other digitalis products with respect to liability to cause gastric irritation and consequent vomiting.
In view of the unsatisfactory character of the reply on the second and third points, the Council voted that Digalen be omitted from N. N. R. and that publication of the report on Digalen which appears below be authorized, as well as of the two reports26 (A and B) referred to therein.
W. A. Puckner, Secretary.
Referee’s Report on Digalen
Because of persistent conflict with Rule 6 (unwarranted therapeutic claims) and Rule 1 (composition) it is recommended that Digalen be omitted from New and Nonofficial Remedies; also that a copy of the report be sent to the manufacturers, and that publication of this report and the two previous reports submitted to the Council be authorized.
The nature of the problems involved necessitates a somewhat extended discussion of the subject.
Digalein (liquid) is said to contain 1 part of soluble amorphous digitoxin Cloetta in 1,000 parts of glycerin and 1,600 parts of water with 7.5 per cent. of alcohol. One c.c. is said to contain 0.0003 gm. of the amorphous digitoxin.
Digalen was accepted by the Council27 and the following footnote was appended to the description in New and Nonofficial Remedies:
“The Council has not determined whether digalen contains ‘soluble amorphous digitoxin’ or not, but accepts it simply as a soluble digitalis preparation.”
Tablets of Digalen were accepted by the Council as a dosage form of Digalen. Each tablet is said to represent 0.5 c.c. (eight minims) of Digalen (liquid).
One of the principal considerations which led the Council to accept Digalen was that it was regarded as affording a fairly constant and stable preparation of digitalis suitable for intravenous administration. If Digalen is not fairly stable and of fairly constant composition it has no obvious advantage over an active soluble digitalis preparation, such as digitalein.
The evidence now at hand seems to show: 1. Digalen is not of constant composition or activity. 2. The manufacturers, or their agents, continue to make misleading statements. 3. It is merely a solution of certain digitalis principles, probably of digitalen mainly, in impure form.
COMPOSITION
Cloetta28 prepared a soluble amorphous substance which he called “Digitoxinum solubile Cloetta,” but no information concerning the method of preparation has been published.
Cloetta reported the result of an elementary analysis of his product which he compared to the analyses of digitoxin (crystalline) made by Schmiedeberg and by Kiliani, and stated that there could be no doubt concerning the chemical identity of the two substances.
Kiliani29 characterized as preposterous Cloetta’s claim that the active constituent of Digalen is chemically identical with digitoxin and stated that Digalen was merely an impure digitalein. Kiliani has recently reiterated the statement that the so-called “amorphous digitoxin” is not identical with digitoxin.30
Cloetta’s failure to publish his method of preparing Digalen places an additional burden of proof on him (or the manufacturers of Digalen), concerning the identity of the product, and in the face of Kiliani’s denial of the correctness of Cloetta’s contention we must have strong corroborative evidence of Cloetta’s claim before we can accept it as being established.
The difficulties of dealing with the chemistry of digitalis are so well known that they hardly require further mention here, but under the circumstances Cloetta cannot be considered as being wholly unprejudiced, and, while the same might perhaps be said of Kiliani, such evidence as can be deduced tends strongly to support Kiliani’s view, and to disprove the contention of Cloetta.
There is much confusion regarding the names which have been applied to the various principles obtained from digitalis, and while it is undesirable that an established name should be given to a newly discovered principle, one might overlook this if no effort were made to associate the therapeutic actions of the two substances to an extent which the truth did not justify.
While the Council at that time did not challenge the existence of “amorphous digitoxin” and made no attempt to determine the identity with digitoxin of the substance forming the basis of Digalen, the manufacturers of Digalen have sought to show that Digalen and digitoxin were identical so far as their therapeutic actions were concerned, but that Digalen lacked the disadvantages of digitoxin. What was a purely academic question when the acceptance of Digalen was under discussion by the Council becomes a matter of very great practical importance when the manufacturers of Digalen seek to mislead the physician by these claims.
The evidence which lends support to the view that Digalen and digitoxin are wholly dissimilar may be summarized as follows: Digalen differs greatly in its physical properties from digitoxin and in certain of its physiologic actions, as the manufacturers themselves state, Digalen being amorphous, and soluble in water, while digitoxin is crystalline and insoluble in water. The manufacturers state that Digalen differs from digitoxin in certain of its physiologic actions, but the two substances do indeed differ far more than they admit.
Cloetta and the manufacturers of Digalen lay especial stress on the claim that Digalen is cumulative to a far less extent than digitoxin, and that it has far less tendency to cause gastric disturbance than the latter. The first of these claims is true; the second is the very opposite of the truth, as we shall show.
We know nothing of the structure of any of the digitalis principles, and even though one were to admit (purely for the sake of argument) that Digalen and digitoxin were chemical isomers, that fact could not be taken to lend any support to the contention that the two substances were identical, in the face of the established fact that they differ physically and physiologically in nearly every particular, and agree only in that they both cause standstill of the heart in the same way—an action possessed also by so dissimilar a substance as barium.
The manufacturers of Digalen support the claim of the identity of their product with digitoxin by stating that “Digalen is a solution of the most active glucoside of digitalis.”31 Of course, it is very generally admitted that digitoxin is the most active principle of digitalis, though there is some question concerning its glucosidal nature.
Digalen is in fact far less active than digitoxin, as has been shown by a number of independent observers[M] (Worth Hale, 1910; Hatcher and Brody, 1910; Neave, 1907; Miller, 1908; the referee; Weis, 1912).
The essential fact which appears from the investigation of Weis is that Digalen did not behave like digitoxin in any case.
Hale also found that Digalen gave atypical actions in which the effects on the central nervous system became prominent. The referee can corroborate these observations of Hale’s on frogs, but the convulsive symptoms were prominent with some specimens of Digalen on mammals, though not with others, the more recent specimens of the preparation showing the action prominently.
The results of all these biologic tests, as well as of the physical tests made by Weis, certainly lend no support to the contention of Cloetta that the potent constituent of Digalen is identical with digitoxin, but, on the contrary, they show conclusively that the two substances differ widely in many essentials, and the continued claim of the manufacturers that the “amorphous digitoxin” said to be contained in Digalen is the same as digitoxin, or that it is the most active glucosid of digitalis, can be considered only as misleading, and therefore in conflict with the rules of the Council.
CONSTANCY OF COMPOSITION AND ACIDITY
The manufacturers of Digalen continue to claim that it is of constant and uniform activity,32 and they imply this even when they do not state it in those words; for example, a substance cannot be considered reliable if it is variable in activity. “Digalen is Absolutely Reliable. It is Standardized and consequently always uniform. It does not produce gastric disturbances.”
That the foregoing is absolutely untrue can be shown abundantly. Hale33 found digalen not to be uniformly stable; Weis found very different degrees of activity for Digalen in the liquid and tablet forms, the tablets being but one-third as active as the liquid, and the referee found very great variations in the activity of different specimens of Digalen, one specimen being almost inert. The results obtained by Miller show that Digalen is sometimes very slightly active, or not at all so.
The foregoing citations show conclusively that Digalen is not of uniform activity. When reliability is claimed for Digalen in contrast to the known variability of digitalis, it must be considered as tantamount to the claim that Digalen is not subject to such variability and it must be held that the manufacturers make misleading statements when they assert that Digalen is absolutely reliable.
The manufacturers claim that Digalen does not produce gastric disturbances (see advertisement cited).
It is quite true that when small doses of Digalen are used therapeutically it fails to produce gastric disturbances because it is of such slight activity, as previously stated, but when it is used in amounts which correspond in activity to such doses of the ordinary galenical preparations of digitalis as commonly cause nausea and vomiting it does cause gastric disturbances quite as readily as the latter.
Among the clinicians who have found that Digalen causes gastric disturbances may be cited: Veiel,34 Mueller,35 Eichhorst36 and Teichmann.37
Eggleston and Hatcher38 compared the emetic and cardiac activity of Digalen and numerous other digitalis bodies and preparations and found that the emetic activity of Digalen was decidedly greater in proportion to its cardiac (or therapeutic) action than was that of digitalis or digitoxin.
In the absence of any evidence to controvert this clinical and experimental evidence, the continued claim that Digalen does not disturb the stomach must be looked on as deliberate misrepresentation.
MISLEADING THERAPEUTIC CLAIMS
The recommendation that Digalen be dismissed from N. N. R. is made with the full appreciation of the fact that the manufacturers of Digalen and their agents have repeatedly stated that they desired to comply with the rules of the Council, and that they have withdrawn several statements to which the Council has taken exception, but the fact remains that despite these reiterations the advertisements of Digalen continue to embody statements which the Council can only consider misleading.
The Council believes that the following advertisements constitute gross therapeutic exaggerations:
“Digalen a sheet anchor in pneumonia; a strong support to the heart in this deadliest of infectious diseases among adults. The prompt action of Digalen, by intravenous or intramuscular injection makes it possible to save lives which might be otherwise hopelessly lost. The best digitalis preparation which we have at the present time.”39
“The digitalis for children. Because its dosage can be controlled. Endorsed by pediatrists everywhere.”40
“The myocarditis of Tuberculosis so frequently encountered, especially in the advanced stage of the disease, may be controlled with the aid of Digalen. The standard digitalis preparation.”41
“Digalen is Absolutely Reliable. It is standardized and consequently always uniform. It does not produce gastric disturbances.”42
Digalen is not a sheet anchor in pneumonia, for there is no drug deserving such a title. Digalen has no action which other digitalis preparations lack, and cannot save lives otherwise hopelessly lost. The dosage of Digalen cannot be controlled any better than that of other digitalis preparations, since its activity is variable. We cannot control the myocarditis of advanced tuberculosis by this or any other means.
CLAIMED SUPERIORITY
Various digitalis principles, including digitoxin, digitalin (true) and digitalein, have been known for many years. Therapeutically they have been found wanting and there appears to be no basis for the continued claim that Digalen has any superiority over these several digitalis principles. On the contrary, the evidence is accumulating that Digalen has no advantage in any particular over a solution of digitalein, and misleading claims of the manufacturers and their agents certainly interfere with the formation of that calm and unbiased opinion on the part of the general practitioner, which, when applied to the non-proprietary digitalis principles has caused them to fall into disuse.—(From The Journal A. M. A., Sept. 5, 1914.)
DIORADIN REFUSED RECOGNITION
Report of the Council on Pharmacy and Chemistry
A preparation called Dioradin was placed on the market as a cure for consumption three years ago in Europe and somewhat later in this country. It was first submitted to the Council in July, 1911. Because of the manifestly unwarranted claims made for its use in the treatment of tuberculosis, the Council voted that the product be refused recognition for conflict with Rule 8, without at that time taking under consideration the question whether or not it was in conflict with other rules of the Council.
In June, 1912, further consideration of Dioradin was requested. The American agent having promised a reform in the methods of advertising, the Council considered the available evidence regarding the identity and value of the preparation. Examination of evidence regarding the composition of Dioradin—claimed to consist of radium chlorid, iodoform and menthol in an ether-oil solution—showed serious discrepancies as to the amount of radium as well as to the identity and amounts of other constituents. It was further found that the experimental evidence was insufficient and biased. Then, too, in view of the difficulty of judging the effects of medicines in tuberculosis, the clinical data were unconvincing. There was nothing to prove that the reported improvements, even if they actually occurred, were to be ascribed to the mixture as a whole rather than to any one of its constituents.
As a result of these findings, the Council voted that Dioradin be refused recognition and that the publication of these facts be authorized. In accordance with its regular procedure, it also submitted the report to the agent. In reply the agent submitted evidence which showed that he was not responsible for the misstatements about Dioradin but offered no facts that affected the Council’s findings.
The entire matter having been referred to a second referee, minor modifications of the first draft of the report were authorized. Since then the Dioradin Company has submitted two reports of examinations of Dioradin made for the company in Germany showing a higher radium content than that previously found. These reports do not alter the facts brought out in the report of the Council that the composition of Dioradin has been variable, which past variability arouses a feeling of uncertainty or lack of confidence. In view of this the amended report was ordered published and appears below.
W. A. Puckner, Secretary.
FIRST SUBMISSION OF DIORADIN
Dioradin, a preparation for the treatment of consumption originated by Dr. R. de Szendeffy, Budapest, Hungary, was submitted to the Council by Louis Gero, Ltd., New York, with the following statement of composition:
[L] For the unabridged report of the Council’s action on Cystogen, Cystogen Aperient and Cystogen-Lithia, see Reports Council Pharm. and Chem., 1914, p. 66.
22 The Journal A. M. A., July 11, 1908, p. 140.
23 New and Nonofficial Remedies, 1912, p. 68; The Journal A. M. A., April 15, 1911, Part 2, p. 18.
24 Wohlgemuth: Biochem. Ztschr., March 18, 1912.
25 The Journal A. M. A., Sept. 11, 1909, p. 869.
26 These reports (A, first report on Digalen and B, examination of Digalen Tablets) will be published in the 1914 Annual Council Reports. A reprint of the entire matter dealing with the rejection of Digalen will be sent on receipt of a two-cent stamp.
27 The Journal A. M. A., Sept. 11, 1909, p. 869.
28 Cloetta: München. med. Wchnschr., 1904, No. 33.
29 Kiliani: München. med. Wchnschr., 1907, p. 886.
30 Kiliani: Am. Jour. Pharm., 1913, lxxxv, 224.
31 Clinical Suggestions and Reports, December, 1912, p. 24.
[M] Owing to lack of space a portion of the report is here omitted. A detailed discussion of these results is included in the full report contained in the reprint.
32 Advertisement Brit. Med. Jour., April 26, 1913.
33 Hale: Hyg. Lab. Bull., 74.
34 Veiel: München. med. Wchnschr., 1906, liii, 2140.
35 Mueller: München. med. Wchnschr., 1909, lvi, 904.
36 Eichhorst: Deutsch. med. Wchnschr., 1905, xxxi, 49.
37 Teichmann: Therap. d. Gegenw., 1907, xlviii, 199.
38 Eggleston, Cary, and Hatcher, Robert, A.: The Emetic Action of the Digitalis Bodies, The Journal A. M. A., Feb. 15, 1913, p. 499.
39 Advertisement in Am. Med., January and February, 1913.
40 Advertisement in Merck’s Arch., April, 1913.
41 South. Medical Journal, January to May, 1913, inclusive.
42 Advertisement in Brit. Med. Jour., April 26, 1913.
“A radio-active preparation of Menthol, Iodin and Radium Barium Chlorid 1⁄10 of a drop; in ether solution.”
A circular which accompanied the submission stated:
“Preparation No. 3 of Dioradin contains not only terpins but also iodin salts.... In view of the fact that emanations of the radium as well as the combinations of the evasive iodin terpins enter into the organism through the lung....”
Later these indefinite statements of composition were supplemented by the following:
“In 100 c.c. there are:
1
gr. Iodoform.
5
" Menthol.
10
drops Radium chlorid solution (1 milligr. in 100 c.c. of water).
5
gr. ether.
90
" Oil (ol. amygd. frig. press).”
In a circular contained in the package these claims were made:
“The preparations of the Dioradin are based on the miraculous effects which scientific researches have shown in regard to the different sicknesses treated with radium.
“It is generally known that radium, even if externally employed, has proved itself to be a bactericidal remedy. Its effect is multiplied if one employs it internally even in infinitesimal doses, in consequence of its permanent action of emanation on the organism.
“The preparations of the Dioradin contain the radium itself. For this reason their antiseptic and bactericidal effect is much more intensive than with medicaments which contain only its emanation, which disappears in a short time.”
In view of the general extravagance of the claims made for its therapeutic action the preparation was rejected without considering other possible conflicts with the rules of the Council.
SECOND SUBMISSION OF DIORADIN
Having been advised of the rejection by the Council of Dioradin the American agency, which in the meantime had become the Dioradin Co., requested further consideration. The Council therefore took up the subject again. After certain typographical errors had been corrected the following was now given as the composition:
“1
gram Iodoform.
5
grams Menthol.
10
drops Radium Chlorid Solution (containing 1 milligram of radium chlorid in 100 cubic centimeters of water).
5
grams Ether.
89
grams expressed oil of almond.
This liquid is put up in ampules containing one cubic centimeter of liquid.”
In support of the therapeutic claims for Dioradin the American agent submitted literature consisting chiefly of articles by Dr. Bernheim of Paris. Before reporting on the requested reconsideration of Dioradin the referee directed the secretary of the Council to point out to the American agent that in the formula given, the amount of non-volatile matter should be about 90 per cent., whereas the report of the Lederle Laboratories which accompanied the request for reconsideration states that but 72.08 per cent. was found in the analysis. In reply the agent stated that he had called the attention of Dr. Szendeffy (the originator of Dioradin) to the discrepancies concerning non-volatile matter and that he felt sure the discrepancy was wholly accidental (sic). In a later communication the agent submitted a statement of analysis from the Lederle Laboratories of a new specimen of Dioradin according to which the amount of non-volatile matter agreed essentially with the amount claimed by the agent.
The referee, having examined the evidence, is of the opinion that the statement of composition is misleading and that the therapeutic claims are unwarranted, thus:
DISCREPANCIES IN RADIUM CONTENT
The chief claims for its therapeutic value are based on the radium content, yet the discrepancies and contradictions, regarding this are serious.
In connection with the reconsideration of this product the agent presented a certificate of chemical examination by the Lederle Laboratories in which the following statement was made as to the radio-activity:
“Examination shows the preparation to possess slight radioactivity, corresponding in activity to less than 1-10,000 of 1 milligram of radium bromid per ampule. According to the sworn statement of Dr. A. de Szendeffy, the originator of Dioradin, the preparation contains 10 drops of radium chlorid solution (1 milligram in 100 cubic centimeters of water) in 100 cubic centimeters of the preparation. This would correspond to 5-1,000 milligram of radium chlorid in 100 cubic centimeters, or about 1-20,000 of 1 milligram per ampule.”
A cursory reading of this paragraph gives the impression that Dioradin possesses fully the amount of radio-activity claimed by its originator, Dr. A. de Szendeffy. This impression is greatly strengthened by the concluding paragraph of the Lederle report, which says:
“In conclusion, our examination shows that the preparation submitted to us as Dioradin possesses radio-activity, and contains a fixed oil (apparently expressed oil of almond), iodoform, menthol and ether, thus confirming the sworn statement of Dr. A. de Szendeffy in regard to the composition of this product.”
On inquiry as to the method used by the Lederle Laboratories, in determining radio-activity the agent submitted a further statement of the Lederle Laboratories which describes the gamma ray test by which the determination was made and a radium value equivalent to 0.000041 mg. of radium bromid per capsule was obtained. The report then says:
“The variations of the single measurements from the mean in the case of the natural leak and the leak with the Dioradin near were so large that we did not feel justified in assigning much accuracy to the figure, 0.000041, but stated that the amount of radium per capsule could not be greater than 0.0001 mg., with the possibility of there being a much smaller amount present.”
It is evident that the wording of the reports of the Lederle Laboratories is liable to give the impression that their examination confirms the claims made for Dioradin.
It is further evident from these reports that the amount of radio-active matter has not been definitely ascertained but that it is at the best very small. The unreliability of the claims for radium content of Dioradin was recently shown by Buechner,43 who found a specimen obtained from an apothecary to contain but 1-1,000 of the amount claimed.
