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is no longer a matter of doubt."

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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
separately[1] 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.

[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.

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                                              9

    Agar-Lac                                                        10

    Anasarcin and Anedemin                                          11

    Maignen Antiseptic Powder                                       19

    Tyree’s Antiseptic Powder                                       21

    Apergels                                                        26

    Aseptikons                                                      26

    Betul-Ol                                                        27

    Peacock’s Bromides and Chionia                                  28

    Bromidia                                                        31

    Cactus Grandiflorus                                             36

    Calcreose                                                       40

    Campho-Phenique                                                 40

    Celerina, Aletris Cordial and Kennedy’s Pinus Canadensis,
      Light and Dark                                                43

    Cineraria Maritima                                              49

    Hagee’s Cordial of the Extract of Cod Liver Oil Compound        51

    Wampole’s Perfected and Tasteless Preparation of an Extract
      of Cod Liver                                                  52

    Waterbury’s Metabolized Cod-Liver Oil Compound                  54

    Waterbury’s Compound                                            57

    Colchi-Sal                                                      58

    Cypridol Capsules                                               59

    Cystogen, Cystogen Aperient and Cystogen-Lithia                 60

    Cysto-Sedative                                                  61

    Taka-Diastase and Liquid Taka-Diastase                          62

    Digalen Omitted from N. N. R.                                   68

    Dioradin Refused Recognition                                    73

    Echinacea                                                       79

    Echtisia, Ecthol and Echitone                                   81

    Ergoapiol                                                       82

    Erpiol (Dr. Schrader)                                           83

    False Unicorn (Helonias)                                        84

    Formurol                                                        85

    Gastrogen Tablets                                               87

    Glyco-Heroin, Smith                                             88

    Glyco-Thymoline                                                 92

    Glycozone                                                       95

    Gardner’s Syrup of Hydriodic Acid                               97

    Hyperol                                                        100

    Ingluvin                                                       101

    Intestinal Antiseptic W-A                                      103

    Bannerman’s Intravenous Solution                               105

    Iodalia                                                        106

    Iodex                                                          107

    Iodia                                                          108

    Burnham’s Soluble Iodine                                       110

    Iodotone                                                       113

    Iosaline                                                       113

    Nourry Wine                                                    115

    Labordine                                                      115

    Lactobacilline Omitted from N. N. R.                           120

    Reexamination of Lactopeptine                                  121

    Meat and Beef Juices                                           123

    Valentine’s Meat Juice                                         129

    Medicinal Foods                                                131

    Migrainin                                                      135

    Neurilla                                                       136

    Neurosine, Dioviburnia, Germiletum and Palpebrine              139

    Oxychlorine                                                    147

    Pam-Ala, Another Worthless Quinin Substitute                   149

    Papayans Bell                                                  151

    Passiflora and Daniel’s Concentrated Tincture of Passiflora    156

    Liquid Combinations Containing Pepsin and Pancreatin           157

    Pepto-Mangan (Gude)                                            159

    Liquid Petrolatum or “Russian Mineral Oil”                     161

    Clinical Experience with Liquid Paraffin (Liquid Petrolatum)   167

    Angier’s Emulsion                                              169

    Phecolates, Phecolax, Phecozymes and Phecotones                174

    Phenol Sodique                                                 175

    Phytin and Fortossan                                           178

    Prunoids                                                       178

    Sal Hepatica                                                   179

    Sanmetto                                                       182

    Secretogen                                                     185

    Sinkina                                                        188

    Somnos                                                         193

    Succus Alterans                                                195

    Sulpho-Lythin                                                  196

    Taurocol                                                       198

    Tri-Iodides, Three Chlorides and Maizo-Lithium                 198

    Thialion                                                       205

    Unguentum Selenio Vanadic (V. Roemer)                          207

    Unicorn Root, Wild Yam and Wild Indigo                         208

    Proprietary Vanadium Preparations                              209

    Venarsen                                                       212

    Venodine                                                       214

    Veracolate                                                     216

    Hayden’s Viburnum Compound                                     218

    Vin Mariani                                                    221

    Virol                                                          225


  PART II: CONTRIBUTIONS FROM THE CHEMICAL LABORATORY

    Anusol Hemorrhoidal Suppositories                              227

    Aromatic Digestive Tablets                                     229

    Burnham’s Soluble Iodin                                        233

    “Hydrocyanate of Iron-Tilden”                                  235

    Hymosa                                                         238

    Micajah’s Medicated Uterine Wafers                             240

    Noitol and Anadol                                              245

    Pix Cresol                                                     247

    Saliodin                                                       249

    Theobromin Sodium Salicylate Versus “Diuretin”;
      The Economical Aspect                                        251

    Unguentine                                                     254

    Uricedin                                                       256

    Uriseptin                                                      256

    Zemacol                                                        259

    Zyme-Oid                                                       261


  PART III: CONTRIBUTIONS FROM THE JOURNAL: NOSTRUMS

    Alleotone                                                      264

    Baume Analgésique Bengué                                       267

    Antidiabeticum-Bauer                                           267

    Antikamnia                                                     268

    Anusol Suppositories                                           280

    Aspiro-Lithine                                                 281

    Bell-Ans (Pa-Pay-Ans, Bell)                                    282

    Biosol                                                         284

    Bromin-Iodin Compound                                          285

    Calmine                                                        286

    Camphenol                                                      287

    Chologen                                                       288

    Hagee’s Cordial of Cod-Liver Oil                               289

    Waterbury’s Compound Once More                                 291

    Collyrium-Wyeth                                                292

    Diatussin                                                      293

    Enteronol                                                      294

    Expurgo (Sanol) Anti-Diabetes                                  299

    Formamint                                                      303

    Gomenol                                                        304

    Headache Cures                                                 305

    Hectine                                                        308

    Hydronaphthol                                                  308

    Hydrozone                                                      309

    Hypoquinidol                                                   310

    Iodonucleoid                                                   310

    Iridium                                                        312

    Iron Tropon                                                    313

    Kutnow’s Powder                                                314

    Lymph Compound R-H and Orchitic Fluid Tablets                  317

    Lysol--The Evolution of a Proprietary                          318

    Thompson’s Malted Food Company                                 319

    Manola                                                         323

    Mercol                                                         326

    Midol and Nurito                                               327

    Mu-col                                                         329

    Narkine                                                        329

    Papine                                                         330

    Pasadyne                                                       332

    Pas-Avena                                                      333

    Pertussin                                                      334

    Phenalgin--A Typical Example                                   335

    Pheno-Bromate                                                  343

    Phenolphthalein                                                343

    Mixed Vaccine and Phylacogens                                  346

    The Danger in Protonuclein, a Preparation Containing Thyroid   348

    Purgen                                                         349

    Pyo-Atoxin                                                     350

    Resinol                                                        352

    Resor-Bisnol                                                   353

    Robinol and Sevetol                                            353

    Salacetin                                                      356

    Sal-Codeia-Bell                                                357

    Sanatogen                                                      358

    Sanatogen: a Scientific Investigation of Its Alleged Action
      on the Recuperating Powers of the Blood                      378

    The Feeding Value of Sanatogen Compared with Commercial
      Casein with Respect to Maintenance and Growth                385

    Poehl’s Spermin in Arteriosclerosis                            395

    Syrup of Cocillana Compound                                    396

    Aubergier’s Syrup of Lactucarium                               399

    Tartarlithine                                                  401

    Thoxos                                                         402

    Trypsogen                                                      403

    Tyree’s Antiseptic Powder                                      404

    Vapo-Cresolene                                                 408

    Vasogen and Iodovasogen                                        408

    Viburnum Compound--and other Nostrums                          409

    Wheeler’s Nerve Vitalizer                                      411

    Zymotoid                                                       412


  PART IV: CONTRIBUTIONS FROM THE JOURNAL: MISCELLANEOUS MATTER

    Acetphenetidin and Phenacetin--Their Relative Purity           414

    Clean Advertising                                              418

    Lippincott’s Magazine                                          419

    Medical Journal Advertising                                    422

    Medical Journals and the Great American Fraud                  426

    The Army and Navy Medical Record                               432

    The Medical Times Advertisements                               438

    Cause for Optimism                                             440

    The Comparative Nutrient Value of Cod Liver Oil and Cod Liver
      Oil Cordials                                                 442

    Diabetic Foods Offered for Sale in the United States           446

    The Jireh Diabetic Food Company                                451

    The Name “Epinephrin” Versus the Name “Adrenalin”              454

    The Hord Sanitarium                                            456

    The German Propaganda for Reform                               458

    The German Council on Pharmacy and Chemistry                   459

    Grand Prix and Gold Medals for Sale                            462

    The Hypophosphite Fallacy                                      464

    Buffalo Lithia Water                                           467

    Meat Extracts and Meat Juices                                  470

    Pharmaceutical Manufacturers and the Great American Fraud      474

    Dowd’s Phosphatometer                                          476

    Amorphous Phosphorus                                           478




          THE PROPAGANDA FOR REFORM IN PROPRIETARY MEDICINES




                                PART I

                            COUNCIL REPORTS




                        ACETANILID MIXTURES[A]

            Report of the Council on Pharmacy and Chemistry

[A] See also Labordine, p. 115; Headache Cures, p. 305; Anadol, p. 244;
Phenalgin, 335.


_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]

[B] See also Antikamnia, The Nostrum and Its Method of Exploitation,
page 268.

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]

[C] See also Phenalgin--A Typical Example, p. 335.

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]

[D] See also Salacetin, p. 356.

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.,  }
  W. A. Puckner, Ph.G.,     } Committee on Chemistry,
  S. P. Sadtler, Ph.D.,     } Council on Pharmacy and
  J. Stieglitz, Ph.D.,      } Chemistry of the A. M. A.
  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. 4-1/2
    Phenolphthalein                        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._)




                        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.

[Illustration: 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

[E] See also Tyree’s Antiseptic Powder, p. 404.


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, or 38.46 per cent.
    Alum                            50 parts, or 38.46 per cent.
    Phenol (carbolic acid)           5 parts, or  3.85 per cent.
    Glycerin                         5 parts, or  3.85 per cent.
    Thymol                           5 parts, or  3.85 per cent.
    Oil of eucalyptus or eucalyptol  5 parts, or  3.85 per cent.
    Oil of gaultheria
      (or methyl salicylate)         5 parts, or  3.85 per cent.
    Menthol                          5 parts, or  3.85 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                     15.56
    Boric acid                                   81.26
    Volatile matter at 100° C. for four hours     0.45

  The 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 everything[2]] 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]]

    [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?

    “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

[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.


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               1   gr.
    Aloin                 1/8 gr.
    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:

    “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

[G] For the unabridged report of the Council’s action on Betul-ol, see
Reports Council Pharm. and Chem., 1914, p. 62.


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 14-1/2 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]

[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.”

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_
  _American Journal of Surgery_
  _American Medicine_
  _Archives of Pediatrics_
  _Atlanta Journal-Record of Medicine_
  _Buffalo Medical Journal_
  _Charlotte Medical Journal_
  _Chicago Medical Recorder_
  _Denver Medical Times and Utah Medical Journal_
  _Eclectic Medical Journal_
  _Ellingwood’s Therapeutist_
  _Indianapolis Medical Journal_
  _International Journal of Surgery_
  _Lancet-Clinic_
  _Louisville Monthly Journal of Medicine and Surgery_
  _Maryland Medical Journal_
  _Medical Brief_
  _Medical Fortnightly_
  _Medical Herald_
  _Medical Record_
  _Medical Review of Reviews_
  _Medical Sentinel_
  _Medical Standard_
  _Medical Summary_
  _Medical Times_
  _Medical World_
  _Nashville Journal of Medicine and Surgery_
  _New Orleans Medical and Surgical Journal_
  _New York Medical Journal_
  _Pacific Medical Journal_
  _Southern Practitioner_
  _Texas Medical Journal_
  _Texas Medical News_
  _Therapeutic Gazette_
  _Wisconsin Medical Recorder_
  _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 reported[5] 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.

[5] The Journal A. M. A., July 9, 1887, p. 55.

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.”

[6] The Journal A. M. A., April 21, 1906, p. 1220.

Dr. Horatio C. Wood, Jr., gave[7] a striking illustration of how
preparations like Bromidia come to be used even by physicians without
consideration of their constituents:

[7] The Journal A. M. A., April 21, 1906, p. 1220.

    “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                      15 grains
    “Potassium bromid                     15 grains
    “Extract of Cannabis indica          1/8 grain
    “Extract of henbane                  1/8 grain”

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                      15 grains
    “Pot. brom.                           15 grains
    “Cannabis indica                     1/8 grain
    “Hyoscyamus                          1/8 grain”

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_
  _Nashville Journal of Medicine & Surgery_
  _Medical Brief_
  _Annals of Surgery_
  _Charlotte Medical Journal_
  _Medical Sentinel_
  _Memphis Medical Monthly_
  _Laryngoscope_
  _Medical World_
  _Medical Review of Reviews_
  _Louisville Monthly Journal_
  _Indianapolis Medical Journal_
  _Monthly Cyclopedia & Medical Bulletin_
  _Journal of Nervous & Mental Diseases_
  _Maryland Medical Journal_
  _Merck’s Archives_
  _Iowa Medical Journal_
  _Medical Standard_
  _Southern Practitioner_
  _New Orleans Medical & Surgical Journal_
  _Therapeutic Gazette_
  _Medical Herald_
  _Medical Times_
  _Texas Medical Journal_
  _Wisconsin Medical Recorder_
  _International Journal of Surgery_
  _Vermont Medical Monthly_
  _Atlanta Journal-Record of Medicine_
  _St. Paul Medical Journal_
  _Hospital Bulletin of the University of Maryland_
  _Denver Medical Times_
  _Buffalo Medical Journal_
  _Medical Review_
  _Ellingwood’s Therapeutist_
  _Eclectic Medical Journal_
  _Massachusetts Medical Journal_]

--(_From The Journal A. M. A., May 16, 1914._)




                          CACTUS GRANDIFLORUS

          Report of the Council on Pharmacy and Chemistry[H]

[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.


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. Myers[8] 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.

[8] New York Med. Jour., 1891, liii, 681-683.

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-Teissier[9] 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.

[9] Bull. gén. de thérap., 1891, cxxi, 343-349.

L. E. Sayre[10] 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.

[10] Am. Pharm. Assn., 1906, liv, 405.

R. A. Hatcher[11] 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.

[11] The Journal A. M. A., Sept. 21, 1907, pp. 1021-1024.

Gordon Sharp[12] 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.

[12] Practitioner, London, 1894, iii, 444-446.

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. Matthews[13] 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.

[13] The Journal A. M. A., March 21, 1908, pp. 956-958.

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. Williams[14] 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.

[14] Practitioner, London, 1891, xlvii, 266-273.

Ellingwood[15] 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.

[15] Med. Rec., New York, 1905, lxvii, 857.

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.

Aulde[16] recommends it as a cardiac tonic free from cumulative effects.

[16] Practitioner, London, xlvii, 223; Therap. Gaz., 1890.

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:

    “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]

[17] See Unicorn Root, Wild Yam, and Wild Indigo, p. 208.

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]

[18] See False Unicorn (Helonias), p. 84.

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
    Diarrhea-Dysentery
    Fetid Perspiration
    Endometritis
    Fissures
    Fistula
    Gonorrhea
    Hemorrhage from the Nose
    Uterine Hemorrhage
    Leucorrhea
    Nasal and Pharyngeal Catarrh
    Piles
    Sore Throat
    Ulceration of the Cervix

The 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

[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.


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 opinion[19] 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.

[19] The Journal A. M. A., Oct. 9, 1909, p. 1201.

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

[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.


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.

[20] The Journal A. M. A., Oct. 9, 1909, p. 1201. (See following
report, this volume.)

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

[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.


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.

[Illustration: 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.

[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 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:

    “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

[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.


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, 3-1/2 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:

[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.

  “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.

[24] Wohlgemuth: Biochem. Ztschr., March 18, 1912.

  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 accepted[25] 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.

[25] The Journal A. M. A., Sept. 11, 1909, p. 869.

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 reports[26] (A and B) referred to
therein.

[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.

                                              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 Council[27] and the following footnote
  was appended to the description in New and Nonofficial Remedies:

[27] The Journal A. M. A., Sept. 11, 1909, p. 869.

    “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

  Cloetta[28] prepared a soluble amorphous substance which he called
  “Digitoxinum solubile Cloetta,” but no information concerning the
  method of preparation has been published.

[28] Cloetta: München. med. Wchnschr., 1904, No. 33.

  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.

  Kiliani[29] 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]

[29] Kiliani: München. med. Wchnschr., 1907, p. 886.

[30] Kiliani: Am. Jour. Pharm., 1913, lxxxv, 224.

  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.

[31] Clinical Suggestions and Reports, December, 1912, p. 24.

  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).

[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.

  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_.”

[32] Advertisement Brit. Med. Jour., April 26, 1913.

  That the foregoing is absolutely untrue can be shown abundantly.
  Hale[33] 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.

[33] Hale: Hyg. Lab. Bull., 74.

  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] Eichhorst[36] and
  Teichmann.[37]

[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.

  Eggleston and Hatcher[38] 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.

[38] Eggleston, Cary, and Hatcher, Robert, A.: The Emetic Action of
  the Digitalis Bodies, The Journal A. M. A., Feb. 15, 1913, p. 499.

  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]

[39] Advertisement in Am. Med., January and February, 1913.

    “_The_ digitalis for children. Because its dosage can be
    controlled. Endorsed by pediatrists everywhere.”[40]

[40] Advertisement in Merck’s Arch., April, 1913.

    “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]

[41] South. Medical Journal, January to May, 1913, inclusive.

    “Digalen is Absolutely _Reliable_. It is _standardized_ and
    consequently _always uniform_. It _does not produce gastric
    disturbances._”[42]

[42] Advertisement in Brit. Med. Jour., April 26, 1913.

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:

    “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.

[43] Buechner: Pharm. Weekblad, March 2, 1912, p. 161.

                   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 Dieupart[44] 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.

[44] Bernheim and Dieupart: Revue Internationale de la Tuberculose,
May, 1911, p. 336.

  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.

[45] Wall, C.: Brit. Med. Jour., July 20, 1912, p. 109.

                              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:

    +------------------------------------------------------------+
    |                   MEYER’S BLOOD PURIFIER                   |
    |                         DIRECTIONS                         |
    | This is a powerful drug as an Alterative and Antiseptic    |
    | cases: _Rheumatism, Sick Headache, Erysipelas, Dyspepsia,  |
    | Old Sores and Biles, Open Wounds, Dizziness, Scrofula and  |
    | Sore Eyes._                                                |
    |                                                            |
    | In case of _Poisoning by Herbs, & C._, take the double     |
    | dosis, and _Bites of Rattlesnakes_ take three ounces three |
    | times a day, until the swelling is gone. This is an        |
    | absolute cure within 24 hours.                             |
    +------------------------------------------------------------+

After Lloyd had identified the plant, Meyer put the preparation out
under another form with the following label:

    +--------------------------------------------------------------+
    |                    ECHINACEA ANGUSTEFOLIA                    |
    | This is a powerful drug as an Alterative and Antiseptic      |
    | in all tumorous and Syphilitic indications; old chronic      |
    | wounds, such as fever sores, old ulcers, Carbuncles, Piles,  |
    | eczema, wet or dry, can be cured quick and active; also      |
    | Erysipelas. It will not fail in Gangrene. In fever it is a   |
    | specific; typhoid can be adverted in two to three days; also |
    | in Malaria, Malignant, Remittent and Mountain fever it is a  |
    | specific. It relieves pain, swelling and inflammation, by    |
    | local use, internal and external. It has not and will not    |
    | fail to cure Diphtheria quick. It cures bites from the bee   |
    | to the rattlesnake, it is a specific. Has been tested in     |
    | more than fifty cases of mad dog bites in human and in every |
    | case it prevented hydrophobia. It has cured hydrophobia. It  |
    | is perfectly harmless, internal and external.                |
    |                                                              |
    | Dose.--One half to one fluid-drachm 3 or 4 times a day.      |
    |                                                              |
    |     Manufactured by H. C. F. Meyer, M.D.                     |
    | Price, $                      Pawnee City, Neb., U. S. A.    |
    |   Patent                                                     |
    +--------------------------------------------------------------+

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

[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.


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.)      5   grains
    Ergotin                       1   grain
    Oil Savin                     1/2 grain
    Aloin                         1/8 grain

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: “C_{6}H_{7}O_{7}Na.C_{6}H_{12}N_{4}.”

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.

[46] Zernik: Arb. a. d. Pharmazeut. Inst. d. Univ. Berlin, 1907, iv, 46.

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 Zernik[47] and show that the product now, as
  then, is not true to claims.

[47] Therap. d. Gegenw., February, 1909.

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 3-1/2
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:

    “_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.

[48] Phillips, John: Prevalence of the Heroin Habit, The Journal
A. M. A., Dec. 14. 1912, p. 2146.

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,[1] 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.

[49] Facts about Heroin, Current Comment, The Journal A. M. A., Dec.
21, 1912, p. 2262.

                    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 out[51] 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.

[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.

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.”

[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.

                       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” C_{3}H_{6}O_{4} +
C_{3}H_{8}O_{3} appears under the word Glycozone. From the Council’s
report it is apparent that C_{3}H_{6}O_{4} stands for glyceric acid
and the C_{3}H_{8}O_{3} 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.”

[Illustration: 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.

[53] Feb. 2, 1907, p. 415, and Feb. 9, 1907, p. 521.

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

    “... 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       1 1-9 Gr.  or 0.075 Gm.
    Ferri Albuminas
          Iron Content          4 1-4 Grs. or 0.286 Gm.
    Sodii Chloridum             6 1-5 Grs. or 0.412 Gm.
    Calcii Salicylicum          4     Grs. or 0.26  Gm.
    Guaiacol                    4     Grs. or 0.26  Gm.
    Creosote (Beechwood)        5     Grs. 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 out[54] we know little of the
secondary or remote effects of the intravenous injection of toxic
substances; some of them probably do permanent harm.

[54] The Journal A. M. A., July 4, 1914, p. 1.

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

[O] For the unabridged report of the Council’s action on Iodalia, see
Reports Council Pharm. and Chem., 1914, p. 69.


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]

[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.

                       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 2-1/2 grains of
potassium iodid; actually it contains only 1-1/2 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

[P] See also Burnham’s Soluble Iodine, p. 233.


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

[Q] For the unabridged report of the Council’s action on Iodotone, see
Reports Council Pharm. and Chem., 1914, p. 72.


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)                     48.05 per cent.
    Menthol                                  2.07 per cent.
    Methyl salicylate                       10.25 per cent.
    Potassium iodid (4.25 per cent. iodin)   5.55 per cent.
    Soap                                    12.68 per cent.
    Glycerin                                a trace
    Water 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

[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.


Nourry Wine (E. Fougera and Co., New York) is a proprietary iodin
preparation said to contain 12 per cent. of alcohol and 1-1/2 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”    35-3/8
    Gaultheria Fragrantissima
         (true active principle) “Process-Laborde”    25-1/8
    Acete Amide-Phenyle                               15-1/8
    Quinina                                            1-1/8
    Benzoyl-Sulphyonic-Imide                          23-1/4

  It 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.”

  [Illustration]

  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                     37.9
    Free salicylic acid             6.9
    Quinin                      present
    Corn starch                 present
    Milk sugar                     34.7

  This report of analysis only makes apparent that Labordine is not
  what it is claimed to be. While it is claimed to contain 23-1/4 per
  cent. saccharin, this substance was not present, or mere traces only.
  While, in a disguised way, it is stated to contain 15-1/8 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.

[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.

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 23-1/4 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

[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.


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                  40 ounces
    Pepsin                          8 ounces
    Pancreatine                     6 ounces
    Ptyalin or Diastase             4 drachms
    Lactic Acid                     5 fl. drachms
    Hydrochloric Acid               5 fl. 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

[U] See also following report on Valentine’s Meat Juice and article on
Meat Extracts and Meat Juices, p. 470.


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]

[57] Brunton, Sir Lauder: “Disorders of Assimilation, Digestion, etc.,”
p. 183.

“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.”

[58] Bull. No. 21, U. S. Dept. Agricult., Office of Experiment Stations.

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 (P_{2}O_{5}), 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

“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:
   1 = Name of Preparation
   2 = Per cent. volatile matter 100 C.
   3 = Per cent. inorganic matter
   4 = Per cent. sodium chlorid
   5 = Per cent. phosphoric pentoxid (P_{2}O_{5})
   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

  ==================+=====+=====+====+====+=====+====+====+=====+====+======+=====
           1        |  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   |98.11|  .39| .05| .12|  .25| .24|....| 1.00| .25| 24.00|  .70
  60-100 C.         |     |     |    |    |     |    |    |     |    |      |
                    |     |     |    |    |     |    |    |     |    |      |
  MADE IN           |     |     |    |    |     |    |    |     |    |      |
  LABORATORY:       |     |     |    |    |     |    |    |     |    |      |
                    |     |     |    |    |     |    |    |     |    |      |
  Beef Juice,       |     |     |    |    |     |    |    |     |    |      |
  John Wyeth & Bro.,|58.84|16.21|6.71|3.27|12.51|3.15|2.88| 3.56|6.00|154.56|16.80
  Philadelphia, Pa. |     |     |    |    |     | [V]|    |     |    |      |
                    |     |     |    |    |     |    |    |     |    |      |
  Bovinine,         |     |     |    |    |     |    |    |     |    |      |
  The Bovinine Co., |     |     |    |    |     |    |    |     |    |      |
  75 W. Houston St.,|80.40| 1.55|1.05| .09| 3.64|2.36|3.38|10.75| .28|339.12|  .78
  New York City     | [W] |     |    |    | [X] |    |    |     |    |      |
                    |     |     |    |    |     |    |    |     |    |      |
  Carmine Co.,      |     |     |    |    |     |    |    |     |    |      |
  Lefranco, Paris,  |     |     |    |    |     |    |    |     |    |      |
  France; Imported  |     |     |    |    |     |    |    |     |    |      |
  by Fougera & Co., |     |     |    |    |     |    |    |     |    |      |
  Agents, New York  |24.80|  .86| .09| .33|68.94| .96|2.25| 2.56| .59|115.44| 1.65
  City              | [Y] |     |    |    | [Z] |    |    |     |    |      |
                    |     |     |    |    |     |    |    |     |    |      |
  Meat Juice,       |     |     |    |    |     |    |    |     |    |      |
  M. J. Valentine,  |57.64|10.26|1.77|3.41|20.41|3.06| .19| 5.44|6.06|135.12|16.97
  Richmond, Va.     |     |     |    |    |[AA] |[AB]|    |     |    |      |
  ------------------+-----+-----+----+----+-----+----+----+-----+----+------+-----

[V] Including 0.20 per cent. as NH_{3};

[W] 8.17 per cent. alcohol found;

[X] 3.1 per cent. glycerol found;

[Y] vacuum 70 C.;

[Z] 47.50 per cent. cane sugar--14.2 per cent. glycerol found;

[AA] 8 per cent. of glycerol found.

[AB] including 0.22 per cent. NH_{3};

  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 3-1/2 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[AC]

            Report of the Council on Pharmacy and Chemistry

[AC] See also preceding report on Meat and Beef Juices, and article on
Meat Extracts and Meat Juices, p. 470.


Some time ago the Council authorized publication of a report[AC]
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_
  _Old Dominion Journal of Medicine & Surgery_
  _Medical World_
  _Virginia Medical Semi-Monthly_
  _Medical Times_
  _American Medicine._]--(_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:
   1 = Name of Preparation and Manufacturer
   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[AD]
  12 = Number c.c. required per diem to supply 1,430 calories

 =================+=====+====+=====+=====+=====+=====+====+=====+=====+=======+=======
                  |     |    |     |     |     |     |    |     |     |       |
         1        |  2  | 3  | 4   | 5   |   6 |  7  |  8 |  9  |  10 |   11  |  12
                  |     |    |     |     |     |     |    |     |     |       |
  ----------------+-----+----+-----+-----+-----+-----+----+-----+-----+-------+-------
  Carpanutrine    |     |    |     |     |     |     |    |     |     |       |
  --John Wyeth    |28.45|4.28|102.7| 5.34|109.5|212.2|12.5|437.5| 25.5|   78.0|1,100.7
  & Brother       |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Carpanutrine    |     |    |     |     |     |     |    |     |     |       |
  --John Wyeth    |21.29|6.24|149.8| 5.78|118.5|268.3|14.0|490.0| 32.2|   91.0|  942.9
  & Brother       |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Liquid Peptones |     |    |     |     |     |     |    |     |     |       |
  --Eli Lilly &   | 3.63|4.50|108.0| 6.05|124.0|232.0|18.0|630.0| 69.6|  258.6|  829.4
  Company.        |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Liquid Peptones,|     |    |     |     |     |     |    |     |     |       |
  with Creosote   |     |    |     |     |     |     |    |     |     |       |
  --Eli Lilly &   | 4.34|3.84| 92.2|13.47|276.1|368.3|18.0|630.0|110.5|  299.5|  716.2
  Company         |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Nutrient Wine of|     |    |     |     |     |     |    |     |     |       |
  Beef Peptone--  |14.97|0.64| 15.4|15.43|316.3|331.7|17.5|612.5| 66.3|  188.8|  757.4
  Armour & Company|     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Nutrient Wine of|     |    |     |     |     |     |    |     |     |       |
  Beef Peptone--  |13.70|0.43| 10.3|15.57|319.2|329.5|17.0|595.0| 65.9|  184.9|  773.3
  Armour & Company|     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Nutritive Liquid|     |    |     |     |     |     |    |     |     |       |
  Peptone--Parke, | 1.02|1.86| 44.6|12.89|264.2|308.8|18.8|658.0| 74.2|  232.1|  739.5
  Davis & Company |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Nutritive Liquid|     |    |     |     |     |     |    |     |     |       |
  Peptone--Parke, | 1.95|1.16| 27.8|13.19|270.4|298.2|17.7|619.5| 71.5|  220.2|  779.2
  Davis & Company |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Peptonic Elixir |     |    |     |     |     |     |    |     |     |       |
  --Wm. Merrell   | 3.21|2.54| 61.0|11.46|234.9|295.9|16.5|577.5| 53.3|  157.2|  818.6
  Chemical Company|     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Tonic Beef      |     |    |     |     |     |     |    |     |     |       |
  S. & D.--       |12.91|3.40| 81.6| 2.36| 48.4|130.0|12.0|420.0| 13.0|   55.0|1,300.0
  Sharp & Dohme   |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Tonic Beef      |     |    |     |     |     |     |    |     |     |       |
  S. & D.--       |12.63|3.28| 78.7| 2.22| 45.5|124.2|13.0|455.0| 12.4|   57.9|1,234.4
  Sharp & Dohme   |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Liquid Peptone  |     |    |     |     |     |     |    |     |     |       |
  --Stevenson &   | 0.44|1.81| 43.4| 0.55| 11.3| 54.7|12.0|420.0|  9.8|   85.4|1,506.8
  Jester Company  |     |    |     |     |     |     |    |     |     |       |
                  |     |    |     |     |     |     |    |     |     |       |
  Cow’s Milk      |     |    |     |     |     |     |    |     |     |       |
  (3.8 per cent.  |  -- |3.50| 84.0| 4.80| 98.4|182.4| -- |  -- |  7.3|1,429.6|2,000.0
  fat)            |     |    |     |     |     |     |    |     |     |       |
  ----------------+-----+----+-----+-----+-----+-----+----+-----+-----+-------+-------

[AD] 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:

    “But more striking was the following case: One evening between
    5 and 6 o’clock I was sent for, family lives near me, and I was
    informed that the young lady had promised to be bridesmaid, a
    function she had never performed. Her mother said the daughter
    would certainly drop in her tracks as she walked up to the altar
    with the procession, and they had about concluded to send a note
    saying to the parents of the bride that she could not come,
    although that would be very disagreeable (and no less offensive,
    said I). They agreed with me. I ordered Neurilla for two hours.
    She went to church, and, I was informed the next morning, passed
    through the dreaded ordeal simply fatigued, and was now fast asleep
    on account of the nice effect of Neurilla.”

It might provoke a smile to think that a manufacturer would publish so
silly a testimonial were it not that the very fact of its publication
indicates that there are medical men thoughtless enough to read and
accept such stuff as reliable evidence as to the value of any product.

           TESTIMONIALS GIVEN LONG AGO--THE REMEDY ABANDONED

A number of physicians who had given testimonials were asked in
writing whether the testimonials were genuine and whether they still
entertained the high opinion of Neurilla expressed at a former date.
Several replied that, if they had ever given such testimonials, they
had forgotten the circumstance. From the replies received we select the
following:

The testimonial which bears Dr. A’s name reads:

    “_I am using Neurilla with most satisfactory results._”

Dr. A now says:

    “=As to its positive value as a therapeutic agent I have not used
    it enough to know.... If the language you quote ... appears as
    given in or as a ‘testimonial’ it must in some way be garbled and
    appears wholly without my knowledge or consent.=”

Dr. B is quoted as having written:

    “_I do not often lend my influence to furthering the fame of a
    proprietary remedy, but I have achieved such excellent results
    from the use of Neurilla as a calmative in hysteria and other
    nervous disorders, that I feel its manufacturers are entitled to an
    acknowledgment of gratitude from me._”

Dr. B writes:

    “=I have not prescribed a dose of the nostrum in years. The use of
    my name in connection with Neurilla is unauthorized.=”

Dr. C once wrote:

    “_I have used Neurilla with good results._”

Dr. C now writes:

    =“In re ‘Neurilla’ I think I used the preparation once or twice and
    it seemed to do good work, but if due to the preparation or other
    influences, I am not able to verify. I have not used it since nor
    will, as I am opposed to using these preparations except in certain
    cases where the ℞ contains remedies whose value I have verified
    under the most rigid tests.=

    “=P. S. This testimonial must have been given many years ago.=”

Dr. D’s testimonial is admitted to be based on a single case:

    “_I am using Neurilla in a bad case of neuralgic tic with very good
    results on an aged lady. She has taken several bottles, and is
    still taking it with very good results._”

Dr. D sums up his later experience by saying:

    “=I have long since abandoned the use of Neurilla in practice.=”

The following bears Dr. E’s name:

    “_I endorse Neurilla without hesitation. It meets all indications
    for which it is intended._”

This is what Dr. E writes now:

    “=As to the enclosed testimonial in regard to Neurilla said to
    be written by me I have no recollection. I am not prescribing
    Neurilla.=”

Dr. F’s experience is similar. The testimonial credited to him reads:

    “_I have prescribed Neurilla in nervous disorders with good
    results._”

Dr. F now writes:

    “=I don’t remember of ever having prescribed ‘Neurilla’ or of
    having given a testimonial for it or any other patent medicine if I
    knew it to be so.=”

                                SUMMARY

In the booklet from which the foregoing are taken, there are forty
testimonials. Those which we quote are merely samples. To sum up the
results of this analysis: Of the testimonials some are said to be
unauthorized; a number were written with so little thought that the
writers had since forgotten their very existence; the conclusions
expressed in most are not in fact justified by the writers’ mature
judgment and experience. A number of writers admit that their
experience is insufficient to determine whether the supposed good
results were due to the medicine used or to other influences. Of course
such evidence is unworthy of credit and happily, very little is now
being furnished by doctors; even our courts refuse to admit it.

In short, the published formula shows that Neurilla is nothing more
than a preparation of discredited drugs; it is exploited largely by
means of carelessly formed and thoughtlessly expressed opinions of
physicians. It is recommended that this report be published as an
illustration of such methods and as a protest against them.

[Editorial Comment.--Neurilla is advertised in the following
publications:

  _Archives of Pediatrics_,
  _Atlanta Journal Record of Medicine_,
  _Charlotte Medical Journal_,
  _Indianapolis Medical Journal_,
  _International Journal of Surgery_,
  _Journal of Nervous and Mental Diseases_,
  _Medical Herald_,
  _New York Medical Record_,
  _Medical Review of Reviews_,
  _Medical Sentinel_,
  _Medical Standard_,
  _Pacific Medical Journal_,
  _Southern Practitioner_,
  _Texas Medical Journal_,
  _Woman’s Medical Journal_,
  _Eclectic Medical Journal_,
  _Ellingwood’s Therapeutist_,
  _Journal of the American Institute of Homeopathy_.]
  --(_From The Journal A. M. A., March 27, 1914._)




           NEUROSINE, DIOVIBURNIA, GERMILETUM AND PALPEBRINE

            Report of the Council on Pharmacy and Chemistry


Neurosine, Dioviburnia, Germiletum and Palpebrine are “shotgun”
proprietaries typical of the polypharmacy of the past three or four
decades. They are marketed by the Dios Chemical Company, St. Louis, Mo.
On the recommendation of the referee, the Council has authorized the
publication of this report.

                                              W. A. Puckner, Secretary.


                               Neurosine

According to the manufacturers, each fluidounce of Neurosine represents:

    “Bromid of potassium, C. P.         40 grains
    “Bromid of sodium, C. P.            40 grains
    “Bromid of ammonium, C. P.          40 grains
    “Bromid of zinc                      1 grain
    “Extract Lupulin                    32 grains
    “Cascara sagrada, fl. ex.           40 minims
    “Extract Henbane                  .075 grain
    “Extract Belladonna               .075 grain
    “Extract Cannabis indica          .60  grain
    “Oil Bitter Almonds               .060 grain
    “Aromatic Elixirs.”

No physician would think for a moment of prescribing all of the drugs
contained in Neurosine for any one condition. Yet physicians are urged
to use this nostrum in insomnia, hysteria, neurasthenia, migraine,
neuralgia, delirium tremens and in a host of other conditions.

It is recommended in the treatment of epilepsy on this ground:

    “Neurosine is presented in a very palatable and agreeable form
    and can be administered for an indefinite time without untoward
    by-effects as so often attends the use of the commercial bromides.
    In order to secure lasting benefits the treatment should be
    extended over a long period of time.”

The evident implication here is that the recognized drawbacks of bromid
medication are due to impurities present in the commercial bromids and
that the teachings of modern medicine with regard to caution in the use
of bromids do not apply in the case of Neurosine.

The assurance is offered:

    “Neurosine contains no chloral, morphin or other objectionable
    drug--a fact of the utmost importance when administering medicines
    to neurotic women.”

    “As a nerve-calmative and sleep-producer nothing can excel
    Neurosine ... It should be borne in mind that this preparation
    contains no opium, morphine, chloral or habit-forming drugs ...
    Neurosine being a harmless remedy is especially indicated for
    neurotic individuals.”

Apart from cannabis indica, Neurosine contains no efficient hypnotic.
Cannabis indica is a dangerous drug, whose administration to “neurotic
individuals” is by no means free from danger--especially when it is
given under a proprietary name that carries no warning of its presence.

Here is another recommendation--this time for chorea:

    “All authorities recommend the bromides, hyoscyamus and cannabis
    indica in this disease. These remedies are all combined in
    Neurosine, the ideal calmative for both children and adults.”

On the contrary, practically “all [medical] authorities” will admit
that it is undesirable to keep a child under the influence of bromids
if this can be avoided. Such treatment is mentioned only for use as
a last resort in extreme cases. Hyoscyamus and cannabis indica are
mentioned in connection with chorea by few authorities, and then merely
as probably valueless.

Not content with recommending the promiscuous use of this already
too complex mixture, the Dios Chemical Company advises physicians
to combine it with iron, when chalybeate and tonic effects are
to be combined with “a nervine,” with acetanilid for “irritable
cough,” headache and neuralgia, with antipyrin in asthma and with
Dioviburnia--another Dios nostrum--in all female ailments.


                            Dioviburnia[AE]

[AE] For articles on other viburnum preparations, see pp. 218 and 409.

Dioviburnia, another Dios nostrum, according to the label, has the
following composition:

    “Every fl. oz. contains 3-4 dr. each of the fl. extracts,
    Viburnum Prunifolium, Viburnum Opulus, Dioscorea Villosa, Aletris
    Farinosa, Helonias Dioica, Mitchellae [_sic_] Repens, Caulophyllum
    Thalictroides, Scutellaria Laterifolia.” [Lateriflora?--Ed.]

Further, according to the label, Dioviburnia contains 18 per cent.
alcohol. If this statement is correct then the “formula” is false, for
the fluid extracts named contain from 25 to 73 per cent. of alcohol.
As--according to the “formula”--these fluid extracts constitute
three-fourths of Dioviburnia, the average alcohol-content in the whole
mixture must of necessity be much above 18 per cent.[59] According to
the makers, Dioviburnia is “unexcelled” for:

    “Amenorrhea, Dysmenorrhea, Leucorrhea, Puerperal Convulsions,
    Prolapsus Uteri, Menorrhagia, Threatened Abortion, Parturition,
    Subinvolution, Miscarriage, and a general relaxed condition of the
    uterus and appendages, together with the various aches and pains
    peculiar to women.”

[59] Five of these fluidextracts have their alcohol-content determined
by the Pharmacopeia or National Formulary. Three are not recognized and
hence their alcohol-content is not defined by law. The alcohol-content
of the mixture of fluidextracts said to be in Dioviburnia has been
kindly furnished by five leading pharmaceutical houses. If the lowest
alcohol-content of the several fluidextracts is made the basis of
calculation, Dioviburnia should contain at least 30.75 per cent. of
alcohol, or more than half as much again as the amount declared on the
label.

Around the sample bottle of Dioviburnia is wrapped a booklet entitled
“A Treatise on Uterine Diseases and Obstetrical Hints,” said to be
“For the Profession Only.” The booklet has been prepared, physicians
are told, to present “some very valuable suggestions” regarding
the treatment of female disorders and the attention of the medical
profession is “earnestly” called to the “very remarkable medicine,”
Dioviburnia. Further, it is said that Dioviburnia was devised by the
Dios Chemical Company because there was an “absolute necessity” for
some really efficient internal treatment in female diseases. The
company backs up its statements by such claims as:

    “The most valuable preparation, therapeutically, ever offered.”

    “[Contains] every essential for toning up the female organs of
    generation, and relieving pain.”

    “A general and special tonic, antispasmodic and invigorating
    cordial.”

While the company directs the attention of physicians to the
“well-known, therapeutical effects of each individual constituent” of
Dioviburnia, there is in reality little positive evidence regarding
the action of any of the drugs contained in the nostrum. Most writers
on materia medica do not even mention these drugs and the few who
do discuss them, either question or deny their medicinal value. But
if every drug claimed to be present in Dioviburnia had some actual
demonstrated therapeutic properties, it still would be impossible
to predict the action of such a combination in the many and varied
conditions for which it is exploited. Certainly there is no warrant for
such statements as:

    “In Painful Dysmenorrhea [_sic_] Dioviburnia is especially
    indicated, and its continued use will invariably give relief.”

    “In cases of Leucorrhea of long standing, Dioviburnia, together
    with local treatment, invariably gives relief.”

    “Dioviburnia is efficient in cases of subinvolution; it cures by
    its tonic effects....”

The effects of the drugs alleged to be present in Dioviburnia are not
such as to justify the hope of either “cure” or “invariable relief.” In
a way the Dios Chemical Company seems to recognize the inefficiency of
Dioviburnia since it frequently suggests that it be used in combination
with drugs of known value; but it ascribes all favorable results to its
own product:

    “In chronic constipation fluid extract of cascara sagrada aromatic
    may be combined with Dioviburnia.”

    “In cases of habitual abortion, depending on syphilitic taint, a
    prescription containing the following should be used during the
    entire pregnancy:

    ℞ “Hydrarg. Chlor. Corros        gr.  1
      “Potass. Iodid                dram  1
      “Dioviburnia                ounces 16”

    “An Anemic or Chlorotic patient, suffering with absence of the
    menstrual flow, should take DIOVIBURNIA combined with Iron.”

    “In leucorrhea depending on endocervicitis, hot astringent douches
    once daily should be given. Local applications of iodin are useful
    in chronic conditions. Internally, D i o v i b u r n i a promotes
    healing.”

    “Rest in bed, hot douches of a one-half per cent. solution of
    compound cresol solution and D i o v i b u r n i a internally, a
    teaspoonful every 3 hours will rarely fail to cure endometritis in
    a few days.”

    “In specific vaginitis, a solution of potassium permanganate (1 to
    1000) should be used as a douche twice daily. Internally give the
    following:

    “Sodii benzoate          1/2 ounce
    “Dioviburnia             16 ounces
    “M. sig., Teaspoonful every three hours.”

    “Prolapsus Uteri is benefited, and often cured, by DIOVIBURNIA
    combined with local treatment in the shape of tampons, pessaries,
    electricity, etc.”

If Dioviburnia will cure specific vaginitis, anemia, etc., so will a
cobblestone make excellent soup. All that is necessary in the former
case is to add certain potent drugs that might be indicated in the
pathologic conditions mentioned and, in the latter case, to combine
suitable amounts of beef, chicken, green turtle or vegetables, with
herbs and other seasoning.


                              Germiletum

Germiletum is a member of the large class of alkaline antiseptic
solutions with excessively complex formulas. In this case not only
is the formula complex but also the Dios Chemical Company finds it
impossible even to assign a constant composition to it--at least the
“formulas” which appear on the different styles of Germiletum labels
and advertising circulars vary greatly.

The company says:

    “We appeal only to the Doctor’s judgment of his estimation of the
    formula.”

    “Doctor you will readily determine from the formula the class of
    cases in which you have a right to expect satisfactory results.”

Yet the “formulas” given present so great a variety and such confusion
that it is not clear even to a chemist just what the Dios Company wants
the medical profession to regard as the composition of Germiletum.

The following statements of “composition” have appeared at various
times:

1. In an advertising circular sent out some time ago:

    “[HBF_{4} + BOH (OC_{6}H_{4}COOH)_{2}
    + BOH (OC_{6}H_{3}COOH)_{2} + C_{3}H_{5}BO_{3}
    + CH_{2}O + C_{10}H_{14}O
    + C_{10}H_{20}O + C_{24}H_{28}N_{3}Cl.]”

2. In advertising circulars which have been received of late, being
wrapped with a sample package and with the “large size” trade package:

    “[C_{7}H_{6}O_{2} + H_{3}BO_{3} + C_{3}H_{5}BO_{3}
    + (CH_{2}O)_{3} + C_{10}H_{20}O + C_{10}H_{14}O + C_{2}H_{6}O]”

3. In another advertising circular:

    “Germiletum is a slightly alkaline chemical solution of
    Borohydrofluoric Acid, Borosalylbenzoic Acid, Boroglycerine,
    Formaldehyde with Menthol, Thymol and Antiseptic Aromatics.”

4. On the label of a sample package sent through the mails during 1914,
and on the label of a “small size” trade package purchased in 1914:

    “FORMULA.--Borohydrofluoric Acid, Borosalylbenzoic Acid,
    Boroglycerine, Formaldehyde with Menthol, Thymol, Amyl Acetate and
    other Antiseptic Aromatics.”

5. In the circular which was wrapped around the sample package referred
to above, and around the “large size” trade package purchased at the
same time that the “small size” package was bought:

    “Germiletum is a slightly alkaline chemical solution of Borobenzoic
    Acid, Boroglycerine Formaldehyde, with Menthol, Thymol and other
    Antiseptec [_sic_] Aromatics.”

6. On the sample package, on the “small size” trade package and on the
wrappers of the “large size” trade package:

    “Alcohol 18 per cent.; Formalin 3/4 M. per oz.; Amyl Acetate 1/3 M.
    per oz.” (also written “Acetate Amyl.”)

The label on the large trade package states that Germiletum contains
“Formalin 1/2 M. per oz.”

One and all of these various formulas spell mystery. The existence
of some of the constituents is problematic; even if the theoretical
possibility of such combinations be conceded, some of them could not
exist in Germiletum, for they would be broken up by the alkaline fluid.
As illustrating the contradictions which the formulas present: While
the wrapper of the “large size” trade package claims that Germiletum
contains 3/4 minims Formalin (Formalin is a proprietary name for a
40 per cent. formaldehyd solution) the label on the bottle claims
only 1/2 minim. Again, while the composition expressed in chemical
symbols asserts that “H_{3}BO_{3}” (boric acid) is a constituent of
Germiletum, the “formula” which follows it states that Germiletum
has an alkaline reaction; hence it cannot contain much boric acid.
Finally, the “small size” bottle of Germiletum purchased at the same
time as the “large size” bottle and also the label of a sample package
sent through the mails to a physician in 1914, give as a constituent
“Borohydrofluoric Acid,” which is mentioned neither on the label of the
“large size” trade package nor in the pamphlet wrapped around it. The
only information which these contradictory “formulas” can convey to a
physician is that Germiletum is an unscientific, varying mixture of
many drugs.

A trade package, having the name “Germiletum” blown in the glass, bears
on the label recommendations for its use in the treatment of “catarrh,”
“Gastritis, Stomatitis, Gastric and Intestinal Catarrh,” “Leucorrhea
and Uterine Diseases,” “Hemorrhoids,” “Whooping Cough,” “Tonsilitis and
other forms of sore throat” and “Eczema.”

The following statement on the label is designed to induce physicians
to place false confidence in Germiletum to the danger of their patients:

    “The lying-in-room should be thoroughly sprayed with Germiletum.
    Can be relied upon to destroy the living particles which so
    generally constitute contagion.”

This claim, as well as the assertion which appears on the label of
a sample package and of the “small size” trade package that it is
“PAR-EXCELLENT IN OBSTETRICAL PRACTICE” is almost criminal, as
Fussell[60] has said, since to depend on any preparation of this sort
is to court disaster.

[60] Fussell, M. H.: Dangers of Certain Ethical Proprietary
Preparations to Both Physicians and Public, The Journal A. M. A., Oct.
7, 1911, p. 1196.

The booklet around the trade package makes the claim that Germiletum
“is the best antiseptic”--evidently largely because it is claimed to be
“the blandest of all”--and that it is “thoroughly germicidal” and even
that it is “the best disinfectant obtainable.” It also contains such
unwarranted and misleading claims and suggestions as:

    “... preparatory to all operative work--Germiletum should be used
    freely in spraying the atmosphere ...”

    “Operative wounds, whether large or small, can be rendered
    thoroughly antiseptic by freely spraying them with Germiletum....”

    “... it may be given internally in many dyspepsias and in all
    zymotic diseases.... In such conditions Germiletum is the ideal
    internal antiseptic and disinfectant.”

In the present advertising, no evidence whatever is offered for
the value of Germiletum, the Dios Company contenting itself with
unsupported claims and cant phrases such as

    “... the truth is only reached through a final appeal to
    intelligent practical experience.”

In the old circulars only crude, uncritical and meaningless tests
to establish the antiseptic value of Germiletum are reported and
none whatever as to its germicidal action. In the advertising matter
sent out some time ago, for instance, were given “Microscopical,
Bacteriological and Chemical Tests, Comparing Germiletum with Carbolic
Acid.” These tests have no value whatever, unless it be to show the
worthlessness of the preparation. This is particularly true as regards
a series of experiments on “Germiletum as a Preventive of Lactic
Fermentation,” in which one part of Germiletum in thirty parts of milk
did not prevent fermentation. Such effect as indicated is probably due
to the formaldehyd present. The tests show the absurdity of using the
preparation for internal and external purposes. The referee challenges
the therapeutic claims on the basis that they are extravagant and
unsubstantiated. (The Chemical Laboratory of the American Medical
Association reports that the alkalinity of Germiletum corresponds
approximately to a 1 per cent. borax solution.)


                              Palpebrine

According to the Dios Chemical Company, Palpebrine is “A Reliable
External Ocular Antiseptic” having, it is said, the following
composition:

    “... each fluid ounce contains 1/116 grain Sulphate of Morphia, 1/7
    grain Sulphate of Zinc, 1/11 grain Bi-Chloride of Mercury, 5-3/8
    grains Boric Acid, 3/4 grain Salicylic Acid.”