VOLATILE AND NON-VOLATILE MATTER
The varying claims regarding the content of volatile and non-volatile matter throw doubt on the entire composition of Dioradin, for if the statement as to these is wrong the rest of the statement regarding composition cannot be given credence.
In the first submission of Dioradin about 89 per cent. of non-volatile matter was claimed but in the report of the analysis by the Lederle Laboratories, which accompanied the resubmission, only about 72 per cent. was found. Later the Lederle Laboratories reported that an examination of a new specimen of Dioradin had shown about 90 per cent. of non-volatile matter. The discrepancies between the composition claimed for Dioradin and that found for the product in the first Lederle report has shown that the agent was quite ignorant of the composition of the product which he was selling.
INDEFINITENESS OF THE IODIN CONTENT
The label on the trade package of Dioradin first submitted to the Council stated that the product contained iodoform; a similar statement was made in the submission of the product; the circular accompanying the first submission stated that “iodin salts” were contained in the product while the iodin content was referred to further on in this circular as “combinations of evasive iodin terpins.” In Bernheim’s papers, which have been used to advertise Dioradin, and which are referred to in the same circular, the iodin compound is called “iode peptonisé,” which, according to information stated by the American agent to have come from Budapest, is to be translated “iodized peptone.” What is the meaning of this confusion? One would naturally suppose that the preparation to be sold in this country contains iodoform in an ether-oil solution while the one used by Bernheim and Dieupart44 was stated to contain an ethereal solution of “iodized peptone.” This is another mystification, for an ethereal solution of any kind of peptone would be a novelty. The matter is of some importance, for Bernheim and Dieupart lay great stress on the difference between “peptonized iodin” and other iodin (loc. cit., p. 333) and of the superiority of ethereal over oily solutions (loc. cit., p. 334). The American agents, however, in the second submission, state that this is all a mistake; that the Dioradin used by Bernheim is the same Dioradin which was submitted to the Council; and that this does not contain, and never did contain, the ethereal solution of “iode peptonisé” to which Bernheim attached so great importance. Bernheim (report to Medical Congress of Lyons) himself has come to the same conclusion; for five months after his first paper he believes that the “special salt of radium” (sic) is the principal agent; so that the “peptonized iodin” must be unimportant, and in a cablegram of July 4, 1912, he now informs the Dioradin Company that the formula was incorrectly given in his first papers “owing to my ignorance of actual composition,” and that all the Dioradin used by him was of the composition stated in the submission to the Council.
While this vindicates the good faith of the American Dioradin Company, it does not clear up the mystery. The question occurs at once: What led Dr. Bernheim to make such positive statements? Was he drawing purely on his imagination? If so, why did his imagination take this peculiar special direction? Or if he did have some reason to imagine the “iode peptonisé,” who supplied this reason? And if, at that time, he was given to understand by Szendeffy, who must have supplied him with the material, that it contained the iodized peptone, how can he be positive at this time, that it did not contain it? Has he actually analyzed the old material?
There is also a further question which needs to be answered. Why has Dr. Szendeffy waited until Dioradin was rejected by the Council before correcting Bernheim’s serious misapprehension, in the meantime permitting the circulation of Bernheim’s paper?
Until these questions have been satisfactorily answered, the element of mystery about the composition of Dioradin cannot be cleared away.
EXPERIMENTAL EVIDENCE
The available experimental evidence regarding “Dioradin” is restricted to some quotations from its inventor Szendeffy, in the paper of Bernheim and Dieupart (p. 334). These, if confirmed, would show that radium alone has practically no effect on cultures of tubercle or colon bacilli; that 0.1 gm. of “iode-menthol” (concentration not stated) checks the growth of the acid-fast organisms; and that this antiseptic efficiency can be nearly doubled by the addition of a little radium. No quantitative data are given, so that it is difficult to judge the accuracy of the observation. Granting that it is correct, it would have little bearing on the therapeutic actions of Dioradin, for there is nothing to show that the effective test-tube concentration is reached in the pulmonary tissues.
It is also claimed that the injection of Dioradin prevents tubercle infection. The referee believes that the Council and the medical profession should hesitate to accept this conclusion without further details; and these would require confirmation by unprejudiced observers.
CLINICAL EVIDENCE
The Dioradin Company submits considerable clinical data in favor of Dioradin. It must be remembered that most favorable opinions have been published, from time to time, about scores of “consumption cures,” which have mysteriously lost their efficiency when their novelty wore away. There is no more reason to doubt the good faith of those who are enthusiastic about Dioradin than of those who have been enthusiastic about other “cures.” There appear to be features in the course of tuberculosis which make the judgment of therapeutic measures peculiarly difficult. It is possible that impartial clinical trials of Dioradin by tuberculosis experts appointed by the Council might facilitate judgment as to the actual efficiency of Dioradin. The referee doubts, however, whether this would advance the Council very much toward the acceptance of the substance. Such an investigation would be so lengthy that it should not be undertaken until the Dioradin Company itself has offered at least presumptive evidence in this direction, especially in view of the adverse report recently made by Cecil Wall.45 Ten tuberculous patients were treated by Wall in strict accordance with the method outlined to him by Bernheim, yet Wall concludes that none of the cases, though treated accurately in accordance with the instructions, can be quoted to justify any of the claims for the therapeutic efficiency of Dioradin. The Council cannot undertake lengthy investigations of this character until it is put in possession of data which would show to its satisfaction that such investigations would probably be fruitful.
CONCLUSIONS
From investigations made, it appears that the claims in regard to the composition of Dioradin have contained vague statements and contradictions which arouse a feeling of uncertainty and lack of confidence. Until this uncertainty is cleared away, Dioradin cannot be considered as complying with Rule 1. The experimental data are insufficient and unconvincing. Some favorable clinical reports have been submitted, but the accuracy of the observations is to be questioned and they are more than offset by the negative results observed by Cecil Wall. As might be expected, other negative results, if observed, have not been submitted and there is nothing in the manufacturer’s claim to show whether the improvement reported is really due to the peculiar mixture called Dioradin or to any one of its ingredients.
It is therefore recommended that Dioradin be not accepted for New and Nonofficial Remedies. In view of the extensive advertising of this preparation and because of the admittedly incorrect statements in the earlier papers it is recommended that publication of this report be authorized.—(From The Journal A. M. A., Oct. 26, 1912.)
ECHINACEA
Report of the Council on Pharmacy and Chemistry
The Council has voted to reject several non-proprietary articles and has recommended that the reasons for their rejection be given in The Journal; among these is echinacea. The following paper has been submitted by a subcommittee with the recommendation that it be published. This recommendation was adopted.
W. A. Puckner, Secretary.
Echinacea
When this drug was first introduced, it was a typical nostrum, with exaggerations regarding its therapeutic value that were somewhat more gross than usual. It was later adopted by the eclectic school without being freed from the stigmata of its origin. It was also pressed into use as the main ingredient of such proprietary preparations as Echafolta, Ecthol Eusoma, etc. Efforts have been made to get the regular profession to use it in these various forms.
According to J. U. Lloyd (Pharm. Review, vol. xxii, p. 9–14), the introduction of echinacea into eclectic medicine is due to the efforts of Dr. H. F. C. Meyer to increase the sale of Meyer’s Blood Purifier, a secret remedy containing it. The following is a literal copy of the label on this nostrum:
After Lloyd had identified the plant, Meyer put the preparation out under another form with the following label:
These absurd claims of an evidently ignorant man have passed into the more recent proprietary advertising matters and into much of the eclectic writings. Indeed, the seemingly impossible had been attained by even surpassing Meyer’s all-but-all-embracing claims. Not content with endorsing echinacea as a positive and speedy “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia, later enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus and exophthalmic goiter, and with the power of retarding the development of cancer.
It is worth noticing—although it is not surprising—that these far-reaching claims have been made on no better basis than that of clinical trials by unknown men who have not otherwise achieved any general reputation as acute, discriminating and reliable observers. No attempt seems to have been made to verify these claims by accurate scientific methods, clinical or otherwise, although this could very easily have been done.
Not one of the eulogistic reporters and exploiters seems to have considered it worth while to determine by the simplest control experiments whether the drug possesses any bactericidal or antiseptic powers whatever. It is therefore not very strange that discriminating physicians have failed to show much enthusiasm. One of the warmest endorsers of echinacea, C. S. Chamberlain (who later became the president of the Eusoma Pharmaceutical Company), complains that he has been unable to interest regular physicians in the remedy. He reviews the statements of previous authors and reports eight cases of infection, only two being acute or extensive, in which he used it with asserted success.
In view of the lack of any scientific scrutiny of the claims made for it, echinacea is deemed unworthy of further consideration until more reliable evidence is presented in its favor.
REFERENCES
Meyer, H. F. C.: Eclectic Med. Jour., 1887; Goss: Chicago Med. Times, 1888; Hages: Eclectic Med. Jour., 1888; Shelly: Medical Gleaner, 1894; Lloyd, C. G.: Eclectic Med. Jour., 1897; Lloyd, J. U.: Eclectic Med. Jour., 1897; Lloyd, J. U.: Pharm. Review, xxii, 9–14; Schnitz, Elsie M.: Wis. Med. Recorder, 1898, ii, 202; White, J. N.: Texas Med. News, 1898, viii, 110–113; Stinson, J. C.: Therap. Gazette, 1900; Hale, E.: Lancet-Clinic, March, 1901; Thielen, B. F.: Echafolta, Its Uses in Dental Surgery, Dental Reg., 1903, vii, 462–465; Gorse, C. A.: New Albany Med. Herald, 1903–4, xxii, 384; Chamberlain, C. S.: Louisville Monthly Jour. Med. & Surg., 1904–5, xi, 219–223; Lancet-Clinic, 1905, M. S., liv, 279–283; Ellingwood, F.: Therap. Gazette, 1905, 3, S., xxi, 298–300; French, J. M.: Med. Brief, 1905, xxxiii, 537; Mathews, A. B.: Georgia Pract., 1905, i, 137–140.—(From The Journal A. M. A., Nov. 27, 1909.)
ECHTISIA, ECTHOL AND ECHITONE
Report of the Council on Pharmacy and Chemistry
Echtisia (Wm. S. Merrell Chemical Co.), Ecthol (Battle and Co.) and Echitone (Strong, Cobb and Co.) are proprietary preparations each of which is alleged to contain echinacea as its chief constituent. In 1909 the Council examined into the claims made for echinacea. This drug has been claimed to be a “specific” for rattlesnake bite, syphilis, typhoid fever, malaria, diphtheria and hydrophobia. Enthusiasts have credited it with equally certain curative effects in tuberculosis, tetanus, and exophthalmic goiter and with power of retarding the development of cancer. Of course there is no reliable or trustworthy evidence to substantiate these claims. Echinacea is not often prescribed under its own name, but is employed as an ingredient in proprietary preparations mixed with other little-used or obsolete substances. Thus Echtisia is said to contain echinacea, wild indigo, arbor vitae and poke root; Ecthol, to have echinacea and arbor vitae; Echitone, to consist of echinacea, pansy and blue flag. Naturally the manufacturers of such proprietaries make use of all available optimistic reports in promoting their sale, while each manufacturer ascribes special and peculiar virtues to the combination represented in his particular preparation. The Merrell Chemical Company claims that baptisia (wild indigo) is a “destroyer” of devitalizing elements in the blood “a vitalizer of the blood as well”; that thuja (arbor vitae) is a “perfect antiseptic and a generator of vital force in disorganized tissues,” and that a long list of diseases, including diphtheria, syphilitic sciatica and gonorrheal rheumatism, “are all more or less amenable to full doses” of phytolacca (poke root). Strong, Cobb and Co. maintain that Iris versicolor (blue flag) is “one of the most powerful excitants of the biliary, salivary and pancreatic secretions,” and that the “principal sphere of action of Viola tricolor [pansy] is in the gastro-intestinal canal and the skin.”
There is no satisfactory evidence that the claims for any of these substances are any more reliable than those for echinacea. Notwithstanding, Strong, Cobb and Co. claim for Echitone “not only the virtues of its constituent parts, but a wider field and a particular therapeutic value of its own”; Battle and Co., maintain that Ecthol is the “‘Ideal Corrector’ of depraved conditions of the fluids and tissues,” while the Merrell Company urges the virtues of Echtisia in a list of diseases ranging from acne to appendicitis and from gangrene to rattlesnake bite. The Council refused recognition to these three products and directed publication of reports to call attention to the exaggerated, unwarranted and often utterly absurd claims made for these and similar preparations.—(From The Journal A. M. A., Jan. 2, 1915.)
ERGOAPIOL[N]
Abstract of Report of the Council on Pharmacy and Chemistry
Ergoapiol (Martin H. Smith Co., New York) is a mixture put up in capsules, each of which is said to contain
Apiol (Special M. H. S.)
5grains
Ergotin
1grain
Oil Savin
1⁄2grain
Aloin
1⁄8grain
Examination discloses the fact that, contrary to the claim made, each capsule, instead of containing 5 grains of apiol, really contains some liquid preparation of the type of oleoresin of parsley seed. Ergoapiol is recommended (on the label) for such diseases as “Amenorrhea, Dysmenorrhea and other Menstrual Disorders,” while a circular enclosed in the package contains many suggestions that may be counted on to lead to its indiscriminate and uncritical use.
Ergoapiol is an unscientific, shot-gun mixture of drugs having widely different therapeutic effects. Where the action of parsley is desired, the effects of ergot would ordinarily, be contra-indicated; furthermore, neither aloin or savin would be called for in conditions that demanded the effects of apiol. It would be impossible to predict the action of a mixture of this kind in the varying conditions for which its use is advised by the manufacturers. To combine four drugs of dissimilar action in fixed proportions for the routine treatment of conditions which have little in common except that they involve the female generative organs, is unscientific and absurd. The Council refused admission to Ergoapiol.—(From The Journal A. M. A., Dec. 12, 1914.)
ERPIOL (DR. SCHRADER)
Report of the Council on Pharmacy and Chemistry
The original rules of the Council governing the acceptance of articles have recently been modified, particularly by adoption of Rule 10, which reads:
“Unscientific and Useless Articles.—No article will be admitted which, because of its unscientific composition, is useless or inimical to the best interests of the public or of the medical profession.”
In view of these modifications, the Council is reconsidering the articles already accepted with the view of determining their compliance with the rules as amended. In line with this the Council reconsidered Erpiol (Dr. Schrader), manufactured by the William S. Merrell Chemical Company, and from the evidence given below concluded that one of the constituents, gossypin, is inert and its use unscientific. The Council therefore voted that Erpiol (Dr. Schrader) be omitted from New and Nonofficial Remedies and authorized publication of the following report.
W. A. Puckner, Secretary.
Erpiol
In consequence of the more thorough scrutiny now given by the Council to the therapeutic value of the remedies admitted to New and Nonofficial Remedies, the Council has reconsidered Erpiol (Dr. Schrader), previously accepted for New and Nonofficial Remedies. Erpiol (Dr. Schrader) is the name applied to capsules containing apiol, ergotin and gossypin, which are sold as an emmenagogue. The first two ingredients have a recognized value in the treatment of diseases of the female generative organs. The third, gossypin, is a preparation from cotton-root bark, belonging to the somewhat indefinite class of pharmaceutical preparations known as resinoids.
Cotton-root bark (Gossypii radicis cortex, U. S. P.) has been credited by some with pharmacologic and therapeutic properties, similar to ergot, especially in its action on the uterus; experiments on pregnant animals do not confirm this view. Most authorities on gynecology either make no reference whatever to the drug or ascribe little or no value to it. The preparations from the dried bark are inert.
From reports made to him, Professor J. U. Lloyd concluded (Eclectic Med. Jour., 1876, xxxvi, 545) that a prime fluidextract of fresh cotton-root bark is an active therapeutic agent and deserving the attention of the medical profession, while that of the dry bark is inert and worthless. The gossypin on the market is made from the dried bark.
Professor Lloyd, who is considered an authority on eclectic medicine, says: “Were it left to me to admit or exclude it, by reason of its therapeutical position, I should exclude it, because, in my opinion, it has never been demonstrated, in clinical practice, to be worthy of any therapeutic recognition whatever.”
As the available evidence indicates that gossypin is an inert preparation, Erpiol (Dr. Schrader) was considered in conflict with Rule 10 and the Council has therefore voted that it be deleted from New and Nonofficial Remedies.—(From the Journal A. M. A., June 3, 1911.)
FALSE UNICORN (HELONIAS)
Report of the Council on Pharmacy and Chemistry
The Council voted to refuse to recognize false unicorn as a non-proprietary article and the following statements, submitted by a subcommittee, were ordered published.
W. A. Puckner, Secretary.
False Unicorn-Helonias
Helonias dioica, or more properly Chamælirium luteum, is a plant, preparations of which enter into various proprietary mixtures for diseases of the female pelvic organs. In the advertisements of these preparations it is usually credited with hemostatic powers and is asserted to be a uterine tonic.
There is practically no reference to this drug in reliable medical literature, and as there is no evidence worthy of credence to support the claims made for it, the drug was not considered deserving of a place in the Pharmacopeia. Hence, it may be regarded as a drug not worthy of attention of physicians.—(From The Journal A. M. A., Nov. 27, 1909.)
FORMUROL
Report of the Council on Pharmacy and Chemistry
Formurol, Citrocoll and Aspirophen were submitted to the Council by the Cellarius Company of San Francisco. The manufacturers having failed to substantiate the claims they make for these products, the Council has voted that the preparations be refused recognition. The Council also authorized the publication of the following report, which deals particularly with one of the preparations—Formurol.
W. A. Puckner, Secretary.
Formurol is the product of the Chemische Fabrik Falkenberg, Falkenberg-Gruenau, near Berlin, Germany. The Cellarius Company, San Francisco, acting as selling agents for the United States, submitted Formurol (along with Aspirophen and Citrocoll, also made by the same firm) to the Council, with the statement that it is “hexamethylentetraminsodium-citrate,” and that it has the following composition: “C6H7O7Na.C6H12N4.”
Zernik,46 who examined these products, reported that Aspirophen, Citrocoll and Formurol do not have the composition that is claimed for them by the Fabrik Falkenberg. Formurol, he states, is not a definite chemical compound, but a mixture of hexamethylenamin and sodium citrate. The agents were advised of this fact by the Council and were asked to submit evidence to substantiate their claims. No such evidence was submitted.
Since a compound having the composition that is claimed for Formurol is theoretically possible, the Council requested that the product be examined in the Association Laboratory to determine whether it still was the simple mixture reported by Zernik, or whether, perhaps, it now possessed the formula claimed for it. The following report was made by the Association chemists:
Formurol, as submitted to the Council, was in the form of tablets weighing about 1 gm. each and appeared to be composed of a fine white substance interspersed with some transparent particles. The tablets were readily soluble in water, were odorless and possessed a slightly acid taste. The aqueous solution responded to tests for hexamethylenamin, citrate and sodium. To determine whether hexamethylenamin was present in the free or the combined state, the method of Zernik was employed. This consists in the extraction of Formurol with chloroform, which dissolves out hexamethylenamin, leaving insoluble sodium citrate. As the use of the solvent, chloroform, would seem to preclude decomposition of such a hypothetical compound as “hexamethylenamin-sodium-citrate,” the extraction of hexamethylenamin from Formurol may be taken to demonstrate its presence in the free state.
That Formurol is not a compound of hexamethylenamin, but a mixture of hexamethylenamin and sodium citrate, was further indicated by the appearance of the crushed tablets described above. Further, on the low-power microscope the powder was found to be composed of transparent crystals and white opaque particles which appeared to be masses of minute crystals. When treated with chloroform the transparent crystals dissolved, leaving the white masses intact, demonstrating the presence of two distinct substances, one soluble and the other insoluble in chloroform. It having been demonstrated that the residue obtained by evaporation of chloroform could not be weighed as hexamethylenamin, due to enclosed chloroform, the amount of this substance in the residue was determined.
The method used has been described in the Report of the Chemical Laboratory of the American Medical Association, Vol. I, p. 55, and depends on the decomposition of hexamethylenamin by means of sulphuric acid to form ammonium sulphate and formaldehyd. From this solution the ammonia is liberated, distilled and determined by titration and from the ammonia found the amount of hexamethylenamin is calculated. By this method Formurol was found to contain (a) 35.42 per cent. and (b) 35.32 per cent., or an average of 35.37 per cent. hexamethylenamin. The residue insoluble in chloroform was shown to consist essentially of disodium hydrogen citrate by determining the amount of sodium (Na) contained in Formurol. The percentage of sodium calculated from the amount of sodium sulphate found was (a) 11.38 per cent. and (b) 11.20 per cent., or an average of 11.29 per cent., equivalent to 62.50 per cent. disodium hydrogen citrate.
As a check on this determination, the amount of material contained in Formurol which is insoluble in chloroform was determined. It was found to be (a) 63.23 per cent. and (b) 63.49 per cent., making an average of 63.36 per cent., and thus agreeing fairly well with the results obtained when the sodium content was assumed to be disodium hydrogen citrate. From this analysis it appears that Formurol is not a definite compound of hexamethylenamin and sodium citrate, but instead is a mixture of these substances consisting approximately of hexamethylenamin 35.37 per cent. and sodium acid citrate (disodium hydrogen citrate) 63.36 per cent., practically a mixture of 1 part hexamethylenamin and 2 parts sodium acid citrate. These results agree with those reported by Zernik47 and show that the product now, as then, is not true to claims.
In view of the findings of the laboratory, it is recommended that Formurol be refused recognition. As the exploitation of well-known remedies under false and misleading names is detrimental to the progress of medicine, it is recommended that publication of this report be authorized.
[Editorial Note: This report illustrates once more the value of the Council on Pharmacy and Chemistry and the Chemical Laboratory to the medical profession. Before the Council was organized there was no agency to protect the physician’s interests in the matter of pharmaceuticals. Under the old régime Formurol would have been heralded as a new “synthetic” of the most approved made-in-Germany type—and the claims would have gone unchallenged. To-day its status is made clear and the profession is informed. Only those who have closely studied the question can realize what a wonderful power for commercial probity the Council has proved. Under the laissez faire system of the past, many large pharmaceutical firms gave little attention to the accuracy of the claims made for their products. If the advertising gave good “pulling” results, that was all that was asked or expected. Within the past five years a wonderful change has taken place in this regard, and firms of the better class have so modified their advertising as to make it not only conservative in tone, but to approximate scientific accuracy.]—(From The Journal A. M. A., Jan. 21, 1911.)
GASTROGEN TABLETS
Report of the Council on Pharmacy and Chemistry
The Bristol-Myers Co., Brooklyn, N. Y., sells Gastrogen Tablets which are described as “A Neutralizing Digestive” to be “used in connection with Sal Hepatica.” Sal Hepatica, it will be remembered, is another product of the Bristol-Myers Company and has been the subject of previous unfavorable comment. The label on a recently purchased package of Gastrogen Tablets contains the following:
“For gastric distress, weak stomach and dyspepsia, one to two tablets after eating; repeat in half an hour if needed.
“Also indicated in nausea, flatulence, sour stomach and heartburn.”
While these recommendations sound as if they were addressed to the public, Gastrogen Tablets are advertised in medical publications and hence come within the scope of the Council. Gastrogen Tablets are said to be composed of pepsin, calcium carbonate, calcium phosphate and “aromatics.” As each tablet, according to the label, contains 7 grains of calcium carbonate (chalk), the recommended dosage would in most cases be sufficient to neutralize the gastric fluids in the stomach and would thus tend to prevent the pepsin from exerting its digestive effects. The means adopted to relieve one symptom of dyspepsia, in other words, defeats the action of the means for relieving the indigestion. The fact is that patients who need an antacid do not need pepsin, while those who need pepsin will be harmed by the administration of an antacid. Gastrologists hold that, except in rare cases, the evidence tends to show that wherever there is a sufficiency of hydrochloric acid there is a sufficiency of pepsin. When pepsin is lacking it should be administered along with hydrochloric acid to make it effective. The Council voted that Gastrogen Tablets be refused recognition.—(From The Journal A. M. A., Dec. 12, 1914.)
GLYCO-HEROIN, SMITH
Report of the Council on Pharmacy and Chemistry
The following report was submitted to the Council by a referee and publication authorized.
W. A. Puckner, Secretary.
Glyco-Heroin, Smith (Martin H. Smith Co., New York) is marketed in a showy “patent-medicine” type of package, the label on which announces the presence of 1⁄2 grain of heroin to the fluidounce and admits the presence of 3.5 per cent. alcohol, an active ingredient that is not discussed in any way in the literature sent out by the manufacturer.
The composition of Glyco-Heroin, Smith, is given as follows: “Each teaspoonful represents: Heroin 1⁄16 grain, White Pine Bark 31⁄2 grains, Ammonium Hypophosphite 3 grains, Balsam Tolu 1⁄4 grain, Hyoscyamus 1 grain, Glycerin Q. S.” The alcohol is not mentioned in the formula.
The advertising matter says of the merits of the formula:
“Despite the fact that heroin, which is universally recognized as an invaluable respiratory sedative, is a conspicuous element of Glyco-Heroin, Smith, the other constituents, henbane, ammonia hypophosphite, balsam tolu and white pine bark are factors of no less importance; indeed, it is through the concerted action of its several ingredients that the preparation proves so notably beneficial in the class of affections in which it is indicated. The constantly increasing popularity of the preparation in the treatment of respiratory affections is the best adducible evidence of its value in such disorders.”
The absurdity of this assertion will be appreciated on comparing the nature, quantities and activities of the several ingredients. Thus, while heroin, a potent habit-forming drug, is present in unusually large proportions, tolu, an innocuous or comparatively harmless product, is said to be represented by 1⁄4 grain, a relatively small quantity, hardly sufficient to impart even a distinctive taste or flavor. Ammonium hypophosphite, in the amount said to be present, may be considered to be practically useless, while the dose of hyoscyamus, an additional narcotic, is fairly large. The white pine bark present is probably as active as would be a corresponding amount of white pine shavings or of turpentine sufficient to give the preparation a slight odor. The vehicle, glycerin, is claimed to be “notably advantageous,” but not a word occurs in the discussion by the manufacturer in regard to the presence of alcohol, which is certainly quite as active medicinally as the balsam of tolu and contributes fully as much to the flavor or taste of the preparation as does the white pine bark.
In prominent type on the outer label of the trade package we are told that the preparation is intended for the treatment of “COUGH, ASTHMA, PHTHISIS, PNEUMONIA, BRONCHITIS, LARYNGITIS, WHOOPING-COUGH AND KINDRED INFECTIONS.” In much smaller type: “Glyco-Heroin (Smith) is distinctly a product designed expressly for the use of physicians.” The circular included with the trade package, however, bears statements which would tend to encourage self-drugging by the layman, and in view of the manner in which the preparation is exploited are undoubtedly intended to do so. For instance:
43 Buechner: Pharm. Weekblad, March 2, 1912, p. 161.
44 Bernheim and Dieupart: Revue Internationale de la Tuberculose, May, 1911, p. 336.
45 Wall, C.: Brit. Med. Jour., July 20, 1912, p. 109.
[N] For abstract of report on a similar mixture, see Apergols, p. 26; for unabridged report of the Council’s action on Apergols and Ergoapiol see Reports Council Pharm. and Chem., 1914, p. 64.
46 Zernik: Arb. a. d. Pharmazeut. Inst. d. Univ. Berlin, 1907, iv, 46.
47 Therap. d. Gegenw., February, 1909.
“Bronchitis.—In the acute form of bronchitis, Glyco-Heroin (Smith) acts most happily. It tends to diminish the congestion and inflammation of the lining of the air passages, relieves the pain and institutes repair....
“Phthisis.—In the treatment of the cough of phthisis, Glyco-Heroin (Smith) is used with the most gratifying results. It checks the night sweats, acts favorably upon the reflexes, increases expectoration and induces refreshing sleep.
“Asthma.—The preparation diminishes the intensity of the paroxysms and lengthens the intervals between their recurrence. By the administration of the preparation, asthmatic attacks can frequently be aborted.
“Pneumonia.—In the initial stage of pneumonia, the preparation exercises a calming, antipyretic and sedative effect. In the latter stages of the disease, the analgesic and expectorant properties of the product are well displayed.
“Whooping-Cough.—Administered in doses of from five to ten drops this preparation affords surprisingly satisfactory results. The cough rapidly loses its spasmodic character and the frequency of the paroxysms is considerably diminished.”
How cruelly misleading the literature put out by the manufacturer of this nostrum is, will be apparent from a comparison of the rather large dose of heroin in a teaspoonful of the nostrum and the directions on the package that:
“The adult dose of Glyco-Heroin (Smith) is one teaspoonful repeated every two hours or at longer intervals, as the case may require.
“Children of 10 or more years, from a quarter to a half-teaspoonful.
“Children of 3 years or more, 5 to 10 drops.”
A WICKED FALSEHOOD
Included in much of the advertising matter that has been put out is the bare-faced untruth that the preparation does not produce narcotism or habituation. Here is a quotation from an undated circular:
“Glyco-Heroin (Smith) is decidedly preferable to preparations containing codeine or morphine, by reason of the fact that it does not produce narcotism, constipation, gastric disturbance nor habituation, even though its administration be protracted.”
That this assertion is not in keeping with facts is evidenced by the recent report of a study on the sale and use of heroin made by the U. S. Department of Agriculture. From the information gathered it appears that the sales of heroin and heroin-containing preparations have increased greatly, particularly in those states which have rigid laws preventing the indiscriminate sale of morphin and cocain. Investigation of the subject establishes the fact that many drug victims who formerly used morphin and cocain, and who under the new laws find it difficult to obtain these substances, have begun using heroin, the sale of which is not as yet carefully restricted under state laws. The drug is said to be fully as dangerous as morphin, and by many is held to be much worse, for the reason that it occasionally kills the victim outright, and its habitual use is far harder to overcome than that of other drugs.
Phillips,48 in discussing the prevalence of the heroin habit, reports, among others, the case of a physician aged 60 who began to take heroin because he suffered from a chronic cough and thought there was no danger of habit from the use of this drug because he believed the statements of various manufacturing firms who claimed that there was no danger of habit.
In a pamphlet now being distributed to the medical profession, entitled, “Glyco-Heroin (Smith), an exposition of its components together with references to its value in the treatment of Bronchitis, Cough, Cough of Phthisis, Laryngitis, Pneumonia and allied disorders of the Respiratory Tract,” the several alleged uses of the nostrum in the treatment of cough, “Regardless of the nature of its underlying cause,... whether of recent origin or of long duration,” are discussed at length, and eminent practitioners with degrees extending the width of the printed page are quoted in support of the statements made. While it may be permissible for a theoretically trained medical tyro who lays claim to the right of appending the abbreviations M.A., M.D., D.C.L., L.R.C.P. to his name to laud a heterogeneous habit-forming cough-syrup like Glyco-Heroin, Smith, similar testimonials from a man entitled to append Ph.G., M.S., M.D. to his name makes one doubt the value of the training, either scientific, pharmaceutical or medical, that has been given the poor unfortunate who, according to his own statements, indiscriminately doses a female patient of 7 and a male patient of 40 with huge doses of heroin every two, four or six hours.
The danger of contributing to the spread of the heroin habit by the use of preparations of this type is indicated by an editorial in The Journal of the American Medical Association,49 which points out that although heroin and its hydrochlorid have been in use but a few years they have already established themselves among the habit-forming drugs and have become sufficiently conspicuous in this respect to awaken the thinking public to the deplorable results for which they may become responsible. Phillips,49 in the article mentioned above, quotes Petty, who reports that in the last 150 cases of drug habit coming under his care he saw eight cases of heroin addiction. Three of these were initial cases; in one the patient had been cured of the opium habit, but following an operation heroin was prescribed, and the habit followed. The remaining four patients purposely substituted heroin for morphin, to which they had been addicted.
THE GROWTH OF HEROIN ADDICTION
The imminent danger of substituting heroin for either morphin or cocain is shown by the fact, reported by the U. S. Department of Agriculture, that during the early months of 1913 the coroner’s office in Philadelphia County, Pa., held inquests on five sudden deaths from heroin poisoning. In each case the victim was a heroin fiend and took an overdose. Drug fiends are apparently able to consume relatively large quantities of morphin or cocain, but any sudden and material increase in the amount of heroin taken is liable to prove fatal. As indicating the wide sale of this substance, it is known that one druggist in Pennsylvania whose store is located in an undesirable section of his city has been buying heroin tablets in 25,000 lots.
GLYCO-HEROIN, SMITH, A “PATENT MEDICINE”
The popularity of Glyco-Heroin, Smith, as a household nostrum is suggested by the fact that one of the larger department-store type of drug-stores in the city of Philadelphia lists this preparation in its “patent-medicine” catalogue at $1.75 per bottle and sells it freely to all who care to buy. This is due to the fact that Pennsylvania, like many other states, does not include heroin in the prohibited list of habit-forming drugs that can be supplied only on physicians’ prescriptions.
To what extent Glyco-Heroin, Smith, is responsible for developing the rapidly growing heroin habit is of course problematic. It is reasonable, however, to suppose that a preparation, each teaspoonful of which contains so large a dose of heroin as does this nostrum, when taken as repeatedly and as indiscriminately as is directed by the manufacturer, would offer possibilities for harm sufficient in number to induce the thinking medical practitioner to avoid its use altogether and at least to suggest to even the most commercial dabbler in the healing art the desirability of carefully considering its potency for harm before endorsing its use in the treatment of “cough and kindred affections.”—(From the Journal A. M. A., June 6, 1914.)
GLYCO-THYMOLINE
Report of the Council on Pharmacy and Chemistry
The Council, having voted that Glyco-Thymoline be refused recognition, authorized publication of the following report.
W. A. Puckner, Secretary
Glyco-Thymoline (Kress and Owen Company, New York) is a typical example of a “patent medicine” advertised to the public through the doctors. Bottles of the mixture with the name blown in the glass are issued to physicians for distribution to patients, and the circular which comes around the bottle more or less directly recommends it for use in almost every form of infectious disease.
COMPOSITION AND VARYING FORMULAS
Different formulas for Glyco-Thymoline have appeared. At one time it was said to contain:
“Sodium 24, Boric Acid 4, Benzoin 4, Acid Salicylic 0.33, Eucalyptol 0.33, Thymoline 0.17, Betula Lenta 0.08, Menthol 0.08, Pini Pumilionis 0.17, Glycerin and solvents, q.s.”
Another formula, which appeared about the same time, was:
“Benzo-Salicyl. Sod. 33.33, Eucalyptol 0.33, Thymol 0.17, Salicylate of Methyl from Betula Lenta 0.16, Pini Pumilionis 0.17, Glycerin and solvents q.s.”
A later formula was like the second except that it included “Menthol, 0.08.”
Analysis in the chemical laboratory of the American Medical Association showed that Glyco-Thymoline contained borax, but no boric acid; sodium salicylate, but no salicylic acid; sodium benzoate, but no benzoin; the compound benzo-salicyl. sod. could not be determined, but a mixture of sodium benzoate and sodium salicylate was demonstrable.50 Later Puckner pointed out51 that while such a combination as benzo-salicylate of sodium is known, it could not possibly be present in Glyco-Thymoline because the alkalinity of this mixture would decompose the compound. As the manufacturers evidently recognize that false formulas can no longer be made plausible, only vague statements as to the composition are now offered.
Two points should be noted in this connection:
1. Glyco-Thymoline conflicts with Rule 1 of the Council on Pharmacy and Chemistry, which declares that no article shall be accepted for inclusion with New and Nonofficial Remedies unless its composition be furnished.
2. No matter which published formula be accepted as correct, it is at best a weak antiseptic. The antiseptic ingredients present cannot act as germicides in the strength in which they are used, or in the alkaline solution on the unique virtues of which the circular lays so much stress (“the one antiseptic solution based on the alkalinity and saline strength of normal blood”). As shown by Verhoeff and Ellis,52 undiluted Glyco-Thymoline does not kill Staphylococcus aureus in four hours. It evidently, they say, “could have but little if any greater therapeutic value than sterile salt solution.”
DANGEROUS RECOMMENDATIONS
In Diphtheria: “Case-reports” in the advertising pamphlet describe the treatment of diphtheria with Glyco-Thymoline. It is surely unnecessary to point out that, whatever the possible merits of Glyco-Thymoline or its ingredients, they are utterly irrelevant here. But let a “case-report” be quoted:
“............., M.D., states: ‘I have many an interesting story of Glyco-Thymoline. I just finished up a family in which I was treating five cases of diphtheria—two of which presented diphtheritic membrane in nasal cavity. I decided not to use antitoxin in these cases. I used only the regular constitutional treatment and Glyco-Thymoline as a local antiseptic. I believe the Glyco-Thymoline worked wonders. My cases are all now in good health, with no after troubles. I think it an ideal antiseptic for every trouble in nose and throat.’”
Words of denunciation fall flat before the complacent self-revelation of the physician who “decided not to use antitoxin.” Surely if any other physicians have been misguided by this example, there must be many another “interesting story of Glyco-Thymoline” to tell—not to speak of other families that have been “finished up.”
In Ophthalmia Neonatorum: We gain from the same advertising pamphlet the following information on prophylaxis:
“The treatment in the past has consisted of instillation of silver nitrate, boric acid, salts of mercury, nucleinated salts of silver and mercury, etc. ..., but these agents have proved to be failures as an absolute specific.... During the past few months experiments have demonstrated the efficacy of a new mode of treatment that is both rapid and thorough, and devoid of danger in its use. This method consists of thorough irrigation of the eyes in fully developed cases of the disease with a solution of Glyco-Thymoline.”
At the very best, Glyco-Thymoline is a weak, a very weak antiseptic—not a germicide. To assert, or even to imply, that it is superior to the well-tried and efficacious Credé method of treatment for ophthalmia in the new-born is cruelly wicked.
In Consumption: This from the same pamphlet:
“The indifference of phthisical patients toward the maintenance of sanitary conditions is proverbial.
“That the environment of all such patients should be absolutely aseptic both for the good of the patient and for the welfare of those who are brought into contact with them is a well-established fact.”
It is, instead, an ill-established fiction. To talk about maintaining an “absolutely aseptic” environment under any practical conditions of daily life is to talk nonsense; the thing is impossible, even were it desirable. But, not to be distracted from the main issue by subsidiary falsehoods:
“In Glyco-Thymoline we have an antiseptic which, while mild and soothing ... is still a powerful agent for promoting asepsis, and a potent factor in the maintenance of sanitary environment in the sick room.