The essential virtues ascribed to Palpebrine, according to its makers,
are its harmlessness and its therapeutic efficiency due, presumably, to
its complex composition:

    “Attention is called to the constituents of this formula, each
    one of which is used by ophthalmologists. Their combination in
    Palpebrine is such as to blend their action in a very happy manner.
    Palpebrine acts as an antiseptic, an irritant, an astringent, and a
    nerve tonic to the mucous membrane of the eye.”

    “Palpebrine is superior in its action to the remedies now in use.
    It contains all the constituents of Aqua Conradi ... But to these
    are added a number of other agents which will prove it to be of
    much greater value and give it a broader field for action.”

In all external afflictions of the eye the free use of Palpebrine is
suggested in such statements as:

    “They [general practitioners] will therefore gladly receive from
    our hands an efficacious preparation which may be used with perfect
    safety.”

    “The name of our preparation--Palpebrine, is derived from the Latin
    _palpebra_, the eyelid, and is well fitted, as it designates at a
    glance the sphere of action of Palpebrine.”

    “With the assistance of Palpebrine the general practitioner can
    successfully treat all cases of external eye disease ordinarily
    encountered in his practice.”

One of the members of the Council staff of clinical consultants calls
attention to the fact that much vitally valuable time might be lost
in a case of iritis, for example, which being unrecognized, should be
treated with Palpebrine on the strength of the Dios Chemical Company’s
advertisements. Even more dangerous is the recommendation of Palpebrine
for the prevention of ophthalmia in the newborn, especially as this
recommendation is coupled with an attempt to discredit the established
treatment with silver nitrate solution:

    “The use of severe remedies for this purpose has been discarded by
    most physicians....”

While it is doubtless true that ophthalmia neonatorum may be averted by
other drugs than silver salts, it is utterly unjustifiable to suggest
that the established method of treatment by means of silver salt
irrigations has been generally discarded.

  [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.

  This is simply one illustration of the fact noted above. Some
  physicians have been and are prescribing nostrums originated,
  manufactured and advertised by laymen who are not in the legitimate
  pharmacy business. In addition, such physicians have been accepting
  the statements of laymen, not only as to the composition of the
  nostrums, but as to their use. In every state the practice of
  pharmacy is regulated by law: before assuming the responsibility of
  compounding medicines a druggist must have studied and passed an
  examination in pharmacy. Public safety demands and the law requires
  it. There are some doctors, however, who will allow laymen who are
  not chemists, pharmacists or physicians to formulate and compound a
  prescription and tell them what it is good for and how to use it.

The Dios Chemical Company is not an isolated instance: we have already
referred to some; we shall take occasion to refer to others in the
future. That such concerns flourish is a reflection not so much on the
shrewd laymen who exploit the medical profession--and through it the
public--as it is on the physicians who cast their scientific training
to the winds and permit themselves to be thus exploited.]--(_From The
Journal A. M. A., Jan. 9, 1915._)




                              OXYCHLORINE

            Report of the Council on Pharmacy and Chemistry


The following report on Oxychlorine has been submitted to the Council
by the subcommittee to which it was assigned:

  _To the Council on Pharmacy and Chemistry_:--Your subcommittee
  submits the following report: The Oxychlorine Chemical Company, 1326
  Wabash Avenue, Chicago, states in its advertising literature that:

    “Chemically, Oxychlorine is the tetraborate of sodium and potassium
    combined with oxychlorid of boron, thus: 6 (NaKB_{4}O_{7})
    BOCl_{3}.”

Analysis of Oxychlorine showed:

    Potassium                           12.26 per cent.
    Sodium                               8.20 per cent.
    Chloric acid--CLO_{3}               25.32 per cent.
    Nitric acid--NO_{3}                 21.70 per cent.
    Boric acid anhydrid--B_{2}O_{3}     18.63 per cent.
    Water, calculated                   13.29 per cent.

Thus, Oxychlorine is not a definite chemical substance of the
composition claimed, but instead is a mixture of alkali chlorate and
nitrate with boric acid. Assuming that the chlorate is present as
potassium chlorate and the nitrate as sodium nitrate, the analysis
above quoted corresponds to a mixture approximately as follows:

    Potassium chlorat                   37.19
    Sodium nitrate                      29.76
    Sodium and potassium tetraborate     2.18
    Boric acid                          30.52
    Undetermined                         0.35
                                       ------
                                       100.00

Your committee recommends that Oxychlorine be not approved and that
this report be published.

The report of the subcommittee was adopted by the Council, and in
accordance with the recommendation is published herewith.

                                              W. A. Puckner, Secretary.

In commenting on the above report it is hardly necessary to call
attention to the palpable untruthfulness of the furnished formula or
its lack of correspondence to the real composition of the preparation,
to the imposing claims made by its pseudo-scientific exploiters or
the absurdities, from a chemical standpoint, of the statements made
in their literature. These features are more or less common to all
nostrums. The physician who prescribes or uses Oxychlorine under
the impression that he is getting a definite and unique chemical
compound described as tetraborate of sodium and potassium combined
with oxychlorid of boron is, according to our chemists, getting simply
a mixture of potassium chlorate, sodium nitrate (or, perhaps, sodium
chlorate and potassium nitrate), and boric acid in about equal amounts.
More than one-third of this mixture is potassium (or sodium) chlorate,
drugs by no means harmless.

In order that there may be no suspicion of unfairness to the promoters
of the preparation, we quote from one of the advertising circulars sent
out by the Oxychlorine Company:

    “Oxychlorine owes its recognition as a therapeutic agent to its six
    principal qualities:

    “1. It will oxygenate the blood at the seat of application,
    maintain nutrition and heal an uninfected solution of continuity of
    first intention without scar formation.

    “2. It will disorganize all pus and ferment-producing
    micro-organisms, their toxins, ferments and ptomains.

    “3. It will restore an inflamed mucous membrane to its normal
    condition, except where the membrane is sclerosed or atrophied.

    “4. It will destroy pathogenic micro-organisms and their toxins in
    the blood current.

    “5. It will stimulate the blood to absorb more oxygen in the lungs
    than it at the time carries. [We do not know what this means;
    perhaps the Oxychlorine Company does.]

    “6. It is absolutely harmless to the tissues and will not destroy a
    living cell.”

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!

Here is another claim made for this nostrum:

    “Two or three rectal injections of a one or two per cent. solution
    of Oxychlorine and ten grain doses given six to eight times per day
    is the best and most reliable treatment for typhoid fever.”

If 80 grains of Oxychlorine contain 30 grains of potassium chlorate,
three rectal injections each consisting of 1 pint of 2 per cent.
solution, would contain approximately 160 grains of potassium chlorate.
Such an injection might prove decidedly dangerous, especially when used
by one ignorant of its true composition. However, the physician, not
the promoters, bears the responsibility.

Oxychlorine sells at $3.50 a pound; the ingredients can be obtained
for about 44 cents a pound. Perhaps the margin of profit is intended
as a reward due the promoters for the profound physiologic discoveries
announced in their reading matter.--(_From The Journal A. M. A., July
6, 1909._)




             PAM-ALA, ANOTHER WORTHLESS QUININ SUBSTITUTE

            Report of the Council on Pharmacy and Chemistry


The following report of a referee on Pam-ala, an asserted malaria
specific, was adopted by the Council and its publication authorized.

                                              W. A. Puckner, Secretary.

Soon after publication of the Council’s report on Sinkina, an alleged
malaria specific proved worthless, the referee’s attention was called
to Pam-ala, which is sold under very similar claims.

According to the advertisements which have been appearing in Southern
medical journals, Pam-ala is “A new and effective remedy for MALARIA.”

The label describes Pam-ala as “An Effective Vegetable Remedy For
MALARIA. Guaranteed free of any Quinine, or other harmful [_sic_]
drugs.” It is said to be indicated in “Malarial Intermittent and
Remittent Fevers, especially curative in Chronic Malaria and
Malarial Cachexia and all conditions even where Quinine fails.”
One tablespoonful three times a day is said to be the “Curative
Dose,” while one tablespoonful three times a week is stated to be a
“Prophylactic Dose.” The label further claims that Pam-ala “Surpasses
Quinine in its action and has none of its Disadvantages.” Assertions
that Pam-ala is superior to quinin are followed by the usual
“guarantee” claim: “Guaranteed by the Pam-Ala Co. under the Drugs
Act, June, 1906, Ser. No. 2909 A.” Finally, the label says that it is
“Endorsed by Medical Authorities Throughout the world.”

As regards the composition, a circular says that “PAM-ALA is a purely
vegetable remedy for the cure, without Quinine, of all forms of
Malaria.” “‘PAM-ALA’ is derived from a plant of the genus Umbelliferae,
a native of the mountainous regions of Mexico and northern parts of
South America. Its medicinal properties have not been known to anyone
but the native Indians, who for years past have used it as a specific
in all forms of fever and malarial diseases so prevalent in tropical
countries. The seeds are more active as a therapeutic agent than the
dried-up plant; hence their collection for medicinal purposes requires
special skill in the selection of the same so as to be able to extract
all the possible medicinal properties from them, viz., its active
principle. An oil may be abstracted from the seeds which is of a yellow
color with an intense characteristic odor.”

At the close of the circular the following unenlightening formula
appears:

      Each fluid ounce contains:
    Ext. Fid. Pam-ala                          10 per cent.
    Alcohol                                    15 per cent.
    Ol. Aurant Syr. Sacchari aqua ad. q. s.   100 per cent.

In addition to being a cure for malaria, Pam-ala is claimed to have a
“favorable influence upon the broncho-pneumonia of measles ...,” “will
avert an attack of acute catarrh,” and “abort acute tonsilitis.”

The testimonials are of the usual character. Most of them seem to have
been given some four years ago by physicians in Italy, Cuba, Porto
Rico, Guatemala, etc., and therefore cannot readily be looked into. Two
are of more recent date and come from physicians in this country. They
furnish good illustrations of the manner in which proprietary concerns
make use of opinions hastily formed and thoughtlessly put in writing.
One testimonial was given in July, 1912:

    “I take pleasure in testifying to the seemingly marvelous and
    gratifying effect of Pam-ala in 2 cases of malaria....”

On Jan. 2, 1914, its writer, in reply to an inquiry whether in the
light of continued experience, his first estimate of Pam-ala had been
confirmed, wrote:

    “... Since then I tried Pam-ala on a number of cases without any
    results whatever; in fact my patients seemed to get worse until
    I resorted to the usual treatment of malaria, mercurial laxative
    followed with quinin. I was too hasty in stating that Pam-ala cured
    malaria. I now know and have known since August, 1912, that Pam-ala
    will not cure malaria....”

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:

    “With due allowance for the fact that certain cases will for a
    time improve on any kind of treatment, new or old, I see no reason
    for supplanting or even augmenting, the recognized treatment for
    malarial conditions, with either Pam-ala or Sinkina.”

Incidentally it should be mentioned that this physician also noted the
general similarity of Sinkina and Pam-ala. He observes:

    “The physical appearance and properties of the two preparations
    seem to be identical, the advertising matter and literature are
    surprisingly alike and the only marked difference seems to be that
    one remedy is purported to be prepared from a ‘new’ South American
    plant and the other from an equally fresh discovered addition to
    Asiatic flora.”

                           WHAT IS PAM-ALA?

From a comparison of the statements regarding the composition which
are made for Sinkina and for Pam-ala, as well as from the physical
characteristics of the preparation, particularly the odor and taste, it
seems evident that the essential constituent is oil of cumin. Although
definite proof that oil of cumin forms the essential constituent
of Pam-ala would have shown the worthlessness of this nostrum for
the reason that the clinical investigation of Sinkina proved the
worthlessness of oil of cumin, it did not seem worth while to the
referee that this be demonstrated by chemical analysis. It seemed to
him that in such cases as these, the secrecy with which the identity of
the preparation is surrounded, as well as the extravagant and highly
improbable claims, should be sufficient to condemn it.--(_From The
Journal A. M. A., Feb. 28, 1914._)




                           PAPAYANS BELL[AF]

            Report of the Council on Pharmacy and Chemistry

[AF] See also Bell-Ans (Papayans Bell), p. 282.


The following report of a subcommittee was submitted to, and adopted
by, the Council and its publication directed.

                                              W. A. Puckner, Secretary.

Papayans (Bell) made by Bell & Co., Orangeburg, N. Y., is said to
consist of the “digestive principle obtained by our own exclusive
process from the fruit of _Carica papaya_, combined with willow
charcoal, chemically pure sodium bicarbonate and aromatics.” The
following statement appears on the package: “For the treatment of
dyspepsia, flatulence, nausea, vertigo, hyperacidity, palpitation
and other symptoms of indigestion and the vomiting of pregnancy.
Peritonitis, cholera morbus, alcoholism and seasickness.” “Digests
every variety of food, removes every symptom of indigestion, restores
the entire digestive tract to a normal condition.” The dosage is
recommended as follows: “From one to three tablets before meals, or two
hours after eating. In severe cases, three tablets dissolved in hot
water and repeated as necessary.”

A circular which accompanies the package details the therapeutic
virtues of the preparation and contains what purports to be extracts
from medical journals, in which Papayans is recommended.

Examination of specimens purchased in the open market showed them
to contain the following ingredients: Charcoal, sodium bicarbonate,
ginger, saccharin and oil of gaultheria. As the product is said to
contain papain, the presence of enzymes was tested for, with the
result that it was found to possess neither proteolytic nor amylolytic
properties. The results of our examination are in accord with the
results obtained by a member of the Council, who examined the product
independently, and who writes:

  “We have made some extended tests with Papayans Bell, and find that
  the tablets consist essentially of sodium bicarbonate and charcoal,
  with a little flavoring matter. We find no digesting power for starch
  or egg albumin. At any rate, no appreciable change follows in the
  albumin in three hours, and no conversion to sugar in the same time,
  or change of starch to a point where the iodin reaction is weakened.
  The product seems to be practically inert.”

It is recommended that Papayans Bell be refused recognition, and that
publication of this report be authorized.

Comment: It will be remembered that two other products of Messrs. Bell
& Company have been discussed in this department: Salacetin (Bell)[61]
and Sal-Codeia (Bell).[62] Salacetin was examined with several
“synthetics” which all turned out to be mere acetanilid mixtures.
Salacetin, advertised as “a combination, with heat, of Salicylic and
Glacial Acetic Acids and Phenylamine” when examined “was found to be a
mixture and to contain the following ingredients approximately in the
proportion given: Acetanilid 43; sodium bicarbonate, 21; and ammonium
carbonate, 20.” Sal-Codeia (Salacetin-Codein) therefore, would be the
same with codein added.

[61] See p. 356.

[62] See p. 357.

Papayans (Bell) seems to be consistently fulfilling the life-history
of the average nostrum. Made of well-known drugs and invested by its
manufacturers--or exploiters--with virtues absurdly disproportionate to
the known properties of the alleged constituents of the nostrum, the
preparation was introduced to the world via the medical profession.
With the help of thoughtless physicians, aided by a skilful and
aggressive advertising campaign and augmented by the “free sample”
device, the business grew and prospered. The bottles with the name
and address of the company blown in the glass and with the varied
therapeutic indications for the nostrum printed both on the label
and on the circular in which the bottle is wrapped, have carried the
manufacturer’s message to the drug-taking public.

Apropos of this point, the recent “literature” contains what purports
to be endorsements of the nostrum by medical journals. Thus there is
quoted from the _New York Medical Journal_, Jan. 2, 1909, in part, the
following recommendation: “... we venture to suggest to our readers who
have not tried this remedy that they prescribe one _original sealed
package_ of Papayans (Bell) and that they carefully note the results
from its use.” [Italics ours.--Ed.] Having seen an “original sealed
package” we believe that we can predict the “results from its use.” On
any patient not mentally unbalanced, the result would be that the next
dose of Papayans (Bell) he thought that he needed would be purchased
from the druggist direct.

That such results are not hypothetical is evidenced by the statements
of the exploiters of Papayans (Bell) that “the annual sale now exceeds
four hundred million tablets.” Assuming that statement to be true,
it would be necessary for every physician in the United States to
prescribe over three thousand of these tablets every year--if they
reached patients only through the physician! The company’s own figures
indicate that the time is about ripe to take care of this vast army
of self-drugging laymen and recent circular letters seem to recognize
it. The physician is notified that druggists are now furnished with
Papayans (Bell) “in sealed packages of thirty and one hundred tablets.”
The medical man is told that the firm has “not forgotten the days
when physicians’ orders made our success possible” and it says it is
“sincerely grateful to the doctors who gave us orders in the days when
we were struggling for recognition.” This tacit admission of the value
of the physician as an unpaid agent for nostrum houses should be given
thought by those physicians who prescribe such preparations.

While, so far as we know, Bell & Co. have not yet advertised in the
daily press, they are not averse to furnishing the laity with samples
when requested. An Ohio physician sent us the following letter received
by a young woman who had written asking for samples:

    +----------------------------------------------------------+
    |                                                          |
    | Miss X---- Y----,                                        |
    |   Z----.                                                 |
    |                                                          |
    | Dear Madam: As requested, we are mailing you sample of   |
    | our Papayans (Bell) for Indigestion.                     |
    |                                                          |
    | If a sufferer from Indigestion, we want you to give it a |
    | thorough trial as directed and note remarkable results   |
    | that we believe you will get from its use.               |
    |                                                          |
    | Kindly write us if you are unable to obtain it from your |
    | local druggist, as it is stocked by nearly every good    |
    | drugstore in the United States.         Yours truly,     |
    |                                             Bell & Co.   |
    |                                                          |
    +----------------------------------------------------------+

Evidently Bell & Co., while admitting that their financial success is
largely due to the kindly, though misguided, efforts of physicians, are
not going to let a little thing like loyalty to the medical profession
interfere with a possible sale of their tablets.

                        THE L. D. JOHNS COMPANY

A discussion of the methods of Bell & Company would not be complete
without reference to a concern which seems to be closely connected with
it: the L. D. Johns Company, whose “only product” is a sugar-coated
laxative tablet. Regarding the “sugar coated” tablet, a visitor at the
place of business of Bell & Company and the L. D. Johns Company wrote:
“These companies apparently are not in possession of any tablet coating
machines and in questioning on this point stated that some of their
tablets were sent out to be coated.” There is a sameness regarding the
claims for the laxative tablets of the two companies that might lead
one to suspect that the same individual prepared both circulars. For
instance:

                           CASCARANS (BELL)

    “Taken as directed, it permanently removes the great majority of
    cases of habitual constipation.”

    “... a harmless vegetable preparation.”

    “... for the removal of pimples, yellowness and greasiness of the
    skin ...”

    “... one tablet at night, one night and morning, or, in severe
    cases, one three time a day, gradually decreasing the frequency of
    the dose as improvement permits.”

                          DR. JOHNS’ TABLETS

    “Taken as directed ... permanently remove the great majority of
    cases of habitual constipation, torpid liver and sick headache.”

    “A harmless vegetable remedy.”

    “... removes pimples, blotches, sallowness and greasiness of the
    skin ...”

    “One at night, one night and morning, or, in severe cases, one
    three times a day. Gradually decrease the frequency of the dose as
    improvement permits.”

According to a leaflet sent out with samples by the L. D. Johns
Company, the company is capitalized for $500,000, divided into 50,000
shares at $10 each; these shares are sold to those physicians who
will agree “to prescribe the tablets at every suitable opportunity,
to introduce them to other physicians” and “to promote their sale in
every ethical way!” If the list of physicians’ names and addresses
which the company sends out as comprising the eastern stockholders is
to be relied on, it would seem that many medical men are promoting
their sale. In prescribing it is, of course, “necessary to specify
‘Dr. Johns’ Tablets No XXX (_Original bottle_).’” As the name is on
the bottle, it is not unbelievable that, as the company says in its
prospectus, because of “our method of advertising, a large and very
profitable business is being created.” That the L. D. Johns Company
expects to profit by the self-drugging which this method of prescribing
fosters is evident:

    “Physicians not stockholders in this company suffer from
    the continual refilling of their prescriptions and from the
    recommendation of the _preparation prescribed by patients_ to
    others. [Italics ours.--Ed.] Our stockholders _benefit_ by the
    refilling of their prescriptions and by these recommendations.”

Put baldly the case amounts to this: Physicians who prescribe “Dr.
Johns’ Tablets” not only are likely to foster self-drugging, but they
will reap dividends therefrom. Truly a nice business to be in!

While Bell & Company and the L. D. Johns Company are said to be
entirely distinct, they are to be found at the same address at
Orangeburg, New York, and as will be seen, the officers of the two
companies are more or less related.

     BELL & CO.                           L. D. JOHNS CO.

    _President_        John L. Dodge     _President_
    _Secretary_        Geo. C. Tennant   _Vice-President_
    _Vice-President_   Chas. B. Smith    _Secretary and Treasurer_

                       EXPLOITING THE PROFESSION

Nostrum promoters have two simple ways of “working” the medical
profession. The first--and the more profitable--is, by lavish
distribution of free samples, to get physicians to prescribe the
blown-in-the-glass “original package” with the inevitable result of
large sales direct to the laity. By the second method, which is merely
a modification of the first, the physician furnishes the capital for
floating the nostrum and then takes his share of the resulting profits.
There may not be quite as much money in the second method for the
promoter, but then the risks are correspondingly less. If the firm
fails, the stockholders are the losers; the promoter is not necessarily
“out” anything. From a commercial standpoint, a combination of the two
methods is, of course, ideal--(_From The Journal A. M. A., Aug. 14,
1909._)




    PASSIFLORA AND DANIEL’S CONCENTRATED TINCTURE OF PASSIFLORA[AG]

            Report of the Council on Pharmacy and Chemistry

[AG] See also Pasadyne, p. 332.


The Council has voted that the drug passiflora (passion flower) be not
accepted for New and Nonofficial Remedies, and has recommended that
the following article be published in The Journal. It is considered
important to call attention, not only to the lack of reliable evidence
of the therapeutic value of passiflora, but also to the absurdity
of the claims which are made for Daniel’s Concentrated Tincture of
Passiflora, a preparation which has been already refused recognition.

                                              W. A. Puckner, Secretary.


                              Passiflora

Although passiflora was introduced into medicine nearly seventy years
ago, the literature concerning it is not very extensive; it is not
mentioned in the standard works on pharmacology and its chemistry
seems never to have been worked out. There appears, also, to be no
record of experimental investigations of the drug with reference to
its pharmacologic action, except an article by I. Ott,[63] who used
“Daniel’s Concentrated Tincture.” Ott claimed that it lessened the
reflex irritability of the cord and paralyzed motion by acting on
the motor centers in the cord, and that it increased the rate of
respiration. He also stated that because of its action on the vasomotor
centers it reduced the frequency of the heart-beat and lowered arterial
tension, but that these effects were only temporary.

[63] Med. Bull., 1898, xx, 457-464.

On the clinical side the reports are not numerous and such as have
been made do not appear to be based on very extensive trials nor on
conditions of observation that would entitle them to more than slight
consideration. S. D. Bullington[64] reports good results, but no cure,
in one case of epilepsy, and improvement in a case of insomnia. W. J.
Stapleton[65] recommends it in the form of a concentrated tincture (not
the one advertised so extensively), and states that he has used it with
great success in insomnia, hysteria, neurasthenia, neuralgia, nervous
and physical prostration, and in alcoholism. In his opinion its action
is most apparent in cases of nervousness due to causes other than
pain. S. Harnsberger[66] reports two cases in which partial blindness
followed the taking of potassium bromid and passion flower.

[64] Nashville Jour. Med. and Surg., 1897, lxxxi, 107-109.

[65] Detroit Med. Jour., 1904-5, lv, 17.

[66] Virginia Med. Semimonthly, 1898-9, iii, 392.

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.

None of the evidence is sufficient to show that passiflora has
therapeutic value; hence it is deemed inadvisable to include this drug
in the list of nonofficial remedies.--(_From The Journal A. M. A.,
March 19, 1910._)




       LIQUID COMBINATIONS CONTAINING PEPSIN AND PANCREATIN[AH]

        Report of the Council on Pharmacy and Chemistry of the
                     American Medical Association

[AH] See also Reexamination of Lactopeptine, p. 121. A reprint of
articles bearing on this subject is issued under the title Digestive
impossibilities.


The following report was submitted to the Council by a subcommittee:

  _To the Council on Pharmacy and Chemistry_:--The U. S. Pharmacopeia,
  8th revision, pages 334-5, states: “Pepsin and pancreatin in solution
  are incompatible with one another. If the solution be neutral or
  alkaline the pancreatin gradually destroys the pepsin, and if
  acid the pepsin destroys the pancreatin.” The correctness of this
  statement has been amply demonstrated by the reports which have been
  submitted to the Council from time to time on liquid preparations
  claimed to contain these two ferments.

  Thus an elixir was investigated which was by the manufacturers
  claimed to contain “the five active agents of digestion, pepsin,
  veg. ptyalin, pancreatin, lactic and hydrochloric acids,” and to be
  “superior to all other remedies in dyspepsia and diseases arising
  from imperfect digestion,” and the committee which investigated the
  article in question reported that “it was impossible to establish the
  presence of either the proteolytic or the amylolytic ferment.”

  Similarly, on another liquid preparation, which was said to
  contain “pancreatin, pepsin, lactic and muriatic acids, etc.” ...
  “the combined principles of digestion to aid in digesting animal
  and vegetable cooked food, fatty and amylaceous substances,”
  the committee reported “this product possessed only very slight
  proteolytic action and failed to digest 2 per cent. of its own weight
  of starch.”

  Again, the report on still another preparation stated: “But while it
  was said to contain pancreatin, the U. S. P. test for the valuation
  of pancreatin failed to indicate this ferment.”

  The report on yet another elixir, claimed to be “the only true
  digestant, because it contains the enzymes of all the glands which
  are necessary for digestion,” showed that this article did not
  contain “any appreciable enzyme activity, either amylolytic or
  proteolytic.”

  The correctness of these findings of the committee of the Council was
  generally acknowledged by the manufacturers when their attention was
  called to the matter. Thus, one manufacturer of digestive ferments
  writes: “We will ask you to hold this matter up until you hear from
  us further on the subject. The reason for this request is that we
  have been going over our liquid preparations very carefully in order
  to be sure that after aging they would contain the ferments that we
  put into them. The pancreatic ferments in alcoholic liquids seem to
  lose their strength.”

  The chemist for a large manufacturing house writes: “There are now on
  the market a number of preparations in which pepsin and pancreatin
  are combined in liquid form, and the result is that we have had
  numberless requisitions from our representatives that we also market
  such a preparation. As the result of this we have carried out a
  series of experiments no less than four or five times in order to
  determine whether pepsin, diastase, and pancreatin would retain their
  activity in the form of a syrup, wine or elixir. We have proved
  incontrovertibly that this cannot be done. While any two of these
  substances, or even all three of them, can be dispensed in the form
  of a liquid by the retail druggist and will retain their normal
  activity for as long a period as three to six weeks, yet if allowed
  to stand sufficiently long, they mutually destroy each other; so that
  in a combination of pancreatin and pepsin the pancreatic enzyme is
  lost and the pepsin greatly injured, and where diastase is present,
  both diastase and pepsin (or diastase and pancreatin) mutually
  destroy each other.”

  Since it has been demonstrated that pepsin and pancreatin cannot
  exist in one and the same solution for any reasonable length of
  time, it becomes apparent that liquid preparations said to contain
  these two ferments are sold under impossible claims. It is therefore
  recommended:

  1. THAT THE COUNCIL ON PHARMACY AND CHEMISTRY REFUSE TO APPROVE
  LIQUID PREPARATIONS THAT ARE CLAIMED TO CONTAIN BOTH PEPSIN AND
  PANCREATIN.

  2. THAT THE MEDICAL PROFESSION THROUGH THE JOURNAL OF THE AMERICAN
  MEDICAL ASSOCIATION BE ADVISED OF THE FALLACY OF EMPLOYING SUCH
  COMBINATIONS.

  3. THAT THE ATTENTION OF MANUFACTURERS BE CALLED TO THE WORTHLESSNESS
  OF SUCH INCOMPATIBLE LIQUID PREPARATIONS OF PEPSIN AND PANCREATIN,
  AND THAT THEY BE URGED TO CEASE OFFERING SUCH PRODUCTS TO THE
  PROFESSION.

  4. THAT, SINCE THE NATIONAL FORMULARY HAS RECOGNIZED A PREPARATION
  OF THIS KIND UNDER THE TITLE “ELIXIR DIGESTIVUM COMPOSITUM,” THE
  AMERICAN PHARMACEUTICAL ASSOCIATION BE REQUESTED TO INSTRUCT ITS
  COMMITTEE ON THE NATIONAL FORMULARY TO OMIT THIS PREPARATION FROM THE
  NEXT EDITION.

The recommendations of the subcommittee were adopted by the Council and
publication of the report directed.--(_From The Journal A. M. A., Feb.
2, 1907._)

                                              W. A. Puckner, Secretary.




                          PEPTO-MANGAN (GUDE)

            Report of the Council on Pharmacy and Chemistry


The following report was adopted by the Council and its publication
authorized.

                                              W. A. Puckner, Secretary.

About ten years ago the M. J. Breitenbach Company circulated what
pretended to be an abstract of the report of a government commission
for the investigation of the anemia then prevalent in Porto Rico. The
company asserted that “this report alone would suffice to establish
Pepto-Mangan at once as the foremost hematinic known.” Examination of
the official report of the commission[67] revealed the fact that the
administration of iron in hookworm anemia was considered of secondary
importance, and that of the various preparations of iron, Blaud’s pill
was found to be more efficient than Pepto-Mangan (Gude). A protest[68]
was made at this time by the commission against the unwarranted use of
its report by the Breitenbach Company.

[67] The Journal, Sept. 23, 1905, p. 934.

[68] The Journal, Oct. 7, 1905, p. 1099.

Later the Breitenbach Company sent out a report pretending to prove
that at the Infants Hospital, Randall’s Island, New York City,
Pepto-Mangan (Gude) had been found a most superior preparation in the
treatment of infantile anemia. Inspection of the hospital records
and daily charts of the cases disclosed[69] a remarkable disparity
between the claims of the Pepto-Mangan pamphlet and the real results of
treatment. And so here, also, as well as in the Porto Rico commission’s
report the trials, selected by the Breitenbach Company prove the
limitations and non-superiority of Pepto-Mangan.

[69] The Journal, April 6, 1907, p. 1197.

The preceding false reports, though no longer circulated, have never
been definitely withdrawn and while it is now generally conceded that
the good results in anemia are obtained by the administration of the
various simple inorganic iron preparations the Breitenbach Company
still attempts to convey the impression that Pepto-Mangan (Gude) is
of most superior efficacy. Thus the present Pepto-Mangan circular
attempts to discredit by obsolete and absurd or untrue statements the
various preparations of iron which are in general use and to carry the
impression that only iron and manganese, in the particular form and
proportion in which they are contained in Pepto-Mangan--namely, 3 parts
Fe to 1 part Mn--are useful for the treatment of anemia, chlorosis,
etc. Thus contrary to general conceptions, the impression is given that
the now generally accepted course of chlorosis is due to the three
varieties of insufficiency of certain blood elements: (1) insufficiency
of manganese, (2) insufficiency of iron, (3) insufficiency of iron and
manganese; and that the administration of iron often fails because
manganese is not supplied to the system at the same time and in
sufficient amounts. The following statement is made:

    “Doctor:

    “If you have a case of ANAEMIA, CHLOROSIS, or AMENORRHOEA, that
    shows no visible sign of improvement, and you have exhausted the
    entire list of Nauseating Iron preparations with little or no
    effect, it is because the blood is deficient in that _essential
    oxidizing constituent_, _MANGANESE_, in a soluble, readily
    assimilable form, the best being in combination with iron.”

Another extravagant claim:

    “Usually after taking it for a week its restorative influence on
    the functions of the stomach is felt; appetite reappears, and the
    general health is improved by the increase in bodily warmth, an
    effect directly due to manganese.”

The following statement implies that Pepto-Mangan is absorbed
unchanged, for which there is no justification:

    “As the ferruginous and manganic ingredients of Pepto-Mangan
    (Gude) exist in the form of organic peptonates, they have already
    undergone the changes necessary to insure prompt absorption and
    appropriation by the circulating fluid.”

The following declaration implies that it repairs the individual
defective blood-cells which is, of course, also ridiculous:

    “That Pepto-Mangan (Gude) quickly and efficiently builds up
    defective red blood cells, and generates, or at least potently
    encourages the formation of new ones, and materially increases
    their richness in hemoglobin, has been abundantly demonstrated....”

The M. J. Breitenbach Company is still trying to mislead physicians; it
also aims to make use of them in its direct appeal to the physicians’
patients. For instance, the name “Pepto-Mangan (Gude)” blown in the
bottle, the advertising circular suggesting Pepto-Mangan as the
treatment for anemia, etc., and the recommendation to physicians that
it be prescribed in “original bottles” all tend to encourage the use
of Pepto-Mangan by the public with the likelihood that it will be
depended on where good food and fresh air are of prime importance. The
attempt to exploit it directly to the public is further attested by the
advertisements of department-store drug departments.

It is evident from the foregoing that Pepto-Mangan (Gude) is in
conflict with Rules 4 and 6 and therefore not eligible for admission to
New and Nonofficial Remedies.--(_From Reports Council Pharm. and Chem.,
1914, p. 121._)




            LIQUID PETROLATUM OR “RUSSIAN MINERAL OIL”[AI]

            Report of the Council on Pharmacy and Chemistry

[AI] See also following reports on Clinical Experience with Liquid
Paraffin (Liquid Petrolatum) and Angier’s Emulsion.


The following report was submitted to the Council by a referee and its
publication authorized by the Council.

                                              W. A. Puckner, Secretary.

Petroleum has been in use as a medicine from time immemorial. It
was known to Herodotus 400 years before Christ and is mentioned
by Plutarch, Dioscorides, Pliny and other early writers. It was
extensively used by the Arabians and evidently played an important part
in the practice of medicine in India, being known to the Bengalese as
Muthe Katel. The raw product was the substance used in earlier times
and differed much in character and composition, as obtained from
different sources.

As an internal remedy it was early employed in chronic pulmonary
affections, in obstinate skin diseases, in rheumatism, and for the
expelling of tapeworms. It was extensively used for these several
purposes in France under the name of “Oleum Gabianum” and in North
America as “Seneka oil.”

The internal use of the refined product may be traced to a patent
granted to Robert A. Chesebrough of New York, in June, 1872, for
the manufacture of a “new and useful product from petroleum, named
vaseline.” This name was originally applied only to a semisolid
preparation, but later a liquid product known as liquid vaseline
was marketed and for a time exploited as a cure for coughs, colds,
consumption and a number of other diseases and conditions.

The liquid petrolatum has since become known under a variety of names,
proprietary and otherwise, in addition to being used as a substitute or
an adulterant for other, more costly, fats and oils. Some of the names
applied to the product are:

  Adepsine oil             Neutralol
  Amilee                   Olo
  Atoleine                 Paraffin Oil
  Atolin                   Paroline
  Blandine                 Petralol
  Crysmalin                Petro
  Deeline                  Petrolax
  Glyco                    Petrolia
  Glycoline                Petronol
  Glymol                   Petrosio
  Heavy petroleum oil      Rock Oil
  Liquid Albolene          Russian liquid petrolatum
  Liquid Cosmoline         Russian mineral oil
  Liquid Fossiline         Russian paraffin oil
  Liquid Geoline           Russol
  Liquid Paraffin          Saxol
  Liquid Petrolatum        Terraline
  Liquid Saxoline          Terralbolia
  Liquid Vaseline          Usoline
  Mineral Glycerin         Water-white mineral oil
  Mineral Oil              White paraffin oil.

A preparation similar to that official in the Pharmacopeia of the
United States as liquid petrolatum has been included in many, if not
all, of the foreign pharmacopeias, the official titles under which this
preparation is recognized being as follows:

Petrolatum Liquidum, U. S. Pharmacopeia; Paraffinum Liquidum,
pharmacopeias of Great Britain, Germany, the Netherlands, Japan,
Belgium, Austria, Denmark, Switzerland, Sweden, Servia, Italy, Hungary
and Russia; Oleum Paraffinae, Spanish Pharmacopeia; Vaselinum Liquidum,
French Pharmacopeia, and Oleum Vaselini (as a synonym) pharmacopeias of
Denmark and Russia.

The requirements of the several pharmacopeias differ somewhat and the
specific gravity as given is as follows:

  U. S. P. VIII, 1905                  0.870 to 0.940 at 25°
  Ph. Brit. IV, 1895                   0.885 to 0.890 at 15.5°
  B. P. C. II, 1911, usually           0.875 or lower at 15°
  Ph. Germ. V, 1910, at least          0.885          at 15°
  Ph. Ross. VI, 1910                   0.880 to 0.885 at 15°
  Ph. Hung. III, 1909                  0.88  to 0.89  at 15°
  Ph. Ital. III, 1909                  0.875 to 0.890 at 15°
  Ph. Fr. V, 1908, about               0.875          at 15°
  Ph. Serb. II, 1908, about            0.880          at 15°
  Ph. Svec. IX, 1908                   0.88  to 0.90  at 15°
  Ph. Helv. IV, 1907                   0.880 to 0.885 at 15°
  Ph. Dan. VII, 1907, at least         0.880          at 15°
  Ph. Austr. VIII, 1906, at least      0.880          at 15°
  Ph. Belg. III, 1906, not below       0.880          at 15°
  Ph. Japon. III, 1906                 0.875 to 0.945 at 15°
  Ph. Ndl. IV, 1905, not below         0.860          at 15°
  Ph. Hisp. VII, 1905                  0.840          at 15°

For pharmaceutical purposes, liquid petrolatum may be divided into two
grades, the lighter or more limpid oil, used extensively as a vehicle
for oil sprays, and the heavier, more viscid oil generally recognized
in European pharmacopeias and used as an ingredient of ointments and
more recently as a remedy in the treatment of intestinal stasis.

Under petrolatum liquidum the U. S. P. recognizes a mixture of
hydrocarbons, chiefly of the methane series, which occurs as a
colorless or very slightly yellowish, oily, transparent liquid without
odor or taste and having a specific gravity of about 0.870 to 0.940 at
25 C. For the U. S. P. IX, it is proposed to change this requirement
somewhat so as to have it apply to a transparent liquid free from
fluorescence, without odor or taste and having a specific gravity of
from 0.845 to 0.940 at 25 C.

Such a requirement would include all of the available paraffin oils
irrespective of origin. The now commonly available commercial liquid
petrolatum, used for pharmaceutical purposes, is practically colorless
and all of the better grades are free from odor or taste. The specific
gravity varies from 0.855 to 0.895. The lighter oils, having a specific
gravity of from 0.860 to 0.870, are usually preferred in the making of
oil sprays or solutions of substances to be used as local applications.
The product having a specific gravity above 0.875 evidently contains
a considerable amount of dissolved solid paraffin which separates
out at temperatures at or below 0 C., but readily dissolves again at
temperatures above 10 C.

There is considerable difference in the chemical composition of the
paraffin oils obtained from various sources. The American oil consists
largely of hydrocarbons of the methane series, while the Russian oil
contains naphthenes or hydrocarbons of the benzene series, having
the empirical composition of ethylene, (C_{n}H_{2n}) which may be
considered as hydrogenated aromatic hydrocarbons, though they behave
with reagents very much in the same way as do the hydrocarbons of the
methane series.

Mineral oils with a naphthene base are best suited for making white
petrolatum, and at the present time the production of the colorless
water-white liquid petrolatum appears to be confined largely or almost
exclusively to the crude product of the Baku district of Russia, though
it is asserted that it is now also made from the Hanover (Germany)
crude oil and that some is being produced by “cracking” the white solid
paraffin.

It is also said that the American oil can be made water white but
that it is not being so produced at present for economic reasons; the
yellowish oil, free from fluorescence, having a very wide sale, both
as a lubricant and as a substitute for lard oil and other of the more
costly lubricating oils.

From a pharmaceutical point of view it would appear important to note
the physical characteristics of the oil and to insist on absence of
color, absence of odor and taste, absence of acid and of alkali and a
specific gravity in harmony with the purposes for which the oil is to
be used.

During the past year or two liquid petrolatum has attracted
considerable attention as a remedy in the treatment of intestinal
stasis or chronic constipation, the practice of using it having been
developed largely through its recommendation by Sir W. Arbuthnot Lane
and his associates. This use of liquid petrolatum and of petrolatum
products generally is by no means novel. N. A. Randolph[70] of
Philadelphia was among the first to suggest its use for this purpose
in an article published in 1885. Randolph also appears to have
been the first to experiment with petrolatum and to determine its
non-absorbability from the intestinal tract. In an article[71] in 1884
he concludes that “pure petrolatum while entirely unirritating to the
digestive tract is valueless as a foodstuff.”

[70] Randolph, N. A.: Therap. Gaz., ix, 732.

[71] Randolph, N. A.: Proc. Acad. Nat. Sc., Philadelphia, 1884, p. 281.

The experiments recorded by Randolph were evidently prompted by
the fact that vaseline and a number of imitation products then on
the market were being sold as substitutes for lard and butter, and
opinions regarding the food value of petroleum products appear to
have differed very materially. Following the experiments of Randolph,
Robert Hutchison in 1899 made a series of experiments to demonstrate
that petroleum, petrolatum, paraffin and related products were
absolutely unassailable by any of the digestive fluids, despite the
“large vogue that had of late years been given to various petroleum
emulsions, chiefly by ingenious and unterrified advertising.” He came
to practically the same conclusions arrived at by Randolph fifteen
years earlier and pointed out that “liquid paraffin in one sense may be
regarded as an artificial intestinal mucus and might in that way have
some value on certain forms of constipation.”

William Duffield Robinson[72] reports on the use of a perfectly
refined colorless and odorless petrolatum, supposedly of American
origin. He was able to show that all of the product passed unchanged
through the intestinal tract and could be regained from the feces.
In his conclusions he expressed the belief that the effect of the
administration of these petroleum products is far more than as a
simple intestinal lubricant. In over fifty selected cases in which
nutrition, digestion and body-weight were impaired, and the purest
oil administered in 1- or 2-dram doses each day for a period of from
four to six months, there was in every instance an improvement of
weight, health and feeling of well-being. The administration of refined
paraffin oil gave no discomfort in any instance, even in cases in which
nearly a pint was given in a few hours.

[72] Robinson: William Duffield: Med. News, 1900, lxxvii, 56.

William Ewart[73] suggests liquid paraffin as a safe agent for the
local treatment of the lesions in typhoid fever. He says in part:
“Mineral oil, such as petrolatum or paraffin, is neither absorbed nor
dissolved; therefore, after all absorbable ingestions are taken up
by the lacteals, it will still remain in the bowel. In this way pure
liquid paraffin is valuable, precisely because it is inert; moreover,
it might some day, perhaps, be made the vehicle for effective topical
remedies.”

[73] Ewart, William: Brit. Med. Jour., 1902, ii, 1505.

A. D. Schmidt[74] quotes Stubenrath as having given liquid paraffin in
the treatment of chronic constipation, and he himself gave as much as
20 gm. of liquid paraffin to adults without observing any injurious
effect whatever. He says, “As a result of the administration of liquid
paraffin, the feces are softened considerably and are found under
the microscope to contain numerous minute globules of paraffin.” He
was, however, unable to recover from the feces the entire quantity
of paraffin administered and believes that a certain portion of it,
probably the fractions with a low boiling-point, are absorbed or
possibly oxidized in the organism.

[74] Schmidt, A. D.: München. med. Wchnschr., 1905, lii, 1970.

Maurice Vejux Tyrode[75] also refers to the use of liquid petroleum in
the treatment of constipation.

[75] Tyrode, Maurice Vejux: Boston Med. and Surg. Jour., 1910, clxii,
673.

Sir W. Arbuthnot Lane in his recommendations of liquid petrolatum calls
it an ideal remedy for stasis, but cautions against the use of the
lighter oil as extensively prescribed in this country as a vehicle for
sprays in nose and throat work.

Paraffin oil is not absorbed from the alimentary tract and so far
as known exerts no deleterious influence. It is usually given in
quantities of from 10 to 20 c.c. half an hour or an hour before meals
or in larger doses, from 30 to 50 c.c., at one time on retiring.
From available evidence it appears that comparatively huge doses
may be administered without the production of any untoward results.
According to many observers, liquid paraffin should not be given
with or after meals because of the inhibiting influence that it may
have on the digestion of food. It is not soluble in water or the
ordinary solvents and therefore cannot be diluted. The denser oils are
preferably slightly warmed or drunk with warm water so as to obviate
the disagreeable slimy sensation that persists when taken cold.

Volatile oils may be used in moderate amounts to give a distinctive
taste to the otherwise rather insipidly tasteless paraffin oil. Among
the more desirable oils to be used for this purpose would be oil of
peppermint, oil of cinnamon, oil of betula or methyl salicylate and oil
of cloves. From 2 to 10 drops of any of these oils can be added to a
pint of the oil. When larger doses of the oil are to be given at one
time, it would, of course, be advisable to use a comparatively smaller
quantity of the volatile oil as a flavor.[76]

[76] In addition to the articles referred to in the preceding
footnotes, the following are of interest in connection with this
subject:

Editorial, Therap. Gaz., 1885, ix, 353.

Junker, F. A.: Med. Record, London, 1885, xiii, 506.

Editorial, Med. News, 1886, xlviii, 105.

Dunbar: Deutsch. med. Wchnschr., 1896, xxii, 33.

Stubenrath, Franz Casimir: München. med. Wchnschr., 1897, xliv, 639.

London Letter, Med. News, 1899, lxxiv, 504.

Hutchison, Robert: Brit. Med. Jour., 1899, i, 724.

Schlesinger, E. G.: Boston Med. and Surg. Jour., 1913, clxix, 14.

Lane, W. Arbuthnot: Brit. Med. Jour., 1913, ii, 1126; Proc. Roy. Soc.
Med., 1913, vi, 49; Surg. Gynec. and Obst., 1913, xvi, No. 6.

Jordan, Alfred C.: Practitioner, London, February, 1913.

Chrysospathes, J. G.: Zentralbl. f. Chir., 1913, No. 45; abstr., The
Journal A. M. A., Dec. 13, 1913, p. 2201.

From the foregoing it would appear that apart from the Pharmacopeia of
the United States, practically all other known pharmacopeias describe
a water-white mineral oil under the title “Paraffinum Liquidum” or
“Liquid Paraffin” as a colorless, odorless, tasteless, non-fluorescent,
oily liquid, free from acids, alkalies and organic impurities. As
explained before, the specific gravity of the preparation as recognized
in other countries and as offered on the American market at the present
time varies considerably, and there appears to be some difference of
opinion as to the exact nature of the product that is preferable for
use for different purposes. This matter requires further investigation.

Since the definition of liquid petrolatum in the U. S. Pharmacopeia
permits the use of fluorescent products of widely varying specific
gravities, it is recommended that physicians who desire the water-white
non-fluorescent (Russian) mineral oil should use the term “Petrolatum
Liquidum, Grave,” or “Paraffinum Liquidum, B. P.,” if the heavy product
recommended by Lane is desired, and “Petrolatum Liquidum, Leve” if the
light varieties are required. It is further recommended that under the
foregoing names, manufacturers and pharmacists be requested to dispense
the products, in accordance with the following descriptions:

=Petrolatum Liquidum, Grave.=--Heavy (Russian) Liquid
Petrolatum.--Paraffinum Liquidum, B. P., liquid paraffin.--A
transparent, colorless, tasteless, non-fluorescent, oily liquid,
odorless when cold but giving off a faint petroleum odor on heating.
This preparation should correspond to the requirements of the British
Pharmacopeia for liquid paraffin and have a specific gravity of about
0.885 to 0.890 at 15 C. It is insoluble in water or alcohol but soluble
in boiling absolute alcohol and readily soluble in ether, chloroform,
carbon disulphid, petroleum benzin, benzene and fixed and volatile
oils. It serves as a solvent for volatile oils and related substances
like camphor, menthol and thymol.

This is the type of preparation used by Sir W. Arbuthnot Lane, and his
associates for internal administration. It is also used as a basis
for ointments and salves and as a local application to wounds, ulcers
and in certain forms of skin diseases in which a simple protective is
desired.

=Petrolatum Liquidum, Leve.=--Light (Russian) Liquid Petrolatum.--A
transparent, colorless, tasteless, non-fluorescent, oily liquid,
odorless when cold, but giving off a faint petroleum odor on
heating. In other respects this preparation should correspond to the
pharmacopeial tests for liquid petrolatum and have a specific gravity
of about 0.860 to 0.875 at 15 C. Like the heavy variety of liquid
petrolatum, it is insoluble in water and alcohol, but soluble in
boiling absolute alcohol and rapidly soluble in ether, chloroform,
carbon disulphid, petroleum benzin, benzene and fixed and volatile
oils. It serves as a solvent for volatile oils and related substances
like camphor, menthol and thymol.

This is a type of preparation extensively used as a vehicle for the
oily sprays in nose and throat work. It is also being used as one of
the constituents in the now popular paraffin oil cold cream and has
been used to some extent for internal administration in the treatment
of chronic stasis. Being more limpid than the preparation preferred by
Lane, it is more readily taken, though greater care must be exercised
in securing a sample devoid of the lighter fractions of petroleum
distillates.--(_From The Journal A. M. A., May 30, 1914._)




   CLINICAL EXPERIENCE WITH LIQUID PARAFFIN (LIQUID PETROLATUM)[AJ]

      A Comparative Investigation Made Under the Auspices of the
                 Council on Pharmacy and Chemistry[AK]

                     W. A. Bastedo, M.D., New York

[AJ] See also preceding report on Liquid Petrolatum or “Russian Mineral
Oil” and following report on Angier’s Emulsion.

[AK] This investigation was made under the auspices of the Committee
on Therapeutic Research of the Council on Pharmacy and Chemistry of
the American Medical Association. At the request of the committee, Dr.
W. A. Bastedo has prepared this critical review of the reports made by
those who collaborated in this investigation.


During the past three or four years, “mineral oil” has come into
extensive use in the treatment of constipation. Preparations of the
Russian and the American oil, both heavy and light, have appeared on
the market, but there have been no satisfactory data on which to base
a selection of oil for use. Therefore, in order to obtain reliable
clinical information concerning the relative efficiency of the
different oils, the Therapeutic Research Committee of the Council on
Pharmacy and Chemistry of the American Medical Association submitted
samples of the oils to various clinicians for testing. The following is
a synopsis of the investigation, which I have prepared at the request
of the committee.

The collaborators were advised that specimens of the best obtainable
light Russian liquid petrolatum, heavy Russian liquid petrolatum and
an American brand of liquid petrolatum would be sent out, but that, to
avoid bias, these specimens would be distinguished only by numbers or
letters. The oils sent out were (1) a light “Russian” liquid petrolatum
having a specific gravity of 0.860 at 20 C., (2) a heavy “Russian”
liquid petrolatum having a specific gravity of 0.885 at 20 C., and (3)
an “American” liquid petrolatum having a specific gravity of 0.857 at
20 C. and being markedly fluorescent. The collaborators were advised
that the reports should furnish information as to size and frequency of
dose, the agreeableness to the taste, the effect on the stomach, the
number and character of the stools, the degree of admixture of the oil
with the other ingredients of the stool, the degree of leakage of oil
about the anus, and the need of other cathartic measures.

Reports have been received from Drs. L. F. Barker, W. A. Bastedo, J. B.
Champion, Henry A. Christian with C. K. Drinker and F. A. Hatch, Alfred
Stengel and R. L. Wilbur.

                              CONCLUSIONS

The conclusions to be drawn from the clinical reports are:

_Dosage._--Half an ounce to 3 ounces a day. In the same patient, the
same amount of each of the oils was required.

_Frequency of Dose._--The same amount daily seemed as efficient when
given in one dose as when given in divided doses two or three times a
day.