“Inhaled from a vaporizer or a fine spray atomizer, it will loosen the mucus in a marvelous manner and in a wonderfully short time, shorten the paroxysms of coughing to a marked degree, at the same time reducing the danger of contagion to a minimum.”
And this is the preparation, it will be remembered—this “powerful agent for promoting asepsis”—which, when applied in undiluted strength, was unable to kill Staphylococcus aureus in four hours!
It would be a waste of space to cite further evidence to show that the advertising of Glyco-Thymoline is in conflict with Rule 6 of the Council, which provides that no article shall be accepted “concerning which the manufacturer or his agents make unwarranted, exaggerated or misleading statements as to the therapeutic value.” It is further in conflict with Rule 4, against indirect advertising by means of the label, package or circular accompanying the package.
CLAIMS TO ORIGINALITY
Hatcher and Wilbert have pointed out that from a therapeutic point of view the composition of Glyco-Thymoline is based on the formula of the widely known “compound solution of sodium borate,” or Dobell’s solution. For the phenol in the original, a mixture of antiseptic acids and volatile oils has been substituted.
SUMMARY
Glyco-Thymoline is in conflict with Rules 1 and 4 of the Council on Pharmacy and Chemistry, because of its indefinite composition and the method of advertising it to the public. It is in conflict with Rules 10, 6 and 8, in that it is an unscientific, shot-gun mixture sold under unwarranted therapeutic claims and under a misleading name. Altogether it must be considered an unscientific heterogeneous mixture, in which a few valuable ingredients are hidden by the useless shrubbery which surrounds them.—(From The Journal A. M. A., Oct. 10, 1914.)
GLYCOZONE
Report of the Council on Pharmacy and Chemistry, with Comments
A number of specimens of Glycozone purchased in the open market were examined by a subcommittee. The product was found to be a mixture of approximately 90 per cent. glycerin, 5 per cent. glyceric acid, a small amount of water and traces of undetermined matter. The absence of hydrogen peroxid or other peroxids was demonstrated.
In its report the subcommittee held that: (1) The name of the product is objectionable and misleading; (2) the statements made in regard to its composition also are misleading; (3) the claims for its therapeutic value are exaggerated and untrue. Since the objectionable statements have been given wide publicity among physicians as well as among the laity, the subcommittee recommended that attention should be called to the matter in The Journal.
The report of the subcommittee was adopted by the Council.
W. A. Puckner, Secretary.
Comment:—While the name gives the impression that ozone or some similar substance is an essential constituent of Glycozone, or else that the preparation is a compound or derivative of ozone, and while the earlier advertisements stated that Glycozone was “glycerine combined with ozone,” the examination made by the Council shows that there is no basis of fact for such inferences.
In the advertisements the “chemical formula” C3H6O4 + C3H8O3 appears under the word Glycozone. From the Council’s report it is apparent that C3H6O4 stands for glyceric acid and the C3H8O3 for glycerin, and that these, therefore, indicate the chief constituents of Glycozone. Few, doubtless, would recognize the first formula as being that of a glyceric acid, a product practically unknown in medicine, nor would many associate glycerin with the second. The evident intent is that physicians should accept the formula as a badge of respectability.
According to the label on a trade package, Glycozone is “prepared only by Charles Marchand, chemist,” and is {“}an absolute cure for dyspepsia, catarrh of the stomach, ulcer of the stomach, heart-burn,” etc. The label further reads: “This remedy is positively harmless. By destroying the microbian element in the stomach it prevents the fermentation of food and stimulates digestion.” An examination of medical literature fails to reveal any basis for these claims. While glycerin possesses some antiseptic properties, it is evident that the glycerin which constitutes 90 per cent. of this remedy is not the agent that gives the glycozone such phenomenal virtues. General literature contains nothing that would indicate that glyceric acid in any quantity, with or without glycerin, possesses these miraculous properties. If by “microbian element” is meant microbic organisms, the statement is without foundation. There is nothing in this product which possesses these bactericidal powers.
The circular which accompanied a trade package envelops the preparation in an air of mystery. Derivation from, or close relation to, ozone and hydrogen peroxid is vaguely hinted at, without definite assertion. Thus, the chief therapeutic properties of glycozone and hydrozone are compared as follows:
“Hydrozone instantly destroys the microbian element, leaving the tissues beneath in a healthy condition.”
“Glycozone acts more slowly, but not less certain as a stimulant to healthy granulations.”
Much-reduced photographic reproduction of one of the older Glycozone advertisements. Attention is directed to the false claim that this nostrum is “glycerin combined with ozone.”
There is no similarity between the action of hydrozone, which is a hydrogen peroxid preparation, and glycozone, which consists of a mixture of glycerin and glyceric acid. The representation is false and misleading. The following statement, also, is an unwarranted exaggeration of the facts:
“As an internal medication in fermentation of food, catarrhal and inflammatory conditions of the stomach, and intestinal disorders, its action is prompt and effective, giving immediate relief to the patient.”
The following is another illustration of the vague statements made: After asserting that Glycozone is hygroscopic and that it will deteriorate by absorption of water unless securely corked, it is stated that “Its healing properties increase with age.” Whatever mysterious ingredient there may be present in this mixture to justify the statement that the healing properties increase with age can only be conjectured. To humbug the patient further, the circular advises him to use only a “silver, glass or hard rubber spoon.”—(From the Journal A. M. A., June 5, 1909.)
GARDNER’S SYRUP OF HYDRIODIC ACID
Report to the Council on Pharmacy and Chemistry
The following report on Gardner’s Syrup of Hydriodic Acid was submitted to the Council by a subcommittee:
This product was first taken under consideration in February, 1906. Reference to several committees was necessary, on account of the peculiar claims for the pharmaceutical, and especially the therapeutic, superiority of this preparation. At this time, as the Council did not have the necessary facilities for investigating therapeutic claims, the product was approved by the Council.
Since this time, however, the manufacturers have laid especial stress in their advertisements on some highly improbable claims, stating, for instance, that this Syrup of Hydriodic Acid possesses “all the advantages, with none of the objectionable symptoms caused by potassium iodid, or other forms of iodin medication.” To one with even an elementary knowledge of chemistry, the absurdity of this statement should be evident. The alkaline reaction of the tissues makes it impossible that hydriodic acid should persist as such in the body. In fact, the iodin must circulate in precisely the same form, whether administered originally as potassium iodid or as hydrogen iodid. The qualitative identity of the therapeutic actions is further proof of this fact, were such needed.
Since the most important objectionable symptoms of iodid medication arise after the absorption of the drugs, and since hydrogen iodid is conceded to be readily absorbed, it is evident that these symptoms must be equally liable to occur with hydrogen iodid as with potassium iodid, provided that equivalent doses of iodin are administered. An apparent difference in clinical results would arise if one drug were habitually given in smaller doses than the other. Since, however, the iodin is present in the body in precisely the same form, whether it is administered as a hydrogen iodid or potassium iodid, it is evident that a given degree of therapeutic effect would correspond to an identical tendency to iodism, whichever drug was used. If, as appears to be the case, the use of hydriodic acid is commonly restricted to those cases in which only minimal doses of iodin are required, the relative infrequency, or even absence of symptoms with such doses would not prove that the drug itself is less apt to cause them than is the potassium salt.
These facts are in reality self-evident; but since the Council now has proper facilities for obtaining the views and experiences of clinicians, it voted to submit the statement in question to its staff of clinical consultants, and to be guided by their advice.
OPINIONS OF THE CLINICAL STAFF
The following is an epitome of the replies of the eleven members of this staff who had used the article or who expressed an opinion to the questions sent out by the Council:
1. Query: “Do you think it possible that such a preparation could be devoid of the usual effects of iodin preparations?”
Eight reply that they consider this, a priori, impossible; three stamp the statement as highly improbable, but do not care to say that it would be impossible. One of the correspondents remarks: “While distinctly taking the position that under many conditions we must accept clinical results which we find not explainable by our theoretical knowledge, where the conditions are so simple as in this case and where we know that the iodin, whether administered as hydrogen iodid or potassium iodid, must behave in the same way, after absorption, I believe that no properly educated and correct thinking physician can or will, after due consideration, fail to reject the claims of superiority made by the proprietors of this preparation.”
2. Query: “Would you consider it necessary to make clinical experiments to settle this question?”
Seven of the correspondents consider this superfluous; four of these have had some experience with the article. Four, who have not used this product, consider a clinical test advisable. Under Query 3 we discuss the results of such tests.
3. Query: “When using Gardner’s Syrup of Hydriodic Acid, have you ever noticed from it any of the objectionable effects of iodin preparations?”
Six of the correspondents have not used it, or are uncertain whether or not they used the product made by Gardner. One correspondent remarks: “Never used it. Repelled by claims of superiority which exaggerate disadvantages of potassium iodid and overlook the small amount of iodin used in the preparation advertised.” The five clinicians who have prescribed the preparation report as follows: 1. Objectionable iodin effects in two cases, both patients being intolerant of all iodin preparations. 2. Has only prescribed it once or twice, but thinks he has seen iodism in one case, some years ago; does not recall clearly. 3. No; but has used this make very little, and then always in very small but continued doses. 4. No, always used it in small doses. 5. Yes, several cases in children; typical coryza, etc., with doses of three drams three times a day.
Conclusions: It appears that typical iodism occurred in several cases, after doses corresponding to 10 grains or less of potassium iodid per day, and this is a rather limited clinical material. Objectionable iodin effects are, therefore, not uncommon. Several correspondents remark that the relative infrequency of iodism is easily explainable by the fact that syrup is rarely employed in conditions which demand an active iodin medication and that it is, therefore, always taken in small doses. In fact, the main if not the only point of superiority of the syrup appears to be in its flavor.
These clinical opinions and experiences, therefore, are in complete agreement with the judgment of the committee, namely, that the therapeutic claims made by the manufacturers for this article are exaggerated and misleading.
OTHER MISSTATEMENTS
The above is by no means the only misstatement in the printed matter issued by this manufacturer. In the publication, “The Applications of Iodin,” issued in 1907, there occur the following misleading statements which, since they refer to plainly chemical facts, did not require submission to the clinical staff:
That the administration of potassium iodid after meals greatly impairs its physiologic action “by its chemical union with the various food products” (page 19). So far as the committee knows, potassium iodid does not combine with the food products in the stomach.
“Iodid of potassium, having an alkaline reaction, neutralizes the hydrochloric acid in the gastric secretions, causing indigestion, loss of appetite and depression” (page 19). The United States Pharmacopeia states, under Potassii Iodidum: “Its aqueous solution is neutral or has a slightly alkaline reaction on litmus paper.” The slight occasional alkalinity would be physiologically insignificant, and it is absurd to claim that this alkalinity causes “indigestion, loss of appetite and depression.”
“The dose of iodid of iron is so small that the amount of iodin contained therein is of little advantage” (page 19). As a matter of fact, the pharmacopeial average dose (1 c.c.) of the Syrup of Iodid of Iron contains as much iodin (0.85 grains) as a teaspoonful of Gardner’s Syrup of Hydriodic Acid (0.83 grains).
“In hydriodic Acid the iodin is in combination with hydrogen, one of the elements of the natural secretions of the body, and is, therefore, in physiologic harmony” (page 21). No comment is needed.
It is implied elsewhere (page 29) that potassium iodid decomposes more readily, with the liberation of iodin, than does hydrogen iodid. This is contrary to the prevailing opinion, and would require definite evidence before it could be accepted. It is also stated the large doses of potassium iodid in syphilis are necessary, because the gastric decomposition prevents complete absorption. This is certainly untrue, for potassium iodid is absorbed almost quantitatively.
These, and numerous other misstatements, constitute violations of Rule 6; and it is, therefore, recommended that Gardner’s Syrup of Hydriodic Acid be removed from the list of remedies approved by the Council; it is further recommended that this report be published.
The Council postponed final action on the report, pending its submission to R. W. Gardner. This having been done, and the reply of Mr. Gardner submitted to the Council, the above report was adopted and ordered published.
W. A. Puckner, Secretary.
(From The Journal A. M. A., Nov. 14, 1908.)
HYPEROL
Report of the Council on Pharmacy and Chemistry
The Purdue Frederick Company, exploiters of Gray’s Glycerine Tonic, have recently been advertising to the medical profession a nostrum called Hyperol. The following report to the Council, by the referee, was adopted and its publication authorized.
W. A. Puckner, Secretary.
According to the label, Hyperol is “A Utero-Ovarian Corrective and Tonic.” The circular accompanying the trade package states that it is:
“Indicated in all functional diseases of women such as: Amenorrhea, Dysmenorrhea, Menorrhagia, Metrorrhagia, Subinvolution, and in all conditions requiring a utero-ovarian corrective and tonic.”
From another circular we learn that:
“Hyperol is a combination of Hydrastine, Aloin, Iron, Apiol and Ergotin. Its components to a certain extent will indicate its action, but the therapeutic effects of each ingredient seem to be augmented to an unusual degree by use in this particular combination. The proportions of each have been determined by extensive clinical experimentation, and the formula seems to be exactly balanced to produce the best therapeutic effects in all derangements of the utero-ovarian functions.”
This “formula” is not very enlightening and a physician who wrote for further details was told that Hyperol contained:
Hydrastin
1⁄40 gr.Aloin
1⁄12 gr.Iron salts
3 gr.Apiol (Special)
3♏
Ergotin
1 gr.And excipients.
If this is correct, then, so far as its active ingredients are concerned, Hyperol is but a mixture of well-known drugs, having contradictory properties. According to the claims in the circular quoted above, it is useful both in amenorrhea and in menorrhagia. The mixture is as unscientific as it is unnecessary. It cannot be adapted to any individual case; when ergot is indicated, apiol would naturally be contra-indicated; if aloes is appropriate, hydrastis may defeat the object sought. It is unnecessary because no intelligent physician would prescribe such a combination of drugs in any given case. The claims are exaggerated, improbable and foolish. Hyperol conflicts with the following rules of the Council:
Rule 4, in that statements on the label and in the circular enclosed with the trade package advertise it to the public in the treatment of diseases.
Rule 6, in that exaggerated and unwarranted claims are made for its therapeutic qualities.
Rule 8, in that the name of this pharmaceutical mixture fails to disclose the potent constituents.
Rule 10, in that it is unscientific.
It is recommended that publication of this report be authorized to call attention to the unscientific character of such complex mixtures.
[Editor’s Note: Hyperol is advertised in American Medicine and the St. Paul Medical Journal.]—(From The Journal A. M. A., April 18, 1914.)
INGLUVIN
Report of the Council on Pharmacy and Chemistry
A subcommittee of the Council reported that unwarranted claims and misrepresentation were made for Ingluvin by its manufacturers, William R. Warner & Co., recommended that the preparation be refused recognition and that the report be submitted to Warner & Co. for action.
The report was submitted to the firm, and after waiting one month and no acknowledgement or reply having been received, the Council directed its publication. It is as follows:
REPORT ON INGLUVIN
Ingluvin is manufactured by W. R. Warner & Co., chemists, Philadelphia, Pa. The printed matter contains numerous claims and representations of which the following are specimens:
“A positive specific for indigestion, dyspepsia and the most effective remedy in obstinate cases of vomiting of gestation.... A specific for vomiting in pregnancy in doses of from 10 to 20 grains, and a potent and reliable remedy for the cure of marasmus, cholera infantum, indigestion, dyspepsia, and sick stomach caused from debility of that organ. It is superior to the pepsin preparations since it acts with more certainty, and effects cures where they fail.... The natural glycocholic acid in Ingluvin is the active principle and the most efficient agent in the treatment of all stomachic and enteric disorders.”
Two samples were purchased at different times in the open market and on examination found to consist essentially of powdered meat fiber mixed with what appeared to {be} a membranous tissue resembling the lining of a gizzard. Both samples on being tested by the method prescribed by the U. S. Pharmacopeia for estimating the strength of pepsin were found to possess little, if any, proteolytic activity. In order to determine whether or not the lining of a fowl’s gizzard possesses proteolytic action, a fresh gizzard was secured, the lining washed slightly with water, then removed and on using one-half of same in place of pepsin as prescribed by the Pharmacopeial method, it was found to digest 10 grams of albumin within the time limit. Pepsin, when properly kept, does not lose its strength to any material extent.
A careful examination was made for the presence of glycocholic acid, claimed to be the active principle of Ingluvin, but its presence could not be established. Furthermore, the anatomic relations of the fowl are such as to preclude its presence.
The above shows that Ingluvin does not possess nearly as much proteolytic activity as ordinary saccharated pepsin recognized by the 1880 Pharmacopeia, which was prepared on the basis of digesting 300 times its weight of egg albumin. Inasmuch as no glycocholic acid is present in Ingluvin, it would seem that saccharated pepsin would be far more efficacious in treating the abnormal conditions for which Ingluvin is recommended in the advertising circulars. Furthermore, the claims made for the preparation are grossly extravagant.
A communication from Warner & Co. has been received since the above report was adopted, in which it is stated: “The reason that previous letter was not replied to was because we were desirous of securing all the information possible on the subject. Since that time we have made considerable research and also made laboratory investigation, and are enclosing the accumulated data with diagram of a part of the alimentary canal showing the esophagus, crop and gizzard.”
Much of the other matter submitted is immaterial. The following, so far as it means anything, seems to confirm the correctness of the report of the Council’s referee that Ingluvin is practically devoid of proteolytic activity: “... the therapeutic activity must be due to the bitter property, rather than any proteolytic activity, and it probably increases, thereby, the functional activity of the stomach, by which the normal digestive process is increased. Ingluvin in a 0.4 per cent. hydrochloric acid solution at 37 to 40 C. or if mixed with an aqueous solution of pepsin under the same conditions possesses an acrid, bitter taste and increases the secretion of the saliva and this is practically the same condition as when in the stomach, it no doubt stimulates the depressed mucosa peptic glands and increases gastric solution.”
W. A. Puckner, Secretary.
COMMENTS
The fallacies attending the use of digestive ferments in most stomach diseases have been previously noted in The Journal.53 In most digestive disorders a deficiency of the digestive ferment has not been proved. In cases in which pepsin is lacking, its administration is valueless unless it is combined with large doses of hydrochloric acid, and it is doubtful whether this combination is either necessary or conspicuously useful. There is, however, something so alluring about medication by digestive ferments which are assumed to supply a physiologic need, that since their discovery they have formed a fertile field for the activity of the manufacturer of proprietaries. As by scientific laboratory tests, it is possible to determine whether a given preparation has digestive power, the manufacturers of Ingluvin avoid this point by claiming that the remedy acts, not on the food, but on the stomach itself. That remedies may exist which act as stimulants to the digestive secretions can not be denied, although at the present time this power has not been satisfactorily demonstrated. The proprietors of Ingluvin, finding that proteolytic activity is not to be attributed to this preparation of chickens’ gizzards, announce a new therapeutic fact in the claim that “the natural glycocholic acid in Ingluvin is the active principle and the most efficient agent in the treatment of all stomachic and enteric disorders. According to the report made to the Council there is no glycocholic acid in this preparation, nor is it possible, from the anatomic arrangements of the fowl’s digestive apparatus, for it to get there. By all the tests which can be applied to determine its value this preparation is of much less value in digestive disorders than saccharated pepsin, which was discontinued in the Pharmacopeia because of its inferiority to the other forms of the ferment.
The repudiation, by the manufacturers, of the more absurd claims made for Ingluvin, shows the need of maintaining an attitude of healthy skepticism toward the advertised therapeutic virtues of proprietary preparations. If a physician is disposed to use digestive ferments, he should give preference to the official preparations, and ferments from other sources should be required to stand the exact tests which demonstrate the worthlessness of so many preparations on the market.—(From The Journal A. M. A., July 11, 1908.)
INTESTINAL ANTISEPTIC W-A
Report of the Council on Pharmacy and Chemistry
The Council voted that Intestinal Antiseptic W-A be refused recognition, and that the publication of the following report be authorized.
W. A. Puckner, Secretary.
The Abbott Alkaloidal Company advertises “Intestinal Antiseptic W-A” as
48 Phillips, John: Prevalence of the Heroin Habit, The Journal A. M. A., Dec. 14. 1912, p. 2146.
49 Facts about Heroin, Current Comment, The Journal A. M. A., Dec. 21, 1912, p. 2262.
50 The Formula for Glyco-Thymoline, Pharmacology Department, The Journal A. M. A., Jan. 9, 1909, p. 147.
51 Puckner, W. A.: Rep. Chem. Lab., A. M. A., 1910, iii, 7.
52 Verhoeff, F. H., and Ellis, Edward Keith: The Bactericidal Values of Some Widely Advertised Antiseptics, The Journal A. M. A., June 29, 1907, p. 2175.
53 Feb. 2, 1907, p. 415, and Feb. 9, 1907, p. 521.
“... A scientifically blended and physiologically adjusted mixture, of the pure sulphocarbolates of calcium, sodium and zinc, grs. 5, with bismuth subsalicylate, gr. 1-4 and aromatics.”
This formula is in conflict with Rule 1 in that it does not state in what proportion the sulphocarbolates are present.
The name “Intestinal Antiseptic W-A” is in conflict with Rules 4 and 8, since it is therapeutically suggestive.
The preparation is in conflict with Rules 6 and 10, in that exaggerated claims are made for it, no evidence being submitted to prove the superior value of the mixture.
The most serious of these conflicts consists in the exaggerated and misleading therapeutic claims. The advertisements say:
“This combination has no equal as an antiseptic and inhibitive agent in typhoid fever, diarrhea, dysentery,” etc.
“Numerous cleverly devised and scientifically constructed intestinal antiseptics have been introduced to the profession, but not one of them has ever rivaled for one moment these salts in popularity.”
“... we are convinced that no small share of the credit for the reduction of the death rate in infantile diarrheas is due to the widespread application of this general method of treatment, associated of course with the calomel clean-out and the regulation of diet, now known to be essential.”
“But the use of the sulphocarbolates is not restricted to diseases of the alimentary canal, although in the summer diarrheas, gastric fermentation, intestinal indigestion, typhoid fever, dysentery—indeed in all alimentary disturbances—it is the one essential remedy. It is also indicated in practically all infectious diseases.”
“Typhoid Fever (in this disease the W-A Intestinal Antiseptic is of great value; used early, with the proper synergistic cleanout, it will often cut short the disease).”
These extreme claims exceed the limits of permissible optimism, unless they are supported by strong dependable evidence. They contrast sharply with the low esteem in which the phenolsulphonates (sulphocarbolates) are generally held. To accept these claims, and to justify encouraging physicians to rely on them, it would be necessary to establish:
First, that feasible concentrations have a distinct antiseptic action on cultures of intestinal bacteria. This experiment could be easily made, but the claims do not seem to be based on evidence of this kind.
Second, that the preparation actually checks putrefaction in the intestines. There are several methods by which this proof may be attempted; but the claims do not appear to be based on evidence of this kind.
Third, that the preparation actually has a favorable influence on the progress of diseases. This sort of evidence is exposed to so many fallacies that it would have to be gathered very carefully and critically, duly discounting the effect of other treatment; for instance, by comparison with similar cases which do not receive this preparation. This is especially important; and yet we find directions to use this preparation in conjunction with active cathartic treatment, which in itself has considerable influence on the conditions for which this preparation is recommended. No evidence of this kind is presented.
The testimonials contained in the advertisements cannot be considered as serious evidence. None present any indication of accurate record or proper control of conditions, or of the performance of control observations. They are superficial impressions, to which little or no weight can be attached.
It is recommended that Intestinal Antiseptic W-A be considered ineligible for New and Nonofficial Remedies.—(From The Journal A. M. A., Dec. 19, 1914.)
BANNERMAN’S INTRAVENOUS SOLUTION
Report of the Council on Pharmacy and Chemistry
Bannerman’s Intravenous Solution (Wm. Bannerman and Co., Chicago) was refused recognition because vague, indefinite and misleading statements were made regarding its composition, because it was recommended for anemia, tuberculosis and syphilis under grossly exaggerated and unwarranted claims and because the intravenous injection of complex and indefinite mixtures is unscientific and dangerous. Notice of the action of the Council having been sent to the Bannerman Company, the firm submitted a revised statement of composition and also a revised advertising circular.
The claim is made that Bannerman’s Intravenous Solution “is a compound of only the purest and proven efficient U. S. P. drugs.” According to the latest statement:
Each 10 c.c. of Bannerman’s Solution contains:
Hydrargyri Albuminas Mercury Content
11-9
Gr. or
0.075 Gm.
Ferri Albuminas Iron Content
41-4
Grs. or
0.286 Gm.
Sodii Chloridum
61-5
Grs. or
0.412 Gm.
Calcii Salicylicum
4Grs. or
0.26 Gm.
Guaiacol
4Grs. or
0.26 Gm.
Creosote (Beechwood)
5Grs. or
0.32 Gm.
The solvent is said to be distilled water.
The formula is unsatisfactory in several particulars. The stated amounts of some of the ingredients are in excess of their solubility in water; the nature and amount of albumin contained in the “Hydrargyri Albuminas” and “Ferri Albuminas” are not given; the claim that the solution contains only U. S. P. drugs is not true. But the main objection to the preparation is its unscientific character and the unwarranted therapeutic claims made for it.
Even though a patient had all three diseases, syphilis, tuberculosis and anemia, it would be most irrational to use a shotgun prescription, containing, in fixed unvarying proportions, mercury for the syphilis, iron for the anemia and germicides for the tuberculosis. In syphilis the mercury-content of Bannerman’s Solution is inadequate; in anemia the intravenous administration of iron is unwarranted, and in tuberculosis there is no evidence that the injection of bactericides is efficient.
Exception must be taken, moreover, to the statement that “its use is absolutely safe.” The danger of anaphylaxis from repeated injections of albuminates cannot be disregarded, and as J. F. Anderson, director of the Hygienic Laboratory, has pointed out54 we know little of the secondary or remote effects of the intravenous injection of toxic substances; some of them probably do permanent harm.
Such claims as the following require no comment:
“It builds up and increases the hemoglobin in the blood.
“It increases the number of red blood corpuscles.
“It regulates the white cells.
“It stimulates cell growth; therefore, it is reconstructive.
“It is a powerful antiseptic.
“It is useful in any septic condition.”
In view of the facts given, the Council again refused recognition to Bannerman’s Intravenous Solution.—(From The Journal A. M. A., Jan. 2, 1915.)
IODALIA[O]
Abstract of Report of the Council on Pharmacy and Chemistry
Iodalia is sold by Geo. J. Wallau, Inc., with the claim that because of the peculiar combination in which it contains iodin it is a valuable and efficient substitute for iodids. The preparation was examined in the Chemical Laboratory of the American Medical Association, which reported to the Council that, contrary to claim, iodin in the form present in Iodalia would, when administered, act like an ordinary iodid. Further the proportion of iodin present was so small that to administer the equivalent of 20 grains of potassium iodid it would be necessary to give the contents of a one-dollar bottle of Iodalia. In view of this report it is evident that the claim that Iodalia is “always well tolerated” and that it cannot produce “symptoms of iodism” is true only because of the small percentage of iodin it contains. The claims made in the advertising matter, that Iodalia is an efficient iodin medication in the treatment of syphilis, that it is a suitable substitute for cod-liver oil and that it may be used in anemia, dysmenorrhea, dyspepsia, malaria and diseases of the heart, are entirely unwarranted.
Iodalia is exploited in a way to suggest its use to the public for a host of diseases. Particularly reprehensible are the recommendations contained in a circular which accompanies the trade package that Iodalia:
“... offers the same protection against grippe, bronchitis, pneumonia, tuberculosis, pleurisy and other infectious diseases that vaccine does against small pox ...”
“It is also the best preventive against the slight infections and ailments to which debilitated and delicate children are subject.”
The Council voted that Iodalia be refused recognition.—(From The Journal A. M. A., Dec. 12, 1914.)
IODEX
Report of the Council on Pharmacy and Chemistry
Iodex is manufactured by Menley and James, Ltd., New York. It is advertised as
“... an embodiment of vaporized iodin in an organic base, reduced and standardized at 5 per cent. by incorporation with a refined petroleum product.”
The advertising conveys the impression that the effects of free iodin are to be obtained from the preparation; it is said to contain “5 per cent. Therapeutically Free Iodine,” and to do
“... everything the doctor expects of FREE iodin employed by inunction, without one physical or therapeutic drawback.”
The statements are also made that the preparation “neither stains, irritates, blisters or cracks the skin,” and that “thirty minutes after inunction iodin can be found in the urine.”
The following report of an examination made by the Chemical Laboratory of the American Medical Association has been submitted to the Council:
“Iodex is dark green, practically black. The green color is apparent when the ointment is rubbed on the skin, but disappears on continued rubbing. This nonstaining property is explained by the results of a test for free iodin, made on five specimens, four of which yielded only minute traces of free iodin, while the fifth yielded none. Of course, the statements that Iodex is an ‘Effective Free Iodin Application Without Drawbacks’ and also a means of ‘Really Efficient External Iodine Therapy Without Stain or Irritation’ contradict each other. Free iodin cannot be present in a sufficient quantity to be therapeutically efficient in any application which does not stain or irritate the skin.
“The total iodin content of the five specimens was found to be 2.63 per cent.—a little over one-half of the content claimed.
“Absorption and excretion experiments were performed to test the claim that ‘thirty minutes after inunction iodin can be found in the urine.’ In several subjects, from 1 to 2 gm. of Iodex was rubbed on the skin of the forearms, and the urine, for periods varying from seven to seventy-two hours, was collected and tested for iodin. In all of the tests the results were negative.”
Iodex is advertised as beneficial in muscular soreness, sprains, sciatica, neuritis, chronic rheumatism, enlarged glands, orchitis, epididymitis, gout, burns and dermatomycoses. It is also said to be “Indicated in Glandular Enlargements, Inflammatory Conditions, Various Joint Diseases, Rheumatism, Skin Diseases, Chilblains, etc., etc.”
To sum up:
1. As shown in the foregoing laboratory report, the composition is incorrectly stated, for the actual iodin content is only about half of that claimed.
2. It is not true that the action of Iodex is essentially that of free iodin, which is the impression conveyed by the advertising.
3. The assertion made in the advertising, that iodin may be found in the urine shortly after Iodex has been rubbed on the skin, has been experimentally disproved.
In view of these findings, the Council voted that Iodex be refused recognition for conflict with Rules 1, 4 and 6.—(From The Journal A. M. A., June 19, 1915.)
IODIA
Report of the Council on Pharmacy and Chemistry
The following report on Iodia was adopted by the Council and its publication authorized.
W. A. Puckner, Secretary.
Iodia is put on the market by Battle and Company, under the claim that it contains potassium iodid in combination with iron phosphate and vegetable “principles.” It is extravagantly recommended for use in many and varied conditions. For instance, it is “an unexcelled altero-reconstructive,” “almost a specific” in eczema and rheumatism and “a highly efficient form of iodin,” which will not produce iodism!
The therapeutic effects of iodids result from a chemical transformation by which molecular iodin is set free in the tissues, thus producing a mild degree of iodism. It follows, then, that a preparation which cannot give rise to the symptoms of iodism cannot be expected to produce the therapeutic effects of the iodids. The claim that Iodia is therapeutically efficient without producing iodism therefore justifies suspicion, to put it mildly.
In view of the exaggerated tone of the advertising, together with the fact that a report from the Chemical Laboratory of the American Medical Association showed marked discrepancies between the formula and the composition of Iodia, it seemed desirable to investigate this product. The report of the laboratory, which is given below, shows conflict with Rule 1 (secrecy of composition) and with Rule 2 (false claims of standardization). A discussion of the claims made for Iodia follows the report.
LABORATORY REPORT
The composition of Iodia is given thus:
“Formula.—Iodia is a combination of active principles obtained from the green roots of Stillingia, Helonias, Saxifraga, Menispermum and aromatics. Each fluid drachm also contains two and one-half grains Iod.-Potas. and one and one-half grains Phos.-Iron.”
We are told that:
“Its several ingredients are selected with scrupulous care, and the most exacting methods are constantly employed to insure absolute uniformity and maximum therapeutic potency.”
This “formula” is an absurdity: First, the amounts of the “active principles” of the plants named are not given; second, these “principles,” with the possible exception of menispermum alkaloids, have not been isolated; and, third, ferric phosphate and potassium iodid are incompatible! Incidentally, there are no methods whereby it is possible to secure “absolute uniformity” of a mixture such as Iodia is claimed to be.
Qualitative tests demonstrated the absence of iron and the absence of all but traces of phosphorus compounds (0.015 gm. phosphorus per 100 c.c.). Minute traces of alkaloids, possibly from menispermum, were found (that amount being about 0.004 gm. per hundred c.c. of the preparation). Therapeutically this quantity is entirely negligible. Determinations of iodid demonstrated the presence of only about 60 per cent. of the amount of potassium iodid claimed. The “formula” for Iodia is false and misleading.55
DANGEROUS RECOMMENDATIONS
One of the Iodia labels reads:
“Indications.—Syphilitic, scrofulous and cutaneous diseases, dysmenorrhea, menorrhagia, leucorrhea, amenorrhea, impaired vitality, habitual abortion and general uterine debility.”
Such recommendations are likely to lead to self-drugging in conditions that are not only dangerous to the individual but also a menace to the community. The preparation thus conflicts with Rule 4 of the Council. After admitting the need of efficient iodid medication in certain stages of syphilis and after exaggerating the frequence and severity of symptoms of iodism, an advertising circular entitled “Practical Therapeutics” asserts:
“Iodia then is the preparation of iodid of potassium to be preferred whenever it requires to be administered in large doses or for prolonged periods of time ...
“Not only does the association of the iodid of potassium with the vegetable alteratives offer a measure of protection against iodism but the latter exert depurative effects on their own account ...”
It is generally accepted that in certain stages of syphilis the only hope of success lies in efficient iodin medication. The exploiters of Iodia state that a dose of the nostrum contains 21⁄2 grains of potassium iodid; actually it contains only 11⁄2 grains. To urge physicians and the public to depend on this product for efficient iodid medication constitutes an unwarranted therapeutic exaggeration (Rule 6) which approaches criminality. The reason Iodia does not produce iodism is that, in the doses recommended, the iodin action is extremely feeble.
Likening the human body to a factory and discussing the “break downs” which are likely to occur, a circular entitled “Always Trustworthy” says:
“When administered in proper dosage, Iodia stimulates organic functions, promotes the elimination of waste products, and re-establishes metabolic activity. It increases the solvent properties of the blood, and arrests abnormal tissue metamorphosis. In other words, it lends material assistance to weakened cells and curbs those unduly active. Iodia, obviously, has a wide range of indications. It has been most generally and successfully employed, however, in Syphilitic, Scrofulous and Cutaneous Diseases, Rheumatic and Gouty Ailments, Dysmenorrhea, Menorrhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortion and General Uterine Debility, and wherever a reliable altero-reconstructive is required.”
These recommendations show that in addition to the objections already given, this nostrum is an unscientific shot-gun mixture. This brings it in conflict with Rule 10 (unscientific articles inimical to the medical profession and the public).
It is recommended that Iodia be refused recognition.—(From The Journal A. M. A., Nov. 21, 1914.)
BURNHAM’S SOLUBLE IODINE[P]
Report of the Council on Pharmacy and Chemistry
The Council has authorized publication of the following report on Burnham’s Soluble Iodine.
W. A. Puckner, Secretary.
Burnham’s Soluble Iodine is offered to the medical profession by the Burnham Soluble Iodine Company, Auburndale, Mass., under the claim that by
“... a new process hitherto unknown to chemistry,... Iodine is converted into a soluble article—soluble in water and soluble in gastric secretions and in the tissues.”
Beyond this no statement as to the qualitative or quantitative chemical identity of Burnham’s Soluble Iodine is furnished; this secrecy, of course, has given the preparation a certain mysterious prestige among unthinking physicians.
Burnham’s Soluble Iodine was examined in the Chemical Laboratory of the American Medical Association some six years ago and was found to be an alcoholic solution of free iodin (approximately 3 gm. per hundred c.c.) and combined iodin in the form of iodid (equivalent to about 2 gm. of potassium iodid per hundred c.c.). Thus the total iodin content was somewhat less than half of that of the official Tincture of Iodin (Tr. Iodi), which contains 7 gm. of free iodin and 5 gm. of potassium iodid to each 100 c.c. The official tincture, diluted one-half, therefore, would be essentially equivalent to the Burnham preparation, both being miscible with water. The Burnham Soluble Iodine Company objected to the conclusions drawn, from this analysis, but admitted the correctness of the analysis itself.
Any one who gathered his first knowledge of the subject from the Burnham advertising might readily infer that no soluble iodin had been known prior to Burnham’s Soluble Iodine. This, of course, is not the case; the method of producing a solution of iodin by the use of an iodid has long been known.
The following statement is not only obviously untrue but also nonsensical:
“In all the history of iodin medication, covering a period of laboratory research of many years duration, every effort to produce a free iodin, prior to the evolution of Burnham’s Soluble Iodine, was attended by failure.”
The company lays stress on the assumed superiority over the iodids of a preparation containing free iodin. This assumption is based on a fallacy. Those who regard free iodin as superior to combined iodin forget that free iodin taken by the mouth is converted in the intestines, by the action of the alkaline intestinal secretions, into an iodid with a small amount of iodate, while administered intravenously (a procedure that, while advocated by the Burnham concern, is therapeutically indefensible), it enters into combination with the alkaline salts and proteins of the blood. The free iodin in Burnham’s Soluble Iodine must act in the system as an iodid, and the whole iodin content, to furnish a correct estimate of the value of the preparation, should be reckoned as an iodid.
Bearing this in mind, then, it is evident that the doses of Burnham’s Soluble Iodine recommended by the manufacturers are extremely small. They range from 20 minims (equivalent to 1 grain of potassium iodid) to 1⁄2 minim (equivalent to 1⁄40 grain of potassium iodid). From 5 to 20 minims (equivalent to about 1⁄4 to 1 grain of potassium iodid) is the dosage recommended for syphilis; from “1 to 3 minims [equivalent to from 1⁄20 to 3⁄20 grain of potassium iodid] three to six times daily” for typhoid and other intestinal diseases. No wonder the exploiters can say that this nostrum does not irritate the intestines, that it is “non-irritating to the weakest stomach” and that there is an “entire absence of toxic action from maximum doses”! Its alleged freedom from the irritating and untoward effects of ordinary iodids is due, not to any inherent superiority of the preparation, but to the insignificant amount of iodid present.