_Agreeableness to the Taste._--There is a difference of opinion in this
regard. Two reports favored the heavy Russian oil. One report favored
the light Russian petrolatum. But the taste of any of the samples was
so slight as to be a negligible quantity after the patient had taken
the remedy for two or three days.

_Stomach Effects._--In about 20 per cent. of the patients, the oil
produced a slight degree of nausea or tended to repeat. This is most
likely in patients who have gastric stagnation with retarded emptying
of the stomach. All the oils acted the same in this regard. Vomiting
was reported in two cases.

_Number of Stools._--To produce one or two copious stools a day the
dose required varied considerably, but there was no difference noted on
account of difference in the specific gravity or character of the oils.

_Character of Stools._--The stools were soft, usually formed, sometimes
mushy, obviously greasy. They had a peculiar odor described as sour.
Their consistency varied with the dose, but was the same for the
different kinds of oil.

_Admixture of Oil with Other Ingredients of Stool._--Generally well
mixed, but from time to time a patient would have a stool of free oil.
This occurred with all varieties of oil. (It necessitated reduction
of the dose, and if then the bowels were not active enough, the
administration in addition of cascara, aloin, etc.)

_Leakage About the Anus._--A disagreeable feature complained of by
many is that when they take enough of the oil to move the bowels,
there is sufficient leakage from the anus to keep the neighboring skin
continually in a greasy condition, and sometimes to stain the clothes.
That there is any difference in this regard between the oils has not
been determined.

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.

                                SUMMARY

The results of this clinical investigation appear to warrant the
conclusion that so far as therapeutic results are concerned the
differences in the action of the three varieties of liquid petrolatum,
namely, light Russian liquid petrolatum, heavy Russian liquid
petrolatum and American liquid petrolatum, are too slight to be of
importance. Hence the choice between the lighter and the heavier
oils, and between the Russian and the American is an open one, to
be determined not by therapeutic differences, but by palatability,
dependent on the degree to which the refinement of the oil is carried
out. The U. S. Pharmacopeia, the revision of which is now nearing
completion, no doubt will furnish standards which will insure a
suitable product. From the findings of the foregoing report it would
appear that a satisfactory standard might permit the use of either
Russian or American oil, if suitably refined so as to be as nearly as
possible devoid of odor and taste.--(_From The Journal A. M. A., March
6, 1915._)




                         ANGIER’S EMULSION[AL]

            Report of the Council on Pharmacy and Chemistry

[AL] See also preceding reports on Liquid Petrolatum or “Russian
Mineral Oil” and Clinical Experience with Liquid Paraffin (Liquid
Petrolatum).


Angier’s Emulsion is essentially a petroleum product. When it was first
put on the market commercial interests had been fostering the idea that
petroleum products had food-value, and the manufacturers of Angier’s
Emulsion, making use of the idea, advertised it as a “food-medicine”
and an “ideal substitute for cod-liver oil.” The impression thus
created has been kept alive through persistent advertising in spite of
scientific proof to the contrary. To-day many who know that petroleum
products have no food-value are still likely unconsciously to class
Angier’s Emulsion among nutrients. Although the manufacturers now
advertise this product as “purely mechanical in its action,” they yet
show a disposition to profit by the old misapprehension, since, so
far from expressly disavowing the old claims as erroneous, they mingle
with the new ones vague claims of “tonic and reconstructive merits”
apparently designed to sustain, in those who do not take time to
consider the evidence carefully, the old faith in the claimed nutritive
qualities of the preparation.

While the Council judges a preparation by the claims made for it
at present, and not by any past misstatements when these have been
thoroughly corrected, the past advertising of Angier’s Emulsion so
instructively illuminates the scientific worthlessness of proprietary
therapeutic claims in general, and the whole course of its history is
so typical that the referee has thought it well to review the subject
briefly. The Council has authorized the publication of the following
report.

                                              W. A. Puckner, Secretary.

Angier’s Petroleum Emulsion was brought out in 1881--that is to say,
before the food-value of petroleum products had been experimentally
disproved. Its advertising history well illustrates the weed-like
vitality of a financially profitable therapeutic fallacy. The
shifting claims made for this preparation are such good examples
of the generally unreliable therapeutic pretensions of proprietary
medicines--whether of the “patent medicine” or of the “ethical
proprietary” type--that it has been deemed advisable to present a brief
review of the conflicting claims made for it at various times.

                          A PETROLEUM PRODUCT

Angier’s Emulsion is described by the manufacturers as containing,
in addition to “our specially purified Petroleum,” “the combined
hypophosphites of lime and soda, chemically pure glycerine, and the
necessary emulsifying agents.” So far as the hypophosphites are
concerned, it is probably unnecessary to remark that the latest
researches bring to light no evidence that they influence metabolism in
the slightest degree. The Angier Chemical Company apparently accepts
this view, for in its advertising stress is laid exclusively on the
merits of the emulsion as a petroleum product. It is therefore proper
to consider it from this point of view.

The history of the internal use of liquid petrolatum was sketched in
a recent Council report.[77] As mentioned at that time, a number of
petroleum products were put on the market some thirty years ago as
substitutes for lard and butter. Contemporary opinions regarding the
food value of such products differed widely.

[77] Liquid Petrolatum or “Russian Mineral Oil,” p. 161.

There never was any scientific evidence to support the view that
petroleum and its derivatives are assimilable by the animal organism.
In fact, so far as we can learn, there was no scientific investigation
of the problem until Randolph’s experiments in 1884. These were
probably the first to demonstrate the non-absorbability of petroleum
and its valuelessness as a foodstuff.

In 1899 Robert Hutchison conclusively demonstrated by experiment that
petrolatum, paraffin and related products were absolutely unassailable
by any of the digestive fluids, and therefore could not possibly have
any food value. Various investigators later confirmed these findings.

                 FIRST ADVERTISED AS A “FOOD-MEDICINE”

Let us now take up the advertising history of this nostrum. In 1895 it
was sold under these claims:

    “... a ‘Food-Medicine’ that is far more than a substitute for
    cod-liver oil”;

    “... a Food-Medicine that is readily assimilated and helps to
    digest other foods.”

In 1897 it was an:

    “Ideal Substitute for Cod Liver Oil.”

In 1899 it:

    “... conserves heat and energy by furnishing more material for
    oxidation.”

In 1902 it:

    “... supplants tissue waste by tissue reconstruction.”

The promoters of Angier’s Emulsion thus for some time ignored the
status definitely assigned to petroleum products by the experiments of
Randolph, Hutchison and others. This was only natural. If petrolatum
was absolutely inert in the alimentary canal (and this was now proved
beyond controversy) then an emulsion prepared from it most certainly
was not a “food-medicine,” could not “supplant tissue waste,” or
“conserve heat and energy.” All the credit which previous “unterrified
and ingenious advertising” (to quote Hutchison) had accumulated for
Angier’s Emulsion was bound up with the view that petroleum products
were foodstuffs.

                  LATER ADVERTISED AS NON-ABSORBABLE

The non-absorbability of liquid petrolatum, however, suggested to
Robinson, Schmidt, Lane and others, a new therapeutic use for it in
the treatment of chronic constipation. This method has rapidly gained
popularity and it is not surprising, therefore, that the promoters of
Angier’s Emulsion changed their claims accordingly, and now began to
base their advertising chiefly on the proved properties of petrolatum.
In 1910 the emulsion was advertised for the treatment of chronic
diarrhea on these grounds:

    “... given by the mouth, it passes to the lowermost portions of
    the intestines without changing its identity; hence it exerts
    antiseptic, soothing and demulcent properties upon every inch of
    the intestinal tract, from the duodenum to the rectum.”

The old claims, however, were not discarded altogether, for in 1911 the
preparation was recommended for children’s diseases as:

    “... an aid to appetite and digestion and a splendid tonic and
    builder.”

Before long the attempt was made to weave together the claims based on
opposed and mutually incompatible properties. In 1912 we find Angier’s
Emulsion recommended because it:

    “... corrects digestive disturbance and promotes normal action
    of the bowels. At the same time it has a most invigorating tonic
    influence upon the general health.”

In 1914 medical men are advised through the advertising pages of the
_British Medical Journal_ of the:

    _“... tonic and reconstructive merits of Angier’s Emulsion.”_

A pamphlet on “Constipation,” which is “Presented to Physicians with
Compliments of the Angier Chemical Company” (copyright, 1913; still
distributed in 1914) informs physicians that Angier’s Emulsion is:

    _“... purely mechanical in its action.”_

Notwithstanding this, we are told later on in the same pamphlet that it:

    “... facilitates, hastens and assists the processes of digestion
    and assimilation.” ... “is a most efficacious remedy in Pulmonary
    Tuberculosis because it not only maintains normal nutrition, but
    also exerts a well-defined specific palliative influence upon the
    cough and other symptoms of the disease.”

Evidently the advertisement is written in the hope that in one
paragraph a claim based on the proved properties of petroleum products
may be substantiated, while in another a totally different and
inconsistent claim may be glibly insinuated in vague phrases designed
to lull thought and thus perform the remarkable feat of securing
credence for two contradictory statements.

                   UNWARRANTED AND MISLEADING CLAIMS

Further evidence that Angier’s Emulsion is at present exploited both
to the medical profession and to the public under claims that are
unwarranted and misleading, if not as palpably untrue as the claims
made in the past, is found on the wrapper of a trade package purchased
in 1914 and in the circular accompanying it. Note the following:

    “Indicated in Diseases of the Throat and Lungs and of the
    Digestive Apparatus. Useful in General Debility and Wasting
    Diseases, Especially when due to Faulty Nutrition. The antiseptic
    properties of the Emulsion particularly adapt it to the treatment
    of diseases of septic or bacterial origin.”

    “Angier’s Petroleum Emulsion is indicated in affections of the
    throat, lungs and intestinal tract--both subacute and chronic. In
    diseases of the digestive apparatus due to catarrhal, ulcerative or
    tuberculous conditions, its peculiar soothing, healing and aseptic
    properties make its use especially beneficial. Wasting diseases,
    particularly when due to faulty nutrition, are greatly benefited
    by its use, one of the most noticeable effects being a prompt and
    decided increase in weight.”

It is, of course, unnecessary to point out that, since petroleum is
non-absorbable, Angier’s Emulsion contains no ingredient capable of
affecting the respiratory mucous membrane except by local application,
for which, indeed, this preparation is evidently not intended.

                       COMPOSITION AND FORMULAS

According to a circular which was contained in a trade package recently
purchased

    “Each fluidounce of Angier’s Petroleum Emulsion with hypophosphites
    contains: 33-1/3 per cent. of our specially purified Petroleum; 9
    grains of the combined hypophosphites of lime and soda, chemically
    pure glycerin and the necessary emulsifying agents.”

As regards the nature of the product referred to under the indefinite
term “petroleum” the circular states that Angier’s Emulsion is:

    “... prepared with refined petroleum specially purified for the
    purpose. By a process peculiarly our own the crude petroleum,
    obtained from special wells is so purified that all taste and odor
    and all objectionable and irritating properties are removed, while
    the full medicinal value of the oil is retained....”

The composition assigned to Angier’s Emulsion in an advertising
pamphlet “The Petroleum Idea,” issued in 1907 differs in that it is
said to contain “specially purified crude petroleum” and that each
fluidounce is said to contain 2.84 grains of benzoate of sodium.
While these quotations convey the impression that certain medicinal
constituents of the “specially purified” product obtained from “special
wells” are “retained,” a pamphlet recommending the use of Angier’s
Emulsion for the treatment of constipation assures us that it produces
the “mechanical effects of the purest petroleum” and that it is “purely
mechanical in its action.”[78]

[78] As is the custom in the exploitation of proprietary medicines,
the preparation which is the firm’s main output--the leader--is made
to do duty as an advertising medium for auxiliary preparations. Thus
the Angier Emulsion booklet advises the use of Angier’s Throat Tablets.
These tablets are alleged to be composed essentially of elm bark and
petroleum, are claimed to “promote appetite and aid digestion,” and
it is stated that “their healing action on all mucous surfaces makes
them decidedly beneficial, not only to the pulmonary tract but on the
digestive areas as well.” Angier’s Throat Tablets were examined in the
Association’s Laboratory to determine the amount and kind of petroleum
present in the tablets. Extraction of the tablets with ether yielded
a petroleum product which resembled in every way the product obtained
from the emulsion. Slightly less than 12 per cent. of the tablet was
composed of the petroleum oil. The part insoluble in ether appeared to
consist essentially of elm bark, with gum and sugar.

                           LABORATORY REPORT

The statements regarding the identity of the “petroleum” are so
unsatisfactory and contradictory (in one place “refined petroleum
specially purified for the purpose,” in another “specially purified
crude petroleum”--in one place “medicinal” and in another “purely
mechanical in its action”) that the help of the Chemical Laboratory of
the Association was invoked to establish the character of the petroleum
product and to determine the presence or absence of sodium benzoate, at
one time declared by the manufacturers to be present but later omitted
from the formula. The Association’s chemists reported:

  “From a specimen of Angier’s Emulsion recently purchased there was
  separated by the customary methods of analysis, a yellow fluorescent,
  unsaponifiable, semi-solid residue which has all the properties of
  ordinary yellow petrolatum of a consistence somewhat softer than
  the product described in the Pharmacopeia. It was much more dense
  than the colorless, non-fluorescent liquid petrolatum now in vogue
  as a laxative. The preparation contained benzoate, both in the form
  of free benzoic acid and also in the form of a water-soluble salt
  probably sodium benzoate.”

The petroleum product contained in the emulsion was thus shown to be
intermediate between the ordinary (solid) and the liquid petrolatum.
It also appears that a benzoate is still present, though no longer
mentioned in the formula.--(_From The Journal A. M. A., Sept. 12,
1914._)




            PHECOLATES, PHECOLAX, PHECOZYMES AND PHECOTONES

            Report of the Council on Pharmacy and Chemistry


Phecolates, Phecolax, Phecozymes and Phecotones were submitted by F.
Waldo Whitney, New York, with “literature” indicating that they are
designed to form parts of a system of treatment founded on the theory
of autotoxemia, which they are supposed to prevent by their action
on the functions of the intestinal canal. The different preparations
consist in the main of mixtures of well-known remedies. The basic
preparation is Phecolates, which contains bile salts in combination
with phenyl salicylates and benzo-naphthol in about one-eighth the
regular doses and hence not likely to be of any real service. Since the
proportions of these ingredients ought to be regulated by the physician
according to the needs of the individual patient, they should not be
combined in fixed proportions. The name is not so framed as to indicate
the principal ingredients.

Phecolax contains, in addition to the ingredients of Phecolates,
phenolphthalein and cascarin, of each one-half grain.

Phecozyme is made more complex than Phecolax by the introduction of
additional phenyl salicylate and of pancreatin.

Phecotone contains ten ingredients.

Extravagant claims such as the following are made:

    “Our Health is governed by our bowels; Our bowels are governed by
    our nerves; Our nerves are governed by our digestion; our digestion
    is governed by Phecolates.”

The Council voted to refuse recognition to Phecolates, Phecolax,
Phecozymes and Phecotones as unscientific articles with objectionable
names.--(_From The Journal A. M. A., Nov. 21, 1914._)




                            PHENOL SODIQUE

      Report of Examination by Council on Pharmacy and Chemistry
                             and Comments


An examination of this article by a subcommittee of the Council on
Pharmacy and Chemistry revealed unscrupulous claims which are a
positive menace to public health. In view of this the Council has
directed the publication of the following comments.

                                              W. A. Puckner, Secretary.

                               COMMENTS

Phenol Sodique was not submitted to the Council by the manufacturers,
but was taken up because it is advertised to both physicians and the
public. Some advertisements state: “Phenol Sodique was the standard
antiseptic thirty years ago. It’s the same today.” If this were true,
it would be high time to call a halt; for the unscrupulous claims made
for this nostrum, and the effrontery with which they are pushed, are
only rivaled by those of the most shameless “patent medicines.”

The firm of Hance Bros. & White poses as a reputable pharmaceutical
manufacturing house, but how it can reconcile this position with
their method of exploiting this product passes all understanding. In
the original package of Phenol Sodique (the latest was purchased on
June 20, 1907), there are little booklets and a folder describing
the marvelous properties of the nostrum. The booklets do not refer
to Phenol Sodique, but they are very instructive. They are entitled:
“Dyspepsia,” “Worm News,” and “Catarrh,” advertising “Dyspepsia
Stop”--some form of dyspepsia tablets, a remedy for round worms,
and “Catarrh Stop,” apparently some mild antiseptic tablets. These
booklets are addressed frankly to the laity, although recourse to a
physician is, generously, advised if the patient does not respond to
treatment! The folly of prescribing “original packages” which contain
popular literature has been so often emphasized that further comment
seems superfluous. The following from “Catarrh,” however, throws an
interesting sidelight on the scientific status of Hance Bros. & White:

    +--------------------------------------------------------+
    | “Catarrh is due to a minute insect in the inner lining |
    | membrane of the nose. This insect multiplies rapidly,  |
    | and, unless checked, and destroyed, will produce the   |
    | worst results.”                                        |
    +--------------------------------------------------------+

To return, however, to Phenol Sodique: The folder is also evidently
intended for the lay public rather than for physicians; at least, if we
are to credit Hance Bros. & White with any intelligence whatsoever. It
is headed: “Montyon Prize of Encouragement, Awarded by the Institute
of France, 1861.” This is rather ancient, but what follows indicates
that a little restraint would have been better than encouragement.
The circular is a compact treatise on self-medication--apparently all
that is necessary to retain or regain health is the use of Phenol
Sodique, externally and internally. The following conditions are
among those specifically named as amenable to this remedy. Smallpox,
measles, scarlatina, erysipelas, puerperal fever, typhoid fever,
cholera, diarrhea, cramps, burns and scalds, bites, cuts and wounds,
excoriations, chilblains, chaps, sore throat, scratches, catarrh,
tetter, sunburn, swollen veins, ulcers, hemorrhages, bruises, piles,
gangrene, carbuncle, itching, insect stings, ivy poison, cold in the
head, bunions, inflamed eyes, eczema, ringworm, rheumatism, pains,
toothache, seat worms, etc.--besides numerous diseases of animals.

No antiseptic, whatever its composition, could by any possibility
accomplish anything like what is claimed for Phenol Sodique, so that
the composition of the article is really of little importance. This
is evidently appreciated by the manufacturers, for they have kept the
composition a profound secret, except in so far as it is implied in
the name. An inquiry addressed to Hance Bros. & White, under date of
April 27, 1907, six months ago, has remained unanswered. The Council,
therefore, directed an analysis of Phenol Sodique. This was carried out
at the chemical laboratory of the American Medical Association, and a
check analysis was made by an independent firm of chemists.

This shows that Phenol-Sodique contains something like 0.5 or 0.66 per
cent. of phenols, dissolved in about 0.75 per cent. of sodium hydroxid.
In other words, it appears to be essentially a very dilute alkaline
solution of some impure coal-tar product, presumably a crude carbolic
acid. The analysis could not profitably be carried further, because the
amount of the antiseptic agent is so very small.

The consideration of this analysis, in connection with the claims
made for Phenol-Sodique, leaves little doubt as to one reason for the
secrecy concerning its composition; although no educated physician
could be deceived into believing for a moment that Phenol-Sodique
could fulfil the promises of its promoters, even if it were “the
best antiseptic, hemostatic and disinfectant on the market,” as the
manufacturers say in their advertisements.

From its composition, it can only have the very moderate and ordinary
antiseptic qualities of a dilute phenol or cresol solution, modified
only to a very slight extent by the free alkali. According to the
manufacturers, however, “Phenol-Sodique is a wonderful preparation.”
Just how wonderful appears from these extracts from the dissertations
in the pamphlet which is enclosed in the package.

    “_Catarrh, Old Colds, etc._--Drink every morning and evening a
    glass of water containing ten to thirty drops of Phenol-Sodique ...”

    “_Small-Pox._--To prevent attack take internally three or four
    times a day, fifteen or twenty drops of Phenol-Sodique in one
    tablespoonful of sugar and water....

    “_Measles, Scarlatina and Erysipelas._--Same treatment as for
    Small-pox.”

    “_Typhoid Fever._--To prevent attack take internally three or four
    times a day, fifteen or twenty drops of Phenol-Sodique.”

    “_Cholera._--To prevent, spread sawdust or sand, wet with
    Phenol-Sodique, in apartments.

    “The very best precaution is to drink, morning and evening,
    a glass of water containing from fifteen to thirty drops of
    Phenol-Sodique....

    “... _Premonitory Diarrhea._--... Drink a teaspoonful of
    Phenol-Sodique diluted in an ounce of water....”

This is the kind of therapeutics and prophylaxis taught to the medical
profession by their self-appointed instructors, the proprietors!

But this matter has a serious as well as a ludicrous side: What is the
proper epithet to apply to those who, knowingly and intentionally,
impress on the ignorant lay public that one can with impunity expose
himself to smallpox, cholera, typhoid or scarlet fever, or measles, by
taking a few drops of very dilute carbolic acid, or by sprinkling a
little on sawdust? What must be the consequences to those who trust in
these assurances? And what should be the lawful penalty for those whose
blunted moral instincts permit them wilfully to endanger the lives of
others for a little financial gain? It would be interesting to know the
real opinion of the responsible members of the firm of Hance Bros. &
White on these questions.

The Montyon Prize was awarded by the French Institute in
1861--forty-six years ago--how many victims a year?--(_From The Journal
A. M. A., Nov. 9, 1907._)




                         PHYTIN AND FORTOSSAN

            Report of the Council on Pharmacy and Chemistry


Phytin, manufactured by the Society of Chemical Industry, Basel,
Switzerland, and sold by A. Klipstein and Co., is an organic phosphorus
compound said to be the “Acid Calcium-Magnesium Salt of Phytinic Acid
(Inosit Phosphoric Acid or Anhydro-Oxymethylene-Diphosphoric Acid)”
obtained from cereals and legumes.

The trade package of Phytin constitutes an indirect advertisement to
the public.

The Council rejected Phytin because unwarranted and exaggerated
therapeutic claims are made for this product based on the entirely
undemonstrated assumptions: (1) that phosphorus is assimilated only
from organic combinations (it is even implied that this must be in the
form of Phytin, and that milk is incapable of supplying the phosphorus
needs of infants); (2) that a long list of diseases, ranging from
rickets to hysteria, are due to deranged phosphorus metabolism; (3)
that all these diseases are cured or markedly benefited by Phytin.

In brief, the claims rehearse every point of the more or less
discredited phosphorus propaganda, in exactly the same way as it was
rehearsed successively by the exploiters of hypophosphites, lecithin,
glycerophosphates, and amorphous phosphorus. It is conceded by the
writers of the advertising pamphlets for Phytin that the preceding
claims were erroneous; but no evidence is given to warrant the belief
that the Phytin claims are less erroneous.

The misleading statements are most extreme. By the use of bold type
particular stress is laid on the preposterous and vicious claim that
Phytin

    “radically and permanently removes sexual debility.”

Fortossan is a preparation of Phytin and sugar of milk, also
manufactured by the Society of Chemical Industry, Basel, Switzerland,
and sold by A. Klipstein and Co. Since Fortossan is a simple
preparation of Phytin the Council voted that the rejection of Phytin
should also apply to Fortossan.--(_From The Journal A. M. A., Jan. 30,
1915._)




                               PRUNOIDS

            Report of the Council on Pharmacy and Chemistry


Prunoids are tablets put out by the Sultan Drug Company, St. Louis.
They are said to be:

    “Made of Phenolphthalein (one and one-half grains in each), Cascara
    Sagrada, De-emetinized Ipecac and Prunes.”

The following report on the composition of Prunoids is submitted by the
Association’s Laboratory:

“From an examination of Prunoids it is concluded that the amount of
cascara or extract of cascara in the preparation is very small. Also
the quantity of “de-emetinized ipecac” is insignificant. The claim is
made:

    “The levulose of prunes, a constituent of Prunoids, is hygroscopic
    and thus when brought into contact with the saliva of the mouth or
    contents of the stomach, disintegrates and prompt medication is
    insured.”

“Actually the amount of prunes which may be present in Prunoids is
negligible. For all practical purposes, therefore, Prunoids are
phenolphthalein.”

According to the information included on and in the box Prunoids are

    “An Ideal Laxative, Purgative, and Intestinal Tonic” ...
    “particularly adapted to the treatment of constipation ...”

They are said to act as an “intestinal tonic”--a claim which in the
light of the examination is obviously unwarranted--and because of this,
it is said that they:

    “Will permanently remove constipation without causing after
    constipation.”

The trade package assures the purchaser that Prunoids are:

    “Recommended by Physicians Generally.”

A circular sent to physicians makes the unwarranted claim that Prunoids
are “especially serviceable” in “... Neurasthenia, Jaundice, Chlorosis,
Rheumatism, Gout ...” and that

    “... their success in gouty diathesis and vague rheumatic symptoms
    tends to confirm the opinion expressed by some physicians that they
    have a solvent action on uric acid.”

In the following the haphazard and ill-considered use of purgatives is
suggested:

    “For the expectant mother, or in the treatment of female diseases,
    for bowel elimination, no happier or _safer_ selection can be made.”

The Council refused recognition to Prunoids because the statement
of composition is incomplete and therefore meaningless; because
unwarranted therapeutic claims are made for them; because the name
“Prunoids” gives the false impression that they depend on prunes for
their effect; and because it is irrational and a detriment to medicine
to disguise a well-known drug by means of a misleading name and to
attempt to create the impression of special virtues by combining it
with superfluous drugs.--(_From The Journal A. M. A., Jan. 2, 1915._)




                             SAL HEPATICA

            Report of the Council on Pharmacy and Chemistry


Sal Hepatica, marketed by the Bristol-Myers Co. of New York, has been
refused recognition by the Council, because its composition is secret;
because it is advertised indirectly to the public for the treatment of
diseases; because exaggerated and unwarranted claims are made for its
therapeutic qualities; and because the name fails to indicate its chief
constituents but does suggest its use in liver disorders.

The Council has authorized the publication of the report of its
referee, because it is an important illustration of the ways in which
physicians are being made parties to the introduction to the public of
a patent medicine, whose indiscriminate use must often have resulted in
harm, direct or indirect.

                                              W. A. Puckner, Secretary.

The report of the referee follows:

Sal Hepatica is a saline laxative sold by the Bristol-Myers Company of
New York. No information seems to be given regarding its composition
except such as is contained in the following vague and uninforming
phrases:

    “Effervescent saline combination, hepatic stimulant, laxative and
    an eliminant of irritating toxins.”

    “Sal Hepatica is a saline combination containing the alterative
    and laxative properties similar to the natural ‘Bitter Waters’ of
    Europe with the addition of sodium phosphate.”

    “... more palatable and efficient than sodium phosphate alone or
    other salines.”

A circular around the bottle contains the following:

    “We invite the physicians’ careful consideration of the merits
    of Sal Hepatica in the treatment of Rheumatism and Gout, in
    Constipation and Auto-intoxication, and to its highly important
    property of cleansing the entire alimentary tract, thereby
    eliminating and preventing the absorption of irritating toxins and
    relieving the conditions arising from indiscretion in eating and
    drinking.”

In the same circular, its promiscuous use is invited in these terms:

    “Owing to its palatability, Sal Hepatica is particularly well
    adapted to the requirements of childhood or the feeble and
    delicate.”

Further suggesting its use in the treatment of that popular, if
somewhat vague ailment, “biliousness,” we read:

    “It is especially valuable where there is intestinal sluggishness
    arising from functional derangements of the liver or portal
    circulation....”

As further suggestive of its all-around “goodness,” are the claims:

    “It increases the appetite and promotes digestion by stimulating
    the flow of gastric juice.”

    “In rheumatism and gout Sal Hepatica furnishes the physician with
    an ideal eliminant, usually affording prompt relief.”

The label on the Sal Hepatica bottle suggests--both to physicians and
to the public--its use in the following diseases and conditions:

    “Derangements of the stomach and liver.”
    “Affections of the kidneys.”
    “Bilious attacks.”
    “‘Summer complaints,’ colic and alcoholic excesses.”
    “Headache, dizziness, heartburn and seasickness.”
    “Acute indigestion.”
    “Gastric, hepatic and renal disorders.”
    “Especially beneficial in rheumatism and gout.”

From these quotations it is evident that Sal Hepatica is in conflict
with:

_Rule 1_, in that its composition is not disclosed, although statements
are made which are likely to give a false impression as to what it is;

_Rule 4_, in that the statements on the label and in the circular
around the bottle advertise it to the public and thus make the
physician who recommends it an advance agent for the nostrum;

_Rule 6_, in that exaggerated and unwarranted claims are made for its
therapeutic qualities, and,

_Rule 8_, in that its name fails to indicate its chief constituents,
but does suggest its use in liver disorders.

The absurd claims made for this preparation are such as to put it in
the “patent medicine” class. Even the most credulous members of the
medical profession certainly can take no stock in the claim that a
preparation can be an “eliminant” of uric acid, a hepatic stimulant, a
remedy for gout, rheumatism, liver disease, indigestion, etc. Why then
should such a preparation be tolerated?

In its conflict with Rule 4 Sal Hepatica belongs to that class of
nostrums which have been so successfully exploited by manufacturers
through the unwitting efforts of thoughtless and careless physicians.
The Bristol-Myers Company has been most liberal in distributing free
samples, evidently with the assurance that physicians would do the
rest. Thus, at the present time, the profession is being supplied with
a package containing one regular 25-cent bottle and five single-dose
vials bearing the name Sal Hepatica. If only a small percentage of the
physicians who receive these samples distribute them, the increase in
Sal Hepatica consumers may be imagined. How successful this scheme of
the Bristol-Myers Company has been is only too evident. Sal Hepatica is
one of the best-selling laxatives in department stores and drug stores
to-day.

While the evils of indiscriminate purgation are now generally
recognized, the referee wishes to quote and to indorse the pertinent
comments on this subject by The Journal:[79]

[79] The Journal A. M. A., March 26, 1910, p. 1071.

  “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.”

It is recommended that this report be authorized for publication in
order that physicians may know the extent to which they have been
made to act as advance agents for “patent medicines.” It is hoped
its publication may suggest to those who in thoughtlessness have
recommended Sal Hepatica, that they go to their materia medica and
renew acquaintance with the host of simple and efficient laxative
salts which are available--magnesium sulphate, sodium sulphate, sodium
phosphate and the palatable effervescing preparations of these which
the Pharmacopeia provides--effervescent magnesium sulphate (Magnesii
Sulphas Effervescens, U. S. P.), effervescent sodium phosphate (Sodii
Phosphas Effervescens, U. S. P.).--(_From The Journal A. M. A., Feb. 7,
1914._)




                               SANMETTO

            Report of the Council on Pharmacy and Chemistry


The following report on Sanmetto (Od Chemical Company, New York) has
been adopted by the Council on Pharmacy and Chemistry, which authorized
its publication.

                                              W. A. Puckner, Secretary.

Sanmetto is one of the oldest proprietaries on the market. Its
advertisements have been familiar to the readers of medical journals
for several decades past. It is a typical nostrum. It is secret
although the promoters have published various “near-formulas.” The
following are some of the statements regarding composition:

    “A Scientific Blending of _True_ Santal and Saw Palmetto with
    Soothing Demulcents in a Pleasant Aromatic Vehicle.”

As this did not disclose the identity of the demulcents or the quantity
of the alleged active constituents, the “formula” was, of course,
meaningless.

Again it is:

    “A Scientific blending of _true_ Santal and Saw Palmetto in a
    pleasant aromatic vehicle.”

Here the reference to “soothing demulcents” is omitted. The information
furnished physicians at the present time is:

    “It is a blend of harmonizing drugs.”

A letter from a physician requesting information as to the exact
composition of Sanmetto recently elicited the following reply:

    “... Sanmetto is a blending of true santal and saw palmetto with
    soothing demulcents in a pleasant aromatic vehicle. The demulcents
    are introduced not only for the purpose of modifying the irritant
    properties of the santal, but to add distinctively to the soothing
    properties of the finished product upon the mucous membrane of
    the urinary tract, and are not mentioned in our published formula
    for the simple fact that if we gave them, then we would do the
    advertising and the substitute manufacturer would engage in the
    ‘unfair competition’ of putting on the market his concoction,
    claiming to be made exactly after our formula, without spending
    a cent for advertising, relying upon our propaganda work to sell
    his substitute, although not the same article as nor equivalent to
    Sanmetto, from the fact that he would be working in the dark as
    to the processes in the manufacture of our product. There is no
    mineral substance in Sanmetto, nor any other ingredient that is
    detrimental in any way whatsoever....
      “OD CHEM. CO.,
        “M. Haman, Pres’t.”

                 THE VALUE OF SANTAL AND SAW PALMETTO

The foregoing warrants the assumption that the active ingredients of
the mixture are sandalwood oil and saw palmetto.

There was a period when the internal treatment of gonorrhea had a
marked vogue. Balsamic remedies received the approbation of the medical
profession as the most specific of internal remedies for this disease.
As a representative of this class, sandalwood oil was very highly
esteemed and had great popularity. As in other similar instances,
this popularity was commercialized and the drug became the basis
of many secret or semisecret mixtures, including “specialties” of
pharmaceutical houses.

Sabal or saw palmetto is an official drug which at one time was used in
genito-urinary affections, but now is seldom used, presumably because
it has been found practically worthless. It is not mentioned by most
pharmacologists, and those who do mention it regard it as of doubtful
value. It is included among the preparations recommended for deletion
as given in the report of the Committee on the Pharmacopeia of the
American Medical Association (The Journal, Sept. 4, 1909, p. 792).

Even granting that sandalwood oil and saw palmetto do have therapeutic
value, no one would think of regarding either or both of these
preparations as of use except in inflammatory conditions of the
genito-urinary tract, especially gonorrhea.

If one is to believe the advertisements, however, the combination
of these drugs in Sanmetto is a wonderful medicine. One might even
conclude that there are few conditions in which it cannot be given with
profit. For instance:

    “In Nervous Diseases, especially Neurasthenic cases with origin
    in some sexual or genito-urinary disorder, for its action as a
    vitalizing tonic and reconstructive, restoring nutrition to germ
    plasm, relieving pathological conditions and for soothing and
    sustaining the nerves controlling the parts.”

Bear in mind in reading the foregoing statement and the following that
we are concerned with two drugs whose effects are exerted on mucous
membranes especially of the genito-urinary tract.

    “In Gestation Cases, showing tendency to albumin and convulsions,
    for toning the pelvic organs, clearing up the urine and cleansing
    the urinary bladder and outlet. In the Lying-in-Room for relieving
    the affections of urethra and bladder, painful strangury of the
    urethra and painful micturition due to the pressure of fœtal head
    upon the neck of the bladder and upon the urethra during labor, and
    infection, either septic or gonorrheal.”

    “In Weakness of the Kidneys, causing loss in tone and general
    health and Impairment of Eyesight--for strengthening the kidneys
    and bladder and toning the nervous system; and also for aiding in
    the constitutional treatment of Gonorrheal Infection of the Eyes.

    “In the treatment of the Prostate, Testes, Mammæ, Ovaries,
    and Urethra, Kidneys and Bladder, for its soothing, slightly
    antiseptic, aphrodisiac, toning and restoring action to the mucous
    membrane and glands. By its use the parts affected in many cases
    returning to their normal condition.”

While the reference to its aphrodisiac action and to the restoration of
parts to the normal may have little interest to physicians, it may be
counted on to appeal to the sexual neurasthenic. In premature senility:

    “Sanmetto ... is unexcelled as a vitalizing tonic to the withered
    glands of the reproductive system, promoting their normal secretory
    activity.”

These claims are not only absurd but also harmful; they tend to
perpetuate a hypochondriacal state of mind in the class of patients
appealed to--the sexual neurasthenic. There is, however, a more serious
side; the tendency of certain other claims made for the preparation are
vicious and dangerous as well as misleading. The advertising claims
are likely to induce some physicians--those who accept advertising
“literature” as dependable--to belittle the importance of serious
diseases of the sexual organs and to be content with Sanmetto, which,
even if it gave as good results as other balsamic remedies, would
be, at best, only a halfway measure. This in an advertising pamphlet
physicians are given this advice as to the treatment of gonorrhea.

    “To provide the needed rest the patient should be instructed to
    simply keep the parts clean with warm water for the first week and
    let the discharge continue until you can control it by internal
    medication. I wish to emphasize the fact that there is no way
    that any acutely inflamed portion of the genito-urinary tract
    can get the rest required so completely as by administration of
    Sanmetto.... After the acute gonorrhea has begun to subside the
    Sanmetto should be aided by mild astringent injections.”

If there is any well-established fact in medicine, it is that gonorrhea
is a serious disease--serious alike to the sufferer and to the
community--and one which needs careful attention from the very first.
To claim, either directly or by implication, that it can be cured by
such a mixture designed to act on the kidneys, bladder and nervous
system is false and dangerous doctrine.

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.

Sanmetto is a secret nostrum the exploitation of which is an invitation
to haphazard, uncritical therapy and a menace to public health.--(_From
The Journal A. M. A., March 13, 1915._)




                              SECRETOGEN

            Report of the Council on Pharmacy and Chemistry


The Council has authorized publication of the following report dealing
with two internal secretion specialties--Secretogen Elixir and
Secretogen Tablets--to call attention to the unfounded and extravagant
claims made for this class of products.

                                              W. A. Puckner, Secretary.

Test tube experiments show that pepsin hydrolyzes proteins in acid
solutions; that pancreatin digests protein in alkaline liquids, and
that diastase converts starch into sugar. Based on these facts, it
was assumed that these ferments would aid digestion. This assumption
was correct if limited to certain cases of dyspepsia in which it can
be shown that certain ferments are absent or deficient. But this
limitation was not realized or remembered; on the contrary, the
indiscriminate use of digesting ferments in all kinds of cases of
indigestion became widespread and still continues, although to a less
extent. Herein lies the great disappointment that has followed the use
of these ferments.

More recently hormones were discovered, and while their importance
has not been fully worked out, it has been assumed that they are
responsible for the secretion of digestive ferments, and that in
their absence this secretion fails. Without waiting for proof of this
assumption, that is, that digestive failure is due to lack of hormones,
proprietary medicine promoters are already placing on the market
various secretion specialties.

As an example of this new class of specialties and of the unfounded
claims made for them, your referee presents the following report on
Secretogen Elixir and Secretogen Tablets offered to physicians by the
G. W. Carnrick Company.

Secretogen Elixir is said to contain pancreatic secretin obtained from
the duodenum with 1/10 of 1 per cent. of hydrochloric acid. Secretogen
Tablets are said to be prepared from pure secretin and succus entericus
obtained from the epithelial cells of the duodenum. The claims for
Secretogen are based on the physiologic action of secretin as described
by various observers. To determine whether these claims are justified
it becomes necessary to review the evidence advanced to prove that
secretin stimulates the digestive glands.

Secretin is a hormone, a chemical substance produced by the action of
hydrochloric acid on a previously formed substance, “prosecretin,”
contained in the cells of the intestinal mucous membrane, especially
of the duodenum. Secretin is absorbed by the blood and carried to the
pancreas, liver and intestinal mucosa, which are thereby stimulated
to produce their characteristic secretions, namely, bile, pancreatic
juice and succus entericus. When secretin is injected into the blood,
it causes an increase in the flow of these secretions. Some observers
have claimed that secretin is absent in cases of diabetes in which the
pancreas is still found normal. Wentworth[80] reported several cases of
marasmus in which he found no evidence of prosecretin. This deficiency,
he believes, is the cause of this disease.

[80] Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from a
Study of Secretin in Normal and Atrophic Infants, The Journal A. M. A.,
July 20, 1907, p. 204.

The Carnrick Company, adopting the foregoing views, namely, that
secretin is necessary to secure the normal action of pancreas, liver
and intestine, as proved, placed on the market their specialty
“Secretogen,” to take the place of the missing secretin.

The foregoing conclusion cannot, however, be sustained. There are
numerous cases in which no hydrochloric acid is produced in the stomach
and hence--as it is produced by the action of hydrochloric acid--no
secretin can be produced in the intestine. Yet in these cases the
pancreatic juice and bile are secreted in normal amounts and digestion
goes on normally after the food leaves the stomach. In such cases
the pancreas and liver must be stimulated to secretion by some other
mechanism than secretin.

The proof that the absence of secretin is characteristic of diabetes
or of marasmus is not yet available. Sweet and Pemberton[81] found
that many circumstances interfered with the extraction of secretin,
so that the mere failure to obtain it in a given case is not proof of
its absence, unless the various inhibiting influences are given due
consideration. The conclusions reached by these authors are that “the
evidence so far adduced that secretin is absent in some varieties (of
diabetes) does not seem conclusive,” and that “the specific absence or
deficiency of secretin in marasmus seems to remain as yet unproven.”

[81] Sweet, J. E., and Pemberton, R.: Experimental Observations on
Secretin, Arch. Int. Med., February, 1908, p. 231.

The favorable reports of Moore[82] in regard to the use of secretin in
diabetes are not confirmed by the experience of Foster[83] in five
cases, or by the case reported by Dakin and Ransom.[84]

[82] Moore, Edie and Abram: Biochem. Jour., 1906, i, 28; ibid., i, 446.

[83] Foster, N. B.: Cases of Diabetes Treated with Secretin, Jour.
Biol. Chem., January, 1907.

[84] Dakin, H. D., and Ransom, C. C.: Treatment of Case of Diabetes
with Secretin, Jour. Biol. Chem., January, 1907.

In regard to the use of secretin in intestinal disorders, the G. W.
Carnrick Company refers to an article by J. W. Beveridge.[85] An
examination of this article shows it to be unscientific and uncritical.
The author presents four cases to “demonstrate the peculiar potency
exercised by secretin.” Of the first he says:

[85] Beveridge, J. Wallace: Secretin, Am. Jour. Gastro-Enterology,
April, 1914, p. 170.

    “Stomach was dilated, food delay, seventy-two hours; hyperacidity,
    vomiting daily, five to twelve times, urine high specific gravity,
    over 3 per cent. urea, trace albumen.”

The patient improved somewhat after gastro-enterostomy with removal
of the gallbladder; the vomiting ceased, but the stools continued
clay-colored and the high urea output still kept up. Secretin was
given, and after this the report continues:

    “The stools became normal in color at the end of the second month,
    weight gradually increased until 122-3/4 pounds was reached, and
    the urea is now normal, averaging about 1 per cent.”

This case is offered to prove the absence of secretin and its effect
when given by the mouth. As evidence of hepatic insufficiency the
author apparently relies on the color of the stools, and for pancreatic
insufficiency he cites the high urea output. He claims that when the
pancreas does not furnish an efficient secretion, the proteins of the
food fail to be converted into amino-acids, and instead, raise the
percentage of urea. Consequently, he concludes that a high percentage
of urea indicates the absence of secretin. It is usually held that a
high percentage of urea depends on two factors, ingestion of a large
amount of protein and concentration of the urine. The author gives
no data as to the amount of albuminous food, the amount of urine,
or whether the percentage of urea was learned by examining a single
specimen or the total quantity for twenty-four hours. The mildest
judgment that can be passed on such clinical data is that they are
totally inadequate. Without doubt the percentage of urea could have
been reduced to “normal” by causing the patient to drink water freely.
The remaining cases show similar hasty conclusions from insufficient
data, rendering them worthless as evidence.

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.

A rational basis for the therapeutic value of Secretogen is lacking for
the following reasons:

1. No evidence has been presented that the absence of secretin is a
cause of gastro-intestinal diseases. It is usually present, and if not
present, as in achylia gastrica, there is evidently some compensating
arrangement by which the pancreas is stimulated to perform its regular
functions.

2. There is no evidence that secretin in any form is physiologically
active when administered by the mouth.

                              REFERENCES

  Fleig, M. C.: Action de la sécrétine, Arch. gén. de méd., lxxx, 24.

  Charles, J. R.: Treatment of Diabetes with Secretin, Bristol
  Med.-Chir. Jour., September, 1906; Med. Press and Circular, Nov. 21,
  1906.

  Meltzer, S. J.: Animal Experimentation in Relation to our Knowledge
  of Secretions, Especially in Internal Secretions, The Journal
  A. M. A., May 7, 1910, p. 1506.

  Wentworth, A. H.: The Cause of Infantile Atrophy, Deduced from
  A Study of Secretin in Normal and Atrophic Infants, The Journal
  A. M. A., July 20, 1907, p. 204.

  Bambridge and Beddard: Guy’s Hospital Reports, 1907, lxi, 161.

  Enriquez and Hallion: Nuevas nociones sobre la digestion. Secretin,
  Importancia fisiologica y patologica, Transactions of 14th Int. Med.
  Congress, Madrid, 1904.

  Enriquez: La Sécrétine Médication acide duodénale Stimulation de
  function sécrétiniques chez l’homm., Rev. de. thérap. méd.-chir.,
  Paris, 1904, lxxi, 187.

    --(_From The Journal A. M. A., May 1, 1915._)




                                SINKINA

            Report of the Council on Pharmacy and Chemistry


Sinkina is a malaria “cure” put on the market by the Metropolitan
Pharmacal Company, New York. The product was presented to the Council
on Pharmacy and Chemistry for admission to New and Nonofficial
Remedies and was rejected because insufficient evidence was submitted
to substantiate the improbable claims made for it. The manufacturers
were sent a copy of the report stating that their product was refused
recognition. In view of the advertising that was persisted in after its
rejection, the Council’s referee for Sinkina submitted the preparation
to clinical tests. Both the original report and the results of the
clinical tests are given in the following report, which was submitted
to the Council and recommended for publication. The complete report
having been sent to the manufacturers and their reply considered, the
Council authorizes its publication.

                                              W. A. Puckner, Secretary.

                      THE COUNCIL’S FIRST REPORT

The Council, after investigating the claims made for Sinkina, declared
the product unworthy of recognition and adopted the following report,
which was sent to the manufacturers:

  No experimental evidence regarding the therapeutic value has been
  submitted. The clinical evidence is scant and not of such character
  as to deserve much consideration, no sufficient precautions having
  been adopted to avoid wrong conclusions. Judging from the evidence at
  hand the preparation is simply a dilute sugar-alcohol-water solution
  containing a little oil of cumin--Roman caraway. It is highly
  improbable that such a liquid would have the therapeutic effects
  claimed for it by the Metropolitan Pharmacal Company. In view of the
  improbable claims made for Sinkina, and the failure to substantiate
  them by suitable evidence, it is recommended that the preparation be
  refused recognition without at this time considering the claims made
  in regard to the identity and amount of the drug claimed to be the
  essential constituent.

In spite of its rejection Sinkina was persistently advertised. It was
thought advisable, therefore, to submit the preparation to clinical
tests. This was done and the results are given in the following report:

                          THE CLINICAL REPORT

The following quotations indicate the claims made for this preparation:

    “In malarial conditions there is nothing that acts so promptly and
    efficaciously as Sinkina. Sinkina destroys radically every trace of
    the parasite in the blood from the time of its first appearance,
    builds up the damaged corpuscles, revitalizes the system, and
    completely eliminates every trace of the disease. Sinkina is
    deservedly termed the _Specific_ for Malaria.”

These claims were supported by testimonials which usually gave no
indication of a demonstration of the presence or absence of malarial
plasmodia in the blood. The following is an example showing the
character of most of the evidence presented by the manufacturers:

    “Three weeks ago I prescribed Sinkina for a negro man 40 years
    of age suffering from a double tertian malarial infection having
    a chill every afternoon for four consecutive days. He came to my
    office about 8 a. m. and was due to have a chill about 6 p. m.
    I gave him the sample of Sinkina and directed him to take a
    tablespoonful at once, also at noon and again at 4 p. m., and to
    continue taking it in same size dose three times a day till he had
    taken it all. He reported to me in a week from that date and told
    me he was feeling fine and that he hadn’t had any more chills. The
    patient up to this time is apparently cured.”

As the claims were supported by a few testimonials purporting to be
based on exact investigations, the Council submitted the preparation
to careful laboratory and clinical tests. For this investigation the
Council was fortunate in securing the help of physicians actively
engaged in the study of malaria.

Experiments were made _in vitro_ with the preparation; 1 ounce of
Sinkina was used, and its action was compared with that of 10 grains
of quinin sulphate. When these were added to cultures of malarial
plasmodia in proportion corresponding to 1 ounce of Sinkina or 10
grains of quinin sulphate for a 150-pound man, the quinin was found
to be unfailingly antagonistic to the malarial organism, the drug
prevented the segmentation of the organism, and finally killed it in
about thirty-six hours. The Sinkina did not kill the parasite after
seventy-two hours of continued action, and the parasites segmented in
the presence of it just as actively as they did in the control.

The investigator was furnished with two sets of preparations in plain
prescription bottles so as to avoid all influence of the personal
equation. One set consisted of Sinkina, the other of a mixture of
alcohol, sugar and water with some oil of cumin. The investigator
reported that, so far as the tests on the cultures of malarial
plasmodia were concerned, he could not determine any difference in
the results obtained with the oil of cumin preparation, made in the
laboratory of the Association, and those obtained with the Sinkina
of the Metropolitan Pharmacal Company. Clinical trials were made by
three independent investigators. Two of them received the two sets of
preparations described.

                          FIRST INVESTIGATION

The first investigator treated two cases with Sinkina: one was of the
ordinary estivo-autumnal type and the other an ordinary tertian.

  CASES 1 AND 2.--A good many schizonts were present in the blood of
  each patient forty-eight hours after the administration of Sinkina.
  In the instance of the case of tertian the patient had his chill
  forty-eight hours after the medicine had been started. As the Sinkina
  failed to produce any effect the patients were then put on quinin to
  stop the disease.

  CASE 3.--The patient had taken 10 grains of quinin on the day on
  which the experiment was begun. He had the tertian form of the
  disease, and plasmodia were quite numerous at the beginning. The
  quinin was discontinued and Sinkina was given in doses of 1 ounce
  three times a day. The day following the administration of 10 grains
  of quinin and 1 ounce of Sinkina, no parasites could be found in
  the blood. The Sinkina was continued in the doses mentioned. On the
  seventh day the patient had another chill, and a great many parasites
  were found in his blood. The Sinkina was discontinued and the patient
  was at once relieved by quinin.

This investigator gives it as his opinion, based on these observations,
that the preparation (Sinkina) is absolutely worthless in the treatment
of malaria, and he does not think it necessary to make any further
experiments with it.

                         SECOND INVESTIGATION

The second investigator treated two cases of tertian malarial fever
with these preparations until it was satisfactorily proved that the
drug was having no effect on the presence of the parasites in the
blood, when he began the administration of quinin.

  CASE 4.--After the use of the remedies for one week the investigator
  still found young rings half-grown and gametes present in the blood.
  Apparently there was a relative increase in the number of parasites.
  He then began the administration of quinin. Blood-smears taken the
  next day after 40 grains of quinin had been taken showed one parasite
  after eighteen minutes’ search of one slide, and two after thirty
  minutes’ search of a second slide. At the end of a week’s treatment
  the patient was discharged recovered. The blood examination of two
  slides was negative.

  CASE 5.--This was a case of tertian malaria. After treatment for
  five days with Sinkina the blood still showed tertian parasites with
  increase in the size of the spleen, and the preparation was without
  effect on the clinical course of the disease. Quinin was then begun,
  and the blood examination became negative at the end of three days.

The investigator concludes that the preparations furnished him were
absolutely worthless in the treatment of two cases of the tertian
form of malarial fever, and that these solutions had no effect on the
presence of the parasites in the peripheral circulation. In a case
of quartan malaria, both of the preparations (cumin oil mixture and
Sinkina), sent by the Association Laboratory, were without effect on
the plasmodia in the blood. This investigator employed the solution
made by the Association Laboratory (cumin oil mixture) as well as
Sinkina, and was unable to note any differences between them.

                          THIRD INVESTIGATION

The third investigator began the trial of Sinkina at the instance of
the manufacturers, and used it in three cases, two of them being benign
tertian malaria and one case of mixed infection (benign tertian and
estivo-autumnal).