The preparation is advertised for use in an extremely wide range of diseases, in some of which iodid therapy is recognized as of value, while in others it is generally regarded as either worthless or harmful. Given orally or intravenously (the recklessness of the latter method should again be emphasized) Burnham’s Soluble Iodine is claimed to be of:
“... great utility as an internal antiseptic in tubercular affections ...”
Since, as previously explained, free iodin, when introduced into the body, enters into chemical combination before it has a chance to permeate the tissues, and since the alkali iodids possess very slight (in fact, for this purpose, negligible) antiseptic powers, it is evident that this claim is unfounded. So, for the same reason, is the claim that “as an intestinal antiseptic,” Burnham’s Soluble Iodine is:
“... efficient in Typhoid Fever, Enteritis and other intestinal diseases.”
It is recommended in exophthalmic goiter, notwithstanding that this condition is generally recognized as contraindicating the administration of iodids, which excite the action of the thyroid gland, and which therefore must be used with great circumspection. An especially indefensible recommendation is that 1⁄2 minim of Burnham’s Soluble Iodine (equivalent to 1⁄40 grain of potassium iodid) be administered every five minutes in “membranous croup”—diphtheria—until relief from dyspnea is obtained. But, of all the extravagant claims made for this preparation, perhaps the following is the most reprehensible:
“In the treatment of Phthisis, in its various forms, clinical evidence clearly indicates that the use of SOLUBLE IODINE affords the most potent method of treatment available. Dose—2 minims, increasing to 5 minims in four ounces water before meals.”
Remove the mystery and tell physicians that a dose of 1⁄10 or 1⁄4 of a grain of potassium iodid is “the most potent method of treatment available” in tuberculosis and the absurdity becomes self-evident. Nor is this the worst feature of the advice here offered. Iodin, by combining with the fatty acids of tuberculous tissues, promotes their autolysis and consequently their softening and breaking down. The products of this autolysis are carried by the lymphatics to healthy tissues and thus may spread the infection. Therefore the use of iodids in tuberculosis, even in small dosage, should not be undertaken lightly.
It is recommended that Burnham’s Soluble Iodine, a semi-secret preparation, exploited by means of extravagant and dangerous therapeutic claims, be held ineligible for admission to New and Nonofficial Remedies, and that this report be published.—(From The Journal A. M. A., May 15, 1915.)
IODOTONE[Q]
Abstract of Report of the Council on Pharmacy and Chemistry
Eimer and Amend, New York, who market Iodotone, state that it is a solution of hydrogen iodid (hydriodic acid) in glycerin, containing 1 grain of iodin to each fluid dram. The unwarranted assertion is made that Iodotone
“... will produce the constitutional effect of iodine in a shorter time than other preparations ...”
This cannot be true, for it is certain that, because of the alkaline reactions of the tissues, iodids, whether administered as hydrogen iodid or as alkali iodids, must circulate in precisely the same form and therefore exert the same therapeutic effects in precisely the same way.
Eimer and Amend further assert that the ordinary iodids may to advantage be replaced by Iodotone. The absurdity of this claim is apparent when it is considered that it will be necessary to administer nearly one fluidounce of glycerin to obtain an amount of Iodotone equivalent to a 10-grain dose of potassium iodid. The additional claim that Iodotone will not disturb the stomach or produce the usual disagreeable symptoms of iodism is evidently unwarranted, for it is generally conceded that symptoms of iodism can be avoided only at the risk of insufficient iodin medication. Because of these unwarranted and misleading claims and because the name Iodotone would tend toward the uncritical use of the preparation as a general tonic, the Council voted that Iodotone be refused recognition.—(From The Journal A. M. A., Dec. 12, 1914.)
IOSALINE
Report of the Council on Pharmacy and Chemistry
Iosaline is a rheumatism remedy for external application. In view of the misleading and unwarranted claims which are made for it, the Council voted that Iosaline be refused recognition and recommended publication of the Committee’s report which appears below.
W. A. Puckner, Secretary.
COMMITTEE’S REPORT
The following sweeping but rather indefinite claims are made for Iosaline.
“Iosaline is a penetrator and overcomes the objectionable escharotic properties of Iodine; it is readily absorbed and may be used without discomfort or discoloration.”
“The strong analgesic properties of Iosaline make it especially useful in controlling pain in cases of Neuralgia, Rheumatism, Gout, and Arthritis Deformans.”
As there are few, if any, known iodin compounds which are “readily absorbed” through the skin and which will not at the same time produce discoloration or discomfort, it was thought worth while to take up the examination of Iosaline. The results of this examination are reported by the Chemical Laboratory of the Association as follows:
Laboratory Report:—Iosaline is advertised by the Iosaline Company of New York, as a remedy for the treatment by external application, of rheumatism, gout, neuralgia, pneumonia and numerous other diseases. Concerning its composition the following statements are made:
“A transparent, non-staining gelatinoid of combined iodine with menthol and methyl salicylate.
“Alcohol 070. per cent.
“Chemical tests demonstrate the preparation to contain 5 per cent. of iodine.”
The placing of a cipher before the percentage figure for alcohol, though perhaps accidental and not meant to mislead, might cause a hasty or careless reader to understand 7 per cent. or .07 per cent., instead of 70 per cent., as the proportion of alcohol present.
The preparation examined was a very pale yellowish, translucent solid having a strong odor of methyl salicylate and a fainter odor of menthol. A package sold for 2 ounces contained 51.7 gm. Qualitative tests indicated the presence of alcohol, an iodid, menthol, methyl salicylate, potassium, sodium, combined fatty acids and a trace of glycerin. Thyroid extract was not found. Quantitative examination indicated the following approximate composition for Iosaline:
Alcohol (by weight)
48.05per cent.
Menthol
2.07per cent.
Methyl salicylate
10.25per cent.
Potassium iodid (4.25 per cent. iodin)
5.55per cent.
Soap
12.68per cent.
Glycerin
a traceWater and undetermined matter to make 100 per cent.
Iosaline, therefore, appears to be a solidified, watery-alcoholic solution of soap containing potassium iodid, menthol and methyl salicylate. Physiologic tests carried out by rubbing the preparation on the skin and afterward testing the saliva and the urine for an iodid indicated that none of the potassium iodid is absorbed. Since Iosaline is claimed to contain 70 per cent. of alcohol and 5 per cent. of iodin, the alcohol content is but 68.7 per cent. and the iodin content but 85 per cent. of the amounts claimed. The phrase “combined iodin” is evidently meant to mislead, and adds the element of mystery on which preparations of this class rely so largely.—(From The Journal A. M. A., March 15, 1913.)
NOURRY WINE[R][S]
Abstract of Report of the Council on Pharmacy and Chemistry
Nourry Wine (E. Fougera and Co., New York) is a proprietary iodin preparation said to contain 12 per cent. of alcohol and 11⁄2 grains of iodin in combination with tannin to the fluidounce. Experiments made in the A. M. A. Chemical Laboratory demonstrate that the iodin contained in Nourry Wine is present either in the form of iodid ions or in a form very readily yielding iodid ions and that therefore its action will be that of ordinary iodid. Yet a circular asserts:
“The Nourry Wine is the one preparation ... able to introduce into the organism the active metalloid liberated little by little from the organic combination....”
While Nourry Wine contains but an insignificant proportion of iodin, the circular claims that “Nourry Wine presents a high dose of iodin.” Further, the label on Nourry Wine and the circular which is wrapped with it suggests its use in a number of diseases in which iodin medication is considered of minor importance. These recommendations, bolstered up by testimonials from twelve to twenty-five years old, are likely to lead the public if not the medical profession to use this weak iodid wine where efficient treatment is called for. The attempt is made to give a further false value to Nourry Wine in the minds of those who prize everything that is foreign by the suggestion that it comes from France when in reality it is made in New York. In conclusion the Council held that, though the alcohol of the wine is the most potent constituent, the constant use in the advertising matter of the term “Nourry Wine,” unqualified by the adjective “Iodinated,” was mischievous as likely to lead to the thoughtless use of the preparation in cases unsuitable for iodin medication. The Council refused recognition to Nourry Wine.—(From The Journal A. M. A., Dec. 12, 1914.)
LABORDINE
A Report by the Council and Some Pertinent Comments Added Thereto
The following report was submitted to the Council on Pharmacy and Chemistry by the subcommittee which examined Labordine:
To the Council on Pharmacy and Chemistry:—Your subcommittee presents the following report on Labordine, sold by the Labordine Pharmacal Co., St. Louis.
Labordine is advertised to physicians as having the following composition:
Apium Graveolens (true active principle) “Process-Laborde”
353⁄8Gaultheria Fragrantissima (true active principle) “Process-Laborde”
251⁄8Acete Amide-Phenyle
151⁄8Quinina
11⁄8Benzoyl-Sulphyonic-Imide
231⁄4It is stated to be a “vegetable antipyretic”; that {“}it reduces temperature without heart depression,” and physicians are warned to “avoid acetanilid poisoning and danger from other coal-tar antipyretics.”
While the “formula” and the statement just quoted are sufficient evidence of the fraudulent character of the product, yet an abstract of the reports of the chemists who analyzed it is given further to demonstrate its character.
Taking the average of the reports of analyses, labordine contains:
Acetanilid
37.9Free salicylic acid
6.9Quinin
presentCorn starch
presentMilk sugar
34.7This report of analysis only makes apparent that Labordine is not what it is claimed to be. While it is claimed to contain 231⁄4 per cent. saccharin, this substance was not present, or mere traces only. While, in a disguised way, it is stated to contain 151⁄8 per cent. acetanilid, it contained nearly 40 per cent.
It is recommended that Labordine be not approved and that this report be published.
The recommendation of the subcommittee was adopted by the Council, and in accordance therewith the above report is published.
W. A. Puckner, Secretary.
COMMENTS
A concrete illustration of some general principles previously laid down is furnished by a nostrum too unimportant to be of any value, save to “point a moral and adorn a tale.”
About thirteen years ago Labordine was advertised under the name of Analgine-Labordine, “A purely vegetable product,” “a combination of the active principles of Camellia Thea, Apium Graveolens, saccharin and carbohydrates,” “Superior to Antipyrine, Phenacetine, Antifebrine, Acetanilid”—note the use of two names for the same thing—“or any of their imitations,” and “unexcelled by any coal-tar product or their compounds.” In 1894 the name was changed to Labordine, in order, as its owner stated, to prevent its being mistaken for a coal-tar product of similar name.
What its composition was at this time we do not know, since there is no guarantee of the permanence nor stability of nostrum formulas except “the honor and reputation of the manufacturers,” which, as investigation has shown, is not always unimpeachable. There has been nothing to prevent alteration of the formula, if the proprietors desired, with every change in the moon. But the name and the general tone of the advertising has been the same. The claim of superiority over coal-tar products has been constantly made.
As to the present conditions, a circular enclosed with a sample of Labordine, recently sent from the St. Louis office, contains the formula given above in the report of the Council. In the same circular are also found these illuminating statements: “The medical profession has long appreciated the dangers involved in the administration of various mineral remedies now so commonly employed, and the value of a safe, effective and reliable vegetable antipyretic is universally recognized. Such a remedy is Labordine. It is purely vegetable in its composition and produces none of the evil after-effects of the coal-tar derivatives.... Labordine ... is a purely vegetable cardiac stimulant.... There is nothing mysterious about Labordine or its constituents.... The ‘Process-Laborde’ gives the true active principles of the Celery and Indian Wintergreen, something heretofore difficult to obtain. To this is added the fact that absolutely chemically pure Acet-Amide-Phenyle is used. The latter is the most valuable and, in fact, the only vegetable antipyretic known.”
The above report of the Council shows the following facts:
1. Apium Graveolens (true active principle), “Process-Laborde” is probably powdered celery seed. One chemist says: “The powder has the characteristic odor of celery, while a microscopic examination shows the presence of a substance having the characteristic structure of seeds in general.” If celery seed has any “active principle” it has never been isolated. As to its therapeutic value, nothing whatever is known. It is, we understand, highly beneficial in the case of singing canaries, but authorities in scientific therapeutics have never discovered that it possessed any remarkable medicinal qualities.
2. Gaultheria Fragrantissima (true active principle), “Process-Laborde,” is probably ordinary everyday salicylic acid. One analysis showed salicylic acid to be present to the amount of about 7 per cent. The question of whether or not salicylic acid could in any way be considered the “true active principle” of Gaultheria Fragrantissima, was submitted to Prof. John Uri Lloyd of Cincinnati, the eminent authority on the chemistry of the proximate principles of plants, who replies:
“The advertisement is evidently so worded that, although the name of the Indian plant Gaultheria Fragrantissima is employed, its true and active principle being wintergreen oil, the concoctor can mystify his patrons and at the same time use the well-known wintergreen oil, made in America, which in my opinion, so far as any chemical test might be concerned, could not be distinguished from the methyl salicylic acid (wintergreen oil) derived from the Indian plant. Concerning whether salicylic acid is a proximate constituent of Gaultheria Fragrantissima, in my opinion, it would be a misnomer to make such an announcement. Salicylic acid, per se, does not exist, in my opinion, in the plants mentioned, being made by chemistry.”
3. The third and most important ingredient in this “purely vegetable antipyretic” is brazenly announced as “Acet-Amide-Phenyle,” but it is only necessary to say that this imposing designation is an attempt to “Frenchify” a scientific name for acetanilid.
Analysis shows that this coal-tar product is present to the amount of 37.9 per cent., or 1.89 grains in a 5-grain tablet.56 In other words, this imposing Labordine, made by a mysterious and elsewhere unheard of “Process-Laborde,” is simply one more of the many acetanilid powders that have been foisted on our profession and that have filled our journals for years past. The only thing in it that is of practical therapeutic value is 2 grains of acetanilid to a 5-grain tablet. The statement that Labordine is a purely vegetable preparation is probably intended by the proprietors as a good joke on the medical profession. Acetanilid is not usually regarded as a vegetable product, at least it is not ordinarily found in market gardens. The only vegetable source from which acetanilid can be obtained is the beautiful flowering coal-tar bush, from which so many other nostrum vendors obtain their “perfectly harmless, purely vegetable antipyretics,” all composed of acetanilid and something to hide it. If the statements made by one of the company’s employees and quoted below are true, Labordine is not “manufactured and made chemically pure in the laboratories of the Labordine Pharmacal Company,” for this company has no laboratory, and its product is manufactured for it.
4. Our readers will be interested to know that the important ingredient entered under the imposing name of Benzoyl-Sulphyonic-Imide is simply a highly scientific name for saccharin. Even on this point, however, the formula is misleading, since it claims 231⁄4 per cent. of this substance, whereas the analysis shows that the presence of saccharin could not be proved. If it is present at all it is in quantities much less than stated, and so small as to be difficult of recognition. Instead it appears that the product contains common starch and about 35 per cent. of milk sugar.
THE COMPANY ITSELF
One of the humiliating phases of the proprietary medicine business is that, in many instances, these preparations are foisted on our profession by men who know nothing of medicine, pharmacy or chemistry, yet who not only presume to concoct our medicines for us, but also assume to instruct us how to use them.
Gould’s Commercial Register for 1907 gives the officers of the Labordine Pharmacal Company as H. M. Coudrey, president; M. Crawley, vice-president, and D. E. Gamble, Jr., secretary and treasurer. The place of business is given as 420 Market street, St. Louis. We are informed that Harry M. Coudrey is an insurance agent and the present member of Congress from the Twelfth Missouri District; that Mark Crawley is a clerk in the insurance office of H. M. Coudrey; and that Mr. Gamble is cashier in the same office. A recent visit of a representative of The Journal to 420 Market street, St. Louis, showed that the office of the Labordine Pharmacal Company is in Room 12 on the third floor of an old dilapidated building. There was no sign on the door of the office, but on the wall next to an old elevator was a very small sign which read “Labordine Chemical Company, Room 12.” The office at the time of the visit was apparently in charge of a young woman about 20 years old. Careful scrutiny of the furniture and fixtures showed that the room contained an old oak roll-top desk in one corner and a kitchen table, on which were piled about half a dozen packages of Labordine. The floor of the room was bare and very dirty. In an adjoining room, the door of which was open, was piled a lot of broken furniture. No laboratories nor chemical apparatus were visible. The young woman in charge stated that Labordine was made by the Mallinckrodt Chemical Works, at No. 3600 North Second Street, St. Louis.
This is a fair sample of nostrums and of the methods of exploiting them. The bitterly humiliating fact about the whole business is that a preparation, advertised under such palpably misleading claims, could actually be advertised in medical journals, even in journals of a supposedly high scientific standard, and could be bought and prescribed for years by supposedly intelligent and conscientious physicians. It is not supposed that every physician should be enough of a chemist to detect the ridiculous discrepancies between the published formula and the therapeutic claims made for such a mixture. But that members of a supposedly learned profession should fail to have enough interest in the preparations they prescribe for their confiding patients to find out that acetanilid is being masked under an obsolete and little used name, that under an imposing polysyllabic designation is hidden saccharin, that the so-called “active principle Process-Laborde” (whatever that may be), is equivalent only to one-third grain of salicylic acid in a 5-grain tablet, and that the advertising matter sent out for years by this company contained absolute falsehoods regarding the composition and therapeutic benefits of its preparation, is certainly just cause for shame and humiliation. If a physician, knowing the composition of Labordine, wishes to prescribe it and prescribes it intelligently, he has a perfect right to do so. If he wishes his patient to have 2 grains of acetanilid, 1⁄20 of a grain of quinin, and 1⁄3 of a grain of salicylic acid, and considers a mixture of ground celery seed, starch and milk sugar as a proper vehicle for this medication, no one will question his right to administer it. No physician, however, has any right, either moral or professional, to prescribe a preparation, concerning the ingredients of which he knows absolutely nothing.
Is it possible that such carelessness may be one of the causes of waning public confidence in our profession? We leave it to our readers to determine whether such a moral can be drawn from this typical nostrum story.—(From The Journal A. M. A., March 30, 1907.)
LACTOBACILLINE OMITTED FROM N. N. R.
Report of the Council on Pharmacy and Chemistry
The Franco-American Ferment Company has advised the Council on Pharmacy and Chemistry that, in advertising its products, it will no longer conform to the rules of the Council. This is evident. The Franco-American Ferment Company has distributed circulars in which the public is informed that auto-intoxication is the cause of innumerable ills ranging all the way from arteriosclerosis, rheumatism and gout to chronic headache, odorous perspiration, nervous disorders and melancholia; that the Bulgarian bacillus “is a wonderful corrective or remedy” for all these conditions, and that the Lactobacilline products are the only preparations of Bulgarian bacillus “to be had in America which bear his [Professor Metchnikoff’s] personal endorsement”—by inference, the only reliable products. In view of the action of the Franco-American Ferment Company, and of the tendency of their advertising to cause the public to exaggerate slight ailments into alarming conditions, the Council has voted that the several Lactobacilline products of this concern be deleted from New and Nonofficial Remedies.—(From The Journal A. M. A., April 17, 1915.)
REEXAMINATION OF LACTOPEPTINE[T]
Report to the Council on Pharmacy and Chemistry
In 1907 the Council on Pharmacy and Chemistry published a report on Lactopeptine. At that time it was shown that Lactopeptine did not have the composition claimed for it. The same claims as to composition are still being made for the product. In view of this fact, a second examination of Lactopeptine has been made and the result reported to the committee on chemistry. The report confirms the Council’s findings of six years ago. After adoption by the committee, it was adopted by the Council and its publication authorized.