  CASE 6.--This was one of the cases of benign tertian malaria. The
  patient gave a clinical history of malaria with chills occurring
  on alternate days for a little over a week. There was an immediate
  cessation of all clinical symptoms, and three days after the patient
  had been on 1/2 ounce of Sinkina three times daily there was no
  evidence of any plasmodia in his blood; his additional treatment
  consisted of 5 grains of calomel the evening of the first day
  with a saline the next morning. Before the patient was put on
  treatment, numerous parasites of both the asexual and sexual forms
  were observed. The patient remained in bed for a few days, and then
  returned to work. A week later he was again taken ill with a return
  of all of his previous clinical symptoms.

  CASE 7.--This case was one of mixed infection (benign tertian and
  estivo-autumnal). The patient had a clinical history of malaria
  dating back two weeks, with a maximum temperature of 104 on
  admission. Tertian rings, estivo-autumnal rings and crescents were
  found in the blood. The patient was placed in bed, given thorough
  eliminating treatment, and 1/2 ounce of Sinkina was administered
  four times daily. His clinical symptoms ran on for two days with
  no change, and there was no difficulty in finding the plasmodia
  in blood-smears, which were taken twice daily. The dose was then
  doubled and at the end of four days more there was no change in
  either his clinical symptoms or the blood-findings. The patient was
  then placed on 10 grains of quinin sulphate with 15 drops of diluted
  hydrochloric acid three times daily, to which he responded in less
  than forty-eight hours and made an uneventful recovery.

  CASE 8.--This was the other case of benign tertian malaria. The
  patient had chills every other day while on the treatment, and
  laboratory diagnosis confirmed the clinical findings. Experimental
  treatment was carried on for four days, with a negative result.

The investigator calls attention to the fact that the first case in
which improvement resulted does not show any necessary connection with
the Sinkina administered, for many cases of benign tertian malaria will
clear up in just as short a time under any line of treatment, while
practically all will eventually do so. This investigator later reported
another case and transmitted a clinical chart.

  CASE 9.--This patient was admitted to the hospital, Dec. 30, 1912,
  with a history of having had malaria for some weeks. The diagnosis
  was confirmed by a blood examination. He was then carried for four
  days without treatment other than rest in bed and a liquid diet. His
  symptoms subsided by the third day. On the fourth day a count of
  the parasites was made which showed that there were 1,160 asexual
  parasites and 260 sexual forms to every thousand leukocytes. The
  following day he was placed on Sinkina, 1 ounce three times daily.
  There was exacerbation of symptoms on the following day, which
  gradually increased until the fourth day, remaining about stationary
  for a day or so. The fifth day after the patient had been placed
  on Sinkina, another count of the parasites showed 5,600 asexual
  parasites and 300 sexual forms to the thousand leukocytes, this being
  an increase of 4,440 asexual forms and forty sexual forms to every
  thousand leukocytes. With the second count of parasites the dose of
  Sinkina was increased to 2 ounces every four hours, the patient being
  kept on this until January 14, without result. He was then placed on
  quinin, with a complete reduction of the temperature to normal and
  the disappearance of the parasites from the blood.

The investigator also reported a case of benign tertian malaria.

  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.

This investigator also concludes that the claim put forth by the
Metropolitan Pharmacal Company that Sinkina is a specific in the
treatment of the malarial fevers is entirely without foundation, and
that the firm will be unable to demonstrate to the contrary.

These investigations demonstrate that Sinkina is not a specific against
malaria, and that it has no more effect than a mixture of oil of cumin,
sugar, alcohol and water. They further show the fallacy, first, of
concluding from a temporary cessation of the symptoms in malaria that
the disease has been cured and, second, of ascribing such temporary
improvement to the influence of a remedy which has no known effect on
the malarial organism.--(_From the Journal A. M. A., Sept. 27, 1913._)




                                SOMNOS

            Report of the Council on Pharmacy and Chemistry


_To the Council on Pharmacy and Chemistry of the American Medical
Association:_--Your subcommittee, to whom was assigned Somnos,
H. K. Mulford Company, submits the following report of experiments,
undertaken to compare the effects of Somnos with those of chloral
hydrate. These experiments demonstrate that the statements made in
regard to the action of Somnos are in conflict with Rule 6 of the
Council, which requires: “No article will be admitted or retained
concerning which the manufacturer or his agents make unwarranted,
exaggerated or misleading statements as to the therapeutic value.” It
is, therefore, recommended that Somnos be not approved for inclusion
in the book until the claims made for it are corrected. It is also
recommended that the report be published:


                      The Pharmacology of Somnos

When these experiments were begun, April, 1906, there was nothing in
the advertising literature on Somnos to indicate whether this article
is a solution or a pure substance. On the label on the bottle, in the
circular accompanying the bottle, and in the booklet “Somnos,” the word
Somnos seemed to be used as a synonym of “Chorethanal alcoholate,”
C_{9}H_{11}O_{5}Cl_{9}, and physicians were prescribing and pharmacists
dispensing it in the belief that it was a pure substance. “The pure
substance; some kind of an alcohol; nothing to do with choral,” was the
way the druggist from whom the samples were purchased put it. Thus
information absolutely indispensable for any rational comparison of
Somnos with other hypnotics was withheld from the physician.[86]

[86] Two weeks ago (Journal A. M. A., Sept. 1, 1906, p. 695) it was
pointed out that the manufacturers now give this information, but in a
wholly unnecessarily obscure form.

Hence, before beginning the physiologic experiments it was necessary
to determine the strength of the preparation; for this purpose three
chlorin determinations (by the Carius method) were made. On the
assumption that all the chlorin present was in combination as chloral
glycerate, C_{3}H_{5}[CCl_{3}.C(OH)_{2}]_{3} = C_{9}H_{11}O_{6}Cl_{9},
and calculating the percentage of this in Somnos, the following results
were obtained: (1) 5.11 per cent.; (2) 5.15 per cent.; (3) 5.10 per
cent.

Somnos, therefore, was found to contain approximately 5 per cent. of
chloral glycerate and its physiologic action was compared with that of
a 5 per cent. solution of hydrated chloral. In some experiments the
hydrated chloral was dissolved in water; in others, in 10 per cent.
alcohol (Somnos was found to contain at this time about this percentage
of alcohol); in other experiments glycerin was added, as Somnos was
found to contain this substance. No very marked differences were found
in the physiologic action of the three solutions.

              FATAL DOSE OF SOMNOS FOR THE LOWER ANIMALS

The booklet on Somnos states that “Somnos has no toxicology”; that
while chloral hydrate causes “acute poisoning,” “deep coma,” etc.,
Somnos is “harmless in twenty times the dose prescribed,” “coma
unknown, etc.” The physician would scarcely suspect from such
statements that Somnos is as poisonous a substance as solutions
containing hydrated chloral in corresponding amount; that such is the
case is shown by the following experiments. These experiments were
necessarily made on the lower animals. While such results do not enable
us to draw very definite conclusions as to the absolute toxicity of
poison for man, the results on animals are conclusive as regards the
relative toxicity for man of such closely related drugs as hydrated
chloral and Somnos.[87]

[87] That portion of the report describing the experiments on animals
is here omitted. It was printed in full in The Journal and in the
Report of the Council on Pharmacy and Chemistry, 1905-1908.

       *       *       *       *       *

                              CONCLUSIONS

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]

It is to be hoped that physicians who have been blindly using Somnos
without even knowing the strength of the preparation, much less what
it is, will compare its effects with those of a 5 per cent. elixir of
hydrated chloral.[88]--(_Abbreviated from The Journal A. M. A., Sept.
15, 1906._)

[88] The booklet on Somnos, “Somnos, a Pharmacological Report,” which
is referred to here, contains a “Therapeutic Index to the Usefulness
of Somnos.” We give below a list of diseases mentioned in this index
to show the wide range of usefulness (?) that is claimed for this
chloral compound. Abortions. Abscess--of brain, kidney, liver, tonsils,
parotid gland, mediastinum; in appendicitis, glanders, perinephritic,
retropharyngeal, pyemic, pelvic, ovarian. Somnos lessens pain and
quiets nervous state. Tablespoonful, repeated once or twice. Use
liberally. Alcoholism--full doses repeated often. Gives calm sleep. No
blood changes like those produced by chloral. Anemias--progressive and
secondary. Somnos has no deleterious action on blood as is common with
other hypnotics. Aneurism. Angina. Apoplexy. Appendicitis. Arthritis.
Arsenical poisoning. Arteriosclerosis. Asthma. Biliary colic, Bright’s
disease. Carbuncle. Carcinoma. Catarrh. Cellulitis. Cerebrospinal
fever. Chlorosis. Cholecystitis. Chordee. Chorea. Cirrhosis.
Coccydynia. Colic. Colitis. Concussion. Confusional Insanity.
Contusions. Convulsions. Coryza. Cough. Cramps. Cystitis. Delirium.
Diabetes. Diarrhea. Diphtheria. Dropsy. Dysmenorrhea. Dyspnea.
Ear. Emphysema. Empyema. Endocarditis. Endometritis. Epididymitis.
Epilepsy. Erysipelas. Fevers. Fistula. Gallstones. Gastralgia or
Gastrodynia. Gastritis. Gonorrhea. Goiter. Gout. Hallucinations. Hay
fever. Headache. Heart Disease. Hemicrania. Hiccough. Hydronephrosis.
Hydrophobia, Hydrothorax. Hyperesthesia. Hysteria. Indigestion.
Inflammation. Insomnia. Kidney disease. Laryngitis. Liver abscess.
Cirrhosis. Lobar pneumonia. Lockjaw. Locomotor ataxia. Lumbago.
Mal de mere. Malarial fever. Meningitis. Migraine. Melancholia.
Metritis. Morphinism. Muscular rheumatism. Myelitis. Myocarditis.
Myositis. Nephritis. Nervous dyspepsia. Neuralgia, occipito-cervical,
etc. Neurasthenia. Neuritis. Night sweats. Orchitis. Otitis media.
Parethesia. Paralysis. Parotitis. Peliosis rheumatica. Pericarditis.
Perimetritis. Perihepatitis. Perichondritis. Peritonitis. Pertussis.
Petit mal. Pharyngitis. Phthisis. Pleurisy. Pneumonia. Post-epilepsy.
Prolapsed uterus. Pseudo angina pectoris. Purpura. Rabies. Rheumatic
fever. Salpingitis. Sarcoma. Scarlet fever. Smallpox. Spasms. Stomach.
Stomatitis. Sunstroke. Tenesmus. Tetanus. Tonsillitis. Trauma. Trismus.
Typhoid fever. Typhus fever. Ulcers. Urticaria. Varicella. Vomiting.
Vulvitis. Yellow fever.




                            SUCCUS ALTERANS

            Report of the Council on Pharmacy and Chemistry


The following report was adopted by the Council:

It is, believed that unwarranted and exaggerated therapeutic claims
are made for Succus Alterans by its manufacturers, Eli Lilly & Co.,
Indianapolis. In view of the disastrous results which may follow, if,
from the statements made, physicians should be led to rely on the
product as a treatment for syphilis, it is recommended that Succus
Alterans be refused recognition and that this fact be published with
comments.

                                              W. A. Puckner, Secretary.

Comment: Succus Alterans is a preparation which has been put on the
market for some years by Eli Lilly & Co., as a remedy for syphilis.
The serious character of this disease and especially the deplorable
results that ensue from its improper or insufficient treatment, should
make a firm hesitate to advise any treatment for it which experience
has not demonstrated to be at least as efficacious as that which is
generally accepted and well proved. Succus Alterans is the result
of a combination of circumstances; no one person is responsible for
it. It was probably the natural desire for a remedy free from the
occasional injurious results of mercury that led Dr. J. Marion Sims
to advocate the use of a collection of indigenous American plant
drugs, sarsaparilla, stillingia, xanthoxylum, etc., which had a local
reputation for the cure of syphilis. These drugs are supposed to be
inert when the dried plants were used, and this gave an opportunity
for the development of a nostrum. The ingredients are well known, but
as their virtues are supposed to be lost in drying, the physician can
not have his druggist compound them, but must, perforce, prescribe the
proprietary combination.

Those who consented to experiment with the new remedy soon found that
the claims to curative properties were unfounded, but the strong
commercial interests backing it have prolonged its life to the present
time. Authorities on syphilis either say nothing about the preparation
or mention it merely to condemn; but the proprietors of the nostrum
continue to assert that it is not only practically a specific in
syphilis, but now recommend it for various derangements of the blood
and all sorts of skin diseases.

This being the case, what shall the wise physician do? Shall he blindly
follow an authority of a past generation or shall he recognize that the
claims of an interested manufacturer ought not to weigh against the
consensus of his present-day confrères who have given the treatment
of syphilis their special attention? The exploitation of such a
preparation is deserving of strong censure. By such methods the firm
places itself on the same plane as those nostrum venders, who advertise
certain antiseptic sprays and gargles as cures for epidemic meningitis
and diphtheria and thereby deprive credulous victims of the curative
antitoxin treatment. Succus Alterans is not a new remedy on trial for
its possibilities of improvement in therapeutics; it is an old mixture
which has been tried and found wanting.--(_From the Journal A. M. A.,
June 26, 1909._)




                             SULPHO-LYTHIN

            Report of the Council on Pharmacy and Chemistry


Sulpho-Lythin is sold by the Laine Chemical Company, New York. In
the literature sent to physicians it is said: “This product, the
sulpho-phosphite of sodium and lithium (non-effervescent), is entirely
new and is unique in its action.”

Chemical analysis of a specimen of Sulpho-Lythin purchased in the open
market indicated its composition to be:

    Sodium sulphate, anhydrous                  10.51
    Disodium hydrogen phosphate, anhydrous      56.67
    Sodium thiosulphate, anhydrous              20.78
    Sodium chlorid                               5.98
    Lithium, as citrate                          3.12
    Sulphur, free                                0.16
    Moisture                                     1.53
    Loss                                         1.25

The examination, therefore, shows that Sulpho-Lythin is a mixture
consisting mainly of sodium sulphate and sodium phosphate and sodium
thiosulphate. The statement that it is a “sulpho-phosphite of sodium
and lithium,” therefore, is not correct, and a statement that “it
is entirely new and unique in its action” appears unwarranted and
misleading. It is, therefore, recommended that the preparation be
refused recognition. It is also recommended that an article be prepared
for publication calling attention to the exaggerated claims made for
Sulpho-Lythin.

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._)




                               TAUROCOL

            Report of the Council on Pharmacy and Chemistry


The Paul Plessner Company, Detroit, places on the market Taurocol
Tablets and Taurocol Compound Tablets. The company makes a pretense of
giving the formula--minus any quantities--thus:

    “Taurocol is a combination of bile salts, extracts of cascara
    sagrada, phenolphthalein and aromatics.”

The “formula” given for Taurocol Compound Tablets is:

    “Taurocol (Bile Salts)         Gramme .1296
    Pepsin 1-3000                     "   .0324
    Pancreatic Ext                    "   .0324
    Extract Nux Vomica (1/8 gr.)      "   .0081
    Aromatics                             Q. S.”

A comparison of these two “formulas” with those furnished for
Veracolate and Veracolate with Pancreatin and Pepsin shows that they
are nearly the same.

The claims made for the Taurocol preparations are essentially those
made for Veracolate preparations, as instance the following, which
appears on a physician’s sample of Taurocol:

    “For Hepatic Insufficiency, Intestinal Putrefaction, Habitual
    Constipation.”

Likewise the following, found on a Taurocol circular, duplicates claims
made for Veracolate:

    “... Directly stimulates the liver cells, producing an abundant
    flow of bile rich in cholates, solvent of cholesterin and a biliary
    antiseptic.”

Taurocol is objectionable for the reasons that apply to Veracolate,
and Taurocol Compound Tablets are subject to the objections that apply
to Veracolate with Pepsin and Pancreatin. (See p. 216.) The Council
therefore refused recognition to Taurocol and its preparations.--(_From
The Journal A. M. A., April 24, 1915._)




            TRI-IODIDES, THREE CHLORIDES AND MAIZO-LITHIUM

            Report of the Council on Pharmacy and Chemistry


As an illustration of unreliability of claims and the unscientific
character of proprietary mixtures, the Council has authorized
publication of the following reports on Tri-Iodides, Three Chlorides
and Maizo-Lithium, products of the Henry Pharmacal Co. (J. F. Ballard,
proprietor).

                                              W. A. Puckner, Secretary.


                          Tri-Iodides (Henry)

Tri-Iodides (Henry Pharmacal Co., St. Louis) is a nostrum whose
ingredients apparently were selected at random. Since the effects of
such a mixture cannot be predicted, no thoughtful physician would think
of prescribing in any one condition all the drugs named in the formula
of Tri-Iodides--if he had to write out the prescription. Yet because
the misleading name of the preparation gives it the semblance of a
therapeutic entity--and because it is advertised in medical journals--a
certain number of physicians thoughtlessly prescribe this shotgun
mixture.

                           LABORATORY REPORT

Regarding the composition of “Tri-Iodides” the Association’s Chemical
Laboratory makes the following report:

  A trade package of Henry’s Tri-Iodides purchased in 1910 bore the
  following formula on the label:

    “Colchicin, 1-20 grain,
    “Phytolaccin, 1-10 grain,
    “Solanin, 1-3 grain,
    “Sodium Salicylate, C. P., 10 grains,
    “Iodic Acid (equal to 7/32 gr. of Iodine) in two fluid drachms
      of Aromatic Cordial.”

  In the circular which was wrapped with the bottle the wording of the
  formula differs somewhat from the foregoing, “iodic acid” of the
  label being replaced by “hydro-iodic acid.” While the label on the
  bottle named “phytolaccin” as one of the constituents the label on
  the carton which contained the bottle gave “decandrin.” The following
  formula appears on a trade package purchased June, 1914:

    “Colchicine, 1-200 Grain,
    “Phytolacca, 1 1-5 Grain,
    “Mydriatic Alkaloids, 1-500 Grain.
    “Sodium Salicylate, 3 1-2 Grain.
    “Iodic Acid (equal to 7-125 Grain of Iodine) in two
      fluid drachms.”

  The differences between the formulas are striking. Colchicin has been
  reduced from 1/20 grain to 1/200 grain; sodium salicylate from 10
  grains to 3-1/2 grains; iodin (claimed to be present as iodic acid)
  from 7/32 grain to 7/125 grain. “Phytolaccin” (“Decandrin”) has been
  replaced by “Phytolacca” and “Solanin” by “Mydriatic Alkaloids.”
  While the formula for the preparation has been changed, the circular
  accompanying the package still refers to “solanin” (in some parts
  of the circular wrongly spelled “salonin”) and “phytolaccin.” As no
  principle having the characteristic effects of poke-root is known
  to have been isolated the terms “decandrin” and “phytolaccin” are
  meaningless.

  The circular states that solanin is an alkaloid obtained from
  the sprouts of _Solanum tuberosum_, but wrongly calls this plant
  “bittersweet” instead of potato. At the market price the amount of
  solanin claimed, according to the old formula, to be present in a
  bottle of Tri-Iodides, would cost $1.60, although a bottle of the
  preparation sold at wholesale for 67 cents.

  Tri-Iodides is a dark brown, mobile liquid having a faint clove-like
  odor and a mawkish, sweet taste. Salicylate was found in considerable
  amounts. Traces of alkaloids were found, a portion of which appeared
  to be colchicin. Iodic acid and its salts were absent, although
  claimed by the formula to be present. Potassium iodid was present.
  Determinations of the iodin by distillation with ferric ammonium
  sulphate solution and sulphuric acid indicated the presence of about
  1.68 gm. of iodin (equivalent to 2.18 gm. of potassium iodid) in each
  100 c.c. of the preparation. This is equivalent to about 7.65 grains
  of iodin per fluidounce, or more than thirty-four times the amount
  claimed by the formula on the bottle. An approximate determination of
  the salicylic acid by extraction of the acidified preparation with
  ether and evaporation of the solvent indicated about 2.67 gm. in 100
  c.c., equivalent to 3.09 gm. of sodium salicylate, or about 14.11
  grains per fluidounce. Since the amount of sodium salicylate claimed
  is 3.5 grains in 2 fluidrams or 14 grains in each fluidounce, the
  amount found agrees essentially with the claims.

                             ABSURD CLAIMS

It should be unnecessary, after pointing out the conflict between the
name and the published formula, between the formula and the actual
composition, and between the composition and all established therapy,
to discuss this heterogeneous and unscientific mixture further. A few
specimen absurdities, however, may be quoted from the advertising
“literature”:

    “... Free of the Disagreeable Effects of the Alkaline Iodides.”

[Tri-Iodides, according to the laboratory report, depends for its iodin
action on potassium iodid.]

    “... we have an assimilable form of vegetable hydriodates.

    “The hydriodates of these valuable vegetable alkaloids afford the
    specific alterative action of iodine without such disagreeable
    results as the iodism produced by the ordinary iodides.”

[“The hydriodates” is an obsolete term formerly applied to iodids of
vegetable alkaloids. Iodids of vegetable alkaloids, if present at all
in Tri-Iodides, are present in negligible amounts.]

    “Containing Iodine in an available form, it is obvious that the
    formula must be beneficial in the majority of syphilitic skin
    lesions.”

The falsity of the first two of these claims and the mischievousness of
the last are self-evident.

It would be possible, but is unnecessary, to produce an almost
unlimited amount of evidence to show the transparent character of the
deception by which this preparation is exploited.

The referee feels that the nostrum will have been sufficiently
characterized when he has mentioned further that the name “Henry’s
Tri-Iodides” is blown in the glass of the bottle, that the label
contains the recommendation “For Gout, Rheumatism and other Diathetic
Diseases,” and that the circular accompanying the bottle recommends
the use not only of Tri-Iodides, but also of Three Chlorides,
Maizo-Lithium, Campho-Phenique and Satyria in the treatment of many
diseases.


                        Three Chlorides (Henry)

Three Chlorides (Henry) is advertised as:

    “An oxygen-carrying ferruginous preparation, suitable for prolonged
    treatment of children, adults and the aged. Indicated in anemia and
    convalescence from acute diseases and surgical operations.”

The following report on the composition of Three Chlorides is submitted
by the Association’s Chemical Laboratory:

                           LABORATORY REPORT

  It is claimed that each fluidram of Henry’s Three Chlorides contains:

    “Mercuric Bichlorid      1-72 Gr.
    “Arsenic Chloride        1-40 Gr.
    “Proto-Chloride Iron     2-25 Gr.
    “ ... in a cordial of Calisaya Alkaloids.”

  The preparation is a pale yellow, clear solution having an odor
  of alcohol. The addition of potassium ferricyanid solution does
  not produce any blue coloration, thus demonstrating the absence of
  ferrous chlorid (iron protochlorid). Instead potassium ferrocyanid
  solution produces at once an intense blue precipitate and potassium
  sulphocyanate solution an intense red coloration, thus proving
  the presence of iron in the ferric condition. It is obvious that
  the claimed superiority of Three Chlorides over preparations
  containing ferric iron is absurd. Since it contains iron in the
  ferric condition, Three Chlorides decomposes soluble iodids with
  the liberation of free iodin. The assertion that it is a suitable
  “vehicle” for the administration of iodids is likely to lead the
  physician unwittingly to administer free iodin.

As the laboratory report shows, the “formula” of Three Chlorides
(Henry) is incorrect, for protochlorid of iron (ferrous chlorid)
was absent from the preparation. There is, however, a more serious
objection to the formula than the misstatement of fact. When the
physician is dealing with conditions that call for mercury, arsenic
or iron, it is irrational and unscientific to prescribe a preparation
containing these three drugs in fixed proportions.

                       OBJECTIONABLE ADVERTISING

Three Chlorides is marketed in bottles having the name “Three
Chlorides” blown in the glass, in a carton containing a circular
extolling the curative powers of this and other proprietaries of the
same concern. Thus a physician who prescribes Three Chlorides is likely
to place in the hands of his patient the advice that

    “Three Chlorides ... is suitable for the prolonged treatment of
    children ...”

    “In tertiary syphilis, with or without potassium iodide, it holds
    first rank among remedies directed against the specific taint ...”

Further, that “Maizo-Lithium” is:

    “A Genito-Urinary Sedative” and a “remarkable uric-acid solvent.”

Also that “Satyria” is:

    “An Ideal Genito Tonic and Nerve Reconstituent.”

    “Indicated in Prostatic trouble, Cystitis, Urethritis, Gonorrhea,
    Gleet, Leucorrhea, Sexual Debility and Impotence.”

We are told that

    “As a hematinic, the protochloride of iron justifies the confidence
    of the medical profession.”

    “The protochloride, more than any other salt of iron, stimulates
    the paptic [_sic_] and hydrochloric glandular system of the
    stomach, increasing the flow of acid gastric juice.”

It is unnecessary to discuss the truth or falsity of these assertions,
since Three Chlorides does not contain the protochlorid of iron. For
the same reason, it is obvious that the small amount of iron which it
contains is the only possible justification for the claim that the
preparation is

    “... Non-Productive of ... Constipation or Teeth Discoloration.”

It is hardly necessary to point out that it is a therapeutic
exaggeration to claim that Three Chlorides is of particular value in
the treatment of tertiary syphilis, that in eczema it is “the most
effective remedy,” that in any form of constipation it is “the remedy
par excellence,” or that

    “After arresting malarial attacks with quinine, the combination of
    iron, arsenic and mercury with calisaya is an essential requisite.”

    “Whenever gastric troubles and digestive disturbances furnish a
    contra-indication to iron, this contra-indication disappears when
    the iron is combined with arsenic.”

    “The simultaneous exhibition of small doses of arsenic and
    bichloride of mercury, besides augmenting the effect of iron upon
    the red blood-cells, completely obviates the tendency to vascular
    congestion and hemorrhage.”

Finally, the suggestion that by the use of Three Chlorides iodids may
be prevented from causing iodism is absurd.

In short, whatever may be the advisability of prescribing iron, arsenic
or mercury in any given case, it is irrational to prescribe them in
fixed proportions. A physician who is induced by the exaggerated
advertising claims to prescribe these drugs in a proprietary mixture,
under a non-informative name, does grave injustice to his patients.


                             Maizo-Lithium

Maizo-Lithium (Henry Pharmacal Co., St. Louis) is one of the many
proprietary lithium preparations based on the disproved theory that
lithium dissolves uric acid deposits in the body. The label on a trade
package states that:

    “Maizo-Lithium promptly facilitates the elimination of the uric and
    phosphatic deposits from the system.”

As might be expected, the promoter of Maizo-Lithium ascribes a long
list of ills to “uric and phosphatic deposits,” and argues that,
therefore, Maizo-Lithium is the proper treatment:

    “In lithemia, hematuria, incipient diabetes, cystitis, urethritis,
    pyelitis and ALL inflamed conditions requiring a non-irritating
    diuretic.”

“Inflamed conditions,” naturally, include almost all of the real or
imaginary ills of kidney, bladder, etc.

Maizo-Lithium is distinguished from its congeners chiefly by the claim
that it contains a mythical or problematical compound, maizenate of
lithium.

                           LABORATORY REPORT

The following report on the composition of Maizo-Lithium has been
submitted by the Chemical Laboratory of the American Medical
Association:

  The promoter of Maizo-Lithium makes the following statement on the
  label concerning the composition of the preparation:

    “Each fluid drachm contains two grains maizenate of lithium.”

The following is also found in a circular which is enclosed with the
trade package of Maizo-Lithium:

    “Maizo-Lithium, the remarkable uric acid solvent, is a nascent
    chemic union of maizenic acid, obtained from green corn silk, with
    the alkaline base lithium forming maizenate lithium, of which the
    mother liquid carries two grains to each drachm.”

Standard works on organic chemistry and pharmacology, such as
Beilstein’s Organische Chemie and Cushny’s Pharmacology and
Therapeutics, do not mention maizenic acid. Neither is it mentioned in
comprehensive bibliographies of phyto-chemical investigations, such as
Huseman-Hilger’s Die Pflanzenstoffe or Wehmer’s Die Pflanzenstoffe.
The first to use the term appears to have been a Dr. Vautier (_Arch.
méd. belg._), but his publication is not available to the laboratory.
Rademacher and Fischer (_Amer. Jour. Pharm._, 1886, lviii, 369) claim
to have isolated the substance from green corn-silk, but the record of
their work is unsatisfactory and indefinite and therefore their results
could not be verified; it seems unlikely, however, that they isolated a
pure proximate principle.

Examination of Maizo-Lithium demonstrated the absence of bromids,
chlorids, phosphates, sulphates, acetates, benzoates, salicylates
and tartrates--combinations in which lithium might be expected to
be present. The presence of a citrate, however, was shown by the
usual tests. Lithium and sodium were present. Free acid was absent.
Determination of lithium citrate and of sodium citrate indicated
the presence of a total of about 3.7 gm. of these two salts in each
100 c.c. of the preparation, or about 2.1 grains in each fluidram.
About 25 per cent. of the total salts appeared to be lithium citrate.
The examination, therefore, does not demonstrate the presence of
“maizenate of lithium,” but does show that Maizo-Lithium contains a
mixture of lithium citrate and sodium citrate. Tests for citric acid
and citrates were made on a commercial specimen of fluidextract of
corn-silk. The results were negative, although the preparation had
an acid reaction to litmus. The presence of maizenate of lithium
in Maizo-Lithium--in fact, its actual existence--thus failed of
demonstration. In view of this fact, it was felt that the burden
of proof rested on the promoter of Maizo-Lithium to supply some
satisfactory evidence with regard to this substance. The following
letter was therefore, sent to James F. Ballard:

    “According to the label on a recently purchased bottle of
    Maizo-Lithium, each fluidram of this preparation contains 2
    grains of ‘maizenate of lithium.’ From an examination made in
    this laboratory we are inclined to conclude that this statement
    is not in accordance with the facts. A search of chemical and
    pharmaceutical publications does not reveal that such a compound
    as ‘maizenate of lithium’ has ever been isolated and described,
    and we are very much inclined to question its existence. We should
    be pleased to receive from you any evidence which you may care to
    send in substantiation of your claim in regard to the content of
    ‘maizenate of lithium’ in Maizo-Lithium--particularly a specimen of
    ‘maizenate of lithium’ or the method by which it is produced.”

While this letter was sent Oct. 13, 1914, no evidence has been
submitted up to date (January, 1915) to substantiate the asserted
presence of maizenate of lithium in Maizo-Lithium.

The report just given shows that the manufacturer has found it
expedient to surround his worthless nostrum with a cloak of mystery.
A discussion of the jumble of uncritical claims, baseless assertions
and evident falsehoods presented in favor of Maizo-Lithium would seem
a waste of time when the secrecy of this nostrum is all-sufficient for
its condemnation.

[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._)

[89] The Journal A. M. A., April 20, 1907, reprinted in “Propaganda for
Reform,” 8th Edition.




                               THIALION

            Report of the Council on Pharmacy and Chemistry


The following report was submitted to the Council by a subcommittee
which examined Thialion (Vass Chemical Company):

  _To the Council on Pharmacy and Chemistry_:--We beg leave to report
  on Thialion as follows:

  Thialion is sold by the Vass Chemical Co., Danbury, Conn. In
  the literature supplied to physicians and in the advertisements
  in medical journals, Thialion is stated to be “a laxative salt
  of lithia” with the chemical formula “3Li_{2}O.NaO.SO_{3}.7HO.”
  “Sodio-trilithic anhydrosulphate” is given as a synonym. An elaborate
  graphic or structural formula is also given.

  According to analyses, this preparation is a mixture consisting
  chiefly of sodium sulphate and sodium citrate with very small
  amounts of lithium, the average of several estimations indicating the
  following composition:

    Sodium citrate                      58.6
    Sodium sulphate, anhydrous          26.6
    Sodium chlorid                       3.3
    Lithium citrate, anhydrous           1.8
    Water                                9.7

  Thus, the advertising literature is a deliberate misrepresentation
  of the facts. It is, therefore, recommended that the preparation be
  refused recognition, 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.

In publishing the above report, the Council is presenting to the
medical profession another object lesson, and one that illustrates how
easily our profession is being humbugged. There are several things
that we may learn from the report on this nostrum, but at this time
we will take up only one phase of the lesson. Many of the scientific
chemical compounds and derivatives given us by the German chemists have
been distinct advancements and have proved to be valuable additions
to our therapeutic agents; further, they were received with so much
favor by physicians that they have been profitable for those who made
them. It is not strange, therefore, that imitators should appear. One
of the first was our old friend, Antikamnia (which was introduced as a
“new synthetical” compound). This was followed by Ammonol, Phenalgin,
Salacetin, and a host of others having acetanilid as their principal
ingredient.

[Illustration:

This picturesque “graphic formula” for Thialion appears with many of
the advertisements. To most of us it looks formidable, wonderfully and
deeply scientific and non-understandable; to a chemist it looks absurd.]

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.

There is another factor worth noticing connected with this subject:
When to the claim that the mixture is a “chemical compound” is added a
complex chemical formula, it prevents the impertinent question, “What
is it?” For isn’t the “formula” there, and is not the information given
without the asking? Most of us have been so overcome by the display of
the chemical knowledge of the nostrum maker that we have been afraid
to expose our ignorance by asking for information or explanation. And
thus the promoter avoids perplexing questions, which, if answered
truthfully, would spell bankruptcy.

To a chemist the formula of Thialion furnished by the Vass Chemical
Company signifies nothing. To a physician who possesses but little
knowledge of chemistry, it will seem impressive, and he may absorb the
idea that it stands for a preparation that is the result of exhaustive
scientific research. To the chemist, this formula will appear as a
jumble of symbols and numbers that mean nothing.

It is not worth while to call attention to the simplicity of this
simple mixture of ordinary salts, for it is too self-evident. As to the
remarkable therapeutic qualities of Thialion, the reader is referred to
that ably edited “scientific” periodical, the _Uric Acid Monthly_, and
to the mass of “literature” relating to this wonderful remedy.

While there is a ridiculous side to this business, there is also a
serious one. Those who have been making money out of us undoubtedly
laugh in their sleeves at our gullibility, but to us as members
of a presumably learned and intelligent profession, it is not
a laughing matter. The whole nostrum business is a shame and a
disgrace.--(_Modified from The Journal A. M. A., Nov. 3, 1906._)




                 UNGUENTUM SELENIO VANADIC (V. ROEMER)

            Report of the Council on Pharmacy and Chemistry


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.

When the preceding report was sent to Schering and Glatz, the firm
expressed surprise that evidence of the absorption of selenium and
vanadium should be requested. On June 8 the firm wrote that within
a few days one or more tests would be sent by which the presence of
selenium and vanadium in the urine could be demonstrated. These tests
were not received. So far (November, 1914) no evidence of the value
of the preparation either in carcinoma or in any of the very long
list of other diseases in which it is recommended has been submitted,
and, the pharmacologic evidence that such a preparation would be of
value in such conditions being practically nil, the Council authorized
publication of this report.--(_From The Journal A. M. A., Nov. 21,
1914._)




                UNICORN ROOT, WILD YAM AND WILD INDIGO

            Report of the Council on Pharmacy and Chemistry


The Council has voted that recognition be refused to the following:
Unicorn Root (_Aletris farinosa_), Wild Yam (_Dioscorea villosa_), and
Wild Indigo (_Baptisia tinctoria_) and has authorized the publication
of the following statements.

                                              W. A. Puckner, Secretary.


                    Unicorn Root--Aletris Farinosa

Unicorn Root (_Aletris farinosa_) contains a bitter principle and
starch. Remarkable powers as a uterine tonic have been ascribed
to it but have not been realized by reliable observers, the drug
being practically valueless in these conditions. It enters into the
composition of a number of nostrums. As a bitter it is superfluous and
it should not be included among non-official drugs.


                      Wild Yam--Dioscorea Villosa

Wild Yam (_Dioscorea villosa_) has been little used in medicine.
It contains a saponin and an acrid resin, and is said to possess
expectorant, diaphoretic and--in large doses--emetic properties. It
has been recommended as a remedy in biliary colic and in muscular
rheumatism. Its value in such conditions has not been verified to an
extent entitling it to consideration as a useful remedy.


                    Wild Indigo--Baptisia Tinctoria

Wild Indigo (_Baptisia tinctoria_) has been in use--chiefly by the
eclectics--for about three-quarters of a century, but there is no
satisfactory evidence that it has any therapeutic value. The following
text-books on pharmacology do not even mention wild indigo: Cushny,
Brunton, Dixon, Binz, Sollmann. It is not official in the United States
or other leading pharmacopeias.

A preparation of wild indigo is advertised with extravagant claims
for its therapeutic action, but these claims are not supported by any
substantial evidence. Other virtues ascribed to wild indigo are its
properties as a cardiac and hepatic stimulant and its value in sepsis,
particularly in typhoid fever. It actually has emetic and cathartic
properties, but even these are inferior to those possessed by many
other drugs.

It is very evident that a drug possessing the extraordinary merits that
have been claimed for wild indigo would not have remained unnoticed by
the leading authorities on pharmacology and therapeutics, especially
after its prolonged use in medicine. Owing, therefore, to the lack of
substantial evidence of its usefulness, baptisia is not considered
as of sufficient importance to warrant its inclusion in the list of
non-official drugs. It is probably entirely superfluous.--(_From The
Journal A. M. A., Jan. 22, 1910._)




                   PROPRIETARY VANADIUM PREPARATIONS

    Report of the Council on Pharmacy and Chemistry on Products of
            Vanadium Chemical Co.: Vanadiol, Vanadioseptol,
                  Phospho-Vanadiol, Vanadoforme, etc.


Vanadiol and preparations thereof, the products of the Vanadium
Chemical Company, were submitted to the Council. After thorough
investigation it was concluded that the company has not, and never has
had, any reliable evidence for the therapeutic claims it has presented
to the medical profession regarding these products. Accordingly the
Council voted that the several products under consideration be not
accepted for inclusion with New and Nonofficial Remedies. The findings
of the Council having been submitted to the Vanadium Chemical Company
and its reply considered, the Council authorized publication of the
report which appears below.

                                              W. A. Puckner, Secretary.

The Vanadium Chemical Company, Pittsburgh, Pa., submitted to
the Council on Pharmacy and Chemistry for inclusion in New and
Nonofficial Remedies the following products: Vanadiol, Vanadioseptol,
Phospho-Vanadiol, Vanadium Solution for Intravenous and Hypodermic Use
and Vanadoforme. At the same time, the company submitted statements
and “literature” regarding the composition and therapeutic value
of these products. The committee to which the matter was referred,
after carefully considering both the matter presented and certain
modifications in the advertising matter to which the company consented,
reported that the evidence, especially that relating to the therapeutic
value of the preparations, was insufficient to warrant the acceptance
of the articles. Since the validity of therapeutic claims can be
determined to a certain extent by experimental investigation, the
Council decided to postpone final action until sufficient dependable
evidence as to the therapeutic value had been submitted.

Accordingly, a series of questions was sent to the Vanadium Chemical
Company for the purpose of learning on what pharmacologic evidence
the therapeutic claims were based. After waiting several months, the
information requested not being furnished, the Council took final
action on the products. This action was based both on the evidence
originally submitted and on the advertising matter being sent out by
the company at the time.

Briefly, Vanadiol is said to contain a compound of vanadium with
oxygen and chlorin, which gives up its oxygen to readily oxidizable
substances, such as the blood. In addition to this compound it contains
an oxidizing agent (sodium chlorate) which is said to serve as a source
of oxygen, so that, according to the theory of the promoters, Vanadiol
acts in the animal system as an oxygen-carrier.

The following is quoted from an advertising circular:

  “Most thorough and conclusive physiological tests were made on
  guinea-pigs and other animals, which established undoubted evidence
  as to the truth of this theory.

  “INFLUENCE

  “Under the influence of Vanadiol and the other derivatives, the
  appetite is increased, there is greater ability to peptonize ingested
  proteid material, and, through the improvement in the assimilative
  powers and the checking of abnormal fermentations, leads to an
  increase in weight. A greater excretion of urea follows their use.
  Phagocytic action is promoted by an increase in the leucocytes. All
  phases of the elimination of waste materials are favored by the
  positive increase in the number of red blood corpuscles and the
  percentage of hemoglobin, hematogenesis being thereby rendered more
  perfect. The beneficent effect of nascent (active) oxygen, upon the
  red corpuscles and upon tissue cells of low vitality are matters of
  common knowledge. The results obtained from the vanadium derivatives
  are not drug effects, but are due to improved metabolism, which in
  turn is due to the removal of microbian toxins, and the general
  stimulation of cell activity.

  “In a tubercular organism, the action of Vanadiol is two-fold.
  First, it acts as an antiseptic and antitoxin, combating the Koch
  bacilli and neutralizing their poison. Second, as a reconstituent of
  the economy, to which it furnishes nascent oxygen, fortifying the
  defenseless cells by the very element that is necessary to make them
  healthy and resistant.”

  “In Anemia and Chlorosis, the blood cells lack oxygen, and in
  Neurasthenia the nerve cells are deficient. Vanadiol brings both
  blood and nerve cells from a condition of weakness and decay into
  vital energy, by furnishing them with active oxygen in a manner that
  had not been possible by any other medicine.”

  “Vanadiol accelerates the work of digestion by producing HCl in
  small doses; it does not hinder the peptonization of albuminoids as
  do beta-naphthol, salicylic acid, boric acid, etc., when used as a
  stomachal antiseptic, but on the contrary it favors, by hydrochloric
  acid, the transformation of albuminoids into peptone without the
  assistance of pepsin. Thus, Vanadiol, when given to consumptives,
  favors the digestion of large amounts of proteid materials and
  causes oxidation of toxins of the stomach. The stomachic action is
  reflected in other parts of the organism by the stimulation of the
  chief functions; the pulse becomes stronger and muscular strength
  increases; and, last, but of greatest importance, is the tremendous
  increase which will be noted in the hemoglobin and the red cell
  count.”

  “Phospho-Vanadiol, a combination of Vanadiol with an easily
  assimilable organic phosphorus, is an active accelerator of general
  nutrition with a special action on the nervous system.”

Such remarkable statements as these are past credence, certainly,
unless they are supported by scientific evidence. And evidence, either
in support or in contradiction of the claims made, could be obtained;
for many of these actions, at least, are capable of proof by animal
experimentation. The Vanadium Chemical Company was asked to furnish
such proof but failed to do so. The inference is plain! The committee
has concluded that the company has not, and never has had, any reliable
evidence on which to base the therapeutic claims it has presented to
the medical profession.

Here another fact should be noted. It is the connection shown in The
Journal, June 22, 1912, of the general manager of the Vanadium Chemical
Company, F. M. Turner, with a fraudulent obesity cure concern, the Dr.
Turner Company of Syracuse, N. Y.

It seems, moreover, by all the evidence available, that F. M. Turner
is not authorized to use the title M.D.; yet, under this title his
name appeared on cards representing the Vanadium Chemical Company and
under this title, also, he published an article in a medical journal
recommending to the medical profession the use of Vanadiol. Later this
article was distributed as an advertising circular by the Vanadium
Chemical Company. Turner’s connection with the Dr. Turner Company is
known and acknowledged by the Vanadium Chemical Company, yet it still
retains him as general manager!

While there is not necessarily any direct relation between the
personnel of a proprietary manufacturing company and the value of that
company’s product, it is natural that the medical profession should
view with distrust any concern managed by one who has previously been
connected with such a fraud as the Turner obesity cure.

The committee therefore recommends that the preparations of the
Vanadium Chemical Company be refused recognition, and that this report
be authorized for publication.--(_From The Journal A. M. A., Jan. 18,
1913._)




                               VENARSEN

            Report of the Council on Pharmacy and Chemistry


The report which appears below was sent to the Intravenous Products
Company for consideration. Having considered the firm’s reply, the
Council has authorized publication of its report along with the
explanation sent by the Intravenous Products Company in reference to
the variable composition reported for Venarsen, namely, that “only the
first few experimental ampules, sent to the doctors for clinical tests,
were made without the Mercuric Iodide.”

                                              W. A. Puckner, Secretary.

This product is prepared by the Intravenous Products Company, Denver.
The advertising circulars contain inconsistent statements as to its
composition. According to one circular Venarsen is

    “... a comparatively non-toxic organic arsenic compound, 0.6 Gm.
    representing 247 Mg. (3-3/4 grains) of metallic arsenic in chemical
    combination....”

According to another circular Venarsen is

    “... a comparatively non-toxic organic arsenic compound, 0.6 Gm.,
    representing 247 Mg. (3-3/4 grains) of metallic arsenic and .78 Mg.
    (3/250 grain) metallic mercury in chemical combination.”

Neither one of these statements gives any information as to the actual
composition of the product. Inquiry addressed to the manufacturers
elicited the reply that:

    “Venarsen contains in each 5 c.c. 0.6 Gm. Sodium Dimethyl Arsenate,
    .0016 grams of Mercuric Iodide, .0048 grams of Sodium Iodide in
    solution in a suitable vehicle for intravenous administration.”

The following report of the examination of Venarsen is submitted by the
Association’s Chemical Laboratory:

                           LABORATORY REPORT

  Three ampules of Venarsen were examined. The first ampule was labeled

    “A comparatively non-toxic organic arsenic compound, representing
    247 Mg. (3-3/4 grs.) of metallic arsenic in chemical combination. 5
    c.c.--0.6 Gm.”

Practically the same statement appeared in an advertising circular
wrapped around the ampule. The second and third ampules bore labels
identical with the first. The circulars differed from that accompanying
the first ampule in that the presence of mercury is also announced,
thus:

    “Venarsen is a comparatively non-toxic organic arsenic compound,
    0.6 Gm., representing 247 Mg. (3-3/4 grains) of metallic arsenic
    and .78 Mg. (3/250 grain) metallic mercury in chemical combination
    and is so prepared and enhanced as to present the ingredients to
    the blood in their most acceptable form.”

Thus, although the potent elements said to be contained in Venarsen are
named, its chemical character (the combination in which the elements
occur) is not disclosed.

The ampules contained a transparent, odorless solution, possessing
the yellow color of salvarsan solution (an aqueous solution of sodium
cacodylate, mercuric iodid and sodium iodid in the amounts said to
be present in Venarsen is colorless). Qualitative tests demonstrated
the presence in each of the three ampules of sodium cacodylate
(sodium dimethyl arsenate), and the absence of arsenites, arsenates,
phosphates, arsanilates (atoxyl, soamin) and arsenphenolamins
(salvarsan, neosalvarsan). Titrated with normal hydrochloric acid,
using methyl orange as indicator (as outlined in New and Nonofficial
Remedies, 1915, p. 40), the three ampules were found to contain the
equivalent of respectively, 0.219, 0.253 and 0.216 Gm., or an average
of 0.244 Gm. arsenic. (According to statements of the firm each
5 c.c. of Venarsen contains 0.6 Gm. sodium dimethyl arsenate [sodium
cacodylate], equivalent to 0.247 Gm. arsenic or 41.66 per cent. Sodium
dimethyl arsenate, as described in New and Nonofficial Remedies,
contains 3 molecules of water and 35 per cent. arsenic. This indicates
that the sodium dimethyl arsenate used in Venarsen contains less water
of crystallization than the N. N. R. product).

Neither mercury nor iodid could be found in the first ampule. (The
company has since explained that mercury was absent only from the first
experimental samples.) The second and third ampules contained iodid and
mercury in small amount. The exact quantity was not determined because,
on the basis of the mercury content declared, a single accurate mercury
estimation would have required the purchase of something like 25 to 100
ampules. As each ampule sells for two dollars, the cost of the material
was considered prohibitive.

From the foregoing we conclude that the first ampule examined consisted
essentially of a solution containing 0.625 Gm. of sodium cacodylate,
N. N. R., while the second and third ampules contained 0.722 Gm. and
0.617 Gm. sodium cacodylate, respectively, and in addition, a mercury
compound, probably mercuric iodid, dissolved by sodium iodid.

In other terms, Venarsen as now marketed is a simple solution
containing approximately 9 grains of sodium cacodylate, 1/40 grain of
mercury “biniodide” and 3/4 grain of sodium iodid to each full dose.

In the past the preparation has been in conflict--especially serious
because of the potent character of the drug--with Rule 1 (secrecy
of composition). The manufacturers have removed this conflict by
furnishing a statement of composition; and it is to be expected that
they will likewise take steps to remove the manifestly erroneous
impression now likely to be gathered from the circulars, namely, that
the preparation is rather analogous to salvarsan. These conflicts,
however, call for comment, since physicians have doubtless used the
material under misapprehensions.

As to therapeutic claims, the preparation is said to be effective and
safe in syphilis; “lower toxicity and greater spirochaetacidal power
than other known arsenic compounds” are among the claims. No real
evidence for either of these claims is presented. Sodium cacodylate
has been tried as an antisyphilitic, but with indifferent success;
certainly the results have not been comparable to those of salvarsan.
The mercury could conceivably enhance its effect, but the dosage
appears too small and the course too short for this influence to be
pronounced. Moreover, a careful physician would not give arsenic and
mercury in fixed proportions.

The claim of comparative non-toxicity is probable enough from what is
known about the cacodylate. No physician should feel “safe,” however,
when injecting intravenously 0.6 gm. of sodium cacodylate every four
to six days. Aside from the grave dangers of intravenous injection in
general, the possibility of idiosyncrasies to arsenicals should always
be borne in mind.

Finally, Venarsen is claimed to be “indicated” in pellagra,
tuberculosis, anemia, etc. No evidence is presented on which to base
an opinion as to its efficiency in pellagra. Those who have studied
that disease would not be likely to resort to this treatment. In
tuberculosis and anemia, there is no sufficient advantage in giving the
cacodylate intravenously.

To summarize, Venarsen treatment consists essentially in the
intravenous injection of large doses of sodium cacodylate. The
other ingredients, as well as the name, merely constitute so much
mystification. While the cacodylate probably has some effect on the
conditions for which it is advised, there is no evidence that its value
even approaches that of salvarsan in syphilis, or that the intravenous
use is preferable to the ordinary methods. The dangers are manifest,
although they may not be so great as with salvarsan. No justification
has been established for its use in tuberculosis and pellagra.

Physicians who wish to try intravenous cacodylate administration should
have a full realization of the dangers of such treatment, and in order
to avoid further risks, will do well to refrain from combining other
drugs with the cacodylate in fixed proportions.

It is recommended that Venarsen be held in conflict with Rule 6
(unwarranted therapeutic claims), Rule 7 (poisonous ingredients
not stated on label), Rule 8 (name does not express the chemical
composition) and Rule 10 (unscientific combination) and that this
report be published.--(_From The Journal A. M. A., May 22, 1915._)




                               VENODINE

            Report of the Council on Pharmacy and Chemistry


Venodine (The Intravenous Products Co., Denver), according to
information sent to the Council, is “an Intravenous Iodine Compound”
put up in ampules each of which contains “28 grains of Sodium Iodide,
1/8 grain each of Beechwood Creosote and Guaiacol in a suitable
vehicle, and excipients to enhance its compatibility with the
circulating blood.”

The “Therapeutic Indications” include “infectious diseases, such as
syphilis, tuberculosis, bronchitis, bacteraemias associated with
chronic and acute nephritis (Bright’s disease), and other infections.”
The Council held as unwarranted and grossly exaggerated the following
therapeutic claims: (1) that the full therapeutic value of iodin
medication cannot be readily obtained except by intravenous injection;
(2) that Venodine is “of exceptional value in tuberculosis”; (3) that
in pneumonia Venodine “combines the anaesthetic properties of creosote
and guaiacol with the germicidal value of iodine”; (4) that “Venodine
(or its iodine component) has long enjoyed an exceptional reputation”
as of great value in many infectious diseases including bacteremias.
The facts on these points are the following:

1. Since iodids are easily absorbed from the mucous membrane of the
gastro-intestinal tract and are usually well tolerated by the stomach,
there is no reason for resorting to intravenous injection in their
administration.