W. A. Puckner, Secretary.
SECOND EXAMINATION OF LACTOPEPTINE
Two specimens of Lactopeptine in original unbroken packages were recently examined. One of these was an American preparation said to be produced by the New York Pharmaceutical Association at Yonkers and the other an English preparation from John Morgan Richards and Sons, London.
When Lactopeptine was first examined by the Council about six years ago, it was found to be little more than weak saccharated pepsin, and did not contain the other ferments which were claimed by the manufacturers to be present. A statement concerning this was published in the Council Reports for 1905–1908, p. 43. Because of claims recently made by the exploiters that this preparation contains not only pepsin but also pancreatin, diastase, lactic acid and hydrochloric acid, and that the failure to recognize these must be due to the lack of ability of the chemists making the examination, it seemed worth while to undertake a new series of tests on samples from two sources mentioned, the products on the British and American markets. The label on the British sample gives the following as the composition:
Sugar of Milk
40ounces
Pepsin
8ounces
Pancreatine
6ounces
Ptyalin or Diastase
4drachms
Lactic Acid
5fl. drachms
Hydrochloric Acid
5fl. drachms
The label on the American sample gives no quantities but states that it “represents a combination of the principal digestive and enzymogenic agents, Pepsin, Pancreatin, Diastase, Lactic and Hydrochloric Acids, in the proper proportion to insure best results.”
We have examined both preparations for starch-digesting power according to the methods employed in our previous examinations of such ferments and already reported. Diastase and the amylopsin of pancreatin seem to be completely absent, or, if present at all, in such minute traces that digestion of starch is not shown after one hour when quantities running from 60 mg. up to 150 mg. were allowed to act on 500 mg. of starch made up into paste. These tests were repeated, always with the same results, and were controlled by digestions of the same starch with other diastase preparations of known value.
Tryptic activity appears likewise to be absent, as in weak alkaline solution after fifteen hours’ digestion no effect on coagulated egg albumin or fibrin was observed when 100 mg. of each preparation was used with 1 gm. of the protein material.
As was found in the previous investigation the two products have some peptic activity, but this activity is comparatively weak, as about 200 mg. of each preparation are required to digest 10 gm. of coagulated egg albumin with 0.2 per cent. hydrochloric acid in three hours at 40 C. (104 F.), and 100 mg. portions were unable to completely digest 10 gm. portions of egg albumin with acid of the same strength in four hours at 50 C. (122 F.).
Hydrochloric acid is absent, as might be expected from the character of the preparation, and the amount of combined chlorid is small; but qualitative tests were obtained for organic acid resembling in behavior lactic acid, which is probably present in combined form.
It must be reaffirmed then that in digestive activity both the Lactopeptine purchased in the United States and that bought in England are essentially weak saccharated pepsins.
[Editorial Note.—The report of 1907 demonstrated that Lactopeptine was at that time a weak saccharated pepsin. The present report shows that Lactopeptine, as it is sold both in the United States and Great Britain, is still the same weak pepsin preparation. By the false statements which appear on the Lactopeptine labels the exploiters lay themselves liable to prosecution under the Food and Drugs Act—just as they have laid themselves liable for the past six years. The continued exploitation of this preparation warrants a restatement of facts that have been given many times before:
1. A preparation having the composition claimed for Lactopeptine—a powder containing pepsin, pancreatin, diastase, lactic acid and hydrochloric acid—cannot be produced commercially.
2. Even if such a combination were available, the acidity of the mixture itself and of the gastric juice would in all probability destroy the pancreatin before it could reach the intestinal tract.
3. Even if every constituent could exert its proper function at the right time, the administration of such a shotgun mixture would be unscientific and uncalled for.]—(From The Journal A. M. A., Aug. 2, 1913.)
MEAT AND BEEF JUICES[U]
Report of the Council on Pharmacy and Chemistry
The following was submitted to the Council by a subcommittee:
To the Council:—While meat extracts contain only traces of coagulable proteids and have little food value, meat juices are prepared by a process which ensures the presence in the finished product of considerable quantities of coagulable proteids and they therefore have considerable value as foods. Many preparations which are sold as beef juices or meat juices have no right to these designations. Since the public and physicians are likely to be misled by the names given to these products and by the false claims which are made for them as foods and depend on them in the nourishment of the sick, it is important that their composition and their value as foods should be known.
In the following report is presented the results of an examination of some of the commercial products found on the American market. The report shows that Wyeth’s Beef Juice (John Wyeth & Bro., Philadelphia), Bovinine (The Bovinine Co., New York), Carnine (Carnine Co., Fougera & Co., New York), and Valentine’s Meat Juice (M. J. Valentine, Richmond, Va.) are sold under names which are incorrect, that their composition is not correctly stated by the manufacturers and that false and misleading statements are made in regard to their value as food.
It is recommended that the products named be refused recognition for conflict with Rules 1, 6 and 8. Since these preparations are typical of many others on the market, and as their use is a menace to the public health it is recommended that the report be published.
This report was adopted by the Council.
W. A. Puckner, Secretary.
Beef or meat juices are clearly to be distinguished from beef or meat extracts. The word “juice” applies solely to the fluid portion remaining in fresh meat after proper cooling and storing and may be obtained by pressure or diffusion with or without a low degree of heat. Under heavy pressure freshly chopped meat will yield from 25 per cent. to 40 per cent. of a thick reddish juice and if the meat is previously frozen or heated to 60 C., as much as 50 per cent. may be obtained. This gives some idea as to the probable cost of preparing beef juice at home. The chief characteristics of meat juice are the presence of a considerable proportion of coagulable protein and a low content of meat bases. That above represents the nature of these commodities as usually understood by the medical profession, is clearly shown by this quotation:57
“One or two teaspoonfuls of this (meat juice) are added to a teacupful of cold or warm water, which, however, must not be boiling, or otherwise the albumin would be coagulated, but it may, however, be sufficiently warm to drink comfortably.”
Beef juice is considered by some physicians of much dietetic service and believed to represent liquid food in concentrated form. W. O. Atwater,58 relative to this product says:
“Beef juice obtained from the best steak which has been merely warmed through over the coals and then entirely deprived of soluble substance by a screw press, is undoubtedly the most concentrated of the liquid foods.”
The latter authority gives a number of analyses of beef juices prepared under known conditions.
DEFINITION OF MEAT JUICE
Meat juice is defined by the standards committee of the Association of Official Agricultural Chemists as the fluid portion of muscle fiber obtained by pressure or otherwise, and may be concentrated by evaporation at a temperature below the coagulating point of the soluble protein. The solids contain not more than 15 per cent. of ash, not more than 2.5 per cent. of sodium chlorid (calculated from the total chlorin present), not more than 4 nor less than 2 per cent. of phosphoric acid (P2O5), and not less than 12 per cent. of nitrogen. The nitrogenous bodies contain not less than 35 per cent. of coagulable proteins and not more than 40 per cent. of meat bases.
Meat juices of commerce are supposed to be made by subjecting properly prepared meat to heavy pressure with subsequent concentration of the juice in vacuo at a low temperature. The latter is necessary because if the temperature is raised to any material extent the valuable coagulable, soluble proteins referred to above are precipitated and lost. In order to establish a basis of comparison relative to the composition of natural raw beef juice a number of samples were prepared under known conditions and submitted to analysis. The results contained in the subjoined table clearly show that meat juices made under known conditions vary according to the mode of preparation, but it is evident that practically one-half of the nitrogen is present as coagulable protein.
FOOD VALUES
In order to arrive at the food value of any commodity it is necessary to consider its chemical composition, available potential energy, absorbability, etc. On referring to the analytical table it will be found that the amount of inorganic material in meat juices Nos. 7 and 10 is unduly high. It appears that sodium chlorid, per se, has been added to both Bovinine and Wyeth’s Beef Juice probably as a preservative in the latter and for condimental purposes in the former. The relative and absolute proportions of phosphatic material in both products is excessive. The other constituents present in the ash are those usually found in meat products.
The amount of sugar and glycerin in Carnine is interesting. These agents may be added for preserving purposes, but the resulting product, on account of its syrupy appearance, leads to the belief and is so represented, that it is a concentrated food. Glycerin is also present in Bovinine and Valentine’s meat juice. Bovinine in addition contains about 8 per cent. alcohol.
The total nitrogen content of the trade products excepting Carnine, is greater than the amount of nitrogen present in meat juices proper, but the relative amount of nitrogen present as coagulable protein—the valuable part of meat juice—is much greater in the latter. In fact, the amount of coagulable protein present in Valentine’s Meat Juice may be considered nil, which indicates that an unduly high temperature is used in its preparation. In this connection it should also be noted that even a moderate elevation of temperature influences the chemical composition of meat juices. For example, the coagulable matter present in Nos. 3, 4 and 5, is approximately one-half that present in Nos. 1 and 2, which appears to indicate that the best product can be made without the use of any heat whatever. Several of the trade products, namely Nos. 7, 8 and 9, contain about as much coagulable material as meat juice made by heating beef to 60 C. According to the formula appearing in a circular of the Bovinine Company, a part of the coagulable matter is present in the form of egg albumin, but the company claims egg albumin is not used at present. In the case of Carnine, the coagulable matter appears to be introduced by the use of blood itself. The exact nature of the coagulable protein matter in Wyeth’s Beef Juice has not been ascertained. It is well known to manufacturers and physiologic chemists that it is practically impossible to manufacture a genuine meat juice possessing a reasonable amount of coagulable proteins, which is stable without a preservative.
Meat juices, in addition to the coagulable protein material, contain other protein bodies such as albumoses and peptones. These bodies are largely formed from the original protein bodies present in the meat juice during the process of manufacture. They are highly nutritious and largely and readily absorbed from the alimentary canal, but the amount of these bodies present in the trade products is relatively small excepting in Bovinine, which is not a meat juice, particularly when the high prices are considered.
A considerable proportion of the nitrogenous matter contained in Valentine’s and Wyeth’s products is present in the form of amino bodies frequently included in the general term, “extractives.” These bodies may be oxidized in the body and thus supply heat in a manner similar to alcohol, but it should be remembered that there still appears to be a wide difference of opinion among various observers on this point. Some appear to be of the opinion that the amino bodies are devoid of food value in that these bodies appear in the urine practically unchanged. It would, therefore, appear that the value of the amino bodies is largely of a stimulant character.
The food value of meat juices, therefore, resides largely, if not solely, in the coagulable and other protein material present. Comparing the calorific value or potential energy available in meat juices proper on this basis with that present in the commercial products, excluding Bovinine, it will be seen that on the average the genuine meat juices—that is, those made by pressure, direct from the meat itself as wanted—are much superior to the commercial products, notwithstanding the marked concentration in some cases. The calories given in the accompanying table do not include sugar, alcohol or any other added material of this character.
WYETH’S BEEF JUICE
54 The Journal A. M. A., July 4, 1914, p. 1.
[O] For the unabridged report of the Council’s action on Iodalia, see Reports Council Pharm. and Chem., 1914, p. 69.
55 It should be noted that the discrepancies here reported between the actual and the claimed composition of Iodia were pointed out more than thirty years ago by A. B. Lyons (Detroit Lancet, October, 1882, vi, 157–8), who found that Iodia was deficient in iodid content and practically free from iron.
[P] See also Burnham’s Soluble Iodine, p. 233.
[Q] For the unabridged report of the Council’s action on Iodotone, see Reports Council Pharm. and Chem., 1914, p. 72.
[R] For the unabridged report of the Council’s action on Nourry Wine, see Reports Council Pharm. and Chem., 1914, p. 74.
[S] For reports and articles on other acetanilid mixtures, see pp. 9, 244, 268, 305.
56 Since this article was prepared we find that the national Food and Drugs Act has forced the proprietors of Labordine to put on the label the amount of acetanilid it contains, viz., 40 per cent., or 2 grains in a 5 grain tablet.
[T] See also Liquid Combinations Containing Pepsin and Pancreatin, p. 157. A reprint of articles bearing on this subject, issued under the title Digestive Impossibilities, will be sent on receipt of a 2-cent stamp.
[U] See also following report on Valentine’s Meat Juice and article on Meat Extracts and Meat Juices, p. 470.
57 Brunton, Sir Lauder: “Disorders of Assimilation, Digestion, etc.,” p. 183.
58 Bull. No. 21, U. S. Dept. Agricult., Office of Experiment Stations.
“Wyeth’s Beef Juice” is not a true beef juice, but resembles rather a diluted meat extract. It contains much added inorganic matter, is low in coagulable proteins, and considering the degree of concentration, relatively deficient in nutritive value. Some of the claims contained in the circular accompanying this preparation, in view of its composition set forth above, may be of interest:
“Wyeth’s Beef Juice ..., containing two fluid ounces and representing three pounds of prime lean beef,...”
“... beef extracts made by the Liebig process are utterly devoid of the valuable and nutritious albuminous constituents of meat,...”
[Wyeth’s Beef Juice] “should not be compared with ordinary beef extract,...”
COMPOSITION OF MEAT JUICES
Column Headings:
2 = Per cent. volatile matter 100 C.
3 = Per cent. inorganic matter
4 = Per cent. sodium chlorid
5 = Per cent. phosphoric pentoxid (P2O5)
6 = Per cent. ether extract, glycerol and undetermined matter
7 = Per cent. total nitrogen
8 = Per cent. coagulable proteins (N × 6.25)
9 = Per cent. other proteins (N × 6.25)
10 = Amino bodies (N × 3.12)
11 = Calories per 500 gm. obtained from protein factor 4.8
12 = Calories per 500 gm. obtained from amino bodies factor 0.56
Name of Preparation
2
3
4
5
6
7
8
9
10
11
12
Trade Products:
Chuck beef, cold pressed
86
.85
1
.86
.20
.31
1
.32
1
.74
6
.13
2
.94
.90
217
.68
2
.52
Round beef, cold pressed
85
.76
1
.53
.12
.37
.75
2
.08
8
.56
2
.37
1
.03
262
.32
2
.88
Chuck beef pressed at 60 C.
91
.90
1
.29
.19
.29
.81
1
.09
2
.56
2
.50
.84
121
.44
2
.35
Chuck beef pressed at 60 C.
89
.56
1
.27
.16
.37
2
.98
1
.09
3
.00
2
.63
.56
135
.12
1
.57
Round beef pressed at 60 C.
90
.65
1
.36
.16
.36
2
.09
1
.16
4
.25
.31
1
.34
109
.44
3
.75
Chuck beef heated six hours before pressing
60–100 C.98
.11
.39
.05
.12
.25
.24
....
1
.00
.25
24
.00
.70
Made in Laboratory:
Beef Juice, John Wyeth & Bro.,
Philadelphia, Pa.
58
.84
16
.21
6
.71
3
.27
12
.51
3
.15*
2
.88
3
.56
6
.00
154
.56
16
.80
Bovinine, The Bovinine Co.,
75 W. Houston St., New York City
80
.40‡
1
.55
1
.05
.09
3
.64‖
2
.36
3
.38
10
.75
.28
339
.12
.78
Carmine Co., Lefranco, Paris, France; Imported by Fougera & Co., Agents,
New York City24
.80§
.86
.09
.33
68
.94¶
.96
2
.25
2
.56
.59
115
.44
1
.65
Meat Juice, M. J. Valentine,
Richmond, Va.57
.64
10
.26
1
.77
3
.41
20
.41#
3
.06†
.19
5
.44
6
.06
135
.12
16
.97
*: Including 0.20 per cent. as NH3; ‡: 8.17 per cent. alcohol found; ‖: 3.1 per cent. glycerol found; §: vacuum 70 C.; ¶: 47.50 per cent. cane sugar—14.2 per cent. glycerol found; #: 8 per cent. of glycerol found. †: including 0.22 per cent. NH3;
The several samples of beef juice were prepared from practically fat free, finely comminuted, chuck and round beef, first by pressure at the ordinary temperature; second, by heating the prepared meat for several hours at 60 C., then submitting to pressure. Sample No. 6 was made from chuck beef, prepared as above, by heating six hours at from 60 to 100 C., and expressing after cooling. It is not a beef juice proper but was prepared, analyzed and added to the list for information. Its composition resembles several commercial articles closely. A number of products represented and sold as meat juice in the United States were analyzed and the results recorded in the accompanying table.
BOVININE
Bovinine, advertised as a “condensed beef juice prepared by a cold process” is a mixture of alcohol, glycerin, added sodium chlorid, and apparently some form of defibrinated blood. According to the manufacturer’s literature egg albumin was used formerly but this ingredient is said to be no longer employed. It is not a meat juice in any sense of the word. Numerous misrepresentations will be found on the label and in the literature of Bovinine, of which the following are typical:
“The blood of selected steers prepared by a cold process, furnishing a perfect food, free from insoluble elements.”
“The rapidity with which Bovinine is absorbed and assimilated in the stomach ...”
“It supplies complete nutrition to the patient.”
“Bovinine contains all the elements of the animal, vegetable and mineral kingdoms for the production of new blood with great rapidity. Its principal constituents have been selected with a view to furnish the largest amount of nutriment in the most condensed form and all the resources of modern chemical analysis have been brought to bear on this important problem.”
A series of experiments carried out with dogs under anesthesia, by injecting Bovinine into the stomach, the pyloric end of which was ligated, shows that Bovinine is not readily absorbed and assimilated by the stomach as claimed. The amount of protein material found in the stomach at the end of one-half hour to one hour and a quarter was practically equal to the amount introduced by the Bovinine.
It is also represented that Bovinine is of great service in case of an irritable stomach. This is not borne out by experiment. Bovinine fed to dogs by the mouth, either alone or mixed with food, induced vomiting, which was less marked when Bovinine was given with the regular diet. An examination of the urine of these animals showed a marked diminution of the amount of indican, while the ethereal sulphates were enormously increased, both absolutely and relatively, when Bovinine was given. Experiments on rabbits have shown that Bovinine injected into the peritoneal cavity was invariably followed by large quantities of albumin in the urine, which persisted for from twenty-four to forty-eight hours. Thirty to 50 c.c. per kilo given by mouth daily caused emaciation and weakness; in some cases, irritation of the gastro-intestinal canal, with death of the animal in from seven to twelve days.
CARNINE
Carnine is a French preparation imported into the United States by Fougera & Co., of New York City. In physical appearance it looks like highly concentrated food, but analysis shows that it consists of a small proportion of defibrinated blood dissolved in a mixture of syrup and glycerol, the whole agreeably flavored. It is represented as a “juice of rare meat, prepared by cold process. Each tablespoonful represents 100 gm. of raw meat, or 31⁄2 ounces.” It is clear that Carnine is not a meat juice in any sense of the word.
VALENTINE’S MEAT JUICE
Valentine’s Meat Juice resembles in physical appearance taste, odor and by chemical analysis a diluted meat extract. The nutritive value of meat extracts is virtually nil, as is well known by the medical profession. Notwithstanding the composition of Valentine’s Meat Juice and the fact that beef extract represents little nutritive value, the manufacturer makes the following misleading representations:
“The two-ounce oval bottle, adopted for the Meat Juice contains the concentrated juice of four pounds of the best beef, exclusive of fat; or the condensed essence of one and a half pints of pure liquid juice which is obtained from the flesh of beef.”
“The use of hot water with the Meat Juice changes its character and impairs its value.” [Italics in original.—Ed.]
The company must certainly be aware of the fact that its product contains little, if any, coagulable proteids.