2. The indiscriminate administration of iodids for pulmonary
tuberculosis is strongly to be condemned. The cases in which they
can be given to tuberculous patients without doing harm must be very
carefully selected.

3. There is no evidence either that creosote is excreted by the lungs
in sufficient quantity to exert an anesthetic influence or that
iodin is present in the circulation of the lungs or in the bronchial
secretions in a form which is capable of exerting any germicidal action
whatever.

4. It is generally held that the systemic administration of iodin
compounds in bacteremias is useless.

The Council also held the name “Venodine” objectionable in that it
fails to indicate the chief ingredient (sodium iodid) of this simple
pharmaceutical mixture. The statement in a circular that “Venodine
is a sterile solution representing 1.54 Gm. (24 grains) of iodine in
chemical combination together with creosote and guaiacol” is likely
to lead physicians to use the preparation without considering that
its chief constituent is the well-known substance sodium iodid,
particularly so since no reference to sodium iodid is made in the
circular.

Furthermore, the Council held that the combination of two such similar
substances as creosote and guaiacol (the second a constituent of
the first) as given in the published formula, stamps Venodine as
unscientific; it adds mystery to the preparation, but does not increase
its efficiency, and is therefore against the best interests of the
public.

The Council voted that Venodine be held ineligible for conflict with
Rules 6, 8 and 10.

This report having been submitted to the manufacturers, in
accordance with the Council’s custom, and the reply affording no
reason for modifying the findings, its publication has now been
authorized.--(_From The Journal A. M. A., June 26, 1915._)




                            VERACOLATE[AM]

            Report of the Council on Pharmacy and Chemistry

[AM] For report on a similar compound, see Taurocol, p. 198.


“Veracolate (plain),” “Veracolate with Pancreatin and Pepsin” and
“Veracolate with Iron, Quinine and Strychnine” are proprietary tablets
marketed by the Marcy Company, Boston.

“_Veracolate_ (_plain_).”--For this the following non-quantitative
formula is given:

    “A compound containing the bile acids, sodium glycocholate, sodium
    taurocholate with cascara sagrada and phenolphthalein.”

The dose is three tablets. Examination in the Chemical Laboratory of
the American Medical Association of a specimen of “Veracolate (plain)”
indicated that there was about 20 mg. (1/3 grain) of phenolphthalein to
each tablet. One dose, therefore (three tablets), would contain 1 grain
of phenolphthalein--an average dose.

“_Veracolate with Pepsin and Pancreatin._”--The following “formula” is
given for this mixture:

    “Veracolate                    1-1/4 grain
    “Pure Pancreatin               1     grain
    “Pepsin aseptic (1:3,000)        1/2 grain
    “Oil peppermint                 1/10 min.”

(Note the presence of two mutually incompatible digestive ferments.)

“_Veracolate with Iron, Quinine and Strychnine._”--This is stated to
have the following “formula”:

    “Veracolate                    1-1/8 grain
    “Reduced Iron                  1     grain
    “Quinine Sulphate                3/8 grain
    “Strychnine Sulphate           1/100 grain”

It will be noticed that these mixtures increase in complexity until a
combination of seven diverse ingredients, a veritable shotgun mixture,
is evolved. In none of the “formulas” are the proportions of the
purgative drugs in Veracolate stated. In the second “formula,” the
digestants might as well be omitted, for the pancreatin is destroyed
by peptic digestion and hence cannot pass the stomach while the
pepsin is useless without hydrochloric acid, and, at any rate, of no
value in the intestine. If one is indicated, the other is not. Yet
this unscientific and complex combination of purgatives, mutually
incompatible digestive ferments, and oil of peppermint is called:

    “A scientific Blending of Digestive Ferments, Cholagogues and
    Carminatives.”

    “... for all forms of indigestion and dyspepsia.”

And the third, an equally irrational and complex combination, is termed
“The Ideal Cholagogic Tonic”!

_Extravagant and Misleading Claims._--True to type, the claims are
magnified in accordance with the number of ingredients. For instance,
of “Veracolate (plain),” we are told:

    “Veracolate is a true cholagogue and biliary disinfectant as it
    _directly_ stimulates the liver cells producing an increased flow
    of limpid bile. Although not a purgative, it moves the bowels and
    is definite and dependable in its action.”

    “The action of Veracolate is to bring about a profuse flow of
    healthy bile which prevents bile stasis. As the flow of bile is
    stimulated so antiseptic action ensues, calculi softened and the
    concretion and mucous eliminated. Mucosal swelling is diminished
    and the infection which is usually present is antagonized. Relief
    is in plain evidence. As a result of the treatment the skin,
    eyes and urine become normal in appearance in a short time, the
    appetite and digestion improve and soreness in the region of the
    gall-bladder is entirely relieved.”

Similarly, it is said of “Veracolate with Pancreatin and Pepsin” that:

    “It causes a natural flow of bile which checks fermentation,
    prevents the absorption of toxines and causes the food elements
    to be emulsified and thus rendered easy of assimilation. All this
    conduces to a natural movement of the bowels. Digestion is at once
    improved and the epigastric pain, nervous symptoms and headache
    disappear.”

“Veracolate with Iron, Quinine and Strychnine” is said to be indicated
in:

    “Hepatic Torpor accompanied by Anemia, Chlorosis, Debility,
    Neurasthenia and Neuroses.”

And the physician is asked to believe that it will:

    “... give gratifying results in all _nervous, anemic_, and ‘run
    down’ conditions in which the liver function is usually subnormal.”

The objections to “Veracolate (plain)” are that it is semi-secret
in composition, unscientific in combination and exploited under
unwarranted claims. The same criticisms hold with reference to
“Veracolate with Pancreatin and Pepsin” and “Veracolate with Iron,
Quinine and Strychnine.”

These products are discreditable to the medical and pharmaceutical
profession alike and their use is against the public good. The
Council therefore refused recognition to Veracolate and its
preparations.--(_From The Journal A. M. A., April 24, 1915._)




                    HAYDEN’S VIBURNUM COMPOUND[AN]

            Report of the Council on Pharmacy and Chemistry

[AN] See also report on Dioviburnia, p. 141, and article on Viburnum
Compound and Other Nostrums, p. 409.


The following report on Hayden’s Viburnum Compound was prepared by a
member of the Council’s Committee on Therapeutics. The Council held the
preparation in conflict with its rules and authorized publication of
the referee’s report.

                                              W. A. Puckner, Secretary.

Hayden’s Viburnum Compound, according to the advertising circulars, was
first compounded in 1860 by W. R. Hayden. The medical profession is
told that W. R. Hayden

    “... found by his experiments that a combination of the active
    principles of _Viburnum Opulus, Dioscorea Villosa_, combined with
    aromatics, proved a valuable remedy for _Spasmodic Dysmenorrhea_.”

As in 1860 W. R. Hayden was not a physician (he received a diploma from
the Eclectic Medical College, New York, in 1867), and, so far as we can
learn, he was not a pharmacist or chemist, one wonders what kind of
“experiments” he made. Hayden’s Viburnum Compound is put on the market
by the New York Pharmaceutical Company of Bedford Springs, Mass. The
name of this concern may sound imposing, until it is realized that it
is merely a trade name adopted by Hayden in exploiting his nostrum.

The advertising matter formerly claimed that Scutellaria (skull-cap)
was one of the ingredients of Hayden’s Viburnum Compound. As this is no
longer mentioned, it is fair to assume that even the manufacturer does
not consider the composition to be of vital importance. Stress is laid
on the superior efficacy of viburnum opulus in the conditions for which
the preparation is recommended; it is emphasized that it is viburnum
opulus, and not viburnum prunifolium, that is the important ingredient
of Hayden’s Viburnum Compound. The label, in accordance with the
requirements of the Food and Drugs Act, declares that the preparation
contains 50 per cent. alcohol. The claim is made:

    _“It is free from all narcotics and leaves no unpleasant
    after-effects.”_

The medical profession is told that Hayden’s Viburnum Compound is a
remedy in:

    “Hysteria, Bilious Colic, Cramps of Cholera Morbus, Muscular
    Cramps,... Nervous Diseases of Pregnancy, Threatened Abortion,
    Post-Partum Pains, Puerperal Convulsions, Rigid Os, Dysmenorrhea,
    Menorrhagia.”

                   DISCUSSION OF ALLEGED INGREDIENTS

_Viburnum Opulus_ (_Cramp Bark_).--Botanists and pharmaceutical
chemists declare that this drug has not been on the American market
for many years, if ever, and that the drug used and even described as
viburnum opulus is really the bark of another plant. Viburnum opulus
and its preparations are therefore to be dropped from the next United
States Pharmacopeia. The principal constituents of viburnum opulus are
stated to be a glucosid, viburnin, a bitter resin, and a little tannin,
with small amounts of earthy carbonates and phosphates and organic
acids (Culbreth, Ed. 4, 1906, p. 591). The glucosid and resin being
bitter, the drug might have a slight stomachic action (if, indeed,
any such effect is actually produced by “bitters”); the small amount
of tannin might make it slightly astringent; its fruit acids (citric
and malic) might make it slightly diuretic. Even if viburnum opulus
were present in Hayden’s Viburnum Compound there is no clinical or
laboratory proof that it, if given alone--without alcohol or other
drug--has any antispasmodic or nervous sedative action.

_Dioscorea Villosa_ (_Wild Yam_).--This drug contains a saponin and
an acrid, irritant resin. It has never been proved clinically or
experimentally that this drug has any action whatever except that its
irritant resin might, if taken in sufficient quantity, cause irritation
of the stomach and vomiting.

_Aromatics._--The irritation produced by concentrated aromatics causes
increased peristalsis and consequently may, if there is no obstruction,
relieve intestinal stasis and intestinal colics. Therefore, a
preparation containing large amounts of aromatics, especially if given
in hot water, would have practically the same effects in the “cramps of
a cholera morbus” or other forms of acute diarrhea as a home-brewed cup
of spiced tea--and no more.

_Alcohol._--This drug is a muscle relaxant, and sufficient doses
might, by relieving spasm, relax a muscularly contracted os uteri and
relieve post-partum pains. Alcohol dilates the blood-vessels both
in the abdomen and on the surface of the body. It may thus either
relieve uterine bleeding by lowering the blood-pressure and causing
more blood to go to other parts, or increase uterine bleeding by
relieving arterial and muscle spasm. Alcohol is also a habit-forming
narcotic (Hayden’s Viburnum Compound is advertised as “free from all
narcotics”!) and when habitually used by either males or females tends
to impair the capacity to produce normal offspring.

Even if the manufacturer’s “formula” be accepted, Hayden’s Viburnum
Compound contains no therapeutically active ingredient except alcohol
and aromatics. The recommended dose of this preparation is “... two
teaspoonfuls in six of boiling hot water or milk and one teaspoonful of
sugar, every fifteen or twenty minutes until relief is obtained.”

    “Frequently after taking the Viburnum Compound the patient will
    sleep soundly for several hours from the sudden cessation of
    pain; in such cases she should never be awakened through any
    fear of oversleeping, as Hayden’s Viburnum Compound does not
    contain any narcotic whatever, nor does it leave any disagreeable
    after-effects, and it may be given to a child when necessary
    without any special caution.”

Read the foregoing and then remember that it means that one teaspoonful
of alcohol (the equivalent of two teaspoonfuls of whisky) is to be
given in hot water, every fifteen or twenty minutes until relief is
obtained and the patient is asleep. Why not use plain language and say
“until she is drunk”?

The thoughtful physician would consider it decidedly unwise to give
alcohol to a young girl, to a prospective mother, or to a young mother,
except under extraordinary circumstances. He would know that the
menstrual pains for which this preparation is recommended are likely
to be recurrent, and that the repeated taking of alcohol for recurrent
pain is fraught with danger--the danger of initiating the alcohol
habit. If, however, a physician does elect to give alcohol as a drug,
he must let the conditions that govern each individual case determine
whether it is not better to give it as whisky, or to disguise it in a
prescription of his own. Above all the physician should be conscious
that he is giving the drug, alcohol; and this is not the case when he
prescribes a ready-made nostrum. If he writes a prescription containing
whisky or other alcoholic he will take measures to avert the dangers
inseparable from the use of this drug.

                              CONCLUSIONS

1. Even if the manufacturer’s formula for Hayden’s Viburnum Compound be
accepted, it is apparent that any therapeutic activity the preparation
may have is due essentially to the alcohol and aromatics.

2. Alcohol is a narcotic drug, and a habit-forming drug. Physicians
ordering this preparation may, by so doing, be initiating the alcohol
habit.

3. Whatever result is obtained by the use of Hayden’s Viburnum Compound
in the treatment of uterine or pelvic disturbances, is due to the
alcohol it contains. The fact that menstrual pains are likely to recur
might, when this preparation is relied on, become a factor in the
formation of the alcohol habit.

4. Whatever result is obtained by the administration of Hayden’s
Viburnum Compound in the treatment of gastro-intestinal disturbances is
due to the alcohol and the aromatics it contains.

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.

Holding the exploitation of this proprietary a danger to the public and
a detriment to scientific medicine, the referee recommends publication
of this report as a protest against such irrational therapeutics. The
profession should recognize that most, if not all, of the preparations
recommended for painful menstruation and for all kinds of pelvic pain
contain large percentages of alcohol, and that whatever physiologic
effect is produced is, for all practical purposes, due to the
alcohol.--(_From The Journal A. M. A., Jan. 23, 1915._)




                              VIN MARIANI

   Report by Council on Pharmacy and Chemistry--With Comments Thereon


This preparation was assigned to a subcommittee of the Council and the
following is an abstract of the report of the committee:

  Samples of Vin Mariani and of the literature distributed by the
  manufacturers were examined.

  It appears that the beverage or medicine known as “Vin Mariani” is
  a preparation of red wine, apparently imported from Bordeaux, and
  fortified, in this country, by an alcoholic preparation of coca
  leaves or other parts of the coca plant.

  The committee considered first, the character of the red wine as
  imported. A sample received from the port of New York, March 10,
  1905, from Henry Clausel & Co., Bordeaux, and consigned to Mariani &
  Co., on analysis was found to have the following composition:

    Specific gravity                       0.9959
    Alcohol by volume        per cent.    10.99
    Extract                  per cent.     2.279
    Volatile acids           per cent.     0.0914
    Ash                      per cent.     0.2801
    Reducing sugar                         trace.
    Pol. direct                degrees   --0.8
    Pol. invert                degrees   --0.7
    K.So                  M. per liter     0.092

  A sample of Vin Mariani, as bought in the open market in an original
  package, has also been analyzed and found to have the following
  composition:

    Specific gravity                       1.0125
    Alcohol by volume        per cent.    16.15
    Extract                  per cent.     8.602
    Ash                      per cent.     0.277
    Glycerin                 per cent.     0.444
    Volatile acid            per cent.     0.0747
    Tartaric acid            per cent.     0.2400
    Alkaloids (coca bases)   per cent.     0.0250
    Cane sugar               per cent.     2.35
    Reducing sugar           per cent.     3.38

  The increased alcoholic strength of Vin Mariani over the Bordeaux
  wine from which it is made, as shown by this analysis, doubtless
  comes from the alcohol extract containing the coca bases, as already
  stated. Approximately 6 per cent. of sugar is also added to the wine.
  Judging from the analysis, therefore, Vin Mariani corresponds to
  a mixture of an alcoholic preparation of coca leaves and ordinary
  Bordeaux red wine, with the addition of about 6 per cent. of sugar.

  Vin Mariani conflicts with Rule 5, which requires that “No article
  will be admitted or retained, concerning which the manufacturer
  or his agents make misleading statements as to geographical
  source, raw material from which made, or method of collection, or
  preparation,” by stating in the advertising literature that: “The
  United States government, under the Pure Food Law of March 3, 1903,
  further emphasizes all previous analyses of Vin Mariani by admitting
  Mariani’s wine as absolutely pure and unadulterated.”

  Whatever may have been the intent of the above statement, its effect
  is to deceive. The conjunction of the terms “Vin Mariani” and
  “Mariani’s wine” can only be construed as meaning the same thing.
  Inasmuch as it does not appear that Vin Mariani is imported into
  this country, it would not have been possible for the United States
  government to inspect it, and as to the wine obtained from Henry
  Clausel & Co., from Bordeaux, it is not in any sense Mariani’s wine
  except that of ownership. It is the opinion of the committee that
  this phrase can only result in deception and the construction of the
  language strongly favors the supposition that it is intentionally
  meant to deceive.

  This false claim is practically repeated in the other pamphlets
  published by the Vin Mariani Company, although not always in the same
  words.

  This preparation also conflicts with Rule 6, which states that “No
  article will be admitted or retained of which the manufacturer or his
  agents make unwarranted, exaggerated or misleading statements as to
  therapeutic value,” in that the firm’s letter-heads have printed on
  them the following:

    “Vin Mariani purifies the blood stream, strengthens the
    circulation, stimulates muscular fiber and nerve tissue, is a
    respiratory stimulant, strengthens the heart muscles, and is an
    emergency food in the absence of all other nutriment. Successfully
    employed as an adjuvant in anemia, debility, diseases of the chest,
    nervous troubles, muscular or mental overstrain, neurasthenia,
    and allied conditions, and in certain cases of protracted
    convalescence.”


The committee believes that Vin Mariani is intended as a beverage
rather than as a medicine.

The report concludes:

“The committee recommends, therefore, that Vin Mariani be refused
recognition and that this report be published in full or in part.”

In accordance with this recommendation the above extract of the report
is herewith published.

                                              W. A. Puckner, Secretary.

                   VIN MARIANI MADE IN THIS COUNTRY

According to the above report, Vin Mariani as imported is simply an
ordinary cheap French wine, the preparation sold in this country as
Vin Mariani being compounded in this country. Yet the advertising
literature, the label on the bottle, etc., state directly or indirectly
that it is a French preparation. Until recently--presumably until
the vendors realized that the truth regarding this point would come
out--the advertisements in medical journals contained an analysis made
by a chemist in Paris. The shape of the bottle, the character of the
printed matter accompanying the bottle, etc., are evidently intended to
convey the impression that it is imported. So far, then, as this point
is concerned, Vin Mariani is sold under gross misrepresentations and is
a fraud.

[Illustration: Advertisements of Vin Mariani before and after national
Food and Drugs Act went into effect.]

                       ADVERTISED TO THE PUBLIC

Vin Mariani was at one time advertised to the public in this country,
but, so far as we know, it is not at the present time; at least,
not directly. Yet it is most effectively advertised to the public
indirectly, and this with little expense to the promoters, the cost
of the circular around the bottle being the only expense--doctors who
prescribe it do the rest. If those who are in the habit of prescribing
Vin Mariani will examine the advertising that goes into the hands of
their patients they will realize how true it is that our profession is
responsible for much of the “patent-medicine” taking. Few laymen could
withstand the temptation to buy the stuff for any ailment that comes
along when they read in the circular that this “medicine,” which their
doctor evidently thinks is a good thing, is so highly recommended, for
all the ills that befall us mortals, by the Pope of Rome, the Czar and
the Czarina of Russia, the Queen of England, the Shah of Persia, the
King of Norway and Sweden, the Queen of Portugal, the Queen of Saxony,
the Crown Prince of Cambodia, Ferdinand of Bulgaria, and by a whole
list of ambassadors, generals, politicians, musicians, actresses, etc.
The testimonials of these great men and women are enough to convince
the most skeptical that this remarkable medicine will do everything
but raise the dead--and under favorable circumstances accomplish even
this. And still more--it will win battles! Witness this from the
governor-general of Madagascar: “We were refreshed by Vin Mariani,
and before morning carried the stronghold.” Alexander Dumas and Emile
Zola are credited with calling it “the elixir of life.” One very
strange thing about the testimonials in the circular used in this
country is that all are written by foreigners. But Americans (President
McKinley--think of it--among others) are honored by having their
testimonials quoted in the circulars used on the other side of the
Atlantic. Why? Is it possible that the testimonials are fakes?

                          AN ETHICAL CURE-ALL

Here are a few of the conditions that the circular says Vin Mariani is
good for: “Anemia, winter cough, debility, vocal weakness, la grippe,
continued fevers, bronchitis, nervous troubles, muscular weakness,
diseases of the aged, malaria, melancholia, overwork, neurasthenia,
impotence, malnutrition, depression, heart troubles, wasting diseases,
mental overstrain, and in certain cases of protracted convalescence.”

The following quotations are taken from blotters--circulated in this
country--which are evidently intended for the laity, as well as for
physicians:

    “Vin Mariani creates and sustains vigor and energy. Guards against
    wasting diseases. When everything else has failed try it to prove
    merits.”

    “Lung, Throat and Stomach Troubles benefited by Vin Mariani; this
    Ideal French Tonic strengthens entire system of Body, Brain and
    Nerves.”

    “Most Efficacious, Most Agreeable, Unequaled by anything in
    Fortifying, Strengthening, Refreshing.”

               WHY BLAME THE LAYMAN FOR USING NOSTRUMS?

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?

                   MEMBER OF PROPRIETARY ASSOCIATION

One word more: There is an organization known as the Proprietary
Association of America, but it is usually referred to in common
parlance as the “patent-medicine” men’s association. It will be
remembered that last year we printed a list of the members of this
body, among which was the Vin Mariani Company. It will be remembered
also that in the list were the names of certain firms who were
supplying medicines to physicians, but practically all these resigned
from membership and their resignations were published by us. We have
not had the pleasure of publishing the resignation of the Vin Mariani
Company. On the contrary, we note that at the last annual meeting of
the “patent-medicine” men’s association this firm was still an active
member, Mr. A. L. Jaros, who stands for the Mariani Company in this
country, being one of those registered at the meeting.--(_From The
Journal A. M. A., Nov. 26, 1906._)




                                 VIROL

            Report of the Council on Pharmacy and Chemistry


Virol, sold in the United States by the Etna Chemical Company, is put
out by Virol, Ltd., London, England. It is said to be

    “A preparation of bone marrow, red bone marrow of medullary
    structure of ox rib and calf bones, eggs, malt extract, and lemon
    syrup made from fresh fruit.”

    “Marrow fat is emulsified with extract of malt, lemon syrup and
    eggs, it is further enriched with soluble phosphates of lime, iron
    and soda, and glycerine solution of red bone marrow.”

Many of the therapeutic claims made for Virol the Council considered
grossly exaggerated; among them are the following:

    “... a complete food for children.”

    “... a complete nutrient.”

    “The value of the Lime-Salts (representing the Egg Shells)
    contained in Virol is fully illustrated in its influence upon
    Rickets; whilst Struma, Chronic Bronchitis, Anaemia and Influenza
    are all combated by its use in a degree, which, we venture to say,
    has never been approached.”

    “The fat, as represented by the Marrow-bone and Egg Yolk, is so
    minutely divided that it admits of even far more rapid absorption
    by the _villi_ of the intestine than milk.”

    “It is an ideal form of food, readily digested and assimilated in
    the weakest of conditions.”

    “Virol has a marked effect on the metabolism of the body,
    increasing the production of opsonins and stimulating phagocytosis.
    As an adjuvant to the natural defensive processes of the patient
    in all diseases of bacterial origin its value can scarcely be
    over-estimated.”

The objections of the Council were transmitted to Virol, Ltd. The
firm’s reply was reported to the Council by the referee of the
Committee on Therapeutics who held that no adequate or satisfactory
answer had been made to the objections raised against the advertising
claims for Virol.

The claims made for Virol being unsubstantiated and unwarranted, the
Council voted that the preparation be refused recognition.

In accordance with the practice of the Council, the exploiters of Virol
were afforded an opportunity to comment on the foregoing statement
before its publication. On their objecting to the findings, the entire
matter was turned over to a second referee. This referee, in making his
report, reviewed the claims made for Virol and commented on the lack
of evidence to substantiate these claims. He stated that a chemical
analysis of the preparation had yielded the following result:

    “Sugar, as maltose              60.0 per cent.
    “Fat                            13.2 per cent.
    “Proteins                        3.2 per cent.
    “Ash                             1.6 per cent.
    “Water and volatile matter      21.6 per cent.

“There is no appreciable diastatic action. A little glycerol is present
in the volatile matter. The preparation is therefore an extract of malt
with fat and a small amount of protein.”

He then continues:

“That Virol has food value cannot be denied, but that it has sufficient
value to warrant the claims of the manufacturers is not evident. Virol
cannot be considered a complete food, as the advertising literature
reiterates, or an ideal food for infants. The amount of protein is far
too low in comparison with the carbohydrates to warrant this view.
The dosage recommended is not large. Thirty gm. a day would furnish
only about 1 gm. of protein and 4 gm. of fat. The 3 teaspoonfuls a day
recommended for children would furnish protein and fat even below this.

“If employed alone it cannot be a complete or sufficient food, and
if employed along with other articles of diet--milk and bread, for
example--it is not easy to see wherein lies the efficacy of the small
weights of fat and protein added in the form of Virol. Here the demand
made on our credulity is too great, as the protein in the preparation
is the familiar protein of eggs, meat and malt, and the fat largely
that from the egg-yolk and marrow, according to the claims. It is not
known that any specific virtues reside in these bodies, or in the
egg-shells, also claimed as present.

“In the opinion of the present referee there is nothing in the
composition of Virol to justify the claims made for it. The judgment
and recommendations of the first referee follow from the facts and must
be accepted by the Council.”

The Council directed that the previously prepared report be allowed to
stand and that it be published along with a suitable reference to the
report of the second referee.--(_From The Journal A. M. A., Feb. 20,
1915._)




                                PART II

              CONTRIBUTIONS FROM THE CHEMICAL LABORATORY




                 ANUSOL HEMORRHOIDAL SUPPOSITORIES[AO]

                    W. A. Puckner and L. E. Warren

[AO] See also Anusol Suppositories, p. 280.


An abstract of an article concerning “anusol suppositories” was
published in The Journal, Jan. 23, 1909. This gave the results of an
analysis by a foreign chemist, J. F. Suyver, which were to the effect
that “anusol suppositories” contained no “anusol.” Schering & Glatz,
the American agents for “anusol” suppositories, took exceptions to the
abstract, asked that The Journal retract, and submitted the findings
of a chemist in support of their claim that the suppositories do
contain “anusol.” To determine the composition of “anusol hemorrhoidal
suppositories” as they are found on the American market, trade packages
were purchased (April 6, 1909) and submitted to examination[90] in the
Association’s laboratory.

[90] Details of the quantitative analysis of “Anusol Hemorrhoidal
Suppositories” appear in the annual report for 1909 of the Chemical
Laboratory of the American Medical Association.

According to the claims of the manufacturers, 12 suppositories contain:

    “Anusoli              7.5 grams.
    “Zinc oxid            6.0 grams
    “Balsam Peruv         1.5 grams
    “Ol. theobrom        19.0 grams
    “Ungt. cerat          2.5 grams”

Calculated to percentages the formula reads:

    Anusoli             20.54 per cent.
    Zinc oxid           16.44 per cent.
    Balsam Peruv         4.11 per cent.
    Ol. theobrom        52.06 per cent.
    Ungt. cerat          6.85 per cent.

When this product was submitted to the Council some time ago, Schering
& Glatz stated that, according to the manufacturer, “anusol” is
the “iodo resorcin sulphonate of bismuth, having the following
rational formula: [C_{6}H_{2}ISO_{2}.O(OH)_{2}]_{3}Bi. In the
meta-dioxybenzol C_{6}H_{4}(OH)_{2}, the resorcin, one H has been
replaced by one I, and for another H the sulfonic-acid group SO_{2}-OH
has been substituted, so that meta-dioxybenzol is transformed into
C_{6}H_{2}ISO_{2}-OH(OH)_{2}. In the sulfonic acid the H of OH is
replaced by Bi and, as Bi is trivalent the above rational formula
results.”

According to this formula “anusol” should contain:

    Iodin               32.99 per cent.
    Sulphur              8.34 per cent.
    Bismuth             18.07 per cent.

And the “anusol” suppositories should contain:

    Iodin                6.77 per cent.
    Sulphur              1.71 per cent.
    Bismuth              3.71 per cent.

Examination showed that the suppositories contain about 0.08 per cent.
iodin, or 1.2 per cent. of the amount claimed; 0.28 per cent. sulphur,
or 16.3 per cent. of what is claimed; 0.71 per cent. bismuth, or 19 per
cent. of what is claimed; and zinc equivalent to 16.5 per cent. zinc
oxid, or about 100 per cent. of claim.

From the standpoint of the iodin content alone, assuming that all
of the iodin found is present in the form of “anusol,” the results
of the examination of the product (as found on the American market)
verifies, for all practical purposes, Suyver’s statement that “anusol
suppositories contain no anusol,” for the quantity of iodin present
is so minute (about 1/82 of that required by the formula) as to
be unworthy of serious consideration. The presence of sulphid in
appreciable amounts was demonstrated showing that the sulphur is
present, at least in part, in the form of sulphid and not as sulphonate
as is claimed. In a measure, too, this is in accord with the findings
of Suyver, who concluded that, in the product which he examined, the
bismuth was present in the form of sulphid. The proportions of sulphur
and of bismuth (respectively about 1/6 and 1/5 of the required amounts)
indicate still further that the product is not all that it is claimed
to be.

A specimen submitted by Schering & Glatz to the Council two years ago
contained 0.99 per cent. iodin, or 1.3 per cent. of the amount claimed;
0.23 per cent. sulphur, or 13.4 per cent. of the claimed amount; and
0.52 per cent. bismuth, or 14 per cent. of what is claimed by the
formula. Since the above determinations were made another specimen of
Anusol Hemorrhoidal Suppositories was received from Schering & Glatz,
July 16, 1909. This sample was found to contain about: 0.075 per cent.
iodin, or 1.1 per cent. of the amount required by the formula; 0.265
per cent. of sulphur, or 15.5 per cent. of the requirement and 0.88 per
cent. bismuth, or 23.7 per cent. of the required amount. It will thus
be seen that the composition of the oldest specimen and also that of
the specimen recently sent, corresponds in a general way to that of the
one first examined.

Whether judgment be based on the determination of the bismuth, the
sulphur or the iodin, the results just given clearly show that the
claims made concerning the composition of “Anusol Hemorrhoidal
Suppositories” are not substantiated by the facts.--(_From The Journal
A. M. A., Oct. 2, 1909._)




                      AROMATIC DIGESTIVE TABLETS

                    W. A. Puckner and L. E. Warren


It has been amply demonstrated[91] that pepsin and pancreatin, when in
solution, mutually destroy each other; if the solution be acid, the
pepsin destroys the pancreatin; if alkaline, the pancreatin destroys
the pepsin. By using the characteristic effect of pepsin on proteids
in acid medium and that of pancreatin on proteids and starches in an
alkaline solution it can readily be demonstrated that commercial liquid
preparations labeled as containing both of these ferments actually
contain only one ferment. They are misbranded.

[91] U.S. Pharmacopeia, 8th revision, p. 334.

Besides the liquid a goodly number of solid preparations, chiefly
tablets, containing pepsin and pancreatin are offered to the
profession. Among these are tablets consisting simply of pepsin and
pancreatin. Since pepsin and pancreatin interact only when in solution,
it is quite possible to prepare tablets which contain these ferments.
The use of such tablets is, however, unscientific, since one or the
other of the ferments is destroyed when it comes in contact with the
fluids of the digestive tract. In addition to simple tablets containing
pepsin and pancreatin only there is at present a host of “digestive
tablets” on the market. Among these are some which must be classed with
the “digestive impossibilities” (Reports of the Council on Pharmacy
and Chemistry, 1910, Vol. 1, p. 41). The preparations referred to are
tablets claimed to contain pepsin, pancreatin, diastase, hydrochloric
acid and lactic acid. When it is considered that the United States
Pharmacopeia defines hydrochloric acid as “a liquid composed of 31.9
per cent. by weight of absolute hydrochloric acid (HCl = 36.16) and
68.1 per cent. of water,” i. e., a solution of hydrogen chlorid, a
gas, in water, it would at first appear that the incorporation of
any appreciable quantity of hydrochloric acid in tablets would be
impracticable. Hydrochloric acid, however, possesses to a limited
extent the property of combining loosely with protein substances so
that it becomes possible to bring about its combination with pepsin
and similar substances to form compounds which are relatively stable
at ordinary temperatures. Because of the volatility of the free acid
and its limited combining power with protein substances (100 gm. boiled
beef combine with 2 gm. absolute hydrochloric acid[92]), the quantity
of acid in any tablet can never be large, much less than sufficient to
be of any therapeutic value.

[92] Hemmeter, Diseases of the Stomach, Edition 3, p. 250.

A number of firms offer “digestive tablets” for sale having formulas of
which the following may be considered typical:

    Sacch. Pepsin                 4   grains
    Pure Pancreatin               1   grain
    Diastase                      1/4 grain
    Aromatic Powder               1/4 grain
    Lactic Acid                   1/8 grain
    Hydrochloric acid             1/8 grain

Some manufacturers use United States Pharmacopeia pepsin in place of
the saccharated article; others do not give the exact quantities of
hydrochloric acid which their product is supposed to contain, but
make use of the indefinite expression “q. s.;” still others state
merely that hydrochloric acid is present, but make no claim whatever
concerning the quantity.

From purely theoretical considerations it is possible that the tablets
referred to might contain appreciable amounts of hydrochloric acid.
Since the formulas for some of the tablets furnish no information
concerning the content of hydrochloric acid, it seemed worth while
to determine the quantity, if any, actually present in some of the
tablets on the market. Accordingly a trade package of “digestive
aromatic tablets,” as put up under the label of each of six American
manufacturers, was purchased and submitted to examination in the
Association laboratory.

Qualitative tests made on specimens from each brand of tablets
demonstrated the absence of uncombined hydrochloric acid in each.
Further tests[93] showed that hydrochloric acid in protein combination
was present essentially in the amounts claimed in three of the
specimens. In two of the others hydrochloric acid was entirely absent;
in the remaining one only the merest traces of hydrochloric acid could
be found.

[93] Details of this analysis appear in the annual report for 1910 of
the Chemical Laboratory of the American Medical Association.

    +-----------------------------------------+
    |          H. K. MULFORD COMPANY          |
    |          “_DIGESTIVE AROMATIC_”         |
    | “Pepsin, Sacch.             4    grains |
    | “Pancreatin                 1/2  grain  |
    | “Diastase                   1/16 grain  |
    | “Acid Lactic                1/8  grain  |
    | “Acid Hydrochloric          1/8  grain  |
    | “Aromatic Powder            1/4  grain  |
    |   “Dose: 1 or 2 tablets.”               |
    +-----------------------------------------+

In the above formula each tablet is said to contain 1/8 grain
hydrochloric acid. This amount is equivalent to 0.002584 gm. (1/25
grain) absolute hydrochloric acid. Analysis demonstrated that each
tablet contains about 0.00267 gm. hydrochloric acid (absolute HCl)
or essentially the amount claimed. The average dose of diluted
hydrochloric acid United States Pharmacopeia is 1 c.c., equivalent to
0.1049 gm. absolute hydrochloric acid. To obtain this quantity from the
above preparation the patient would be required to swallow more than
three dozen of the tablets.

    +-----------------------------------------+
    |     WM. S. MERRELL CHEMICAL COMPANY     |
    |     “_DIGESTIVE AROMATIC, 5 GRAINS_”    |
    | “Pepsin                       80 parts  |
    | “Pancreatin                   10 parts  |
    | “Diastase                      1 part   |
    | “Acid Lactic                   1 part   |
    | “Acid Hydrochloric             3 parts  |
    | “Aromatic Powder               5 parts” |
    +-----------------------------------------+

Calculation shows that each tablet should contain about 0.0031 gm. of
absolute hydrochloric acid. The analysis indicated that each tablet
contains about 0.0030 gm. hydrochloric acid (absolute HCl) in protein
combination, or practically the amount claimed. One pharmacopeial dose
of hydrochloric acid is contained in 35 of the tablets.

    +-----------------------------------------+
    |         PARKE, DAVIS & COMPANY          |
    |         “_DIGESTIVE AROMATIC_”          |
    | “Saccharated Pepsin          4   grains |
    | “Pure Pancreatin             1   grain  |
    | “Diastase                    1/4 grain  |
    | “Aromatic Powder             1/4 grain  |
    | “Lactic Acid.                           |
    | “Hydrochloric Acid.                     |
    |   “Dose: 1 to 3 tablets.”               |
    +-----------------------------------------+

Chlorid is present in small amounts, but quantitative examination
indicated that hydrochloric acid, either free or in protein combination
is absent. An ammonium salt is present in small quantities.

    +-----------------------------------------+
    |              SHARP & DOHME              |
    |          “_DIGESTIVE AROMATIC_”         |
    | “Pepsin, Sacch., U. S. P.    4   grains |
    | “Pancreatin, pure            1   grain  |
    | “Diastase                    1/4 grain  |
    | “Aromatic Powder             1/4 grain  |
    | “Lactic Acid                 q. s.      |
    | “Hydrochloric Acid           q. s.”     |
    +-----------------------------------------+

Small quantities of chlorid are present. Quantitative examination
indicated that hydrochloric acid in protein combination is present only
in very small amounts, each tablet containing but about 0.00034 gm.
of absolute acid, or about 0.34 per cent. of the pharmacopeial dose.
Ammonia is absent. Inasmuch as more than 300 of these tablets would be
required to furnish a pharmacopeial dose of hydrochloric acid, this
firm’s interpretation of the expression “q. s.” would prove interesting.

    +-----------------------------------------+
    |         TRUAX, GREENE & COMPANY         |
    |             “_SYNERGIA_”                |
    +-----------------------------------------+

“Synergia” is claimed to be composed of “pepsin, pancreatin, veg.
diastase, lactic acid, hydrochloric acid and aromatics; dose, 1 to 3
tablets.” The specimen contained no hydrochloric acid, either free or
in protein combination. A trace of ammonia and small quantities of
chlorid were found.

    +-----------------------------------------+
    |       THE FRASKE TABLET COMPANY         |
    | “Pepsin Sacch.                80 parts  |
    | “Pancreatin, Pure             10 parts  |
    | “Diastase                      1 part   |
    | “Lactic Acid                   1 part   |
    | “Hydrochloric Acid             3 parts  |
    | “Aromatic Powder               6 parts  |
    |   “Dose: 1 to 2 tablets.                |
    |   “Each tablet represents (5) grains of |
    |       the above mixture.”               |
    +-----------------------------------------+

According to the formula hydrochloric acid (31.9 per cent. absolute
HCl) represents 3 parts in 101 of the preparation from which the
tablets are made. Each tablet (containing 5 grains of the mixture)
should have 0.00307 gm. absolute hydrochloric acid. Analysis showed
that each tablet contains hydrochloric acid in protein combination
equivalent to an average of 0.003066 gm. absolute hydrochloric acid,
or essentially the amount claimed. It would be necessary to give 34
tablets to administer a pharmacopeial dose of hydrochloric acid.

[Editorial Note: The above indicates that the use of such tablets is
irrational, unscientific and that it should be condemned. The only
constituent of these tablets, other than the aromatics, which might
possibly be of benefit in stomach troubles, is the pepsin. But even
if it be assumed that the diastase and pancreatin could exert their
characteristic effects, their aid to digestion (metabolism) would be
but slight, because their amounts in the tablets are too small to be of
any value.

It is claimed that the tablets contain diastase in amounts varying from
1/20 to 1/4 grain. Assuming the diastase used to be of first-class
quality, i. e., capable of converting 200 times its own weight of
starch into soluble products, the quantity of one tablet would be
capable at the most of digesting but from 10 to 50 grains of starch,
an amount equal at the most to but a small spoonful of oatmeal or a
very dainty bite of bread. In the same way the quantity of pancreatin
is insufficient to be of any material aid in digestion should it in
some way escape destruction in the stomach and still retain its full
activity when it reaches the alkaline juices of the intestines. One
grain of pancreatin of full United States Pharmacopeia strength will
digest only 25 grains of starch or the proteids in about 100 c.c. of
milk.

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.

Clinical experience has shown that in the majority of cases of
so-called dyspepsia the stomach contents contain too much rather than
too little hydrochloric acid, and wherever there is a sufficiency of
acid there is usually no decrease in the secretion of pepsin. In many
of such cases, too, digestion is normal, or even more active than
normal, but even when it is imperfect there is seldom any lack of
pepsin.

Insufficient digestive power is most often due to a deficiency of
hydrochloric acid and not to lack of pepsin in the stomach contents.
In the tablets under consideration, however, hydrochloric acid is
present--if at all--in the most ridiculously minute quantities;
quantities that are so small as to preclude any therapeutic effect
except that due to the psychic element.

These tablets, with their six or more ingredients, are typical “shotgun
prescriptions.” Such prescriptions catch the unthinking doctor as
well as the self-drugging public, for, while clinical experience and
physiologic experiments have demonstrated that the old ideas regarding
the value of these digestives and ferments were erroneous, the public
and many members of the medical profession still seem to be influenced
by the old theories.

In conclusion we must not lay all the blame on the manufacturing firms
for supplying these absurd combinations; the physician who prescribes
them should assume a large share of it. If the doctors did not use them
the manufacturing concerns would soon stop putting them on the market.
We hope, however, that those manufacturing concerns that like to be
classed as reputable will cease to disgrace their catalogues with what
they know to be therapeutic absurdities.]--(_From The Journal A. M. A.,
Aug. 20, 1910._)




                      BURNHAM’S SOLUBLE IODIN[AP]

                     W. A. Puckner and A. H. Clark

[AP] See also report on Burnham’s Soluble Iodine, p. 110


Burnham’s Soluble Iodin, according to the manufacturers, is one of the
most noteworthy “discoveries” of the age. The advertisements aim to
create an impression that while the product contains iodin, pure and
simple, yet by some secret process this element has been so changed
as no longer to possess its usual properties. The Burnham Soluble
Iodin Company makes such extravagant claims for its product and
gives such wide publicity to these claims that it seemed advisable,
in the interests of the profession, to determine the nature of the
preparation. Its examination was accordingly taken up in the laboratory
of the American Medical Association.

From the analysis, we conclude that Burnham’s Soluble Iodin is a
solution of iodin in alcohol made miscible with water by the presence
of some iodid. Wilbert[94] and other investigators have arrived at
practically the same conclusion.

[94] Proc. Am. Pharm. Assn., 1903, li, 409.

Whatever the secret process, hinted at in the advertisements, by which
this preparation is evolved, the fact remains that when one prescribes
Burnham’s Soluble Iodin, one is prescribing iodin, together with an
iodid, the nature of which is hard to determine. The iodid is not
present as potassium iodid, nor, entirely, at least, as hydrogen iodid
(hydriodic acid), but this is of slight importance compared with the
fact that it is a solution in alcohol of free iodin and an iodid, and
therefore is essentially the same as Lugol’s solution.

The amount of iodin found corresponds approximately to 3 gm. of free
iodin and 2 gm. of combined iodin in 100 c.c. of the solution. Lugol’s
solution contains 5 gm. free iodin, and 10 gm. potassium iodid in
100 c.c.


                    BURNHAM’S SOLUBLE IODIN TABLETS

Burnham’s Soluble Iodin Tablets are light brown compressed tablets,
stamped with the letters B. S. I. in monogram. Each tablet is said to
contain 3 minims Burnham’s Soluble Iodin.

The average weight of each tablet was found to be 0.3526 gm.; since
Burnham’s Soluble Iodin was found to have a specific gravity of .8527
and to contain 4.5 per cent. total iodin, the tablets should contain
approximately 2.3 per cent. total iodin, about one-half to two-thirds
of which, depending on the condition of the “Soluble Iodin” from which
they are made, should be free iodin. Instead of this, only 0.317 per
cent. free iodin and 1.57 per cent. total iodin was found. Analysis
shows that Burnham’s Soluble Iodin tablets contain approximately
one-fourth the amount of free iodin and approximately two-thirds
the amount of total iodin which should be contained therein if, in
accordance with the label, each tablet contains 3 minims of Burnham’s
Soluble Iodin.

                                COMMENT

The literature put out by the Burnham Soluble Iodin Company is
in itself enough to condemn the products it advertises. The much
emphasized statement of the company that

    “=Something had to be done; and Burnham’s Soluble Iodin is that
    which has been done=”

fulfils, in its blatant assertiveness, all the requirements of nostrum
advertising. The results of the analyses are not, therefore, a surprise.

Secrecy is just as essential today to the successful exploitation of
this class of proprietaries as it was before the demand for formulas
became so universal. The requirement of publicity is evaded, therefore,
in one of two ways: Either a formula is given which is false, or
at least meaningless, or else the claim is made that the method of
preparing the product is a unique and remarkable secret that is
possessed only by the manufacturers. The Burnham Soluble Iodin Company
uses the latter device.

Meanwhile, physicians will be perfectly justified in viewing with
suspicion all claims based on such conspicuously unscientific premises,
more especially so when these claims fail to find substantiation on
careful and painstaking analyses. In brief, whenever the physician
wishes to administer free iodin, Lugol’s solution (Liquor Iodi
Compositus, U. S. P., Physician’s Manual, page 84) is an inexpensive
and perfectly available preparation.--(_From the Journal A. M. A.,
March 28, 1908._)




                    “HYDROCYANATE OF IRON--TILDEN”

                    W. A. Puckner and W. S. Hilpert


Among the many inquiries received regarding the composition of secret
remedies was one in reference to “Hydrocyanate of Iron” manufactured by
the Tilden Company, New Lebanon, N. Y. This preparation is advertised
as being “unexcelled as a remedy for epilepsy, hysteria, chorea,
neurasthenia, locomotor ataxia, neuralgia, migraine, anemic headaches,
and all convulsive or reflex neuroses dependent on impairment of the
brain or spinal cord.” It is also said to be “valuable in uterine
reflex neuroses due to congestion; in amenorrhea due to anemia and
chlorosis and suppressed menstruation.”

The term “hydrocyanate of iron” is an unfamiliar one and is not found
in any available reference work on chemistry. Thinking that the term
might have been loosely applied to ferrocyanid of iron, or Prussian
blue (a compound once suggested for epilepsy, but long ago considered
useless), the correspondent wrote to the manufacturers asking if such
were the case. The Tilden Company answered:

    “... our preparation Hydrocyanate of Iron is not Prussian blue in
    any sense of the word. Prussian blue has no curative properties as
    applied to all forms of epilepsy. Prussian blue is Ferrocyanid of
    Iron while our preparation is Hydrocyanate of Iron.”

The only statements in the Tilden Company’s advertising matter
regarding the composition of hydrocyanate of iron are the following:

    “Hydrocyanate of Iron (Tilden’s) is a correct and scientific
    combination of well known principles.”

    “Hydrocyanate of Iron (Tilden’s) combines well known properties of
    ferruginous salts with the sedative action of Hydrocyanic acid.”

The last statement would lead one to expect the presence of available
iron and cyanogen ions. In fact, the inference to be drawn from
all the company’s “literature” is that “hydrocyanate of iron” is a
definite chemical compound in the same sense as is ferrocyanid of
iron, and that inference is still further borne out in the letter to
our correspondent. This being the case, the Tilden Company was again
written to and asked for the chemical formula of “hydrocyanate of
iron,” with the following result:

    “Replying to your inquiry regarding the formula of Hydrocyanate
    of Iron we beg to state the composition of this preparation is a
    trade secret and we therefore do not care to furnish the desired
    information.”

This reply verified the opinion already formed that “hydrocyanate of
iron” is a secret preparation. Its analysis was then taken up in the
Association’s laboratory.

                      EXAMINATION OF THE TABLETS

  The product appears on the market in cartons said to contain one
  ounce of one-grain tablets. On the cartons, in addition to the name
  of the preparation and the name and address of the manufacturers,
  are the names of diseases for which it is recommended. The tablets,
  in the specimens analyzed, were dark blue, rather hard and slightly
  bitter in taste and had an average weight of 0.1382 gm., or about
  2 grains. They were found to be practically insoluble in water
  and dilute mineral acids; aqueous oxalic acid solution partially
  dissolved them, yielding a blue solution. Boiling with alkali
  hydroxid solution decomposed the tablets, yielding iron in an
  insoluble form and a solution of alkali ferrocyanid, as demonstrated
  by the appearance of a deep blue precipitate on the addition of
  ferric chlorid solution. The portion insoluble in alkali when
  boiled with hydrochloric acid yielded a solution containing iron,
  approximately equivalent to 50 per cent. Prussian blue. These
  properties are all characteristic of Prussian blue, and, taken
  together, identify Prussian blue as a constituent of “hydrocyanate
  of iron (Tilden).” The insoluble residue from the iron determination
  possessed the properties and constituents of talc and constituted
  practically one-half of the tablets. Extraction of the tablets with
  chloroform or ether in the presence of ammonium hydroxid yielded
  a small amount of organic material which contained bodies having
  the properties of, and responding to tests for, quinin or cinchona
  alkaloids and caffein. The presence of a salicylate was also
  indicated.[95]

  [95] Details of the quantitative analysis of “Hydrocyanate of
  Iron--Tilden” appear in the annual report for 1909 of the Chemical
  Laboratory of the American Medical Association.

  From the analysis it is concluded that “hydrocyanate of iron
  (Tilden)” is essentially a mixture of approximately equal parts of
  talc and Prussian blue, containing traces of organic matter having
  the general properties of alkaloids.

Comment: When a firm exploits an abandoned remedy for so hopeless a
disease as epilepsy under a name not known to chemistry and with a
false representation of its pharmacologic qualities, such action may
rightly be assumed to show ignorance or worse. “Hydrocyanate of iron,”
if it means anything, means the cyanid of iron, but the preparation
put out under that name is, according to our chemists, not cyanid of
iron, but the ferrocyanid of iron commonly known as Prussian blue.
This substance has been tried for epilepsy and abandoned. Yet the firm
recommends it as a “peerless remedy” for this disease:

    “The Tilden Company holds the key to the situation in the treatment
    of epilepsy. We have the remedy that does the work.”

Not that epilepsy is the only disease for which this hypothetical
chemical compound may be prescribed. Torticollis has been “successfully
treated with hydrocyanate of iron.” In chorea, we are told “a richer
and better blood supply” should be furnished the nervous and vascular
system and “the irritation of the motor centers” must be allayed.

    “Hydrocyanate of iron serves admirably to accomplish both of these
    purposes. It carries the hemoglobin to the blood in its most easily
    assimilable form and its hydrocyanic acid possesses remarkable
    sedative powers....”

It is not possible for it to have any value in anemia because of its
insolubility, yet we are told:

    “In conditions marked by poverty of the blood producing anemia
    or chlorosis, reacting on the nervous system and calling for
    a chalybeate, hydrocyanate of iron (Tilden’s) takes a front
    rank among the remedies of this class, combining as it does the
    blood enriching qualities of ferrum with the sedative action of
    hydrocyanic acid.”

As Prussian blue yields no appreciable quantity of hydrocyanic acid
under the conditions existing in the animal organism, “the sedative
action of hydrocyanic acid” must be as hypothetical as the chalybeate
properties attributed to it.

It is strange that a manufacturer, in introducing a new chemical
compound, should have to assure his customers that it “contains no
opium or alkaloid of that drug, cocain, chloral hydrate, conium or any
of the bromids.” Imagine a firm putting, let us say, potassium iodid--a
definite chemical compound--on the market and solemnly guaranteeing
that it contained no cocain or chloral hydrate!

Would the Tilden Company of twenty-five years ago have served such
mental pabulum in its advertising matter?

One would think that the dictates of common humanity would protect
the unfortunate epileptic from the machinations of the nostrum maker,
especially from the exploitation of a remedy that has been tried
and found wanting. A nostrum, however, merely has to measure up to
one standard: Will it pay? Meeting this requirement nothing else
matters.--(_From the Journal A. M. A., June 19, 1909._)




                                HYMOSA

                    W. A. Puckner and W. S. Hilpert


Frequent requests for information regarding the composition of hymosa,
manufactured by the Walker Pharmacal Co., St. Louis, and a perusal of
the extensive and nostrum-like advertising the product is receiving,
made a chemical examination of this preparation seem desirable. If the
label is to be believed, hymosa has been of use in “acute and chronic
muscular and articular rheumatism, gout, sciatica, lumbago, pleurodynia
and neuralgia, whether due to uric acid diathesis or not ...”

The composition of hymosa as given by the proprietors is set forth in
the following statement:

    “... Hymosa, in which the remedies Frangula, Actea Spicata,
    Stellaria Media, Franciscea Uniflora, Rhus Toxicodendron,
    Passiflora Incarnata, Phytolacca Decandra and Echinacea
    Angustifolia are combined in the proportions which experience
    has shown will obtain the quickest and best results without any
    of the stomach and heart complications so often following the
    administration of salicylic acid.”

    “Contains no Salicylic Acid.”

Thus the explicit statement is made that hymosa contains certain
vegetable drugs (most of them obsolete and valueless) and that it does
not contain salicylic acid. By inference the claim repeatedly is made
that the nostrum does not contain any salicylates.

    “... Hymosa has achieved most remarkable results in overcoming
    rheumatism in cases where salicylates have been tried in vain ...”

    “Salicylic acid was not successful in this case of rheumatism of
    the stomach.”

    “Negative results from salicylates--Hymosa cures.”

    “... the salicylates didn’t help? Then we must try Hymosa.”

Still harping on the undesirability of salicylates and the value of
hymosa the advertising pamphlets state:

    “Salicylic Acid Replaced. The Use of This Dangerous Agent in
    Rheumatism Obviated.”

    “It seems that the use of the dangerous and ineffective salicylic
    acid will soon be given up and hymosa take its place.”

    “Former methods of treating rheumatism ... have been very
    unsatisfactory ... because of the heart and stomach difficulties
    brought on by salicylates of which most rheumatism remedies are
    composed.”

    “Could not tolerate the salicylates.”

Finally in a letter issued to physicians we are told:

    “... you will find hymosa to possess prompt and positive curative
    action with the additional advantage of avoiding the heart and
    stomach complications, which the salicylates too often cause.”

It is evident from the above quotations, in which the salicylates are
denounced specifically or by implication, and from the label which
states that no salicylic acid is present, that the exploiters of the
nostrum deliberately intended to give the impression that hymosa is
free from salicylates or salicylic acid and contains only the vegetable
or plant drugs enumerated. The very fact that the proprietors make
such repeated efforts to give the impression that hymosa is free from
salicylates is in itself sufficient to arouse suspicion and hence in
the examination particular attention was given to the detection of
salicylic acid or salicylates with the following results:

[Illustration: Reproduction (reduced) of an advertisement of Hymosa.
This indicates the attempt made to convey, by implication, the idea
that the salicylates are absent from Hymosa.]

  _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.

  [96] Details of this analysis appear in the annual report for 1910 of
  the Chemical Laboratory of the American Medical Association.

  From the results of the analysis it is believed that the preparation
  has approximately the following composition:

    Salicylic Acid                0.32 gm.
    Sodium Salicylate             1.15 gm.
    Potassium Iodid               0.32 gm.
    Sugars and extractives        4.60 gm.
    Alcohol, U. S. P.            16.86 c.c.
    Water to make               100.00 c.c.

These results indicate that hymosa is essentially a solution containing
salicylic acid, sodium salicylate, potassium iodid, alcohol, sugars and
plant extractives in the proportions given above, and show that the
various statements referred to, regarding the absence of salicylic acid
and salicylates are misleading and untrue. It further illustrates the
repeatedly demonstrated fact that nostrums exploited as wonderful and
new discoveries are new in name only--and whatever therapeutic value
they possess depends on old and tried medicinal agents.

[Editorial Note: In describing the methods employed by the
manufacturers of Manola in exploiting their product, attention was
called to the fact that the Manola Company was reported as being a
subsidiary affair of the Luyties Homeopathic Pharmacy Company of St.
Louis. It is reported that this same company also operates the Walker
Pharmacal Company, which exploits Hymosa and Psa-avena.]--(_From the
Journal A. M. A., June 11, 1910._)




                  MICAJAH’S MEDICATED UTERINE WAFERS

                    W. A. Puckner and W. S. Hilpert


Evidently touched by the generosity of the manufacturer in sending him
a sample and literature, but not too favorably impressed by the claims
made for the preparation referred to, a correspondent writes:

  I enclose a valuable sample and literature just received. Such a
  palpable humbug as Micajah’s Uterine Wafers would hardly seem to need
  notice were it not probably true that many practitioners habituated
  to the use of samples are still influenced by the glowing accounts of
  cures wrought; especially when attested by such a name and title as
  “Elmore Palmer, M.D., Ex-President Western New York Medical Society.”
  This secret gynecologic medicament is recommended for anything
  from “Pruritis Vulvæ,” “Enlargement of the Womb,” “Displacements,”
  “Cystocele and Rectocele,” to the “Menopause.”

  Following the definition that by her “stomach” a woman means anything
  from her chin to her knees, the ex-president with truly noble
  impartiality has with the wonderful Micajah wafers wrought lightning
  cures all the way from “stone-bruise” of the heel to nasal polyp and
  influenza, and some of them are male patients too.

With the foregoing as an impetus to investigate the nature of this
much advertised nostrum, the wafers were submitted to analysis by the
Association laboratory. The report follows:

                          LABORATORY FINDINGS

  Trade packages of the wafers purchased on the open market bear the
  name of the preparation and that of the manufacturers, Micajah & Co.,
  Warren, Pa. The label states that the nostrum is a:

    “Disinfectant, astringent and local alterative of the greatest
    virtue. A remedy for the local treatment of the diseases of women.
    Inflammation, engorgement and prolapse of the womb, vaginitis,
    leucorrhea, menstrual derangements and the disturbances incidental
    to the menopause. Also highly recommended for affections of the
    mucous membranes in general, particularly those of the nose, the
    throat, the rectum, and for gonorrhea, cystitis, etc.”

    “This box contains wafers for three months’ treatment.”

    “Price per box $1.00.”

The box contained 25 tablets, and a circular entitled, “Hints on the
treatment of diseases of women,” in which directions for the treatment
of many diseases are given. It ends with a paragraph which contains the
following statement:

    “There is no doubt that the field of usefulness of Micajah’s Wafers
    can be indefinitely enlarged by the ingenuity and therapeutic skill
    of the physician.”

Much of the advertising “literature” is in the form of leaflets,
brochures and small pamphlets full of testimonials by physicians.

Micajah’s uterine wafers as found on the market are white, hexagonal
tablets, odorless and possessing an astringent taste. The wafers are
soluble in water with extreme difficulty. Hot hydrochloric acid and
alkali hydroxids dissolve the powdered tablets readily, leaving a
slight residue which under the microscope and by physical tests was
identified as lycopodium.

The acid solution of the wafers responded to qualitative tests which
indicated the presence of potassium, sodium, aluminum sulphate,
borate and a mere trace of a fatty material. Quantitative estimation
of boric acid, aluminum sulphate, sodium and potassium were made,
which indicated that Micajah’s Uterine Wafers consist of alum more or
less anhydrous or “burnt,” boric acid and borax in approximately the
following proportions:[97]

[97] Details of this analysis appear in the annual report for 1910 of
the Chemical Laboratory of the American Medical Association.

    Alum, dried             59.86 per cent.
    Borax, dried            15.62 per cent.
    Boric acid               5.67 per cent.
    Water of hydration      18.85 per cent.

The average weight of the tablets is 0.7791 gm (11.8 grains) and
allowing for the fact that the quantity of water present in commercial
exsiccated alum varies, each tablet would contain approximately
0.4986 gm. (7.8 grains) burnt alum; 0.2337 gm. (3.6 grains)
crystallized borax, and 0.0467 gm. (0.7 grain) boric acid.

                                COMMENT

Judging from the “literature” that goes with the packages of this
nostrum, one might imagine that it was put up absolutely for the
layman, but this is not the case. It is advertised only in medical
journals and not directly to the public. But direct advertising to
the public is not necessary; for every physician who prescribes these
wafers at the same time places in the hands of his patient advertising
matter intended to influence that patient--and it usually does. As a
result this preparation is being bought by the public direct. To what
extent we do not know, but physicians are responsible for it. Probably
if physicians realized that the same interests that control Piso’s
Consumption Cure also control Micajah’s Medicated Uterine Wafers they
would not be so ready to act as the unpaid agents for the concern.

That such simple astringents and feeble antiseptics as alum, borax
and boric acid could have such remarkable curative effects on uterine
diseases is absurd. The serious aspect of the matter is, that, by
the encouragement given them in the advertising literature to treat
themselves, women may neglect proper surgical or medical attention in
the early stages of serious diseases such as cancer or dangerous pelvic
infections, until they get beyond the hope of proper management. But
when nostrum promoters urge the use of such inefficient remedies in the
treatment of gonorrhea, it is time to look at the matter seriously.
Considering the vital social significance of the venereal diseases,
the employment of useless remedies can only favor the spread of these
infections, which cause such a large proportion of the diseases which
afflict women particularly.

The medical profession for the most part has become mentally calloused
to the exaggerated claims of the nostrum makers and does not make
sufficient effort to condemn them. There may be some physicians,
however, who use such preparations as these wafers in their practice,
as is indicated by the circulars wherein the manufacturers suggest
that their “usefulness can be indefinitely enlarged by the ingenuity
and therapeutic skill of the physician.” It is only occasionally that
a physician voices his indignation as to these humbugs, as in the case
of the physician whose letter is quoted above.--(_From the Journal
A. M. A., March 26, 1910._)

The Firm Replies

  _To the Editor_:--We have read with interest the report of your
  committee on pharmacology recently published in The Journal, on the
  subject of Micajah’s Medicated Uterine Wafers, and your comments
  thereon.

  We are of the opinion that, in your laudable efforts to reform the
  practice of pharmacology, it is not your desire or intention to act
  other than justly and fairly, and therefore, with this belief, we
  submit the following statements for your consideration, with the hope
  that you will see fit to publish them.

  1. We do not seek by word or deed the patronage of the laity, and
  what few sales are made to the public are not of our contriving,
  nor should we be held responsible for them, any more than is the
  manufacturer of quinin to be blamed for the universal use of that
  drug.

  2. Our literature should not be considered extravagant, for it is for
  the most part made up of clinical reports received from physicians
  and based on the unsolicited testimonials in our possession from
  hundreds of practitioners, many of whom have used Micajah’s Wafers
  in practice from five to twenty years and they are therefore as well
  grounded as are the clinical reports concerning any preparation.

  3. In the past year we have endeavored to place our preparation on a
  higher ethical basis by stating in our advertisements what our wafers
  contain, and by eliminating whatever seems to us open to criticism.

  4. That the ingredients of the preparation are “simple” is no reason
  for considering them valueless. H. A. Kelly, in his work on medical
  gynecology, page 266, recommends these ingredients in a variety of
  conditions. Bandler also made important recommendations bearing on
  this subject in his “Medical Gynecology,” 1909 edition, page 472. We
  feel we have the right to recommend this preparation for these and
  similar conditions, especially when our statements are backed up by
  the clinical experience of numerous general practitioners.

  5. That the owner of Micajah’s Wafers holds stock in a corporate
  firm which manufactures proprietary medicines and toilet articles,
  advertised to the laity, should not militate for or against our right
  to market a meritorious preparation on strictly ethical lines to the
  medical profession, inasmuch as many of the largest drug houses cater
  to both the doctor and the proprietary interests, and several are
  actively engaged in exploiting so-called nostrums.

  6. We enclose a recent advertisement which has been accepted after
  investigation of our methods by careful medical journals, and we now
  believe we are conducting our business in entire conformity with the
  best interests of the medical profession and we feel certain of the
  true merits of our article.

                                         Micajah & Company, Warren, Pa.

[Comment: This letter brings out still more strongly the points raised
in the article which appeared in The Journal, March 26, 1910. Being
unable to analyze motives we must perforce, accept Micajah & Co.’s
statement that they “do not seek by word or deed the patronage of
the laity.” In the comments on the laboratory’s report it was very
explicitly stated that this nostrum was advertised only in medical
journals and not directly to the public. Inasmuch, however, as the
container in which this product comes has printed on it the various
diseases in which the “wafers” are indicated, as, moreover, within the
container there is a leaflet which describes in detail the use of the
preparation in a list of pathologic states varying from “enlargement
of the womb” to “gonorrhea in the male,” and, finally, as the name
“uterine wafers” would seem in itself to be a plain bid to the public,
we still maintain that “one might imagine that is was put up absolutely
for the layman.”

The proposition that advertising matter should not be considered
extravagant because it is largely “made up of clinical reports received
from physicians” is an argument that is as old as the nostrum business
itself--and as fallacious as it is old. Unfortunately, as our files
show, the most extravagant statements made for proprietary products
frequently emanate from men who legally are entitled to write M.D.
after their name. The fact that it is not the manufacturer but a
Buffalo physician who tells of the marvelous results he obtained from
the use of Micajah’s Medicated Uterine Wafers in forty-three cases
comprising no fewer than thirty-six pathologic conditions from “otitis
media” to “injured toe,” and from “bunion” to “ophthalmia neonatorum”
does not exempt the firm that prints such stuff from the charge that
its “literature” is not merely extravagant, but ridiculously so.

As Micajah & Co. say, because the ingredients of their preparation are
simple is no reason for considering them valueless. On the contrary, if
the “wafers” were truthfully exploited for what they are and what they
will do, their very simplicity would be a virtue. But such has not been
done. And therein lies the viciousness of nostrums. Simple mixtures of
well-known drugs are foisted on the medical profession with no hint as
to their composition and with claims made that are not only false, but
would immediately be recognized as absurd, if their actual composition
were known.

That a mixture of borax and alum may be of value in some of the
simple ailments of the female genital tract can easily be granted.
That relief might follow the use of suppositories made of these
ingredients--especially when supplemented by an increased attention to
simple cleanliness--can also be admitted. To say, however, that such
medicaments will quickly and permanently cure gonorrhea, urethritis,
endometritis, etc., is foolish, false and vicious.]--(_From the Journal
A. M. A., April 16, 1910._)




                           NOITOL AND ANADOL

                    W. A. Puckner and L. E. Warren


                                Noitol

The Journal received an inquiry concerning the composition of Noitol,
a preparation which is being advertised to the medical profession as a
“specific” for the cure of eczema and certain other cutaneous diseases.
The preparation is manufactured by the Wheeler Chemical Works, Chicago.
Trade packages of Noitol were purchased and examined in the Association
laboratory. On the label of the package, Noitol--an inversion of the
word “lotion”--is described as follows:

    +--------------------------------------------------------------+
    |                            NOITOL                            |
    |               (Dr. Bradbury’s Eczema Lotion.)                |
    |                For External Application Only!                |
    |                 Our Most Popular Specialty.                  |
    | A specific for the cure of Eczema, Scrofulous and Syphilitic |
    | Eruptions, Lupus, Salt Rheum, Tetter, Itch. This remedy is   |
    | composed of valuable Oils, combined with Vegetable and       |
    | Mineral Acids in such proportions as cause a rapid and       |
    | permanent cure of the above complaints.                      |
    +--------------------------------------------------------------+

Noitol is a clear, nearly colorless, acid solution, the greater portion
of which is water. Its specific gravity is 1.0097 at 25 C.

Qualitative tests demonstrated the presence of a chlorid, a nitrate, a
mercuric salt, free acid and glycerin. No “oils” or “vegetable acids”
could be found.

Analysis[98] of the preparation indicated that its composition is
essentially as follows:

[98] Details of this analysis are published in the annual report for
1910 of the Chemical Laboratory of the American Medical Association.

    Mercuric Chlorid            0.0463 gm. in 100 c.c.
    Mercuric Nitrate            0.0450 gm. in 100 c.c.
    Glycerin                    1.3021 gm. in 100 c.c.
    Nitric Acid                 1.0265 gm. in 100 c.c.
    Water (by difference)      98.5545 gm. in 100 c.c.

From the above it appears that Noitol is simply a weak, acid solution
of mercury salts--the total being approximately equivalent to a 1 to
1,000 bichlorid of mercury solution--exploited under a meaningless
name. It is but one more example of the old, old story of a well-known
remedy being sold at a high price under a name which is in no way
indicative of its composition, and under claims which are absurdly
false.

The price of the mixture is $2.00 a pint; the estimated cost, exclusive
of the container, is about 6 cents a gallon, or, put another way:
the price of a pint bottle, it is estimated, would make a barrel (31
gallons) of the nostrum. The incorrect statement concerning its
components, the unwarranted therapeutic claims made for it, and the
exorbitant price easily place Noitol in the front rank among the
“patent medicine” frauds. Yet it is advertised to physicians as an
ethical proprietary and is evidently being prescribed by them.


                                Anadol

In the circular matter accompanying the trade package of the
preparation, “Noitol,” described above, a preparation called “Anadol”
is described. Anadol is claimed to be an analgesic and antipyretic.
In the descriptive circular there is no information concerning the
composition of the preparation, but from the general therapeutic
description the physician might easily be led to believe that “Anadol”
is a distinct chemical substance.

To reduce temperature the physician is advised to push the
administration of Anadol in 10 grain doses until the febrile condition
is under control or until a maximum of 70 grains of the preparation has
been ingested. The circular further states:

    “... in this lies the special value of ANADOL; there are no
    annoying by-effects; the stomach bears the remedy well and neither
    circulation, respiration, nor the nerve centers show the least
    disturbance.”

As no evidence could be obtained concerning the composition of Anadol
and, as the preparation is being brought to the attention of physicians
by means of circulars in connection with the distribution of Noitol,
it seemed worth while to take up its examination in the Association
laboratory. Accordingly a trade package of the material which had
passed into interstate commerce was purchased.

Qualitative tests demonstrated the presence of sodium, a carbonate,
caffein and acetanilid, the latter in considerable quantities.
Analysis[99] indicated that the composition of the specimen examined is
essentially as follows:

    Acetanilid                79 per cent.
    Caffein                    1 per cent.
    Sodium bicarbonate        20 per cent.

[99] Details of this analysis are published in the annual report for
1910 of the Chemical Laboratory of the American Medical Association.

Since, according to the circular, it is permissible to prescribe 70
grains of this preparation within 2-1/2 hours, a patient thus treated
would receive no less than 55 grains of acetanilid! In view of the
numerous cases of poisoning due to the misuse of acetanilid (“The
Harmful Effects of Acetanilid, Antipyrin and Phenacetin,” U. S. Dept.
Agric., Bur. Chem., Bull. No. 126) the physician should be apprised of
the composition of Anadol.

[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._)


                      Anadol Declared Misbranded

Anadol was analyzed at the Bureau of Chemistry and the chemists
reported that it contained over 82 per cent. of Acetanilid. As the
labels did not bear any statement as to the quantity of acetanilid
contained in the nostrum, the stuff was declared misbranded and the
defendant, on pleading guilty, was fined.--[_Notice of Judgment No.
795._]




                              PIX CRESOL

                    W. A. Puckner and W. S. Hilpert


In a paper on “The Abuse of Chemical Formulas”[100] several examples
were given of the various methods employed by “patent-medicine”
concerns to give standing to their products by assigning to them a
chemical formula. In some cases the formulas given are impossible,
in other cases they may represent the chemical composition of only
one constituent or it may be an attempt at both. To a chemist such
formulas are absurd and on seeing a formula which he knows to be
wrong he naturally thinks “Fake,” “Ignorance,” or both. Just such
a formula (C_{5}H_{6}N.SO) applied to a product called Pix Cresol,
manufactured by the Pix Cresol Chemical Co., Kansas City, Mo.,
attracted our attention. No mention of such a formula can be found in
such works as Richter’s most complete Index of Carbon Compounds, nor
the three supplemental volumes published, 1901-1905, by the German
Chemical Society and Beilstein’s Organic Chemistry (3d Ed.). This fact,
supplemented by inquiries from correspondents as to the composition of
the substance made it seem worth while to make a chemical examination
of it.

[100] Puckner, W. A.: Report of the Chemical Laboratory of the American
Medical Association, iii, 7.

The examination was made and showed that the essential constituent
was oxyquinolin sulphate. As potassium sulphate was also found it
was concluded that Pix Cresol was a preparation containing a mixture
of oxyquinolin sulphate and potassium sulphate, which has also been
known in the past under the proprietary name, “Chinosol.” At this
time a letter was referred to the laboratory containing the report of
an analysis of Pix Cresol, which showed the presence of oxyquinolin
sulphate but no potassium sulphate. As this indicated that Pix Cresol
contained as its essential constituent the substance now sold as
Chinosol, the laboratory purchased a new specimen of Pix Cresol from
the Chicago representative of the Pix Cresol Co. The examination[101]
of this specimen showed that it consisted of approximately 21 per cent.
oxyquinolin sulphate, about 8.3 per cent. potassium sulphate and the
remainder almost entirely milk sugar.

[101] The analytical details will be published in the annual report of
the laboratory.

It is evident, then, that both the specimen of Pix Cresol obtained
directly from the manufacturers and also the one purchased more
recently from the Chicago agent, contain as an essential constituent
Chinosol of the composition sold formerly. The substance now sold under
the name Chinosol and described in New and Nonofficial Remedies is pure
oxyquinolin sulphate, and as the exploiters of Pix Cresol probably
obtain their supply of oxyquinolin sulphate from the Chinosol Company,
the sole American agents for Chinosol, it is to be expected that Pix
Cresol should change in composition. It is probable that the analysis
referred to the laboratory deals with a more recent specimen than the
two examined in the Association laboratory.

Editorial Note: In view of the Council on Pharmacy and Chemistry’s
findings, viz., that chinosol is a powerful antiseptic but a feeble
germicide and considering that Pix Cresol contains but 21 per cent.
oxyquinolin sulphate, the absurdity of the following claims made for
Pix Cresol require no further comment:

    “Pix Cresol is an Absolutely Sure and Yet Perfectly Safe, Never
    Failing Destroyer of Pus (_Staph. Pyogenes Aureus._)”

    “It is germicidal, bactericidal, bacillicidal. It is certain as a
    micro-organism destroyer. It destroys absolutely.”

    “Ridding the blood of germs, it aids in rendering it replete with
    oxygen----.”

    “It kills the germs.”

    “No organism that is causative of morbid processes can withstand
    it.”

    “It destroys micro-organisms of all kinds. It destroys them
    absolutely.”

    “The germ’s tenacity of life does not avail against its action as
    germicide.”

    “It destroys the spores and toxins utterly.”

A further estimate of the pseudo-chemical company, bearing the name
of this “strongest, safest, least expensive medical antiseptic,
disinfectant and deodorizer known” may be gained by a cursory glance at
some of its “specialties”:

“Maizinin compound, Positive Chill and Malaria Specific” the firm says,
“prepares the parasites for execution by the leukocytes.” It is said to
contain arsenic, while the name implies the presence of some plant drug.

“Psora, the Syphilis Specific,” is a shot-gun mixture said to be
“the scientific combination of the soluble Triple Iodids with the
active principles of Echinacea, Cascara amagra, Berberis aquif., and
Phytolacca rad.,” and is claimed to make “the syphilitic lesions
disappear and fail to return.”

“Rectoids--Cones for the treatment of all rectal trouble,” are said to
be “a combination of Rectin (Pix) compounded from Buckeye, Collinsonia,
Hamamelis, Belladonna, Pix Cresol.”

“Tablets for the Female--Pix Cresol Uterettes,” it is said, “for
sanitary purposes may be continued forever ...”

When one realizes that this sort of pseudo-scientific twaddle is
accepted by many physicians at its face value, the outlook for
therapeutics seems dark, indeed. So long as the existence of such
concerns is tolerated by the medical profession, so long will
there be a crying need for a “Propaganda for Reform in Proprietary
Medicines.”--(_From The Journal A. M. A., June 10, 1911._)




                               SALIODIN

                     W. A. Puckner and A. H. Clark


[The Council on Pharmacy and Chemistry refused recognition to Saliodin
because it conflicts with Rules 1 and 6, and directed publication of
the following.

                                             W. A. Puckner, Secretary.]

Saliodin is sold by the Saliodin Chemical Co., Scranton, Pa. In the
literature and on the trade package the following “formula” is given:

    +----------------------------------------------------------+
    |                        FORMULA                           |
    | Each Grs. XX of Saliodin contains approximately:         |
    | ℞                                                        |
    | Salicylic Acid, (Aceto-Salicylate)               Grs. XV |
    | Iodine, (Iodate) Equivalent to Iodide Potass     Grs. XV |
    | Acetic Acid, (Acetate) Equiv. to Acetate Potass   Grs. V |
    | Aconite         Equiv. to ?? Tr. Aconite R.     Gtts. IV |
    | Bryonia           "    "  ??   Tr. Bryonia,     Gtts.  V |
    | Colchicum         "    "   Vin Colchicum R.     Gtts. XV |
    | Capsicum          "    "      Tr. Capsicum      Gtts. II |
    | Oil Gaultheria    "    "                           ♏ III |
    +----------------------------------------------------------+

This formula being indefinite and vague, the examination of saliodin
was taken up in the Association laboratory.

  From the analysis we calculate the composition of saliodin to be
  approximately equivalent to a mixture of:

    Sodium salicylate                                 57.54
    Potassium iodid                                    1.18
    Potassium acetate                                 30.00
    Matter volatile at 130° (oil of anise, oil of
      gaultheria, moisture, etc.)                      8.10
    Undetermined (extractive?)                         3.18
                                                     ------
                                                     100.00

  The analysis shows that the formula is not only indefinite and vague,
  but incorrect and false.

  To emphasize the incorrectness of the published formula the following
  comment on its first two items is offered:

  In the “formula” it is stated that 20 grains of saliodin contain
  approximately “salicylic acid (aceto-salicylate) Grs. XV.” The
  statement is not clear, but conveys the impression that 20 grains
  of saliodin contain an amount of aceto-salicylate, a salt of
  acetyl-salicylic acid (aspirin), equivalent to 15 grains of salicylic
  acid. But the chemical examination shows that it contains neither
  acetyl-salicylic acid, nor salt of acetyl-salicylic acid, nor even
  salicylic acid itself. In the place of these, the analysis shows that
  over half of saliodin is the common, every-day sodium salicylate.

  [Illustration:

    +---------------------------------------------------------------+
    | It is an “Iodated, Aceto-Salicylate with Adjuvants,” and the  |
    | SPECIFIC treatment for every form of URIC ACID DIATHESIS.     |
    | “Saliodin” is a SOLVENT and ELIMINANT of URIC ACID and is a   |
    | happy combination of ℞ Salicylic Acid, Iodine, Acetic Acid,   |
    | Aconite, Bryonia, Colchicum, Capsicum and Gaultheria and      |
    | chemically appears in the form of a PINK, GREYISH POWDER      |
    | soluable in water 1 to 3--dose grs. X to grs. XXX; for the    |
    | EXCLUSIVE USE OF PHYSICIANS--put up in one ounce bottles;     |
    | price PER OUNCE $1.50. Is manufactured ONLY by the Saliodin   |
    | Chemical Co. “SALIODIN is SPECIFICALLY indicated in           |
    | RHEUMATISM, GOUT NEURALGIA, MALARIA and LA GRIPPE; is         |
    | ANALGESIC, ANTIPYRETIC; an INTESTINAL ANTISEPTIC, DIAPHORETIC,|
    | DIURETIC, EXPECTORANT, DEOBSTRUENT, SIALAGOGUE, CHOLAGOGUE,   |
    | EMMENAGOGUE, ANTI-SYPHILITIC, GONOCOCOCIDAL, PARASITICIDAL,   |
    | ASEPTIC, BACTERICIDAL and ALTERATIVE. Doctor, you  may        |
    | prescribe Saliodin with confidence wherever IODINE or a       |
    | SALICYLATE is indicated. Used both internally and externally. |
    +---------------------------------------------------------------+

  Reproduction (much reduced) of a paragraph in the advertising
  pamphlet on Saliodin. Note the twenty-one indications for Saliodin.
  Lest some condition might be overlooked, we are advised to use it
  “internally and externally.” Isn’t this scientific therapy?]

  According to the “formula,” each 20 grains of saliodin contains
  “iodin (iodate), equivalent to iodid potass. Grs. XV.” This
  statement, too, is vague, but conveys the impression that 20 grains
  of saliodin contain an amount of iodin, in combination as an iodate,
  which corresponds in iodin content to 15 grains of potassium iodid.
  But the analysis shows that the product does not contain any iodate
  whatever, and that the amount of iodin contained in it is sufficient
  to account for only 1/4 grain of potassium iodid in each 20 grains of
  saliodin.

                               COMMENTS

The above report is published simply as another example of the “ethical
proprietaries” that physicians are asked to prescribe. It is not
unique. It is neither better nor worse than hundreds of others.

To show what absurdities appear in the “literature” (?) that is sent to
physicians, we reproduce a paragraph from an advertising pamphlet. The
promoters’ statement as to the composition of the product is absurd,
but not more so than are the claims made for it as a therapeutic agent.
There is not a “patent medicine” on the market for which any more
blatant, extravagant and ridiculous claims are made.

The manner of exploiting saliodin is another illustration of the
tendency on the part of nostrum-makers to advertise their wares through
pseudo-scientific articles published in a certain class of medical
journals. In the pamphlet sent out by the Saliodin Company appears
a reprint of an article from the Philadelphia _Medical Summary_ of
February, 1905. It is entitled “A Similarity in the Etiologic Factors
of Rheumatism and Malaria,” and was written by J. C. Denston, M.D. In
it occurs this statement: “The manufacturers (of saliodin) publish
their formula and, _I think_, distribute samples and literature on
request.” The charming ingenuousness of this statement is fully
realized when it is understood that J. C. Denston is the president of
the Saliodin company. This is also another illustration of what is
now a common occurrence, viz.: men who are engaged in manufacturing
proprietary products and who have an M.D. degree use that degree as a
commercial asset, and by this means the average reader is led to think
that articles written by them in praise of their own products are
spontaneous tributes from practicing physicians.--(_From The Journal
A. M. A., Oct. 26, 1907._)




 THEOBROMIN SODIUM SALICYLATE VERSUS “DIURETIN”: THE ECONOMICAL ASPECT

                    W. A. Puckner and Paul N. Leech


The following inquiry is from Dr. Reid Hunt, recently appointed
professor of pharmacology at Harvard Medical School:

  “Have you ever made an examination of the theobromin sodium
  salicylates on the market to determine if they are identical with
  ‘Diuretin?’ The description of theobromin sodium salicylate in
  New and Nonofficial Remedies agrees with the statements as to the
  composition of Diuretin, but I wondered if, at times at least,
  the theobromin sodium salicylate on the market might be a simple
  mixture of theobromin and sodium salicylate just as the Caffeinae
  Sodio-Salicylas, N. F., seems to be a simple mixture. Diuretin is
  quoted in current price-lists at $1.75 an ounce, whereas the price
  of theobromin sodium salicylate is only 35 cents an ounce. Many
  hospitals use diuretin, and both physicians and students often have
  only hazy ideas as to what it is. If the preparations of theobromin
  sodium salicylate now on the market are identical with Diuretin they
  should certainly be used, not only because they are less expensive,
  but because the descriptive name will continually remind the
  physicians of what they are using.”

Theobromin for some time has been regarded as a valuable therapeutic
agent. The obstacle to its use has been its insolubility and the
consequent uncertainty of the degree of its absorption. For this reason
a soluble salt of theobromin, theobromin sodium salicylate, first
introduced and advertised under the proprietary name “Diuretin,” has
come to be used to a considerable extent.

Theobromin sodium salicylate--also called theobromin and sodium
salicylate--is prepared by interaction, in molecular proportions, of
theobromin, sodium hydroxid and sodium salicylate, the theobromin
first being treated with sodium hydroxid in the presence of a suitable
solvent, then the sodium salicylate added and the whole brought to
dryness. The soluble compound which is formed is generally considered
to be a double salt of theobromin sodium and sodium salicylate.

Theobromin sodium salicylate is described in New and Nonofficial
Remedies and in several foreign pharmacopeias. It is also to be
described in the forthcoming United States Pharmacopeia.

Although the product is not controlled by patents of any kind, and
although it is offered for sale under its chemical name by the
leading chemical manufacturers at from 35 to 45 cents per ounce, the
proprietary product, Diuretin, sells for $1.75 an ounce. This is
probably because the manufacturers think that those who have been using
it under its chemically non-descriptive but therapeutically suggestive
title, Diuretin, will remain ignorant of the fact that the same product
is on the market under its chemical name. In view of these conditions,
emphasized by Dr. Hunt’s letter, it was deemed important to examine
the market-supply of theobromin sodium salicylate and to compare the
several specimens with the proprietary brand Diuretin.

The following specimens, purchased in 1-ounce original packages, were
examined:

Diuretin, “Knoll,” Knoll & Co.

Theobromine and Sodium Salicylate, Mallinckrodt Chemical Works.

Theobromine and Sodium Salicylate, Merck & Co.

Theobromine and Sodium Salicylate Powder, Powers-Weightman-Rosengarten
Co.

Theobromine and Sodium Salicylate, “Roche,” Hoffmann-La Roche Chemical
Works.

Theobromine and Sodium Salicylate, Squibb, E. R. Squibb & Sons.

The theobromin content prescribed for theobromin sodium salicylate by
the various standards ranges from 45 to 50 per cent., that of New and
Nonofficial Remedies being the highest. A requirement of not less than
46.5 per cent. theobromin in the dried powder has been proposed for the
new U. S. Pharmacopeia.

The methods of quantitative estimation laid down by the various
authorities are all very similar and consist, in the main, of a
determination of water, of the sodium hydroxid, free and in combination
with theobromin, and of the theobromin itself. For the theobromin
estimation the following method was employed:

A weighed sample (about 2 gm) which had previously been dried, under
slightly reduced pressure, over sulphuric acid, to constant weight,
was dissolved in five times its weight of warm water. Two drops of
phenolphthalein were added, and the solution titrated with normal
hydrochloric acid. To the neutral solution, 1 drop of 10 per cent.
ammonium hydroxid solution was added, and the mixture allowed to
stand, with occasional stirring, for three and one-half hours at the
temperature of 15 C. The precipitate was filtered on a weighed Gooch
crucible, washed with just ten times the weight (of the original sample
taken) of water (temperature 15 C.) and the precipitate dried at
from 100 to 104. To the weight obtained, a correction factor (proved
satisfactory by quantitative extraction experiments on the filtrate) of
0.13 gm. was added, for every 2 grams of the original sample taken.

The full details of the examination will be published in the 1914
Reports of the A. M. A. Chemical Laboratory. The results of the
examination have been abstracted and are compiled in the accompanying
table:

                            SUMMARY OF ANALYSIS
  ============+==========+=======+=====+=====+========+========+========
              |          |Gm. in |Price|Mois-|Alkalin.|Theo-   |Theo-
              |Physical  |1-Ounce|per  |ture,|as NaOH |bromin. |bromin.
              |Appearance|Bottle |Ounce|Per  |on Dry  |in Dry  |in Orig.
              | [AQ]     |       |     |Cent.|Powder  |Powder  |Specimen
              |          |       |     |     |[AR] Per|[AR] Per|[AR] Per
              |          |       |     |     |Cent.   |Cent.   |Cent.
  ------------+----------+-------+-----+-----+--------+--------+--------
  Diuretin    |     3    |  28.5 |$1.75| 0.01|  10.44 |  48.61 | 48.61
              |Pure White|       |     |     |        |        |
              |          |       |     |     |        |        |
  Theo.       |     3    |       |     |     |        |        |
    Sod. Sal. |Pure White|  27.5 | 0.35| 1.89|   9.95 |  46.11 | 45.24
  M. C. W     |          |       |     |     |        |        |
              |          |       |     |     |        |        |
  Theo.       |     1    |       |     |     |        |        |
    Sod. Sal. |Pure White|  29.0 | 0.35| 0.48|  10.38 |  47.87 | 47.58
  Merck       |          |       |     |     |        |        |
              |          |       |     |     |        |        |
  Theo.       |     3    |
    Sod. Sal. |Pure White|  29.1 | 0.35| 2.46|  10.30 |  47.57 | 46.39
  P. W. R. Co.|          |       |     |     |        |        |
              |          |       |     |     |        |        |
  Theo.       |     3    |       |     |     |        |        |
    Sod. Sal. |   Pink   |  28.6 | 0.35| 2.27|   9.92 |  49.05 | 47.92
  Roche       |          |
              |          |       |     |     |        |        |
  Theo.       |     1    |       |     |     |        |        |
    Sod. Sal. |Pure White|  26.8 | 0.45| 0.39|   9.97 |  46.82 | 46.63
  Squibb      |          |       |     |     |        |        |
  ------------+----------+-------+-----+-----+--------+--------+--------

[AQ] In this column, 1, 2 and 3 denote the following:

1. Quite crystalline, under microscope.

2. Fairly crystalline, under microscope.

3. Not crystalline, under microscope.

[AR] Average of determinations.

While the results show some variation in the moisture content and also
in the actual theobromin content of the dried specimens, the variation
is unimportant. The products in their original state (undried), as
compared in relation to the theobromin content (the highest percentage
of theobromin being 48.61, the lowest 45.24), reveal a variation of
only about 3 per cent.--a variation which is negligible in the case of
drugs such as theobromin.

From the preceding investigation, it is concluded that (1) practically
there is no difference between the non-proprietary brands of
“theobromin sodium salicylate” and “Diuretin;” (2) the several
specimens examined were not simple mixtures of “theobromin” and
“sodium salicylate”; (3) essentially all the brands complied with the
standards laid down and can be rated as satisfactory; (4) “Diuretin,”
though sold at an exorbitant price, is not superior to the product
supplied under the descriptive term “theobromin sodium salicylate,” and
(5) “Diuretin” sells wholesale for $1.75 an ounce, against 35 cents
for the “theobromin sodium salicylate,” and therefore its employment
cannot be interpreted otherwise than as a useless and unnecessary
expense.--(_From The Journal A. M. A., April 4, 1914._)




                              UNGUENTINE

                     W. A. Puckner and A. H. Clark


Attention has been called at various times to the fact that the value
of a published “formula” to a proprietary remedy is in direct ratio
to the reliability of the manufacturer publishing it. When medical
journals first insisted on their advertisers letting physicians
know the contents of the remedies they wished to sell them, medical
literature reeked with formulas--some of them of weird and wonderful
design. Since the advent of the Food and Drugs Act, which requires
that labels shall approximate truthfulness, and particularly since
the Council on Pharmacy and Chemistry has investigated a number of
proprietary remedies, the publication of “formulas” is not so common.

Unguentine, manufactured by the Norwich Pharmacal Co., is one of those
remedies whose advertisement for years always included “a formula”;
more recently, however, this is not in evidence. In an advertisement
which appeared about ten years ago, the “formula” given is:

    “Carbolic acid                 2 per cent.
    “Ichthyol                      5 per cent.
    “Alum                   15 to 16 per cent.”

It was claimed that, by a special process of their own, the
manufacturers had eliminated most of the astringent properties of the
alum, rendering it non-irritant. It was also stated that “the base of
Unguentine is pure petrolatum.” Later the manufacturers seem to have
changed the composition of their product, or at least the “formula”
given in the advertisements was changed. Thus it appeared:

    “Alum                         15 per cent.
    “Zinc oxid                     5 per cent.
    “Carbolic acid                 2 per cent.
    “Ichthyol                      5 per cent.
    “Aromatics and antiseptic oils with specially
    prepared petrolatum and animal fat base.”

The introduction of zinc oxid, aromatic and antiseptic oils and
animal fat was a new feature. Somewhat later, and particularly since
the passage of the national Food and Drugs Act, no formula or other
statement regarding the composition seems to have appeared in the
advertisements in the medical press. In the 1906 price-list (p. 170)
the following formula appears:

    “Unguentine represents:
      “Alum (non-irritating)      15 per cent.
      “Phenol                      2 per cent.
      “Ichthyol                    5 per cent.
      “Zinc oxid                   5 per cent.
    “Aromatic and antiseptic oils, with especially
    prepared petrolatum and purified animal fat.”

In the price-list issued for 1908--after the Food and Drugs Act went
into effect--the following appears:

    “Unguentine represents:
      “Alum compound (non-irritating)
      “Phenol,
      “Ichthyol,
      “Zinc oxid,
    “Aromatic and antiseptic oils, with especially
    prepared petrolatum and purified animal fat.”

Thus the proportions are omitted, and alum becomes “alum compound,”
whatever that may mean.

In view of the conflicting statements made by the Norwich Pharmacal
Company, in regard to their leading specialty, Unguentine, and
especially because much stress was laid on the filing of their
“guarantee” under the Food and Drugs Act, it was decided to ascertain
of what Unguentine really consists.

From our analysis we conclude that Unguentine contains not alum but
aluminum acetate (small amounts of alum may be present as impurities
in the aluminum acetate), zinc oxid, or more probably impure zinc
carbonate, and that the entire quantity of both does not exceed 5 per
cent. It contains no ichthyol, or if any but the merest traces, and
less than 1 per cent. of phenol. The aromatic oils amount to not more
than approximately 1 per cent. in all. The ointment-base is, in the
main, petrolatum.

In Unguentine we have, therefore, another proprietary “specialty,”
regarding the composition of which indefinite, false or misleading
statements have been made--this irrespective of protestation of honesty
by the firm.--(_From The Journal A. M. A., March 27, 1909._)




                               URICEDIN

                     W. A. Puckner and A. H. Clark


In view of the results of investigations by Zernik of Uricedin as sold
in Germany, and because it is being advertised to physicians in this
country, an examination of this product was made in the laboratory
of the American Medical Association. Zernik’s report shows how this
remedy has varied in its composition as put on the market in Germany.
From their analysis the authors find that Uricedin is not a definite
chemical compound as is claimed, but is a simple mixture whose
composition is approximately:

    Sodium sulphate (anhydrous)         61.52 per cent.
    Sodium citrate (anhydrous)          29.62 per cent.
    Sodium chlorid                       2.13 per cent.
    Citric acid (anhydrous)              3.25 per cent.
    Moisture                             2.53 per cent.
    Undetermined                         0.95 per cent.
                                       ------
                                       100.00

Uricedin, therefore, is not a definite chemical compound as claimed,
but a simple mixture which consists essentially of sodium sulphate
(dried Glauber salt) 2/3, and sodium citrate 1/3. It is, therefore, a
typical nostrum, and, as it appears, one the composition of which is
changed from time to time to suit the whim of the manufacturer. The
therapeutic claims made for it are of the usual extravagant character.
According to a recent advertisement it is “used successfully for
Gouty Diathesis, urinary Calculi, Rheumatoid Arthritis,” “useful in
Migraine, Occipital Headache, Epilepsy, Hay Fever, Asthma,” etc. If
such a simple mixture will do all that this one is claimed to do, let
us use it, but prescribe its ingredients under their proper names.
Such a mixture would cost only a few cents a pound, but this nostrum
is listed at $1.25 a bottle of five ounces, or probably $1.75 at
retail, and this for the benefit of its foreign manufacturers and their
agents.--(_Abstracted from The Journal A. M. A., Nov. 23, 1907._)




                               URISEPTIN

                    W. A. Puckner and W. S. Hilpert


“Uriseptin,” manufactured by the Gardner-Barada Chemical Co. of
Chicago and claimed to be a “urinary antiseptic, uric acid solvent
and diuretic,” was examined in the laboratory of the American Medical
Association to determine to what extent the claims made for it are
justified.

The preparation as purchased in the open market bears a label which
presents the claims of the manufacturers, emphasized by the chemical
analysis duly signed by an analyst and attested by a notary.
Accompanying is a reproduction of part of the label.

[Illustration:

    +--------------------------------------------------+
    |                  ANALYSIS                        |
    |                                                  |
    |  Sample of “Uriseptin” manufactured by the       |
    |  Gardner-Barada Chemical Co., Chicago. Ill.,     |
    |  was found to contain:                           |
    |                                                  |
    |     Specific Gravity at 15.5 C        1.0716     |
    |     Total Solids                     20.42 p.c.  |
    |     Alcohol (Ethyl)                   7.66 p.c.  |
    |     Water (by Difference)            71.92 p.c.  |
    |     Total Ash                         1.46 p.c.  |
    |     Lithium Oxide                     0.50 p.c.  |
    |     Formaldehyde                      5.62 p.c.  |
    |     Acidity 100 cc equals 6.4 cc Normal Alkali.  |
    |                                                  |
    |     Sugars                              Present  |
    |     Couch Grass Extract                 Present  |
    |     Corn Silk Extract                   Present  |
    |                                                  |
    |  The Total Solids consist mainly of the sugars   |
    |  and extract of corn silk and couch grass. The   |
    |  couch grass and corn silk extracts were         |
    |  determined by taste and smell in comparison     |
    |  with authentic samples of same products. The    |
    |  Lithium Oxide and the Formaldehyde are in       |
    |  combination in the Uriseptin and together       |
    |  represent 26.77 grains per liquid oz. I remain, |
    |                        Yours very truly,         |
    |            (Signed)    Dr. Edwd. Gudeman.        |
    |                                                  |
    |  State of Illinois} _ss._                        |
    |  County of Cook   }                              |
    |                                                  |
    |  Subscribed and sworn to before me this 13th     |
    |  day of May, 1905.                               |
    |            (Signed)  Paul E. Buedefeldt,         |
    |                                Notary Public.    |
    +--------------------------------------------------+

    +---------------------------------------------------+
    |                     URISEPTIN                     |
    +---------------------------------------------------+
    |                      FORMULA                      |
    |                  (See analysis).                  |
    |                                                   |
    |  Each fluid ounce of Uriseptin contains           |
    |  Formaldehyde combined with Lithium dissolved     |
    |  in concentrated liquid extract of Corn Silk      |
    |  and Couch Grass, and will liberate a sufficient  |
    |  quantity of Formaldehyde (24 grains) to          |
    |  impregnate the daily secretion of urine (45-50   |
    |  fluid ounces) to a 1-1000 solution.              |
    |                                                   |
    |                    PROPERTIES                     |
    |                                                   |
    |       Urinary Antiseptic. Uric Acid Solvent.      |
    |                     Diuretic.                     |
    |                                                   |
    |                    INDICATIONS                    |
    |                                                   |
    |   Diseases of the urinary tract and their         |
    |  complications--Nephritis, Pyelitis, Urethritis,  |
    |  Gonorrhea, Gleet, Cystitis, Bacteriuria, Uremia, |
    |  Phosphaturia, Prostatitis. Diseases dependent    |
    |  on uric acid diathesis--Gout, Rheumatism,        |
    |  Calculus, Asthma and generally as an antiseptic  |
    |  and uric acid solvent.                           |
    |                                                   |
    |                        DOSE                       |
    |                                                   |
    |   Tablespoonful night and morning, or one to      |
    |  two teaspoonfuls four times a day, preferably    |
    |  in hot water.                                    |
    +---------------------------------------------------+

Reduced photographic reproduction of part of the Uriseptin label.]

Before the examination had extended very far it was found that
discrepancies existed between facts and claims, and by the time the
analysis was complete Uriseptin was found to be in the same class as
many other proprietary remedies that have been discussed in these
columns.

Our examination shows that the most misleading statement is that
concerning the “lithium-formaldehyd” compound the presence of which
is claimed, more or less directly, by both the manufacturers and the
analyst employed by the manufacturers. Although the chemical properties
of lithium and formaldehyd indicate in themselves that the existence
of such a compound would be most improbable, yet considerable time
was spent in searching the chemical literature for such a compound.
Thorough search, however, demonstrated that no such compound, nor any
that even approximated it, has been described.

The question then arose as to the form in which the lithium and the
formaldehyd are present. The statements regarding its properties as
a urinary antiseptic and the fact that the preparation is said to
liberate formaldehyd slowly in the bladder point strongly to the
presence of hexamethylenamin.

Tests[102] were applied to demonstrate whether the formaldehyd was
present as a lithium compound, and if not, whether it existed in the
form of hexamethylenamin. By these the presence of hexamethylenamin
was proved and the absence of formaldehyd in other combinations
demonstrated. This fact alone shows that the preparation is
deliberately marketed under a false claim, and it shows further that
the analysis on the label is worthless. The quantitative method of
analysis demonstrated the presence of 5.51 gm. hexamethylenamin per
100 c.c. (25.15 grains per fluidounce).

[102] These appear in the annual report for 1908 of the Chemical
Laboratory of the American Medical Association; they were also
published in full in Jour. Am. Chem. Soc., September, 1908; an outline
of the analysis appeared in The Journal A. M. A., Aug. 29, 1908.

Besides the hexamethylenamin, Uriseptin contains lithium and a
benzoate. Concerning the latter nothing is said in the analysis, whose
worthlessness is again demonstrated. By quantitative methods Uriseptin
was found to contain lithium and a benzoate in such proportions as
would indicate that the lithium and the benzoate radicle exist as
lithium benzoate. This fact is further indicated by the claims made for
the preparation regarding its properties as a uric acid solvent, for
which purpose lithium benzoate is often used. Again, the demonstration
that the formaldehyd present is in combination as hexamethylenamin
precluded any possible chemical combination between lithium and
formaldehyd and adds another strong point in support of the conclusion
that the lithium and benzoic acid are in combination as lithium
benzoate.

                              CONCLUSION

By chemical analysis the active ingredients of Uriseptin are shown
to be hexamethylenamin, approximately 5.5 gm. per 100 c.c. (about 25
gr. to each fluidounce), and lithium benzoate, approximately 0.70 gm.
per 100 c.c. (about 11 grains to each fluidounce), neither of which
compounds is mentioned in the advertising matter on the label or in
the so-called “analysis” on the label. The statements concerning the
composition of Uriseptin are false and appear to be a deliberate
attempt to mislead physicians.

Comment.--Investigation of the various “patent” and so-called “ethical
proprietaries” advertised to the public and to the medical profession
shows that those that have any value as therapeutic agents depend
for that value on some well known drug or drugs. Hence, while many
proprietaries have some virtue, the ingredients which are of any value
are so concealed by the coined and “near-scientific” names applied to
them that these drugs are usually unrecognizable. The many and various
acetanilid mixtures furnish examples of this class of proprietaries.
And now we find another example in that much advertised nostrum,
Uriseptin.

According to our chemists, the chief ingredients of Uriseptin are
hexamethylenamin and lithium benzoate. Hexamethylenamin is a valuable
so-called urinary antiseptic--probably one of the best we have. It is
a pity that more physicians do not know the value of this drug in and
of itself; it is a common ingredient of many proprietaries, and yet too
seldom prescribed under its true name. There is no reason for its being
given in the form of a nostrum; it requires no skill in compounding,
for it is best given in its powdered form, either in capsules or
otherwise. So that, like acetanilid, the old argument of the nostrum
men that the preparation needs skill in compounding will not hold. If a
physician wants to prescribe hexamethylenamin let him prescribe it in
its simplest and best form, and thus know exactly what he is giving.

Lithium benzoate also has its rightful place in the materia medica, but
not hidden in a proprietary mixture to be prescribed unknowingly. It
is hard to conceive of any one thing that operates more disastrously
against scientific therapeutics than the vicious practice of marketing
under proprietary names standard and valuable drugs, with their
identity purposely concealed. Yet how frequently it is done. Well-known
drugs of unquestioned worth are combined with those that are little
known and of doubtful value, or more likely absolutely worthless, the
mixture is put on the market under a high-sounding name and it is
exploited through physicians as a panacea for all kinds of diseases.

In this, as in so many other instances, an “analysis” made to order is
given to lend an air of apparent respectability and scientific standing
to the preparation or to its exploiters, with the object, of course,
of misleading physicians into thinking they are reading unbiased
testimony. In addition, the “literature” accompanying the preparation
is usually a jargon of pseudo-scientific verbiage put in to serve the
same purpose as the analysis--that of catching the careless physician.