CONCLUSIONS
In conclusion: Neither Bovinine nor Carnine is a meat juice, the former is anything but palatable and the latter soon cloys. “Valentine’s Meat Juice” and “Wyeth’s Beef Juice” are virtually diluted meat extracts, which are known to possess little food value. A physician depending on any of the foregoing products to supply material nourishment, in case of serious illness, is deceiving himself, starving his patients, and may be lessening their chances for recovery. If a patient recovers while using these commodities, it is certainly not due to the food value contained in them—(From The Journal A. M. A., Nov. 20, 1909.)
VALENTINE’S MEAT JUICE[V]
Report of the Council on Pharmacy and Chemistry
Some time ago the Council authorized publication of a report[V] dealing with the composition and claims made for a number of the more generally advertised meat and beef juices. Among these was Valentine’s Meat Juice. This it was shown was sold under an incorrect name, the claims for its composition were not truthfully stated and its exploiters made false and misleading claims in regard to its food value. As Valentine’s Meat Juice is still widely advertised the referee in charge of this class of products deemed a reexamination of the product advisable. This was made and on it was based the following report which has been submitted to the Council, adopted, and its publication authorized.
W. A. Puckner, Secretary.
Your referee has had examined recently purchased specimens of Valentine’s Meat Juice (Valentine’s Meat Juice Company, Richmond, Va.). The examination shows that it has virtually the same composition as that given in the report of the Council “Meat and Beef Juices” published in The Journal, Nov. 20, 1909. It contains practically no coagulable protein material, one of the products characteristic of a meat juice. It is essentially a diluted meat extract.
The following statement found in former circulars now seems to have been eliminated:
“The two-ounce oval bottle, adopted for the Meat Juice contains the concentrated juice of four pounds of the best beef, exclusive of fat; or the condensed essence of one and a half pints of pure liquid juice which is obtained from the flesh of beef.”
An endeavor is still made, however, to convey the idea that the product contains coagulable protein, as shown by the following:
“Boiling water changes the character of the preparation.”
“The use of boiling water with the Meat-Juice changes the character of the Preparation.”
The proprietors undoubtedly know that the product does not contain any coagulable material and that the statements just quoted are plain misrepresentations.
The advertising circular contains a large number of “Testimonials of the Medical Profession.” As all are undated, one cannot tell how old these testimonials are. One physician recommends it highly for hypodermic use; another says, “I have kept cases on it and it alone for days, without attempting to give any other food, and the results have been entirely satisfactory.” According to another, it is “most invaluable in typhoid fever and also in diphtheria.”
Valentine’s Meat Juice conflicts with the following rules of the Council:
Rule 1, in that its composition is not correctly given;
Rule 6, in that unwarranted therapeutic claims are made, the profession being led to believe that the product is highly nutritious and is valuable in the treatment of pneumonia, diphtheria and typhoid fever;
Rule 8, in that the name is objectionable, for while sold as a meat juice, in reality it has the character of a meat extract.
Valentine’s Meat Juice is a fraud on the public, and in view of its continued exploitation under false claims, the referee recommends that the Council reiterate its former condemnation and authorize the publication of this report.
[Editor’s Note.—The difference between meat extracts and meat juices was fully discussed in the previous report of the Council, Meat “juices” are made by the cold expression of meat with subsequent evaporation, in such a way that the nutritious coagulable proteins remain in solution. In making meat “extracts,” heat is used which almost completely removes the coagulable proteins and thus renders it practically devoid of nutrient qualities.
A list of some of the medical journals that carry advertisements of Valentine’s Meat Juice, follows:
Pediatrics
Virginia Medical Semi-Monthly
Old Dominion Journal of Medicine
& Surgery
Medical Times
American Medicine.]
Medical World
—(
From The Journal A. M. A., May 2, 1914.)
MEDICINAL FOODS
A report, of which the following is an abstract, was submitted to the Council on Pharmacy and Chemistry by the subcommittee which examined the medicinal foods:
In order to determine the food value of any food product it is necessary to consider the following points: Chemical composition; available potential energy; absorbability and cost. No attempt is made in this article to discuss each of these features separately, but they are utilized as required.
The ingredients on which the food value of any article of food depends are the proteid substances, carbohydrates, fats, certain inorganic bodies and—under certain conditions—alcohol. The amount of each of these present in a preparation must be established by chemical analysis. From the results thus obtained it is possible to calculate the potential energy represented by a given food product. In this report the potential or food value is expressed in the large or kilocalorie, that is, the amount of heat required to raise the temperature of one kilogram of water one degree centigrade.
The factors employed in this report for expressing in calories the actual amount of energy utilized by the system are 4.8 for proteid substances, 4.1 for carbohydrates, and 9.2 for fats.
The accompanying table embodies the results obtained by submitting all the well-known so-called “predigested foods” to chemical examination. The table as published in The Journal included columns on: Price of bottle, number of cubic centimeters in a bottle, cost per 500 cubic centimeters, reaction, specific gravity, percentage of non-volatile residue, ash, percentage of nitrogen, calories as proteids in 500 grams, carbohydrates before inversion, alcohol by volume, average recommended adult dose per diem in cubic centimeters, cost per diem to supply 1,430 calories. These columns were eliminated from this abstract, as they were unessential, so far as the practical value of the article is concerned. In most cases two samples of the same brand were purchased at an interval of about six months. All the analyses were made before Jan. 1, 1907. Some of the preparations contain much glycerin which does not, so far as known at present, possess any recognized food value, although there are a number of experiments on record to indicate that it influences metabolism.
The percentage of nitrogen accredited to each of these products represents the total amount of nitrogen, irrespective of the nature of the nitrogenous substances, although some of this nitrogen has no nutritive value.
By multiplying the percentage of nitrogen found by the factor 6.25 we obtain the percentage of nitrogenous matter (proteids) contained in the various preparations. By multiplying the number of grams of nitrogenous matter present in 500 grams of material by the factor 4.8 it is found that the potential energy available by the nitrogenous matter varies from 10.3 calories to 153.1 calories. Five hundred grams of the material is made the basis of calculation, because it approximates a pint, the amount usually believed to be present in the various trade packages, and because it affords a ready basis of calculation.
The carbohydrates are represented by cane sugar, maltose, dextrin and invert sugar. Lactose is probably also present in some, but it is impossible to establish this. By multiplying the number of grams of carbohydrates present in 500 grams of the foods by the factor 4.1 we obtain the potential energy represented by the carbohydrate, which varies from 11.3 to 319.2 calories. The total calorific value of both proteids and carbohydrates ranges from 54.7 to 397.5 calories. The total food value of an equal quantity of milk, including fat, approximates 360 calories.
The value of alcohol as a food product pure and simple in disease is, however, an open question. There is no doubt whatever but that it acts to a certain degree as a food even here, not as a tissue builder, but as a saver of fat and carbohydrate material, and in order to give the preparations in question full value as food products, the calories represented by the alcohol, are credited to each preparation, as are the proteids and carbohydrates. The factor usually recognized for expressing the calorific value of alcohol is 7. By multiplying the number of grams of alcohol present in 500 grams of material by 7, the number of calories varies from 420 to 658.
On looking over the literature and printed matter distributed by some manufacturers, the physician is frequently left under the impression that these preparations contain all the essential constituents necessary for maintaining normal nutrition of the body, as is clearly shown by the following quotation: “Contains sufficient nutritive material to maintain normal nutrition of the body, a valuable food in typhoid fever, pneumonia, tuberculosis,... and all the conditions of the system associated with enfeebled digestion and malnutrition.”
In order to show the insidiousness of such representations it is only necessary to give the actual food value of the average daily dose (the average amount to be taken for twenty-four hours) recommended by the various manufacturers for their products. The average adult daily dose recommended varies from 50 to 150 c.c. The total available calories per daily dose based on the proteid and carbohydrate bodies varies from 9.8 to 110.5. Adding to these figures the amount of energy represented by the alcohol, in each case, the total available calories varies from 55.0 to 299.5. The number of calories per diem in sickness should not fall much below 1,500 during twenty-four hours.
TABULATED RESULTS OF EXAMINATIONS OF MEDICINAL FOODS
Column Headings:
2 = Glycerin and undetermined matter
3 = Per cent nitrogenous matter (6.26)
4 = Calories as proteids in 500 grams
5 = Carbohydrates after inversion
6 = Calories as carbohydrates in 500 grams
7 = Calories as proteids and carbohydrates in 500 grams
8 = Alcohol, by weight
9 = Calories as alcohol in 500 grams
10 = Calories as proteids and carbohydrates per diem dose
11 = Total calories in per diem dose*
12 = Number c.c. required per diem to supply 1,430 calories
Name of Preparation and Manufacturer
2
3
4
5
6
7
8
9
10
11
12
Carpanutrine—John Wyeth & Brother
28
.45
4
.28
102
.7
5
.34
109
.5
212
.2
12
.5
437
.5
25
.5
78
.0
1,100
.7
Carpanutrine—John Wyeth & Brother
21
.29
6
.24
149
.8
5
.78
118
.5
268
.3
14
.0
490
.0
32
.2
91
.0
942
.9
Liquid Peptones—Eli Lilly & Company.
3
.63
4
.50
108
.0
6
.05
124
.0
232
.0
18
.0
630
.0
69
.6
258
.6
829
.4
Liquid Peptones, with Creosote—Eli Lilly & Company
4
.34
3
.84
92
.2
13
.47
276
.1
368
.3
18
.0
630
.0
110
.5
299
.5
716
.2
Nutrient Wine of Beef Peptone—Armour & Company
14
.97
0
.64
15
.4
15
.43
316
.3
331
.7
17
.5
612
.5
66
.3
188
.8
757
.4
Nutrient Wine of Beef Peptone—Armour & Company
13
.70
0
.43
10
.3
15
.57
319
.2
329
.5
17
.0
595
.0
65
.9
184
.9
773
.3
Nutritive Liquid Peptone—Parke, Davis & Company
1
.02
1
.86
44
.6
12
.89
264
.2
308
.8
18
.8
658
.0
74
.2
232
.1
739
.5
Nutritive Liquid Peptone—Parke, Davis & Company
1
.95
1
.16
27
.8
13
.19
270
.4
298
.2
17
.7
619
.5
71
.5
220
.2
779
.2
Peptonic Elixir—Wm. Merrell Chemical Company
3
.21
2
.54
61
.0
11
.46
234
.9
295
.9
16
.5
577
.5
53
.3
157
.2
818
.6
Tonic Beef S. & D.—Sharp & Dohme
12
.91
3
.40
81
.6
2
.36
48
.4
130
.0
12
.0
420
.0
13
.0
55
.0
1,300
.0
Tonic Beef S. & D.—Sharp & Dohme
12
.63
3
.28
78
.7
2
.22
45
.5
124
.2
13
.0
455
.0
12
.4
57
.9
1,234
.4
Liquid Peptone—Stevenson & Jester Company
0
.44
1
.81
43
.4
0
.55
11
.3
54
.7
12
.0
420
.0
9
.8
85
.4
1,506
.8
Cow’s Milk (3.8 per cent. fat)
....
3
.50
84
.0
4
.80
98
.4
182
.4
....
....
7
.3
1,429
.6
2,000
.0
*: Total calories per diem dose includes the calories of alcohol in the liquid medicinal foods and the calories of the fat in milk.
In order to get a fair conception of the actual food value of these various preparations, it is desirable to make some comparison which can be readily comprehended by every physician. The amount of good milk necessary each twenty-four hours to sustain the vitality of a patient during a serious illness is not less than 64 ounces, or approximately 2,000 c.c. The food value in calories represented by this amount of good milk may be placed at 1,430. This includes not only the proteid and carbohydrate matter, but the fat as well. By comparing this available potential energy with the total energy available in the predigested foods under consideration, it can be readily seen that if a physician depends on the representations made by some of the manufacturers, and feeds his patient accordingly, he is resorting to a starvation diet. The largest number of available calories, including alcohol, present in any of the recommended daily doses, is less than one-fifth of the number of calories represented by 2,000 c.c. of milk; and the calories represented by the daily dose of the preparation poorest in food products is only one-twenty-fifth of the amount present in 2,000 c.c. of milk. These figures tell their own story.
Making 2,000 c.c. of milk the basis of calculation, and estimating the amount of the various preparations required to yield this number of calories, it is found that the quantity to be administered daily to supply 1,430 calories, including alcohol, varies from 716.2 to 1,506.2 c.c. In many cases the amount of alcohol exhibited by these quantities would keep the patient in an alcoholic stupor continually. The cost necessary to supply this energy varies from $1.48 to $3.39. Compare these prices with the cost of two quarts of milk. Is further comment necessary?
It is urged in justification of the use of preparations of this class that they contain constituents not found in our ordinary foods and in a more perfectly assimilable condition. As pointed out above, these so-called predigested foods contain no fats; the carbohydrates in them are the ordinary sugars present in our common foods, while the proteins belong to the peptone or albumose class. It is for these latter that the greatest claims are made, but even here no value can be pointed out not found in whey, peptonized full milk or peptonized skimmed milk.
There is likewise another point of considerable importance to consider in this connection. The terms peptone and albumose include bodies of very uncertain composition, and their suitableness as food substances depends largely on how they are prepared. Animal experiments have shown that nitrogen equilibrium may be maintained, for a time at least, by use of enzymic hydrolytic products of the proteins, even where the hydrolysis has been carried far beyond the so-called peptone stage, but it appears to be likewise true that the mixtures secured by acid or high temperature steam hydrolysis have no such value. Some of these, indeed, may exhibit a toxic behavior. This is true in particular of some of the commercial varieties of peptone, and until more is known of the source of the bodies of protein character employed in the makeup of these “predigested” mixtures it is unwise to assume anything concerning the food value of the nitrogen compounds found in them by analysis or even to dignify them by the name of foods.—(Abstracted from The Journal A. M. A., May 11, 1907.)
MIGRAININ
Report of the Council on Pharmacy and Chemistry
The Council, having voted to rescind the acceptance of Migrainin and to omit it from New and Nonofficial Remedies (Appendix), directed publication of the report given below.
W. A. Puckner, Secretary.
SUPPLEMENTAL REPORT ON MIGRAININ
To the Council:—Koechl & Co., American agents for Migrainin (Meister Lucius & Bruning) asserted that this preparation was a mixture of antipyrin 85 parts, caffein 9 parts and citric acid 6 parts. The experiments of F. Zernik (Apoth.-Ztg., 1906, p. 686), however, showed that Migrainin consisted of antipyrin 90.88 parts, caffein 8.4 parts and citric acid 0.45 parts. When the attention of Koechl & Co. was called to this they informed the Council, on June 20, 1907, that the formula they gave was given them direct by the manufacturers abroad and that they, Koechl & Co., did not question its accuracy. They, however, offered to “write abroad and have the manufacturers confirm the formula as given.” On July 23, 1907, Koechl & Co. wrote the secretary of the Council that the manufacturers had informed them that Migrainin contains 90 per cent. antipyrin and 9.1 per cent. caffein citrate. This being an acknowledgment that the former statement submitted was incorrect, the Council voted that the approval of Migrainin should be reconsidered. Examination of the product, therefore, was taken up in the Association’s laboratory and an original specimen, purchased in Chicago, was found to contain moisture 0.7 per cent., antipyrin 90.93 per cent., and instead of caffein citrate 9.1 per cent., citric acid 0.51 per cent., caffein 8.53 per cent. This analysis agreed essentially with the composition of Migrainin as found by Zernik.
While the discrepancies between the statement of the firm and the facts are perhaps not great, nevertheless they show that even the formula last given is incorrect, and that the statements of Koechl & Co., while no doubt made in good faith, were in this instance unreliable.
In recent advertising matter issued by Koechl & Co., “phenozon-caffein citrate” is given as a synonym for Migrainin, one circular stating that “Migrainin is phenozon-caffein citrate,” etc. In the same circular the following also appears: “In the treatment of migraine with phenacetin or antipyrin, the attack is delayed, while with Migrainin it is usually permanently stayed.” This will, no doubt, lead physicians to infer that Migrainin is not a mixture of antipyrin and caffein citrate, but that it is some new compound. While the firm disclaims any intention to mislead, it does not offer to withdraw or modify this circular. It is recommended, therefore, that the approval of Migrainin be rescinded and that it be omitted from New and Nonofficial Remedies.—(From The Journal A. M. A., June 5, 1909.)
NEURILLA
Report of the Council on Pharmacy and Chemistry
The following report was adopted by the Council. Its publication was authorized to show how a practically worthless mixture may be exploited by means of ill-considered testimonials.
W. A. Puckner, Secretary.
Neurilla, which appears to be the sole product of the Dad Chemical Company, New York, is advertised as
“The Ideal Nerve Calmant.”
“... a nerve tonic ... indicated in cases where the nerve centers are poorly nourished and over-sensitive ...”
“... a stimulant to the nervous system.”
“A Valuable Aid in the Treatment of Fevers, Colds, La Grippe, etc.”
The following non-quantitative and indefinite formula is given on the label of a recently purchased bottle of Neurilla:
“Prepared from Scutellaria Lateriflora, Passiflora Incarnata and Aromatics.”
“Proportion of Alcohol 20.3%.
“Made by Dad Chemical Co., New York, U. S. A.
“Dose, One Teaspoonful Four Times a Day.”
According to the formula, then, this mixture contains, aside from alcohol and aromatics, two vegetable drugs, scutellaria and passiflora, on which the alleged virtues of the preparation must be presumed to depend.
Scutellaria lateriflora, or skullcap, is a bitter drug, one of the many “herbs” to which, on wholly unreliable “clinical evidence,” therapeutic properties were at one time ascribed. Most pharmacologists do not mention the drug, and those who do generally state that it has very feeble therapeutic properties. It was admitted to the Pharmacopeia, but in 1909 its deletion was recommended by a committee of the Section on Practice of Medicine of the American Medical Association (The Journal A. M. A., Sept. 4, 1909, p. 792). We understand that the next edition of the Pharmacopeia will omit mention of skullcap.
Passiflora incarnata, or passion-flower, is another “herb,” which, although known for about seventy years, has never gained the confidence of the medical profession and has not even been admitted to the Pharmacopeia. According to a Council Report:
“None of the evidence is sufficient to show that passiflora has therapeutic value; hence it is deemed inadvisable to include the drug in the list of nonofficial remedies” (The Journal A. M. A., March 19, 1910, p. 983).
On these two obsolescent “herbs,” then, rest the remarkable claims made for Neurilla. A certain degree of appetizing effect may be expected from the bitter taste and a very slight degree of physical stimulus from the alcohol. Except for these effects—and they are largely delusive and temporary—the preparation is therapeutically inert and worthless.
The evidence on which the manufacturers of Neurilla base their therapeutic claims appears to consist of testimonials from physicians. As a matter of fact, this is true of practically all of the large group of nostrums of which Neurilla is typical. An analysis of these Neurilla testimonials brings out clearly what such “evidence” is worth.
ILL-CONSIDERED TESTIMONIALS
The testimonials for Neurilla have been given with reference to indefinite conditions of nervousness that border on the psychic and include hysteria, neurasthenia, neuralgia and the like. Nervousness and indigestion are two diseases in which suggestion, especially when aided by bitters and alcohol, produces temporarily a feeling of improvement. As an illustration, take the following testimonial:
[V] See also preceding report on Meat and Beef Juices, and article on Meat Extracts and Meat Juices, p. 470.