This state of affairs will continue just so long as the medical
profession will tolerate it--and no longer. So long as members of our
profession will prescribe proprietaries on the statements of their
owners--as to both their composition and their therapeutic value--just
so long will pseudo-chemical and pseudopharmaceutical companies fatten
at the expense of the medical profession and to the detriment of the
public health.--(_From The Journal A. M. A., Aug. 29, 1908._)




                                ZEMACOL

                    W. A. Puckner and W. S. Hilpert


Attention has been called to the vague and mysterious statements
regarding a preparation called Zemacol, manufactured by the Norwich
Pharmacal Co., Norwich, N. Y. Because of the unsatisfactory statements
regarding the composition of the preparation, it was considered of
sufficient interest to make an analysis and determine its chemical
constituents. Accordingly specimens of the preparation were obtained
and examined.

The preparation Zemacol (Norwich Pharmacal Co.), as found on the
market, is a thick, pink, mucilaginous liquid, highly perfumed and
having besides a suggestion of a phenolic odor. The bottle bears a
label on which appear the following statements:

    “A colloidal emollient containing extract of the rete mucosum
    of the healthy yearling lamb, combined with glycerin, salicylic
    acid and other antiseptic and aromatic oils. Useful in eczema and
    diseases of the integument where cell destruction is a prominent
    factor.”

In the advertising matter the following claims are made:

    “An advance in animal therapy....”

    “... increases the nutritive activity of the cell tissue of the
    skin through the absorbable extract of the rete mucosum.”

    “... clinical tests show its efficacy in both the so-called moist
    and dry eczematous conditions of all parts of the cutaneous
    surfaces.”

    “... rich in animal cells.”

Since nothing could be found in the literature regarding the
therapeutic action of an extract of the rete mucosum of the sheep, it
was thought possible that the statements on the label were given simply
as a vague and mysterious means of indicating the presence of wool-fat
(lanolin), and tests were made to determine the presence or absence
of the latter substance. A substance was isolated from Zemacol which
had the physical properties of, and responded to some of the chemical
tests for, wool-fat; but it was found in such small quantities as to
indicate that it was not present as an active constituent. Since there
are no definite tests for the detection of serums or animal extracts
the presence or absence of these could not be demonstrated. Further
examination indicated the presence of salicylic acid, a gummy material,
having the properties of tragacanth and glycerin. It is practically
free from inorganic matter. By distillation a small quantity of oil was
isolated, which possesses the characteristic odor of the preparation.

Quantitative estimations[103] indicated the presence of the
above-mentioned constituents in approximately the following quantities:

[103] Details of this analysis appear in the annual report for 1910 of
the Chemical Laboratory of the American Medical Association.

                                                       Per Cent.
    Gummy matter having the properties of tragacanth      2.02
    Salicylic acid                                        0.67
    Matter having the general properties of wool-fat
      (lanolin)                                           0.20
    Glycerin                                              5.50
    Volatile matter (water and alcohol)                  91.00
    Aromatic oils and phenol-like bodies                 Trace

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:

  “So far as I know, nobody ever thought of or proposed the use of
  an extract of rete mucosum as a therapeutic agent and if a serious
  suggestion of that sort had ever been made I believe I would know it.
  I can conceive of no service which such an extract could render and
  I think the suggestion of it is a highly fantastic idea. From the
  analysis which you furnish I should say that the mixture described
  is substantially the ordinary 2 per cent. solution of tragacanth in
  glycerin and water with a little antiseptic added to keep it from
  decomposing. That is a commonly known lotion, modifications of which
  are used in practically every hospital as a hand lotion, and has no
  magical virtues whatever. Incidentally, I should think it cost, aside
  from the labor, about twenty cents a gallon to make it.”--(_From The
  Journal A. M. A., May 14, 1910._)




                               ZYME-OID

                    W. A. Puckner and W. S. Hilpert


Zyme-oid, manufactured by the Oxychlorine Chemical Company of Chicago,
is advertised as “a powerful gastro-intestinal antiferment” which
will “arrest and prevent bacterial fermentation in any portion of
the intestinal tract, whether the media be acid or alkaline.” These
extravagant statements, like many others made regarding the properties
of zyme-oid, are very similar in character to those made in the
circulars accompanying the preparation oxychlorine, manufactured by the
same firm and exposed in The Journal, July 6, 1907, page 54. (See page
147 of this book.)

As examples, several parallel statements help to show this similarity.
The formula (?) of oxychlorine, as expounded on the label, is given
in full, while in the case of zyme-oid only a hint is given as to its
composition, but still sufficient to point to a similarity between the
two:

             OXYCHLORINE                        ZYME-OID

    “Oxychlorine is a tetraborate     “Zyme-Oid is a double borate
    of sodium and potassium com-      salt.”
    bined with oxychlorid of boron,
    thus: (6NaKB_{4}O_{7}) BOCl_{3}.”

In the matter of claims for chemical stability the two seem to be very
closely allied:

    Oxychlorine is “a stable salt     Zyme-oid is “a product which is
    under all conditions until        stable enough for keeping pur-
    brought in contact with sub-      poses, but which readily yields
    oxygenated organic matter.”       nascent oxygen in the presence of
                                      bacterial products.”

The therapeutic properties attributed to these sister products are even
more similar, for we find that:

    “Oxychlorine is adapted to all    “Zyme-oid is a powerful gastro-
    morbid and abnormal fermentative  intestinal antiferment.”
    alimentary states.”

Many more statements and claims could be quoted to show a similarity
between, amounting almost to an identity of, oxychlorine and zyme-oid.

With these facts in mind, the analysis of zyme-oid was undertaken in
order to compare it with the previously examined oxychlorine and to
determine to what extent the claims made for zyme-oid are upheld by its
composition. The analysis indicated, as was expected, that zyme-oid
is essentially the same as oxychlorine as is shown in the following,
quoted from the report of the analysis of each:

      ANALYSIS OF OXYCHLORINE           ANALYSIS OF ZYME-OID
    Potassium (K)         12.26       Potassium (K)          13.50
    Sodium (Na)            8.20       Sodium (Na)             9.84
    Chlorate (ClO_{3})    25.32       Chlorate (ClO_{3})     27.50
    Nitrate (NO_{3})      21.70       Nitrate (NO_{3})       24.22
    Boric acid anhydrid               Boric acid anhydrid
      (B_{2}O_{3})        18.63         (B_{2}O_{3})         13.42
    Water, calculated     13.29       Water, calculated      10.42

Assuming that the chlorate in zyme-oid is present as potassium chlorate
and the nitrate is present as sodium nitrate, the figures obtained by
analysis correspond to a mixture approximately as follows:

    Potassium chlorate (KClO_{3})               40.43
    Sodium Nitrate (NaNO_{3})                   33.22
    Potassium tetraborate (K_{2}B_{4}O_{7})      1.60
    Sodium tetraborate (Na_{2}B_{4}O_{7})        3.31
    Boric acid                                  21.14

From the results of the analysis and from the physical properties of
zyme-oid we conclude, just as was done in the case of oxychlorine, that
the preparation is not a definite chemical compound, but is essentially
a mixture of alkali chlorate and nitrate with boric acid, probably
produced by fusing together the constituents.

                                COMMENT

An examination of the claims made for the firm’s two products, while,
as already proved, disclosing many points of similarity, will also
show one remarkable difference. We refer to the skilful indefiniteness
that pervades the claims made for zyme-oid and which defies scientific
refutation. This verbal obscurity is becoming daily more common in
the “literature” of firms marketing nostrums. Since the Council
has analyzed many of the much-advertised articles and proved the
unreliability of the pseudo-scientific claims made for them, the more
cautious of the nostrum-mongers have modified the matter descriptive of
their products. They have called to their aid the principle that words
were given to man to conceal thought rather than to express it, and
they have reduced equivocation to a fine art. Wherever it was possible
to put forward claims by implication rather than by expression this has
been done.

To substantiate further the claims made by the manufacturers of
zyme-oid for their product, a laboratory report is brought in evidence.
This report, which is written more in the style of a peruna testimonial
than that of a conservative scientific statement, fails to verify the
claim that zyme-oid is a “double borate salt,” but confines itself to a
statement of its harmlessness and its anti-fermentative properties. In
passing, it seems regrettable that scientific laboratories should, for
a pecuniary consideration, be willing to jeopardize their reputations
by lending their names to the furtherance of nostrum exploitation. The
results of the examination of zyme-oid demonstrate that the product is
no more worthy of the physician’s consideration than its close, and
equally worthless, relative, oxychlorine.--(_From The Journal A. M. A.,
May 23, 1908._)




                               PART III

               CONTRIBUTIONS FROM THE JOURNAL: NOSTRUMS




                               ALLEOTONE


The formula of this preparation, given in the literature, reads as
follows:

    Alcoholici (Monatomic)                    gr. 1/1000
    Quininæ Sulphatis                         gr. 1/384
    Ac. Sulph. Dil. (10 per cent.)           gtt. 2-1/2
    Ac. Nitrici Dil. (10 per cent.)          gtt. 1/77
    Ac. Butanol-Dioic                         gr. 1/3
    Tr. Ferri Chloridi                       gtt. 1/26
    Aquæ                                     gtt. xx

The formula is worthless. It can only mislead and mystify and the
greater part of the literature is a mere jumble of inaccurate and
mystifying statements. The various constituents of the preparation are
taken up as follows. The advertising literature states:

    “Monatomic Alcohol is one of the constituents of all nerve tissue:
    It is a product of the replacement of one atom of hydrogen of the
    hydrocarbons by their hydroxyl group H.O.”

This information does not inform, since there is a vast number of
monatomic alcohols and of every description. The assertion that the
preparation “contains a salt” would be perfectly analogous and just as
enlightening. Of “Ferri Chlo” the literature says:

    “Ferri Chlo is found with all proteids and nucleins and herein acts
    as magnetic iron, aiding the play of the electrical travel.”

The first assertion is untrue, for iron does not exist as chlorid in
the cells of the body, but as some organic iron compound; neither is it
found in all proteids, but principally in nucleo-albumins; and not all
proteids contain nucleo-albumins. The assertion that the iron chlorid
“acts as magnetic iron aiding the play of the electric travel” is
nonsensical and on a par with the electric belt method of exploitation,
and suggests forcibly the class to which Alleotone belongs. The
literature further states:

    “Sulphuric and nitric acids act in removing hydrogen atoms and
    substitute atoms of the radical NO_{2}; that is, as hydrogen
    tranquilizes the speed of burning or oxidation, its action is
    substituted by the atom nitrogen which is energy itself, nitrogen
    being the base of all explosives.”

Sulphuric acid is certainly an oxidizing agent and in virtue thereof
removes hydrogen; but not in a solution whose concentration with
respect to sulphuric acid is approximately only 0.82 per cent. The
statement that nitrogen is the “base of all explosives” is another
example of the methods of the promoters. As it is a well-known fact,
however, that nitrogen itself is one of the least reactive of gaseous
elements, little confidence can be placed in such remarks as “Nitrogen
which is energy itself.” Another mystifying term used in the formula
is “Ac. Butanol-Dioic,” which is a true chemical name, certainly,
but it is one by which few physicians will recognize simple malic
acid, an ordinary vegetable acid widely distributed in ripe fruits,
such as apples and pears, and possessing the properties simply of a
relatively weak organic acid. To describe it as exercising any potent
influence “in the oxidation of the phosphorus as lecithin in the
cell”--especially in the extremely low concentration in which it is
stated to exist in Alleotone--is simply an absurd juggling with words.
It is not much to be wondered at that the public should be taken in
by pseudoscientific “literature”; but it is not only strange, it is
discreditable to our profession, that among its members should be
found any to accept such rubbish as the above quoted “literature” as
information worth acting on--yet such there are, judging from the
testimonials.--(_Abstracted from The Journal A. M. A., Feb. 1, 1908._)


               The Commercial Value of Adverse Criticism

For skilful attempts to convert a “knock” into a “boost,” commend
us to the discredited nostrum exploiter. The federal Food and Drugs
Act did much to bring out this amiable quality--possibly developed
it. While somewhat ancient history, it is well to call to mind what
happened when the excise authorities insisted either that the “patent
medicine” booze, Peruna, have some medicine put in it, or else that
its manufacturers should go into the saloon business. Hartman at once
got out a new label stating that “for a number of years a multitude of
grateful friends” had urged “that Peruna be given a slight laxative
quality.” Thenceforth the innocents and near-innocents could get their
perunaese jag only at the risk of a “bad quarter of an hour.”

One of the latest attempts to wriggle out of an uncomfortable position,
and at the same time make capital out of the wriggling, is seen in the
advertising of Alleotone, a nostrum of the pseudoscientific type, which
was shown up in The Journal of Feb. 1, 1908. The “formula” furnished is
for the most part a jargon of misleading and mystifying nonsense and
fulfils the same purpose as the voluble “patter” of the gentleman who
is manipulating three shells and a pea at the county fair.

Every constituent of the “formula” was discussed in The Journal and the
absurdities and impossibilities of each dwelt on. Did the manufacturers
of Alleotone feel downcast over the exposure of their humbug? Not to
judge by their advertising, for they write to physicians that “since
the A. M. A. analyzed Alleotone it has made great strides”--direction
not specified. But the choicest piece of impudence, and one that but
for its dishonesty would be laughable, is found in this portion of
their advertising pamphlet:

[Illustration]

In the original, the words “With amendments suggested in the Journal
of the American Medical Association, Feb. 1, 1908,” and also
“(Cholesterin.)” and “(Malic Acid.),” which we have underscored in the
illustration, are printed in red and have been added to the original
“formula.” Such are the uses of adversity.

What claim, if any, the exploiter of this nostrum--B. F. Copeland--has
to medical or pharmaceutical knowledge, we do not know. In fact, to
be consistent with the “ethics” of the nostrum business he need have
none. Such knowledge, indeed, tends to hamper that free play of the
imagination so necessary in this work. We understand that he has at
different times been in charge of a stave factory and connected with
a brokerage firm, which may exert some subtle influence in developing
the ability to relieve suffering humanity, though the connection is
not quite clear. One would imagine, however, that the keen business
instinct, untrammeled by any considerations of conscience, which is
exhibited in the exploitation of Alleotone, would in purely commercial
pursuits have long since assured a competence.--(_From The Journal
A. M. A., Oct. 17, 1908._)




                       BAUME ANALGESIQUE BENGUE


A physician writes asking for the formula of Baume Analgésique Bengué.
This product is another of the “patent-medicine”–“ethical-proprietary”
type of nostrums. In Great Britain, it is advertised to the public as
“A Wonderful Remedy for Rheumatism, Gout, Neuralgia.” In this country,
the exploiters find that space in cheap medical journals, reinforced
by the aid of undiscriminating physicians, is a cheaper method of
getting the stuff to the public. According to the statements of the
manufacturers, Bengué’s Analgesic Balm contains “menthol, salicylate
of methyl and lanolin.” When analyzed by the chemists of the British
Medical Association, it was reported to have the following composition:

    Menthol                        18 per cent.
    Methyl salicylate              20 per cent.
    Lanolin, anhydrous             54 per cent.
    A fat, apparently lard          8 per cent.

The estimated cost of the ingredients of a 50-cent tube of Bengué’s
Analgesic Balm, according to the British chemists, is 2-1/2 cents.
Evidently this imposingly named product is practically a lanolin
ointment containing oil of wintergreen and menthol. Similar products
are catalogued by various pharmaceutical houses under various names
and with varying degrees of frankness concerning their composition.
Two firms give the medical profession full details regarding the
composition of their products: The H. K. Mulford Company, who sell it
under the name “Methyl Salicylate Ointment,” and the Pitman-Myers Co.,
who name their product “Anodyne Balm, P-M Co.” Some other firms are
not so frank. Parke, Davis & Co., for instance, sell “a combination
of methyl salicylate and menthol with a lanolin base” under the name
“Analgesic Balm,” but do not give the quantities of the ingredients;
Frederick Stearns & Co. sell “Analgesic Cream, Stearns” without giving
the quantities; Nelson Baker & Co. sell “Anti-Neuralgic Ointment,” and
no quantities are given.--(_From The Journal A. M. A., Dec. 14, 1912._)




                         ANTIDIABETICUM--BAUER


In Germany the makers of nostrums, their methods and their products are
systematically exposed by the Society for the Suppression of Quackery
(Deutsche Gesellschaft zur Bekämpfung des Kurpfuschertums) through its
publication, the _Geseundheitslehrer_, under the aggressive editorship
of Dr. Kantor.

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.

[104] According to a report in the _Allgemeine medizinische
Central-Zeitung_ Jan. 6, 1912, p. 14.

The persecution of Dr. Kantor previously described shows no signs
of abatement nor has Dr. Kantor given evidence of loss of courage.
Some of the German medical societies have subscribed for the
_Gesundheitslehrer_ for each of their members. It is written in popular
style for the masses and is a sharp and effective weapon for the
campaign against quackery.--(_From The Journal A. M. A., April 27,
1912._)




                              ANTIKAMNIA

              The Nostrum and Its Method of Exploitation


Our readers will be interested to learn some of the remarkable
properties which, according to the statements of the manufacturers,
this Antikamnia possesses. We quote from the advertising literature:

    The well-known nerve specialist (?), Dr. Harley, in an interview
    published in the _London Daily Express_, says: “I have treated more
    than one American for nervousness and ‘brain fag’ directly due to
    their incessant energy. I had a young man in here this morning who
    complained of headache ‘in the back of the neck.’ He was threatened
    with congestion of the brain, and seemed somewhat aggrieved when I
    told him he had been trying to do too much. I also treated a young
    American woman who, since her arrival in London, had apparently
    been living on Antikamnia tablets by the advice of her physician.
    It was the only thing, she said, which kept her ‘braced up’ for the
    strain of sight-seeing.”

(Why did the young woman consult this Dr. Harley--for the drug habit?)

Note the following:

    For the severe pains of rheumatism, dysmenorrhea, neuralgia,
    gout, sciatica and lumbago, as well as for the lightning pains of
    locomotor ataxia, there can be no quicker and more lasting relief
    obtained than by the administration of Antikamnia and codeine
    tablets.

Imagine an intelligent physician trying to treat the diseases
mentioned below with the various impotent means of the pharmacopeia
and physiological therapy when he might depend on Antikamnia! We quote
again:

    As a Pain Reliever.--In headache, cephalalgia, hemicrania, migraine
    [some other words might have been thrown in so as still more to
    emphasize the headache business], myalgia, coryza, la grippe and
    its sequelae, the lightning pains of locomotor ataxia and all pains
    due to irregular menstruation.

    As an Anodyne or Sedative.--In alcoholic delirium, indigestion,
    cardialgia, gastralgia, dyspepsia, hysteria, insomnia, inebriety,
    car-sickness, sea-sickness, worry and sight-seer’s fatigue.

    As an Antipyretic.--In typhoid, intermittent, puerperal and
    malarial fevers, bronchitis, pneumonia, pleurisy, and tuberculosis.

    As an Anti-Neuralgic.--In acute or chronic neuralgia, facial
    neuralgia, earache, pain about the teeth, angina pectoris,
    neurasthenia, palpitation, pains of locomotor ataxia and sciatica.

    As an Anti-Rheumatic.--In acute or chronic rheumatism and gout,
    fever and pleurodynia.

    There is no remedy so useful and attended with such satisfactory
    results as Antikamnia tablets in the treatment of melancholia
    with vasomotor disturbances, anemic headaches, emotional
    distress, and active delusions of apprehension and distrust. They
    increase arterial tension and promote digestion, as well as being
    particularly serviceable in relieving the persistent headache which
    accompanies nervousness.

    In neurasthenia, in mild hysteroid affections, and in the various
    neuralgias, particularly ovarian, and in the nervous tremor so
    often seen in confirmed drunkards, they are of peculiar service.
    In angina pectoris this drug has a beneficial action; it relieves
    the pain and distress in many cases, even when amyl nitrite and
    nitroglycerin have failed entirely. In pseudo-angina, frequently
    observed in hysterical women, its action is all that can be desired.

    Patients who suffer from irritable, weak, or palpitating heart,
    needing at times a pain reliever, can take Antikamnia tablets,
    without untoward after-effects, knowing that the heart is being
    fortified. In delirium tremens, they relieve when there are great
    restlessness, insomnia, the general lowering of the nerve power.

    Only the vivid picture of a crisis in locomotor ataxia or the agony
    of a true migraine, can impress the observer with the full value of
    this pain reliever.

The following testimonials are from physicians:

Dr. Caleb Lyon, an old Bellevue practitioner, in referring to
antikamnia and codein tablets, says:

    In my practice they accompany the maid from her virgin couch to
    her lying-in chamber, assuaging the perplexities of maidenhood and
    easing the trials of maternity with most gratifying results. I
    earnestly hope that the proprietors of this valuable remedial agent
    will keep it up to its present standard of purity and excellence.

Dr. Walter M. Fleming, A.M., M.D., New York City, writes:

    ... With all the experience of more than a quarter of a century,
    in the treatment of winter cough, and all its complications of
    laryngeal, bronchial and pulmonary irritability, dyspnea, asthmatic
    spasms, and finally whooping cough--usually the most persistent
    and tenacious of all these membranous maladies--I find no one
    remedy more strongly indicated, or which yields more prompt and
    satisfactory results than Antikamnia and heroin tablets, composed
    of Antikamnia 5 grains and heroin hydrochloride 1/12 grain....
    Result: a prompt and efficient expectorant, at once relaxing the
    harsh and rasping cough, releasing the tenacious, sticky and
    gelatinous mucus which is soon readily expectorated, while the
    soothing influence of the Antikamnia is at once manifested, greatly
    to the comfort and contentment of the patient.

    ... Independent of the fact of the direct applicability of this
    remedy to the various membranous maladies of the lungs, bronchi,
    fauces and nose, it proves also, an invariable remedy in all
    febrile cases where anodyne is required. This, together with
    its analgesic and antipyretic merits, eminently qualify this
    combination for a responsive agent in the treatment of nearly all
    the numerous febrile attacks characterized by pain, nervousness,
    insomnia and their accompanying symptoms.


                        “Antikamnia and Quinin”

If there is any virtue in the particular combination known as
“Antikamnia,” a physician prescribing the tablets supposed to contain
combinations of “Antikamnia” and some other drugs should have some
guarantee that they contain those remedies. Take, for example, the
tablets advertised and sold as “Antikamnia and quinin.” It might
reasonably be supposed that the tablets contained the combination known
as “Antikamnia”; this, however, seems not to be the case. Previous
analyses, as published[105] by us, have shown that antikamnia contains
approximately 20 per cent. of sodium bicarbonate, yet two chemists,
working separately, have been unable to find this ingredient in the
tablets advertised and sold as “Antikamnia and quinin.” Are we to
understand, therefore, that the manufacturers do not consider the
bicarbonate of sodium of importance in their preparation, Antikamnia;
or are they guilty of misrepresentation and of misleading physicians in
omitting this constituent from their product Antikamnia when that is
combined with the bisulphate of quinin? The above statement regarding
the omission of bicarbonate of sodium from the quinin combination may
be verified by any physician who desires to make a few simple chemical
tests--carbonic acid is not given off when the tablets are treated with
dilute acids, as would be the case if sodium bicarbonate were present.
Further, while the ordinary Antikamnia contains no constituent not
soluble either in water or in chloroform, and while quinin bisulphate
is readily soluble in water, the tablets said to contain Antikamnia
and quinin bisulphate, when treated successively with water and with
chloroform, leave a residue of more than 18 per cent.

[105] The Journal A. M. A., June 3, 1905; reproduced on page 9 of this
book.

One of the chemists who analyzed the preparation for us, in commenting
on this in a letter, says: “The matter which is insoluble in water,
alcohol or in chloroform, i. e., the substance which is neither
‘Antikamnia’ nor quinin bisulphate, amounts to more than 18 per cent.
in ‘Antikamnia and quinin bisulphate tablets.’ The tablets weigh close
to five grains and are said to contain 2.5 grains each of Antikamnia
and quinin bisulphate. How is this possible when each tablet contains
almost one grain of foreign substance (chiefly starch)?”

Further comment is superfluous. We have presented facts to our readers
and leave, them to draw their own conclusions.--(_From The Journal
A. M. A., July 1, 1905._)


                        Adding Insult to Injury

When the Council on Pharmacy and Chemistry began its work of
independent and scientific investigation of proprietary preparations,
some of the questions asked were:

“What guarantee has the medical profession that the formulas of these
proprietary medicines are not changed at the will of the manufacturers?
How can the physician who confidingly prescribes them for his patients
know that the preparation which he orders to-day is the same as that
which was furnished him last year, or which may be given him next year,
under the same name?”

At once a wail, as of injured innocence, went up from countless venders
of proprietary medicines, who replied with one voice:

“The honor and reputation of the proprietors and manufacturers
is sufficient guarantee of the stability and permanence of these
preparations.”

So vehement were their protestations and so well simulated were their
declarations of Pecksniffian virtue that many physicians were deceived
thereby. Many medical journals (whose views were, perhaps, slightly
biased by the consideration of fat advertising contracts) also were
apparently convinced. But the fact was overlooked that guarantees based
on honor are of value only in proportion to the amount and quality of
honor possessed by the guarantors.

The enactment of the national Food and Drugs Act is bringing many
things to light. Some of them are interesting, some would be amusing
were they not so utterly despicable. Among other things, it has
furnished a demonstration of the value of the “honorable assurances” of
nostrum venders.

The nostrum Antikamnia has pointed out many a moral in the campaign
in the last two years. It was hardly to be hoped that it would
deliberately furnish a demonstration of the utter lack of honesty on
the part of a certain class of proprietary manufacturers. Yet, relying
apparently on the ignorance of the public and the long-continued
lethargy of the medical profession, its promoters have, in the last
few weeks, unwittingly convicted and stultified themselves. When
the pure food law went into effect, the proprietors of this mixture
found themselves in a sad dilemma; if they labeled their mixture in
accordance with the provisions of the law they would have to admit
that it contained acetanilid and that the charges against them were
true. Failing to comply with the law, they must go out of business.
The latter alternative was not to be thought of. The profits gained
by selling, with the aid of careless or ignorant physicians, a five-
or ten-cent mixture for $1 were too great to be surrendered without a
struggle. The same brilliant intellect, perhaps, that first saw the
commercial possibilities in the business said: “Change the formula.
Phenacetin is about as cheap as acetanilid; the patent has just expired
and consequently we can get it at a low price. Let us substitute
phenacetin for acetanilid.”

As a result the profession is treated to an edifying exhibition of
virtue triumphant, a wolf so completely covered by the harmless coat of
a sheep that he flatters himself that his wolfish nature is completely
concealed. No longer are skulls and skeletons sent out in calendar form
as grinning advance agents to be displayed in every doctor’s office,
but instead a beautiful domestic scene, showing a convalescent child
nestling in the arms of its mother. The familiar “AK,” however, as
usual, is in the lower right-hand corner. And what a change in labels!
No longer is Antikamnia a chemical entity, but the label now openly but
ingenuously declares that “Antikamnia tablets in this original package
contain 350 grains of acetphenetidin, U. S. P., per ounce. Guaranteed
under the Food and Drugs Act, June 30, 1906. Serial No. 10.” While,
below, as an entirely unnecessary display of conformity to the Pure
Food Act, appears this statement:

    The Antikamnia tablets in this original ounce package contain
    no acetanilid, antifebrin, antipyrin, alcohol, morphin, opium,
    codein, heroin, cocain, alpha- or beta-eucain, arsenic, strychnin,
    chloroform, cannabis indica or chloral hydrate.

Truly, Satan is appearing as an angel of light. What a gratification it
is to the long exploited profession to know that Antikamnia contains
no alcohol, no chloroform, no cannabis indica, no chloral hydrate. How
unfortunate that this spontaneous display of confidence is not carried
far enough to inform the profession of the ingredients, aside from
phenacetin, contained in the mixture!

The label is an admission that the nostrum does not contain what it was
never supposed to contain, with the exception of acetanilid, and is
directly an attempt to conceal the real contents. The proprietors know
that the dear public, whose “pains, headaches, neuralgias, women’s
aches and ills, grippal neuroses, nervousness, insomnia, rheumatism,
lightning pains of locomotor ataxia, sciatica, etc.,” they are
longing to assuage, will not know that acetphenetidin is the official
designation for what is popularly known as phenacetin, and that this
dangerous product is found in the new mixture in the proportion of
approximately 4 grains to a 5-grain tablet. Evidently they also presume
considerably on the ignorance of our profession, or why should they
make the brazen statement that four grains of phenacetin is the “most
reliable remedy” for the long list of diseases enumerated on their
advertising calendar?

[Illustration: A reduced reproduction of a full-page Antikamnia
advertisement appearing in the New York _World Almanac_, 1911.]

When the formula for which such wonderful virtues were claimed was
suddenly thrown overboard, was the medical profession, which by its
short-sighted patronage had built up this business, notified in any
way of the change? Search the new advertising matter of this nostrum
from beginning to end and you will not find one word to show that
“The Antikamnia tablets in this original ounce package” differ in the
slightest particular from those sold to the profession and the public
for years past. This being true (and the statements of the promoters
themselves are our authority for it), what remains of the pratings of
“honor” and the “guarantee of the manufacturers”? Has a physician no
right to know when a change is made in the formula of a preparation
which he has been prescribing for years?

What assurance has the profession that, at any moment, a cheaper or
more dangerous drug may not be substituted for “acetphenetidin” if
thereby the law can be evaded or the profits of the delectable business
enhanced?

How can any conscientious physician prescribe, for those who confide
their lives to his care, a preparation the stability of the formula of
which must depend absolutely on its owner’s whim?

How can a physician with the slightest sense of responsibility to his
patients allow his office to be used as a free advertising bureau
for a preparation manifestly founded and developed on deceit and
misrepresentation?

How can any medical journal, except those avowedly and unblushingly
seeking to aid the nostrum maker to exploit the profession, whose
interests they claim to serve, continue to carry the deceptive and
misleading advertisement of a twice exposed fraud?

How can any physician with a particle of self-respect or manhood
continue to support, by subscription or contribution, any medical
journal which, by accepting such advertising, allies itself with the
army of deceit and chicanery?--(_Abstracted from The Journal A. M. A.,
Jan. 26, 1907._)


                        Still Further Duplicity

When the Food and Drugs Act went into effect the manufacturers of this
preparation, instead of continuing to put out the same mixture as
they had been doing radically changed the composition by substituting
acetphenetidin (phenacetin) for acetanilid. By doing this the company
avoided the disagreeable necessity for acknowledging on the label
that the nostrum contained acetanilid, as was shown by the analysis
published in The Journal, June 3, 1905. In addition to stating that
the package of Antikamnia contained acetphenetidin, the company also
stated that it contained no “acetanilid, antifebrin, antipyrin,
alcohol, morphin, opium, codein, heroin, cocain, strychnin, chloroform,
cannabis indica, or chloral hydrate.” Knowing that the nostrum was
being advertised in Great Britain and Canada as well as in the
United States, The Journal obtained some Antikamnia from London, and
it was analyzed in the Association’s laboratory. As was suspected,
the analysis showed that Antikamnia as sold abroad has the same
composition now as it had in the United States before the Food and
Drugs Act went into force, viz.: Acetanilid, 67.75 per cent.; caffein,
4.88 per cent., and citric acid and sodium bicarbonate, by difference,
25.36 per cent. This corresponds with the analysis previously made
and published in The Journal, June 3, 1905. The Antikamnia on the
market in this country was also analyzed and it was found to contain:
acetphenetidin (phenacetin), 72.05 per cent.; caffein, 13.95 per cent.;
citric acid and sodium bicarbonate, 14 per cent. The preparation sold
as “Antikamnia and Quinin” was also analyzed, and it was found that
starch had been substituted for the bicarbonate of sodium which is
found in the Antikamnia itself. The details of the analyses are given
with the following comments: “The above are brief statements of bald
facts. Two of these should be emphasized: (1) When the Food and Drugs
Act went into force, January, 1907, the manufacturers of Antikamnia,
rather than acknowledge the truth of the past--we can imagine no other
reason--materially and radically changed the composition of their
preparation, and did this without notifying the medical profession
or intimating in any way, so far as we can learn, that such a change
had been made. We have no doubt they believed they had a right to do
as they pleased with their own; that it was nobody’s business but
theirs what they did with their own preparation, or how they changed
it. As they never had told physicians what it contained, there was
no reason why they should do so now. This is logical and we cannot
blame the manufacturers so long as the medical profession is willing
to be humbugged. (2) For the same reason, we presume, they claim
that they have a right to continue to use acetanilid in the product
for the foreign market. The Food and Drugs Act applies only to the
United States, of course, and acetanilid being cheaper, why not use
it? What is the difference if one is more dangerous than the other?
The fact that the Antikamnia sold abroad differs from that sold in
this country some may say is of no special interest to us. Still this
fact is worth noting: The dose of acetphenetidin--phenacetin--(7-1/2
grains) is nearly double that of acetanilid (4 grains): one becoming
accustomed to a certain dosage of the nostrum as sold in this country
might, while abroad, unwittingly be led to take a double dose of
acetanilid.--(_Abstracted from The Journal A. M. A., Feb. 8, 1908._)


      Samples, Form Letters and “Prescriptions” Sent to the Laity

_To the Editor_:--The enclosed “literature” is being sent broadcast
to the laity by the Antikamnia people and still a great many of the
physicians throughout the country are prescribing the preparation
thus advertised. Will the time ever come when the medical fraternity
will awaken to the fact that it has been humbugged by a great many
manufacturing concerns? I certainly hope so.

                               J. W. DuVal, M.D., Wichita Falls, Texas.

Comment:--The “literature” referred to by our correspondent consists of
a form letter and a small pamphlet. The letter was similar to the one
reproduced herewith.

[Illustration]

The pamphlet accompanying the letter is entitled “Practical
Prescriptions,” and contains a list of diseases and morbid states
arranged alphabetically from “Alcoholism,” “Asthma” and “Backache,”
to “Wind,” “Women’s Pains” and “Worry.” For the one hundred and
twenty-two conditions listed, “Antikamnia,” “Antikamnia and Codein” or
“Laxative Antikamnia and Quinin” are prescribed, demonstrating that the
“prescriptions” are more “practical” than scientific.

In many respects the methods of the proprietors of “headache powders”
and “anti-pain pills” are less offensive to one’s sense of professional
decency than the course pursued by the Antikamnia people. The
former have at least never recommended their products as “ethical
proprietaries”; they have not used medical men as their unpaid agents;
the claims made for their products have been no more exaggerated; and
they have not found it necessary, from the requirements of the Food and
Drugs Act, to substitute acetphenetidin for acetanilid to avoid giving
the lie to their former claims.

As to the query propounded by our correspondent: We are optimistic
enough to believe that the time he longs for is already here. The fact
that the proprietors of nostrums of the Antikamnia type are finding
it necessary to advertise to the laity is, in itself, evidence of
the diminishing demand for such products on the part of the medical
profession.--(_From The Journal A. M. A., April 18, 1908._)


                Antikamnia in America and Great Britain

The following letter from the Antikamnia Chemical Company to The
Journal was received about August 1, 1912:

    “You have at various times represented in your Journal that the
    Antikamnia sold in foreign countries, particularly in Great
    Britain, has a different formula from the Antikamnia sold in the
    United States, and you have also published alleged formulas of each
    to show wherein they are supposed to differ.

    “We hereby respectfully notify you that the Antikamnia formula is
    the same for all countries, and the publication of any statements
    to the effect that the formula of Antikamnia is different in Great
    Britain, or any other foreign country, from that sold in the United
    States is a libel, and will be prosecuted as such.”

On the receipt of this a letter was written to a correspondent in
London requesting him to purchase in the open market a package of
Antikamnia. This was done and the original sealed package reached the
Association’s laboratory a few days ago. Careful analysis of this
specimen shows it to contain acetanilid but no acetphenetidin, while
the Antikamnia sold in the United States contains acetphenetidin but
no acetanilid. The company’s protest to the contrary notwithstanding,
the formula of some Antikamnia, at least, _is_ still different in
Great Britain from that sold in the United States. It is possible, of
course, that some time in the future the composition of every package
of this nostrum on sale in the United Kingdom will be similar to that
of every package sold in the United States. It is even possible that
“Antikamnia & Quinin” tablets will--or do--actually consist of quinin
and the mixture called Antikamnia--although, as The Journal has shown,
this has not been the case in the past. Since the patent expired on
acetphenetidin, this drug has become so cheap--it can be bought at
wholesale for less than 6 cents an ounce--that, commercially it must
make very little difference whether acetanilid or acetphenetidin
is used in the manufacture of Antikamnia. But the question arises:
Have our British confrères been notified of the change in formula? A
careful study of the Antikamnia advertisements in English medical
journals shows that the British medical profession has been given
no more consideration by this concern than was the American medical
profession when the change in composition was made on this side.
But then why should it be? Physicians, British or American, who are
addicted to the prescribing of secret proprietaries such as Antikamnia
have little need of formulas--“Theirs not to reason why!” The medical
profession on both sides of the Atlantic has never known the exact
composition of Antikamnia and does not know it now. Physicians who call
for preparations of the Antikamnia type are prescribing names, not
drugs.--(_From The Journal A. M. A., Oct. 26, 1912._)


                           Again, Antikamnia

[Illustration: Reproductions of portions of pages in the booklets sent
out by the Antikamnia Chemical Company to physicians (on the right),
and laymen (on the left), respectively. Those who do not realize the
character of the Antikamnia concern naturally imagine the quotation
here given from The Journal is a comparatively recent one. Notice that
no dates are given. As a matter of fact, it is twenty-two years old.
Dr. McIntyre, who wrote it, has been dead eleven years.]

In season and out of season The Journal has exposed the Antikamnia
fraud until it would seem that its readers would become weary of the
very name. There is nothing new to say about this dangerous stuff, and
yet the number of inquiries indicates that thousands of The Journal’s
readers do not know of the previous exposures. More than fifteen years
ago The Journal ceased carrying the Antikamnia advertisement; more
than ten years ago it notified its readers that the nostrum was being
advertised to the public by means of circular letters; more than six
years ago it proved that, when the Food and Drugs Act went into effect,
acetphenetidin had been substituted for acetanilid in Antikamnia
evidently in order that the presence of the older drug, of whose
dangers the public had been made aware might not have to be admitted;
more than five years ago The Journal showed that the Antikamnia sold
in the British Isles still contained acetanilid, and as late as last
October it verified this statement although threatened with prosecution
for libel by the Antikamnia Chemical Company.

Yet, in spite of all these exposures, not a week passes that we do not
receive one or more letters calling attention to the Antikamnia fraud.
Most of these letters deal with one, or more, of three points: first,
the fact that the stuff is being advertised to the public by means of
circular letters and that sample “vest-pocket boxes” of this dangerous
drug are being sent through the mail to laymen; second, that Antikamnia
is being advertised in newspapers, and, third, that in the booklets
sent out by the Antikamnia Chemical Company both to the medical
profession and to the public, a paragraph is quoted from an article by
Dr. John H. McIntyre that appeared in The Journal.

[Illustration: Photographic reproductions of two typical Antikamnia
advertisements now appearing in newspapers all over the country. These
tablets are advertised in various newspapers as being “safe” and
neither “depressant” nor “habit-forming”--three separate and distinct
falsehoods.]

The first two points have already been discussed so frequently that
it seems hardly worth while to take them up again in detail, though
it might be said that the medical profession has at last become so
familiar with this widespread humbug that the Antikamnia Chemical
Company has finally gone over body and soul to the newspapers. So
far as we can learn only three publications professing to be medical
journals still carry the Antikamnia advertisement. These three are:

    _Southern Practitioner_
    _Therapeutic Record_
    _Pacific Medical Journal_

As is usual in such cases, the British medical journals are not so
particular, and we still find Antikamnia advertised in:

    _Medical Press and Circular_
    _Glasgow Medical Journal_
    _Journal Tropical Medicine and Hygiene_
    _Dublin Journal Medical Science_
    _Lancet_
    _Canada Lancet_
    _Practitioner_

The reproduction of the McIntyre quotation is evidently adopted by the
Antikamnia concern as a means of “playing even” with The Journal for
the unpleasant things it has said about it. In quoting Dr. McIntyre,
the Antikamnia Chemical Company carefully avoids giving the date on
which the article appeared. As a matter of fact, the article was
printed in The Journal over twenty years ago (July 4, 1891), and Dr.
McIntyre himself has been dead for eleven years. Presumably, however,
the Antikamnia Chemical Company will continue to mislead, either
directly or by inference, until the end of the chapter.--(_From The
Journal A. M. A., April 12, 1913._)




                         ANUSOL SUPPOSITORIES


“In Hemorrhoids and all Inflammatory Rectal Diseases, let your first
thought Continue to be Anusol Hemorrhoidal Suppositories; they have
Earned your lasting Confidence.” Thus speaks an attractive folder
recently sent to physicians. With a prodigal use of superlatives, the
medical profession is told that these suppositories have for years
“maintained their World-Wide Reputation” as the “Most Effective, the
Safest ... the Most Economical and ... the Most Credit-Bringing of all
Topical Rectal Remedies.” The short memory of the public is notorious;
from the point of view of the proprietary exploiter, the short memory
of the medical profession must be equally well known. How, otherwise,
would a firm try to make physicians believe that a product had “earned”
their “lasting confidence” when the result of an examination by the
Association’s chemists, published in The Journal,[106] had shown that
Anusol Hemorrhoidal Suppositories contained practically no “anusol.”
Moreover, as the Association’s findings were a practical verification
of the findings of a foreign chemist who also had failed to find any
“anusol” in Anusol Suppositories, it is not quite clear what is meant
by the term “world-wide reputation.” Incidentally, the observant
physician will notice that the list of the ingredients given on the
Anusol Suppositories labels of 1913 differ from those of the vintage of
four years ago. The label of the old boxes gave the ingredients thus:

    Bismuth. iodo-resorcinsulfon (Anusol), Zinc oxydat. pur., Balsam
    Peruv., Ol. cacao, Unguent cereum.

[106] Oct. 2, 1909; see p. 227 of this volume.

On the latest label, however, we find these ingredients given:

    “Bismuth oxyiodid and resorcinsulphonate with Zinc oxid and Balsam
    Peru, incorporated in suitable base.”

What will the formula be four years hence?--(_From The Journal
A. M. A., Oct. 11, 1913._)

ANUSOL SUPPOSITORIES

  _To the Editor_:--In the “Propaganda for Reform” department of the
  October 11 issue of The Journal, you published a short notice on
  Anusol Suppositories. We desire to correct the impression which
  your readers may have received, viz.: that there is any actual
  difference between Anusol Suppositories of the present and Anusol
  Suppositories of the past. We wish, therefore, to state that the
  composition of Anusol Suppositories has not been changed; the only
  modification that we have made is a revision of the label to the
  effect that the active medicinal ingredient of the preparation is a
  mixture of bismuth oxyiodid and bismuth resorcinsulphonate in place
  of bismuth iodoresorcin-sulphonate. The latter was originally claimed
  by the manufacturers, discovered to be doubtful by an investigation
  in the laboratory of the American Medical Association, as well as
  by one on the part of a foreign chemist, and finally disproved to
  our satisfaction by an independent investigation on our part. We
  feel that the remark “What will the formula be four years hence?”
  will carry the impression to your readers that the composition has
  frequently been changed and is likely to be changed again, and it is
  for this reason that we request the above correction and an assurance
  to the contrary.

  The statement in the note that “Anusol Suppositories have been proved
  to contain no Anusol” is also likely to create an entirely erroneous
  impression. We dropped the use of the word “anusol,” as designating
  a definite chemical substance more than two years ago, and changed
  all our propaganda matter accordingly. Schering & Glatz.--(_From The
  Journal A. M. A., Jan. 31, 1914._)




                            ASPIRO-LITHINE


Aspiro-lithine is another comparatively new example of the custom of
proprietary manufacturers in putting forward old drugs under a new name
and with them bidding for the favor of physicians. An inquiry has been
received concerning this mixture. It is prepared by McKesson & Robbins
and is said to contain in each tablet 5 grains of acetysalicylic
acid (aspirin) and 2-1/2 grains of acid citro-tartrate of lithium.
It is recommended for all the purposes for which acetysalicylic acid
is commonly used, and on account of the lithium added is claimed to
have much greater virtues than either of these drugs alone or of both
combined.

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.

But if there be any advantage in combining lithium salts with
acetysalicylic acid in a prescription, it is a simple proposition and
requires no great skill, either on the part of the physician who writes
the prescription or on the part of the druggist who puts it up, and
such mixtures as aspiro-lithine, with the exaggerated claims made for
them, should be avoided in the physician’s prescribing.--(_From The
Journal A. M. A., May 28, 1910._)




                    BELL-ANS (PA-PAY-ANS, BELL)[AS]

  Another “Patent Medicine” Foisted on the Public Through the Medical
                              Profession

[AS] See also report on Papayans Bell, p. 151.


With such nostrums as Antikamnia and Resinol fresh in mind as flagrant
examples of “patent medicines” introduced to the public through the
medical profession, what follows regarding Bell-ans, or, as it is
better remembered by physicians, Pa-pay-ans (Bell) will take on an
added interest. Briefly, Bell-ans is the new name of a tablet that,
according to chemists’ reports, is essentially charcoal, baking soda
and ginger, flavored with oil of wintergreen. Its selling point, in
the past at least, has been the alleged presence of papain. This drug,
Bell & Co. allege, is present in their tablets and they claim is “the
digestive principle obtained by our own exclusive process from the
fruit of _Carica papaya_.” As long ago as 1909, the Council on Pharmacy
and Chemistry attempted to find papain present in what was then called
Pa-pay-ans (Bell) and to determine the digestive power of the tablets
but with negative results.

The efforts of other chemists were equally unavailing.

In January, 1914, Bell and Company changed the name of the product
“Pa-pay-ans (Bell)” to “Bell-ans.” As The Journal remarked soon after,
it seemed probable that, as the name of a nostrum of this kind is the
manufacturer’s most valuable asset, the name was hardly changed, as was
alleged, for purely euphonious reasons. It seemed more likely that as
analyses had indicated there was not, and probably never had been, any
appreciable amount of papain in the product, the change of name might
be due to the fear that some day the misleading name might bring the
preparation in conflict with the federal Food and Drugs Act.

For years physicians have realized that the methods of exploitation
of Pa-pay-ans (Bell) have been such as to make the medical
profession a vast free advertising agency for the nostrum. So far
as we know Pa-pay-ans (Bell) has never been advertised in lay
journals--newspapers, etc. Certain medical journals, however, have,
for a long time, carried the advertisements of Pa-pay-ans (Bell)--and
later of Bell-ans--while Bell & Co. has been lavish in its distribution
of free samples, blotters and other advertising paraphernalia direct to
the medical profession.

[Illustration: Miniature facsimile of a letter received by a layman.
It was accompanied by a small box of Bell-ans. Two points are worth
noting: “... one hundred thousand physicians are now prescribing it”;
“any druggist will tell you” that it is perfectly harmless!]

Now it seems Bell and Company are going direct to the public by means
of vest-pocket samples and letters. The letter, a miniature facsimile
of which we reproduce, is one addressed to laymen and accompanies a
vest-pocket box of the nostrum.

Here are some of the things that Bell and Company claim Bell-ans will
do:

    “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....”

There is no physician living who really believes such claims as
these! Yet on the medical profession rests the responsibility for the
exploitation of this nostrum. Those medical journals which accept
advertisements for things of this kind are not so much to blame as
those physicians who unprotestingly tolerate the journals that do
so. Privately owned medical journals are published, usually, as a
commercial proposition; they reflect, to a greater or less extent,
the attitude of their readers, subscribers and contributors. There
are at least three medical journals which carry the advertisements of
Bell-ans. They are the _New York Medical Journal_, the _International
Journal of Surgery_ and the _Massachusetts Medical Journal_.

Bell-ans (Pa-pay-ans, Bell) possesses the virtues--and they are
few--and the limitations--and these are many--inherent to a mixture of
bicarbonate of soda, ginger and charcoal. Any druggist could put up
just as good a remedy, and any physician could write a prescription for
a better one in those cases in which he might think it indicated. The
whole secret of the commercial success of Bell-ans lies in the mystery
of its composition and the fraudulence of the claims that have been
made for it. The same tablets put out under a non-proprietary name, as
an open formula and with claims that were reasonable and true, would
have had practically no sale. The commercial success of Bell-ans is a
monument whose foundation rests equally on the unscrupulousness of the
manufacturer and on the gullibility of a learned profession.--(_From
The Journal A. M. A., Jan. 16, 1915._)




                                BIOSOL


Dr. A. N. Lakin, State Line, Ind., writes:

  “Kindly advise me concerning Biosol. I am sending you herewith a
  pamphlet describing this product. On the last page note clinical
  report from Dr. Buchman of the Indiana Medical Association and
  president of the Department of Public Health, Fort Wayne, Ind.”

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._)




                         BROMIN-IODIN COMPOUND

                     The Life-History of a Nostrum


A correspondent writes for information concerning a remedy known as
Bromin-Iodin Comp., which he says is manufactured by the Bromin-Iodin
Chemical Company, formerly of Binghamton, N. Y., but now located in San
Diego, Calif. In The Journal for Feb. 5, 1898, appeared an article by
Dr. C. W. Ingraham, Binghamton, N. Y., entitled “Five Years’ Successful
Experience with a Special Mode of Treating Pulmonary Tuberculosis.”
This “special mode” of treatment consisted in using what Dr. Ingraham
called “bromin-iodin compound,” which he said had the following formula:

    Iodin                       gr. 1/2
    Bromin                      gr. 1/14
    Phosphorus                  gr. 1/100
    Thymol                      gr. 2/3
    Sterilized oil          fl. dr.   1

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!

At the time this “treatment” was first tried by its “inventor,”
the results given in fifty cases were: First stage, 90 per cent.
cures; second stage, 50 per cent. cures; third stage, no cures, but
improvement in several cases; this was in 1895. It now appears that
this “treatment” has after a period of “patent-medicine” exploitation
come back into the “ethical proprietary” field. Presumably a mixture
such as that represented by the “formula” did not lend itself to
administration by mouth; there was nothing to do, therefore, but enlist
the aid of “easy” physicians in furthering its sale.--(_From The
Journal A. M. A., June 4, 1910._)




                                CALMINE

                        New Names for Old Drugs


“Calmine, the new Hypnotic,” is another example of the ingenuity of
the exploiters of proprietary preparations in coining new names for
old drugs and the recklessness with which exploiters herald forth
renamed remedies to the profession and the public as new and wonderful
discoveries.

This is what the promoters, sustained by a calm confidence in the
credulity of the profession, have to say:

    In the medical circles throughout the country a good deal of
    interest and even enthusiasm over this new hypnotic is noticeable.
    Very few drug products have attracted so much attention as this one.

    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.

Now this new and wonderful discovery is nothing but Veronal-sodium
(sodium diethyl-barbiturate) under another name. It is the sodium
salt of the more or less favorably known hypnotic, Veronal
(diethyl-barbituric acid). It is also sold as Medinal, and differs
from Veronal only in that the combination with sodium has made it more
readibly soluble, and thus, it is claimed, its absorption is more
prompt. Veronal is protected abroad by a trade-mark and in this country
by a patent, and this, undoubtedly, is responsible for the introduction
of this sodium salt under these fanciful names, because Veronal could
not be sold without infringing on the patent. This in turn induced the
manufacturers of Veronal, in self-protection, also to put the sodium
salt on the market, and now we have it under the name of Calmine. This
probably is only the beginning; soon we may look for it under a host of
other names and the usual result will follow: thoughtless physicians
who have had poor results with it under one name will try it under
others. Or worse still, physicians will thoughtlessly combine Veronal
with Calmine or with Medinal in the same prescription, thus giving a
dangerous dose.--(_From The Journal A. M. A., Jan. 14, 1911._)




                               CAMPHENOL


Camphenol is made by Johnson & Johnson, New Brunswick, N. J. Under
the name of the article on the carton appears the following formula:
C_{10}H_{16}O━C_{6}H_{4}(CH_{3})OH═C_{6}H_{5}OH. This formula
consists of the chemical formulas for camphor, cresol and phenol,
written one after another, and from this one would conclude that
Camphenol is a compound of camphor, phenol and cresol in molecular
proportions. Examination shows, however, that Camphenol is but a
modification of the well-known camphorated phenol (the liquid produced
when solid camphor and phenol are triturated together). In Camphenol
a part of the phenol, in the camphorated phenol, has been replaced by
cresol, and this liquid has been diluted and emulsified with gelatin or
some similar substance and perfumed. In other words, this preparation
is an emulsion containing relatively small quantities of cresol, phenol
and camphor and is another illustration of the attempts of would-be
pharmaceutical houses to produce new synthetics in the simplest manner
possible--that of writing the chemical formulas of the constituents
of a remedy in a way to indicate a chemical combination.--(_From The
Journal A. M. A., Nov. 5, 1910._)




                               CHOLOGEN


The proprietary Chologen is interesting some of our readers and several
have sent us samples and literature. Dr. Philip Marvel, Atlantic City,
N. J., for example, writes:

  “By the way, I am to-day sending you by mail a package which the
  Council on Pharmacy and Chemistry may care to tackle, or it may
  not. I shall not be insulted any way, but since these chologen
  preparations are being used a good deal by various globe trotters,
  who sometimes hook up for a short stay here, I feel it might be of
  some interest to know ‘what fools these mortals be’ and how much the
  profession is being fooled with them.”

Chologen as a medical treatment for gall-stones has been before the
German public for a number of years, and it is somewhat singular that
so simple a method, which could be easily prescribed by the physician
if it had merit, should exhibit such remarkable vitality in proprietary
form in spite of evidence going to show that it rests on erroneous
principles. The Council rejected it as an unscientific mixture. The
treatment is somewhat liberal, consisting of the use, in varying
successions, of three kinds of tablets: No. 1, calomel and podophyllin;
No. 2, calomel, and No. 3, calomel, podophyllin, camphor and menthol.
The proprietors tell us that the treatment should be proceeded with in
spite of disturbances, such as diarrhea and pain in the abdomen, and
that it should be repeated regularly in intervals for some years, so
long as any trouble exists or recurrence is threatened. “A course” of
Chologen tablets should be taken two or three times a year, No. 1 being
given for ten days, then Nos. 1 and 2 for forty days and No. 3 for ten
days.

It is worthy of note that experimental work seems to have been
performed in the attempt to show that bile produced by this remedy will
cause the disintegration and solution of gall-stones. Normal bile has
a certain solvent action on gall-stones, but calomel and podophyllin
have no demonstrable effect in increasing the amount of bile. We had
imagined that these facts were generally known.

It is somewhat discouraging to reflect that some physicians entertain
so low an estimate of their ability to prescribe such well-known
remedies as calomel and podophyllin that they must use them in the
fixed combinations provided by Dr. Glaser. If the self-respecting
physician does not consider himself insulted by a proprietary
manufacturer who presumes to tell him how to use such well-known
remedies, this is a good sign that he needs to take a postgraduate
course in materia medica and elementary prescription-writing. We
feel that medical writers must be short of subjects when they devote
papers to the exploitation of proprietaries consisting of these simple
ingredients.--(_From The Journal A. M. A., Feb. 1, 1913._)




                 HAGEE’S CORDIAL OF COD-LIVER OIL[AT]

             Fraud and Deception Connected with So-Called
                      Cod-Liver Oil Preparations

[AT] See also report on Hagee’s Cordial, p. 51.


The introduction of cod-liver oil as a supposedly easily assimilable
nutrient and reconstructive was followed by its extensive use in
wasting diseases, especially in phthisis, in the treatment of which
it came to be considered almost essential, as it was supposed to
possess some mysterious power different from that of other oils. Its
unpalatable character led to various devices to render it tasteless
and make it more acceptable to the stomach. Emulsions containing the
oil in mixture with other substances were put on the market and served
a useful purpose. But the oily nature, imperfectly concealed, was
disagreeable to many, and gradually other preparations appeared which
attempted to retain the supposed therapeutic virtues of cod-liver oil
while dispensing with its disagreeable character. This attempt has been
carried to the extreme that in many of the cod-liver oil preparations
now on the market the oil has been entirely eliminated and all that
is left of the oil is the name. This is a species of fraud which
has been tolerated too long, but which will be kept up so long as
physicians are willing to be duped. Some of these articles are said to
“represent” the oil and to possess all its virtues. Others are said to
contain oil, while still others are stated to contain “all the valuable
constituents.” What is the standard by which we may determine the true
value of these preparations and by which we may determine whether or
not we, and through us our patients, are being humbugged?

                      A FOOD OR MEDICINE--WHICH?

Is cod-liver oil to be considered a food or a medicine? A food,
certainly. As a food its value will consist in the fats it contains.
These fats are more easily oxidizable and are considered more
digestible than other fats because of the presence of compounds
derived from the liver which favor its emulsification and enable it
to penetrate the mucous membrane more easily than other fats. Aside
from their nutrient properties we have no evidence that the fats of
cod-liver oil possess any therapeutic value; if the oil possesses
therapeutic qualities they must reside in its non-fatty constituents,
and the activity of these non-fatty constituents is not acknowledged by
those who have investigated them scientifically. Most pharmacologists
believe that whatever virtue there is in cod-liver oil depends on its
qualities as an easily assimilable fat.

On the whole, we must conclude with Cushny that “cod-liver oil has not
been shown to have any action apart from that of an easily digested
food, and its superiority to some other fats and oils has not been
satisfactorily established.”

If, then, the value of cod-liver oil depends on the presence of fat as
its nutritive constituent, the amount of fat a preparation contains
will determine the worth or worthlessness of such a preparation; at all
events, a preparation claiming to represent cod-liver oil which does
not contain fat in some form is fraudulent.

        HOW TO PROVE OR DISPROVE THE PRESENCE OF COD-LIVER OIL

Fats may be changed to fatty acids or to soaps, as occurs under the
influence of pancreatic juice in digestion, and still retain their
nutritive value, but it is not possible to manipulate them in any way
so that they are still valuable as food, and yet do not respond to
easily applied chemical tests which demonstrate their fatty nature.

Any preparation of cod-liver oil in which fat or fatty acid is not
recognizable by proper tests is valueless as food, since its food value
depends on the amount of fat or fatty acid present. An elementary
knowledge of chemistry and the application of a few simple tests will
enable any physician to learn for himself whether or not a preparation
contains fat or fatty acids.

The preparations claiming to “represent” cod-liver oil are in liquid
form, and if they contain oil it must be one of the following forms:

1. An emulsion of the oil which may be miscible with water, but from
which the fat tends to separate and rise to the top. In this form the
fat can be seen as globules under the microscope.

2. A solution, resulting from the saponification of the oil, containing
a soap which usually will be alkaline in reaction, especially when
mixed with water, and from which fatty acids are separated as a
precipitate when the solution is acidified.

3. A solution of fatty acids. This will be acid in reaction and will be
precipitated by the addition of water, in which the fatty acids are not
soluble.


                   Hagee’s Cordial of Cod-Liver Oil

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.

In this case the manufacturer misleads by the use of the word
“represents”; he is careful not to say “contains,” although the
average reader would not be apt to notice the nice distinction. The
manufacturer unwittingly admits that it contains no oil when he says
that it “contains everything of value except the grease.” What else
there is of value in cod-liver oil besides the “grease” we do not know.
Certainly, if we estimate the value of the remedy by its nutrient
properties, it must be set down as practically worthless, if not
fraudulent, for although a mixture of sugar, alcohol and glycerin does
possess certain nutrient value, the materials can be purchased for it
far more cheaply in the open market. It is evident that claims are made
for this preparation which cannot be substantiated.

Again, some of the so-called cod-liver oil preparations are termed
extracts of cod-liver oil, but are not in fact made from the oil,
but from the cod-livers instead. They are preparations which, if
honestly made, might be worthy of trial, but they are improperly called
“extracts” of cod-liver oil, since they do not contain the fat, which
is the active constituent of the oil, but the extractives from the
liver which may or may not possess therapeutic virtues. So far as we
know, however, no satisfactory evidence is forthcoming to indicate that
such extractives have any therapeutic value.

The attempt to modify cod-liver oil for therapeutic purposes may be
pronounced a failure and the large variety and extensive sale of
these preparations appear to be owing to the fact that physicians do
not recall the ordinary facts of chemistry and fail to apply simple
tests with little technical skill, but too readily accept as facts the
statements of the manufacturers.--(_Modified from The Journal A. M. A.,
Oct. 13, 1906._)




                  WATERBURY’S COMPOUND ONCE MORE[AU]

[AU] See pp. 54, 57 and 442.


Most of our readers will remember what The Journal has published about
a product that used to be sold as “Waterbury’s Metabolized Cod-Liver
Oil Compound.” Briefly, it was shown by a report of the Council on
Pharmacy and Chemistry and a contribution from the Association’s
laboratory, that this “Cod-Liver Oil Compound” contained practically
no cod-liver oil! Later the federal government declared the stuff
misbranded.

The product is now sold under the name “Waterbury’s Compound.” It was
recently stated in this department that “Waterbury’s Compound” was
one of the proprietary preparations advertised both in “display” form
and also in the form of an “original article,” in the _Army and Navy
Medical Record_--a fraudulent publication that offered its editorial
pages for sale. Physicians are now receiving from the Waterbury
Chemical Company a reprint of what purports to be an editorial from
the _Army and Navy Medical Record_ entitled, “One of America’s Most
Valuable Preparations.” The preparation, of course, is “Waterbury’s
Compound.” The company in sending out this reprint also reproduces
on the reverse side the title-heading of the _Army and Navy Medical
Record_. All of which goes to show that some concerns not only do not
mind being found in bad company, but seem proud of it. By the way,
we wonder whether those physicians who are still prescribing this
nostrum think they are prescribing a preparation containing cod-liver
oil!--(_From The Journal A. M. A., Nov. 15, 1913._)




                            COLLYRIUM-WYETH


  “I should be glad of any information about Wyeth’s Collyrium and
  would also like to know if the position taken by this concern
  measures up to the requirements of the Council on Pharmacy and
  Chemistry.”

This inquiry was received from a Boston physician, who enclosed with
his note the letter quoted below that he had received from John Wyeth &
Brother, Philadelphia, the makers of the preparation in question:

    “We have your letter of the 22d inst., in which you request us to
    send to you formula for ‘Collyrium,’ and in reply thereto, beg to
    advise, being a corporation you will, we think appreciate why we
    are not at liberty to disclose the various formulas under which our
    preparations are made. Such is the competition in the trade that
    secrecy in this respect is a valuable asset.

    “You will not for a moment think that we take this position through
    any distrust of your discretion or good faith, but because we feel
    that our duty to the stockholders of the company prohibits us from
    disclosing our formulas.

    “Let us assure you however, that the eyewash contains only the
    simplest and most harmless remedies well known to the medical
    profession.”

John Wyeth & Brother seek the patronage of the medical profession and
desire physicians to use their preparations, but “being a corporation”
they “are not at liberty to disclose the various formulas” of these
preparations. In other words, they expect physicians of the country to
prescribe “patent medicines” of whose composition they must be ignorant
and to rely wholly on the word of John Wyeth & Brother as to the
innocuousness of these products.

The letter is an insult to the physician to whom it was written. If
physicians were not so apathetic in cases of this kind, the corporation
of John Wyeth & Brother would long since have been forced “off the
fence”--it would have become either a “patent medicine” concern or
would have confined its activities to the manufacture of pharmaceutical
products and ethically exploited proprietaries. Now what about this
Collyrium-Wyeth? It was analyzed in the Chemical Laboratory of the
American Medical Association and the chemists report:

“The specimen of Collyrium-Wyeth examined was a clear, colorless
liquid having a faint odor like benzaldehyd. Qualitative tests
demonstrated the presence of antipyrin, free boric acid and sodium
borate. Acetanilid, ammonium salts, glycerin, nitrates, phosphoric acid
and pyramidon were absent. Such potent alkaloids as atropin, cocain,
homatropin and pilocarpin, which are often used in ocular surgery, were
not found. Preparations of goldenseal were not present. Quantitive
examination indicated that the composition of the preparation examined
is essentially as follows:

    “Antipyrin                        0.41 gm.
    “Sodium borate                    0.55 gm.
    “Boric acid                       2.14 gm.
    “Water (by difference) to make  100.00 c.c.”

The secret of such a formula must indeed be a “valuable asset!” We
venture the assertion that if the medical profession did its duty, the
corporation of John Wyeth & Brother would find that its “duty to the
stockholders of the company” constrained it to abandon secret “patent
medicines” and to confine its activities to a legitimate line of
pharmaceutical products. An examination of the firm’s pricelist reveals
but a very few secret-formula preparations of the type represented by
Collyrium, hence it would probably not seriously damage the business
of the firm either to eliminate all such formulas from its pricelist
or to enable the physician to use them intelligently, if they deserve
it.--(_From The Journal A. M. A., May 17, 1913._)




                               DIATUSSIN


Dr. I. Fleiss, New York, writes:

  “Please state the value of Diatussin, of Bischoff & Co, in pertussis.
  Since pertussis is such an intractable disease, anything which
  promises improvement is apt to attract the physician’s attention.”

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._)




                               ENTERONOL

              The “Greatest Germicide Known to Science!”


This preparation is put on the market by the Enteronol Company, Oswego,
N. Y., which declares that Enteronol is “the greatest antiseptic and
germicide known to science,” and that it “destroys the germs of typhoid
fever, acute and chronic diarrhea, dysentery, cholera infantum, cholera
morbus, summer complaint, Asiatic cholera, etc., within two hours.”
The formula furnished by the company reads as follows: “Ipecac, sub.
nit. bismuth, latalia rad., camphor, lupulin, caffein and rheum.” The
attention of the Council on Pharmacy and Chemistry of the American
Medical Association was directed to this preparation by a correspondent
who had received a circular from the Enteronol Company. He sent a
dollar to the company asking for a sample of “latalia rad.” that he
might study the drug botanically, as he was unfamiliar with it. He
expected to receive by return mail a sample of root or bark, but
instead, he received three boxes of Enteronol and the information that
as “latalia rad.” costs from $25 to $45 a pound the company could not
afford to send samples. In a circular letter sent out by this company
“latalia rad.” is said to grow on the sides of the Himalaya Mountains
in India, and that the company is unable to obtain enough for its own
use. This statement is probably correct, and no one else could secure
the drug either. A sample of Enteronol was submitted to Professor
Day, of the University of Illinois, and to Professor Kraemer of the
Philadelphia College of Pharmacy. Professor Day reports that he was
“unable to find any mention of the drug of ‘latalia rad.’ which is
stated as one of the ingredients of this preparation. I have searched
the usual works of reference on pharmacognosy without being able to
find any reference to a drug of this name. A microscopic examination
of the tablets shows the presence of rhubarb and of ginger, but no
lupulin, at least not in substance; nor could I locate definitely any
ipecac, also stated to be one of the ingredients. Since ginger is not
stated to be one of the ingredients of the compound, it, perhaps, may
be the mysterious stranger ‘latalia rad.’ I was unable to locate any
of the ordinary astringent drugs, such as kino, krameria, or nutgall.”
The results of Professor Kraemer’s examination were practically
identical with those obtained by Professor Day. A report from the
chemical laboratory of the American Medical Association states that
as Professors Kraemer and Day suggested the presence of alum, tests
were made for this substance. The analysis, details of which are
given, leads to the conclusion that alum is the chief constituent of
Enteronol. The report adds strongly to the impression that “latalia
rad.” is simply a ruse to catch the unwary and trusting physician who
lacks the time to look into the botany of every new plant discovered,
and who is willing to trust the honesty of every manufacturer.
Attention is also directed to the fact that while bismuth and caffein
are mentioned as ingredients tests made in the laboratory failed
to discover either of these substances. Since there is no lupulin,
no ipecac, no caffein, no bismuth, and possibly no “latalia rad.”
one is forced to the conclusion that the “formula” is meaningless
and worthless, and that it is simply used to satisfy the demand
for formulas for proprietary remedies. This is one more beautiful
illustration of the absurdity of accepting a preparation because the
“formula is on every package.”--(_Abstracted from The Journal A. M. A.,
March 21, 1908._)


         An Invitation to The Journal to Humbug the Profession

The Journal has received a circular letter from the Enteronol Company,
in which the following liberal offer is made:

    “We are willing to take one-fourth or one-half page ‘ad’ in your
    Journal for a year at the regular rate, on condition that you
    accept payment therefor in our GUARANTEED 7 per cent., preferred
    stock at par; or if you desire, in ENTERONOL at the net wholesale
    price to physicians.”

Not that this offer is made exclusively to The Journal:

    “A large number of medical journals have accepted the foregoing
    proposition; many carrying this advertising for several years
    already.”

    “Our company is cooperative; we paying no cash for advertising. The
    company is owned principally by physicians, medical journals, and
    druggists.”

The journals of which we have record that carry the enteronol
advertisement are: _Kansas City Medical Record_, _Milwaukee Medical
Journal_, _Toledo Medical and Surgical Reporter_, _Proctologist_,
_Pediatrics_, and the _Atlanta Journal-Record of Medicine_. If the
statements made by the Enteronol Co. are true, we might infer that
these journals are being paid for advertising space either with
“preferred stock” or with the nostrum itself. As we have previously
shown, however, the veracity of the enteronol advertising matter is by
no means unimpeachable.

Enteronol, it will be remembered, was exposed in The Journal, March 21,
1908. It is advertised as the “greatest antiseptic and germicide known
to science,” and possesses (?) such remarkable power that it “destroys
the germs of typhoid fever, acute and chronic diarrhea, dysentery,
cholera infantum, cholera morbus, summer complaint, Asiatic cholera,
etc., within two hours.” “The original product is found only high up
on the sides of the loftiest mountains in the world--the Himalayas of
India.”

                       THE “LITERATURE” FORMULA

Of course, it has a “formula”:

    Ipecac                              Lupulin
    Sub. nit bismuth    Latalia rad.    Caffein
    Camphor                             Rheum

This seems very open and above board, except as to quantities, until
one tries to find out what “latalia rad.” is; then it is discovered
that it is the “mysterious stranger” of pharmacognosy. Experts to
whom this “remedy” was submitted were unable even to find mention of
such a drug or plant as “latalia rad.” Nor was this the only fake
found concerning the stuff; carefully conducted experiments repeatedly
carried out in the Association’s laboratory failed to disclose even a
trace of bismuth subnitrate or caffein. These experiments did show,
however, that the tablets contained an amount of aluminum corresponding
to over 25 per cent. of crystallized alum. This led to the conclusion
that alum, whose presence is not even hinted at in the “formula,” is
the chief constituent of enteronol and as a corollary that the formula
is meaningless and worthless.

                           THE LABEL FORMULA

There is a curious lack of coordination between the “formula” as
printed on the label and that given in the “literature.” The Food and
Drugs Act, it will be remembered, makes lying on the label illegal, and
therefore dangerous; statements in advertising matter that does not
accompany the product, however, are not controlled by that law. The
“formula” in the “literature” we have already given; the “formula” on
the label gives the following ingredients:

    Ipecac                                 Lupulin
    Sub. nit. bismuth    Opium, 1/4 gr.    Caffein
    Camphor                                Rheum

Two things about this are worth noting: One is that the name of the
ingredient on which the manufacturer lays so much stress--latalia
rad., the mysterious Himalayan plant--is absent from the label. This
would seem to indicate that what has already been intimated by The
Journal--namely, that latalia rad. is a figment of the imagination--is
a fact. The second noticeable thing about the label “formula,” as
distinct from the “formula” in the advertising matter, is that on the
label we find there is opium in the preparation. Why is no mention made
of the presence of this potent drug in the advertising matter?

To determine how nearly the present statements made by the Enteronol
Company approximate truthfulness, our chemists were asked to examine
the nostrum as it is now sold. Their report follows:

                          LABORATORY FINDINGS

  An original package of enteronol tablets was purchased on the open
  market and submitted to the Association laboratory for examination.
  In general appearance, odor and taste the new tablets are similar
  to those previously examined. The formula for the old tablets was
  given as “Ipecac, Sub. nit. bismuth, Latalia rad., Camphor, Lupulin,
  Caffein, Rheum,” and is still used in the circular. But the label
  on the trade package no longer mentions “latalia rad.” Since the
  presence of “latalia rad.,” in the old tablets, was questioned,
  and as new labels have ceased to display the name, it was thought
  possible that caffein and bismuth might now be constituents of
  enteronol, as the drugs are still mentioned in the new formula on the
  label. Accordingly, enteronol was examined chemically to verify the
  statements on the label regarding the presence of caffein and bismuth
  in the tablets.

  The specimen submitted to the laboratory some time ago was found to
  contain neither bismuth nor caffein. By employing the same methods
  as were used before (the usual tests for detecting caffein and
  bismuth), neither caffein nor bismuth could be demonstrated. It is
  thus evident that this new specimen of enteronol, the statement on
  the label to the contrary notwithstanding, contains neither bismuth
  nor caffein--at least, in appreciable quantities.

One would think that the discrepancy between “formulas” and facts
would prove of interest to the stockholders of the Enteronol Company,
especially as we are told that the policy of the company is to have
“practical men as stockholders.” We are informed:

    “Therefore, we have physicians, advertising experts, printers,
    publishers, engravers, boxmakers, lithographers, druggists,
    lawyers, traveling salesmen, officers and men holding executive
    positions in various manufacturing and commercial corporations,
    editors of medical publications, bishops, clergymen and
    missionaries--men from all the fields particularly valuable
    commercially for our great enterprise.”

Yet if the physician-stockholders do not care to concern themselves
about the composition of the nostrum from the sale of which they derive
dividends, it can hardly be expected that the boxmakers or traveling
salesmen will be interested.

                            STOCK FOR SALE

Medical journals are not alone in being invited to participate in
the exploitation of this nostrum, _vide_ a circular letter from the
Enteronol Company addressed “To Investors”:

    “We offer at par of $10 each, 1,000 shares of our Guaranteed 7 per
    cent. Preferred Stock, cumulative dividends, payable quarterly ...
    Profits on business done last year were 54 cents for every dollar
    expended ... _We guarantee absolute security for your investment.
    Safer than a bank._” [Italics ours.--Ed.]

We are told that at present the Enteronol Company manufactures two
products: a castor-oil preparation, known as fig-ol, and enteronol.
Very shortly, however, the company expects to “add seven equally
efficient products.”

    “The average cost to manufacture, ready to ship, a dollar’s worth
    of these goods is less than ten cents.”

    “In enteronol alone, the company has fortunes and the only thing
    needed to bring tremendous results and dividends of 100 per cent.
    is the proper amount of judicious advertising.”

Here are some samples of the judicious (?) advertising:

    “One Christian missionary, the Rev. Paul Singh of Jubbulpore,
    India, testifies that he cured thirteen severe cases of Asiatic
    Cholera with a box containing less than thirty tablets” [of
    enteronol].

    “Wm. F. Oldham, bishop of Southern Asia, writes us that enteronol
    cured nine cases out of ten of Asiatic Cholera. Now just think of
    India and China with their 800,000,000 people who are dying by the
    thousands of a disease which we have the power to cure so easily.”

How like a discourse by that delightful character of Mark Twain’s--the
visionary Colonel Sellers--this reads. As he said about his
“Infallible, Imperial, Oriental Optic Liniment”:

    “Why in the Oriental countries ... every square mile of
    ground upholds its thousands on thousands of struggling human
    creatures--and every separate and individual devil of them’s got
    the ophthalmia.”

The prospective stockholder is told that an ordinary business concern
reaches the limit of financial possibilities in a few years, but:

    “Not so with the Enteronol Company--it is a mail-order business and
    the world is its territory.”

Even so with Colonel Sellers’ “Optic Liniment”:

    “... it’s a patent medicine whose field of operations is the solid
    earth.”

And we are told elsewhere that “about four-fifths of the outstanding
stock is held by the medical profession alone”!

And this stuff is advertised in medical journals!!

We are sometimes in danger of being too optimistic regarding the
results of the propaganda for reform in proprietary medicine. Cases
like this act as a corrective.--(_From The Journal A. M. A., Nov. 20,
1909._)




                     EXPURGO (SANOL) ANTI-DIABETES

               One More Fraudulent Nostrum for Diabetes


Expurgo Anti-Diabetes is sold and advertised in the United States
by the Expurgo Manufacturing Company, Chicago. The concern is the
United States branch of a Canadian company, the Sanol Manufacturing
Company, Ltd., Winnipeg, which sells its product in Canada under the
name of “Sanol Anti-Diabetes.” The parent company is said to have
been incorporated under the Manitoba laws in 1912 and to have for its
officers and directors the following men:

    Charles Beyer, President.
    Frank Beyer, Vice-President.
    Charles Bauer, Secretary-Treasurer and Manager.

The manager of the United States branch in Chicago is said to be one
E. M. von Amerongen.

The stuff is such an evident fraud that one would imagine that
even intelligent laymen could not be deceived by it. Nevertheless
medical journals both in the United States and Canada have accepted
advertisements for this preparation and physicians--of a certain
type--have been found to give testimonials for it. The medical
profession is circularized widely by the concern and “write-ups” have
appeared in pseudomedical journals. Some of the claims made for Expurgo
Anti-Diabetes are:

    “The only positive cure for Diabetes.”

    “It never fails to effect a Cure in every case of this disease, in
    whatever form it may present itself provided the patient has not
    reached the last stages of the malady.”

    “Expurgo Anti-Diabetes is the New Cure for this deadly affliction.”

    “Diabetes is certainly curable by our new discovery--Expurgo
    Anti-Diabetes, provided that the course of the disease has not
    progressed to the extent that the vital organs are irreparably
    damaged.”

    “... thanks to the discovery of Expurgo Anti-Diabetes, the cure of
    this dread disease is no longer a matter of doubt.”

    “With the exception of very advanced cases of Diabetes ... all
    diabetes can be cured by Expurgo Anti-Diabetes.”

Such claims one would imagine would be more than sufficient to
make plain, even to the most uncritical of physicians, the evident
fraudulence of Expurgo Anti-Diabetes. Nevertheless, the advertisements
of this fraud have appeared during 1913 in the following medical
journals:

  _Medical Times_
  _Medical Brief_
  _Medical Summary_
  _Buffalo Medical Journal_
  _Louisville Monthly Journal_
  _Iowa Medical Journal_
  _Canada Lancet_
  _Detroit Medical Journal_
  _Medical Herald_
  _Medical Review of Reviews_
  _Medical Standard_
  _Medical Review_
  _Therapeutic Record_
  _Medical Fortnightly_
  _Indianapolis Medical Journal_
  _Southwest Journal of Medicine and Surgery_
  _Western Canada Medical Journal_
  _Dominion Medical Monthly_
  _Canadian Medical Association Journal_
  _Canadian Practitioner and Review_
  _Massachusetts Medical Journal_

Physicians will recognize that, with but few exceptions, most of these
journals are utterly unrepresentative of scientific medicine.

The _Army and Navy Medical Record_, shown in The Journal recently
as a journalistic fraud, contained an editorial puff of Expurgo
Anti-Diabetes. The fact that the Expurgo Company reprints the
“editorial” from the _Army and Navy Medical Record_ as a “voluntary and
unsolicited reference” and distributes it among physicians, indicates
how rotten are the props on which the superstructure of this fraud rest.

Another alleged “voluntary and unsolicited reference” used by the
Expurgo Company is taken from the _Therapeutic Record_ of Louisville,
Kentucky. The advertising pages of the _Therapeutic Record_ reek with
frauds and it has more than once given editorial endorsement to some
of the frauds that it advertises. The following enlightening letter is
alleged to have been written by the editor of the _Therapeutic Record_
to the Expurgo Company in February, 1913:

    _Gentlemen_:--Your favor of February 14th came duly to hand. Let me
    advise you to pay no earthly attention to the proceedings of the
    Medical Society where your product was criticized. These people
    exert no influence with the practical up-to-date element of the
    profession and are doing you as they do others. _Never fear--you
    will succeed--your remedy is all right. No man can talk down a
    meritorious product. I stand ready to help you in any way at any
    time._

    With sincere regards, I am,

    Robert C. Kenner, M.D.,
    Editor, the _Therapeutic Record_.

This, it will be noticed, was written in February. Soon thereafter the
_Therapeutic Record_ was carrying the Expurgo advertisement, and the
June, 1913, issue contained a puff on Expurgo, entitled “A Contribution
to the Medical Treatment of Diabetes.” The _quid pro quo_ is fairly
evident.

                          THE ALLEGED FORMULA

The formula for this nostrum is never published, although in some
of the advertising matter it is claimed that it is “at the disposal
of physicians.” A physician wrote to the Expurgo Manufacturing
Company, asking for the formula. He was told that the preparation was
“exclusively derived from the vegetable kingdom,” from which one may
recognize a family likeness to the “dope” put out by the immortal Lydia
Pinkham. Further, to copy the letter exactly:

    “The ingredients of which Antidiabetes is composed are chiefly:
    “fructus syzigii jambulani
    “cortex syzigii jambulani
    “flores Rosmarini
    “fructus Anisi stellati
    “Extr. fl. Colæ
    “Extr. fl. Condurango
    “Extr. fl. Chinæ spir. spiss.
    “Extr. fl. Calami
    “Extr. fl. Gentianæ.”

The recipient of this noncommittal and uninforming “formula” again
wrote the Expurgo Manufacturing Company, asking for quantities.
Evidently this nostrum concern considered such a request a piece of
impertinent inquisitiveness, for it replied to the physician in these
terms, given _verbatim et literatim_:

    “_Dear Sir_:--Yours of the 16th duly to hand. We note that you
    state ‘... I do not like to be working in the dark, and you can
    readily see that this is the case unless I know how much of each
    ingredient I am giving....’

    “In your letter of the 6th you asked for the composition, which
    you promptly received. We would like to state that we are dealing
    with about 600 Doctors. Some of them asked for the formula, which
    they received. They are all very conscientious gentlemen and none
    of them ever pretended ‘to work in the dark.’ You know furthermore
    that none of these ingredients is harmful in any way and yet ‘work
    in the dark.’ You know that if there were any harmful ingredients
    in our preparations, we would expose ourselves to imprisonment.
    If you are so anxious to know all about it, why do you not
    analyse our medicine? This would enlighten you in your ‘perfect
    darkness.’ If you want to deprive your patients and yourselves of
    the indisputable good of our preparations, simply do not prescribe
    them. Why finally do you not write to the Doctors whose names we
    gave, who know enough to be able to enlighten those who need it.

                              Truly yours
                                                  The Expurgo Mfg. Co.,
                                           C. M. v. Amerongen, Manager.

More than a year ago, a Wisconsin physician, himself a sufferer from
diabetes, wrote The Journal that for three months he had been using
Expurgo Anti-Diabetes which the Expurgo people had sent him. He
declared that the nostrum had greatly reduced the percentage of sugar
in his urine. In its reply, The Journal asked him whether, in testing
his urine he had used portions of twenty-four hour specimens or merely
individual specimens. His attention was called to the fact that most of
the nostrums for diabetes are diuretics which, by increasing the amount
of urine passed, give an apparent decrease in the amount of sugar
excreted. A few days later, the physician wrote again, stating that he
had committed the very error The Journal had suspected, and reporting
that an examination of a twenty-four-hour specimen showed that the
glucose-excretion, instead of being diminished, actually increased.
This matter was referred to editorially in The Journal, Nov. 9, 1912,
under the title, “A Possible Fallacy in Testing Diabetic Urine.”

Specimens of Expurgo Anti-Diabetes were examined in the Association’s
laboratory and the chemist’s report follows:

                           LABORATORY REPORT

[Illustration: The letter head of the Expurgo Manufacturing Co. Note
the claim that Expurgo Anti-Diabetes is “the only positive cure for
diabetes.” And this stuff is foisted on the profession through the
medical press!]

  “The specimen of Expurgo Anti-Diabetes (Sanol Anti-Diabetes)
  examined, was a light-brown, opaque liquid, having a faintly aromatic
  odor and bitter taste. The specimen contained considerable amounts
  of brown, insoluble residue resembling the deposits often found in
  fluid extracts. The absence of ammonium salts, iodids, glycerin,
  hexamethylenamin, of antipyrin, pyramidon and similar substances and
  of such purgatives as aloes, frangula, rhubarb, etc., was indicated.
  Potent alkaloids such as aconitin, cocain, morphin and strychnin
  were not found. Qualitative tests indicated the presence of traces
  of phosphates, sulphates, reducing sugars, caffein and cinchona
  alkaloids. Alcohol was present only in traces. Small quantities of
  chlorids, sodium and a salicylate were found. The residue on drying
  amounted to 2.9 gm. in each 100 c.c. A determination of the salicylic
  acid indicated approximately 0.17 gm. in each 100 c.c., which is
  equivalent to less than 0.2 gm. of sodium salicylate per 100 c.c.
  (about 1 grain to the ounce). Evidently the preparation contains
  plant extractives in aqueous solution and small amounts of sodium
  salicylate and sodium chlorid.”

Summed up, the chemist’s report shows that Expurgo Anti-Diabetes
is essentially a watery solution of plant extractives with small
quantities of sodium salicylate and salt. The exploiters claim their
stuff contains the fruit and bark of jambul, rosemary, star anise and
fluid extract of calamus, cinchona, cola, condurango, and gentian.
Since fluidextracts in general are strongly alcoholic and since the
laboratory’s analysis shows that the preparation contains only traces
of alcohol, the fluidextracts of the various drugs, if present at all,
must be in an infinitesimal amount.

Jambul was in vogue as a remedy for diabetes about twenty years ago. It
was tried and found wanting, and has long since been relegated to the
therapeutic scrap heap. Sanol, therefore, is but one more proprietary
humbug, foisted on the profession under fraudulent claims, and having
for its essential constituent a drug that has long been discarded by
scientific men and resurrected for the purposes of quackery. Expurgo
will probably be used by uncritical and unthinking physicians and
its existence will be artificially prolonged through the venality of
pseudo-medical journals. That the medical profession should tolerate
such an evident fraud is not to its credit. There is no excuse, either
moral or otherwise, for a physician giving his patients nostrums of
whose composition he is ignorant, and that is what is done whenever
Expurgo Anti-Diabetes is prescribed.--(_From The Journal A. M. A., Jan.
24, 1914._)




                               FORMAMINT

                   The Profession to Be Worked Again


Formamint Tablets are widely advertised and extravagantly exploited to
the laity in Great Britain. Large and expensive advertisements appear
in the English magazines and newspapers and the tablets are pushed
under the most preposterous claims. The preparation is put out, we
understand, by the same concern that exploits Sanatogen. The medical
profession of this country is now being circularized and advertisements
are appearing in medical journals. They already appear in the _Medical
Record_, _New York Medical Journal_ and _American Journal of Clinical
Medicine_.

It seems then that this is another product which, for the time being at
least, is to be a “patent medicine” on the other side of the Atlantic
and an “ethical proprietary” on this. Doubtless the distinction will
be a temporary one and as soon as American physicians have furnished
the requisite number of testimonials and have recommended it to a
sufficient number of their patients the advertisements will be quietly
dropped from the American medical journals and the advertising pages
of newspapers and magazines will be called into service.--(_From The
Journal A. M. A., Jan. 27, 1912._)


               The So-Called Germ-Killing Throat Tablet

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:

    “Formamint shields humanity against infectious disease.”

    “Cures and prevents sore throat.”

    “The dangers of infection from diseases like diphtheria, scarlet
    fever, measles, tonsillitis, sore throat, mumps, etc., have now
    been reduced to an absolute minimum. This is due to the discovery
    of Wulfing’s Formamint--the ‘germ-killing throat tablet.’”

    “Cleanses the mouth and throat from disease germs as easily and
    rapidly as dirt is removed from the skin.”

    “Formamint will certainly prevent diphtheria.”

    “Quickly render the whole mouth and throat thoroughly antiseptic.”

    “Formamint destroys these [diphtheria] germs so rapidly that when
    a physician mixed a little Formamint with water and added it to
    the germs taken from the throat of a patient dangerously ill with
    diphtheria they were all killed within ten minutes.”

Such are some of the claims by which Formamint goes to the European
public. Doubtless it will be only a matter of time when the required
number of testimonials from American physicians are forthcoming when
we may expect to find the newspapers of this country heralding through
their advertising pages the fact that Formamint is “recommended by
thousands of American physicians.” The medical journals that are
lending their pages to this preliminary advertising campaign are the
following:

  _New York Medical Journal_
  _Medical Record_
  _American Medicine_
  _American Journal of Clinical Medicine_
  _Medical Review of Reviews_

How much longer will the medical profession permit itself to be used
as an unwitting agency for the exploitation of “patent medicines”? The
game has been worked so often that it has become transparently thin. It
is evidently not worn out, however, or shrewd nostrum promoters would
not waste their time or money on it. That it should still be considered
workable is complimentary neither to the standard of advertising ethics
of medical journals that accept the Formamint advertisements nor to the
intelligence of the members of the medical profession who will “fall
for it.”--(_The Journal A. M. A., Feb. 24, 1912._)




                                GOMENOL


A correspondent sends some advertising matter on Gomenol and calls
attention to the number of diseases for which the preparation is
recommended:

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.

    “A real specific for suppurations and catarrh.... It immunizes
    tissues, excites their vitality and favors the formation of new
    cells....

    “The least trace of Gomenol prevents the growth _in vitro_
    of the streptococcus, the tuberculous bacillus and the
    gonococcus.”--(_From The Journal A. M. A., April 4, 1914._)




                          HEADACHE CURES[AV]

      Harmful Effects of Acetanilid, Antipyrin and Acetphenetidin

[AV] See also report on Acetanilid Mixtures, p. 9.


The United States Department of Agriculture Bulletin[107] No. 126,
issued July 3, 1909, sets forth the results of an investigation
conducted by the Bureau of Chemistry with regard to the harmful effects
of acetanilid, antipyrin and acetphenetidin. During recent years the
use of these remedies and preparations containing them by the people at
large, without the supervision of the physician, has increased rapidly
and investigation has shown that coincidently there has been a marked
increase in the number of cases of poisoning reported, in the number of
fatalities, and in the number of instances of habitual use.

[107] The Harmful Effects of Acetanilid, Antipyrin and Phenacetin,
by L. F. Kebler, Ph.G., M.D., chief Division of Drugs, Bureau of
Chemistry, with the collaboration of Drs. F. P. Morgan and Philip Rupp,
assistant chemists.

Since the passage of the Food and Drugs Act, June 30, 1906, the
attention of the Department of Agriculture has been directed to this
subject, particularly in connection with the branding of drug products
containing one or more of these agents, and an attempt has been made to
obtain full and reliable data with regard to their poisonous qualities
with the object of furnishing information to the public which would
enable them to understand that these remedies should be employed with
caution in the absence of reliable medical advice.

The information obtained with regard to the number of an inquiry
addressed to medical practitioners in the United States with regard
to their personal experience with these drugs; and, second, the study
of the cases of poisoning recorded in medical literature. Nearly a
thousand letters, each containing eighteen questions, were addressed by
the department to physicians throughout the country, the object being
to secure information which would represent as closely as possible the
conditions existing among the people at large so far as the harmful
effects of the drugs in question are concerned. Four hundred replies
were received.

The information obtained with regard to the number of instances quoted
in medical literature in which poisoning, death, or habitual use has
been known to result from the administration of acetanilid, antipyrin,
and acetphenetidin is set forth in Section A of the accompanying table.
The information summarized in Section B is based on the data submitted
by physicians. Granting that the 525 physicians who did not reply
had no cases to report, the question may profitably be asked, if 925
physicians have observed 814 cases of poisoning by these drugs, 28
deaths which are attributed to their use, and 136 instances of habitual
use, how many such cases have in all probability been observed by the
125,000 physicians scattered throughout the United States? The summary,
C, includes both the number of cases recorded in medical literature and
those reported by physicians.


           POISONING BY ACETANILID, ANTIPYRIN AND PHENACETIN

A.--Cases Recorded in Medical Literature

                                                     HABITUAL
                                 POISONING.  DEATH.    USE.
    Acetanilid                       297       13       32
    Antipyrin                        488       10       ..
    Acetphenetidin                    70        3        1
                                     ---       --       --
      Total                          855       26       33

B.--Data Submitted by Physicians

                                                     HABITUAL
                                 POISONING.  DEATH.    USE.
    Acetanilid                       614       16      112
    Antipyrin                        105        5        7
    Acetphenetidin                    95        7       17
                                     ---       --       --
      Total                          814       28      136

C.--Total Number of Cases

                                                     HABITUAL
                                 POISONING.  DEATH.    USE.
    Acetanilid                       911       29      144
    Antipyrin                        593       15        7
    Acetphenetidin                   165       10       18
                                    ----       --      ---
      Total                        1,669       54      169

The bulletin contains information with regard to dosage, the extent to
which these drugs are employed by physicians, poisoning and habitual
use, the nature of the ill effects produced, etc. It also contains
references to the recorded cases of poisoning, together with a brief
abstract of each case.--(_From The Journal A. M. A., July 31, 1909._)


                 Sanatoriums and the Acetanilid Habit

_To the Editor_:--I enclose herewith a “form” letter and question blank
which I received recently from St. Louis. I may be entirely too wary
but I am suspicious that this is a collection of “statistics” to combat
the work of the medical profession in educating the physician and the
laity in the harmfulness of acetanilid and similar preparations.

                                    G. H. Benton, M.D., Chester, W. Va.
                                             Sterling-Worth Sanitarium.

Comment: The letter which Dr. Benton encloses is in facsimile form
and purports to come from Uriel S. Boone, M.D., of St. Louis, who
states that he is “preparing an exhaustive article for publication
in a leading medical journal” on the question, “Is acetanilid a
habit-forming drug?” To obtain the necessary data Dr. Boone is “writing
to every hospital and sanitarium in the United States.” Examination of
the question blank which accompanies the form letter discloses the fact
that information is wanted regarding not acetanilid alone, but also
antipyrin and acetphenetidin (phenacetin). The last question asked runs
as follows:

    “If your records [of cases of habitual use of these drugs] are
    incomplete, would you allow a reputable physician to investigate
    the above-mentioned cases so that he could write with positiveness
    about them, and, if necessary, _make oath to the truth of his
    report_?” [Italics ours.--Ed.]

Dr. Boone opines that the recipients of his queries “may hesitate to
answer” the question just quoted, but he trusts that its importance
will be evident when he explains that “it is currently reported that
the manufacturers of acetanilid, phenacetin, etc., _have decided to
prosecute all libelers of these drugs_” [Italics again ours.--Ed.] and
he wishes to make no statement that he “can not substantiate under
oath.” Surely the life {of} the collector of medical statistics is
unusually hazardous.

For the purpose of aiding Dr. Boone in his arduous search for truth
on the “much mooted question, ‘Is acetanilid a habit-forming drug?’”
we direct his attention to a work that should prove of invaluable
assistance. We refer to Bulletin 126 of the Bureau of Chemistry,
entitled “The Harmful Effects of Acetanilid, Antipyrin and Phenacetin.”
This interesting study to which we have previously called attention
records 112 cases of the acetanilid habit. Of this number at least
50, or 44.6 per cent. of the cases were those of patients who took
proprietary preparations of the drug.

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._)




                                HECTINE


Hectine is a French proprietary and is stated to be, chemically, sodium
benzosulphoamino-phenyl-arsenate. If the asserted composition is
correct, Hectine is similar to atoxyl, which is described in New and
Nonofficial Remedies, 1914, page 38. Hectine has not been examined by
the Council on Pharmacy and Chemistry.--(_From The Journal A. M. A.,
Aug. 8, 1914._)




                             HYDRONAPHTHOL


A correspondent having requested information regarding the composition
of “Hydronaphthol,” the product was investigated in the Association
laboratory, which reports as follows:

Hydronaphthol is sold by Seabury & Johnson. The label on a trade
package of Hydronaphthol gives no clew as to the nature of the
product. The statements on the labels do, however, make the claim
that Hydronaphthol is an antiseptic of great power, also that it is
non-toxic and therefore may be used with impunity; thus the following
statements are made:

    “A harmless, practically odorless, non-poisonous, non-corrosive
    antiseptic....”

    “... it is non-poisonous and can be employed with perfect immunity
    as a preservative....”

The substance has the characteristic appearance, odor and taste
of naphthol. It responded to all the tests of the United States
Pharmacopeia for betanaphthol, with the exception of the melting
point, which was found to be 119 C. instead of 122 C., an indication
of impurity. It is evident, therefore, that Hydronaphthol is merely a
trade-name for betanaphthol. While resublimed betanaphthol is listed at
10 cents an ounce, Hydronaphthol is listed at 75 cents an ounce.

  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._)




                               HYDROZONE


The moral principle governing the action of secret proprietary and
patent medicine men is an unknown quantity; sometimes it would seem to
be a negative one. Just how much lower in the scale of humanity a man
can go than to prey on the fears of a people in the time of a terrible
epidemic for the sake of a few dollars we do not know. There may be
something more despicable, but what is it? Two weeks ago we referred to
the cold-blooded methods of the Peruna people; this week we reproduce
an advertisement from the New Orleans _States_ that tells another story
of man’s inhumanity to man.

[Illustration]

This brings up the problem that we are trying to solve, viz.: “What
is the difference between a ‘secret proprietary medicine’ advertised
in medical journals to physicians and a ‘patent medicine’ advertised
in newspapers to the public?” Hydrozone is being advertised in nearly
all medical journals, and at the same time in newspapers. Where shall
we place it? And if hydrozone, with the methods recently adopted to
exploit it, is tolerated in the medical press, why not peruna?




                             HYPOQUINIDOL


An examination of the advertising matter fails to show that R. W.
Gardner makes any definite statement in regard to the nature or the
composition of his Hypo-Quinidol. Certain statements made in the
literature sound much as if the article might be some sort of a quinin
hypophosphite preparation. But if this is true, its action would be
the same as other salts of quinin and the extravagant claims made
could not be substantiated. It is said to be a “non-toxic quinin.”
It is safe to say that a quinin which will not produce the toxic
symptoms--cinchonism--either is not absorbed in sufficient quantity or
has been so changed that it no longer has the therapeutic properties of
quinin. Altogether Hypo-Quinidol must be put down as a preparation the
composition of which is kept secret and regarding which extravagant and
highly improbable statements are made.--(_From The Journal A. M. A.,
Jan. 10, 1914._)




                             IODONUCLEOID

               An Iodin Product Under a Misleading Name


Information has been frequently asked concerning Iodonucleoid, a
product not included in New and Nonofficial Remedies. The Association
Laboratory after investigating this preparation reported as follows:

  This preparation was at one time considered for inclusion with New
  and Nonofficial Remedies, and at that time was examined in this
  laboratory. The examination showed that iodonucleoid contains:

    Phosphorus                          0.79 per cent.
    Calcium                             0.43 per cent.
      (Equal to 0.6 per cent. CaO).
    Iodin                               24.2 per cent.

  When 2 gm. was dissolved in tenth-normal potassium hydroxid
  volumetric solution and acetic acid added until faintly acid, an
  abundant, white, flocculent precipitate formed. This precipitate
  was collected, washed with water, transferred to a beaker,
  phenolphthalein added and tenth-normal potassium hydroxid volumetric
  solution run in until a pink color was produced. This required
  15 c.c. of tenth-normal alkali. Subtracting from the 2 gm. of
  iodonucleoid the 24 per cent. iodin, leaves 1.52 gm.; this divided by
  the c.c. of alkali used indicates an equivalent weight of 1013.

  Authorities differ widely regarding the amount of phosphorus
  contained in nuclein from different sources, the figures ranging
  from 2.9 per cent. to as high as 10 per cent. If the nuclein from
  which iodonucleoid purports to be made contained but 2.9 per cent.
  phosphorus, the preparation, after allowing for 24 per cent. iodin,
  should still contain 2.2 per cent. phosphorus instead of the 0.79 per
  cent. found by analysis. A true nuclein should contain no calcium. If
  iodonucleoid is a casein compound of iodin we might expect to find,
  if the casein had been freed from milk by acidulation without further
  purification, both calcium and phosphorus. The equivalent weight of
  casein is given by Long (_Jour. Am. Chem. Soc._, 1906, xxviii, 372)
  as 1124. This figure was obtained on a casein of high purity, and the
  figure of 1013 given above agrees fairly well with Long’s figure for
  casein. The evidence, therefore, indicates that iodonucleoid is a
  compound of iodin and casein, and not a nuclein compound.

The findings of the laboratory were at that time submitted to Prof.
John H. Long of Northwestern University, who said:

  “We have also made a number of examinations of iodonucleoid. We
  determined in it the iodin and found the amount 24.2 per cent. by
  weight, which is a little more than that claimed by the manufacturer.
  We have also tested the solubility of this substance and find it to
  behave about as your laboratory did. As you know, we have been making
  a number of preparations from casein, and recently we have determined
  the combining power of casein with various acids, including hydriodic
  acid. This acid when evaporated in moderately strong solution with
  casein yields finally a hard, dry mass, which may be ground up to
  a powder resembling very closely the preparation under discussion.
  Various amounts of iodin may be combined here, depending on the
  strength of the iodin solution used, and we have secured some
  containing over 35 per cent. of iodin. Several of these preparations
  resemble closely iodonucleoid, so far as solubility, appearance and
  reaction with alkalies on titration are concerned. I am unable,
  therefore, to distinguish this preparation from the casein compounds
  which we are making.”

From this it would appear that iodonucleoid is not a compound of
nuclein, as indicated by the name, but instead is a casein compound of
iodin.

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 discussion of a number of iodin substitutes is found in an article by
von Notthafft (_Monatsh. f. prakt. Dermat._, Oct. 15, 1910, p. 343),
which was abstracted and commented on in The Journal, March 4, 1911,
p. 685. Von Notthafft believes that the lower degree of toxicity which
these remedies exhibit has its basis in a feebler activity; either the
substitutes evolve too little iodin or they split it off with greater
difficulty. Physicians should, therefore, view with some distrust the
claims of manufacturers that their products are not only non-irritating
but at the same time possess unusual therapeutic efficiency. This will
apply with especial force if there is any tendency to conceal the
nature or origin of the combination.--(_The Journal A. M. A., July 22,
1911._)




                                IRIDIUM


Dr. C. A. Dexter, Columbus, Ga., asks for information concerning the
use of iridium in the treatment of acute and chronic rheumatism.
Iridium is a well-known element although we have not found that it has
been used as a medicine; however, we presume our correspondent refers
to “Iridium (Medicinal),” sold by the Platinum Company of America.
We are not able to locate this company, but in their advertising
circular “Iridium (Medicinal)” is said to be “an agent for the blood,
a laxative, an alterative, indicated in all disorders of the stomach,
in Jacksonian epilepsy,” and “a specific in rheumatism.” As to its
origin, it is said in the circular, “the platinum sands are associated
with and composed of iridium” and some other elements, so that as far
as the circular gives information the nostrum is alleged to contain the
element iridium.

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 man who signs himself president of the Platinum Company of
America is said to be a lawyer, but is not working at it, and was
formerly a promoter, fiscal agent, etc. It should not be difficult
for the physician to fix the status of iridium under this sort of
exploitation.--(_From The Journal A. M. A., April 23, 1910._)




                              IRON TROPON


The composition of Iron Tropon seems to have varied from time to time.
The manufacturers formerly stated that it contained fat, sugar, pepsin
and iron in organic combination with albumin, and its use was advocated
both as a food and as a medicine. It was not claimed to contain over
1 per cent. of pepsin, but tests failed to show that it contained any
pepsin, or if any, such a small amount that there was not sufficient
to digest the albumin in Iron Tropon itself. It was also claimed that
the iron, being in organic combination with the albumin, possessed
advantages over the widely used aromatic fluid preparations of iron.
Tests, however, showed that the iron was not in organic combination,
though even had it been, late investigations fail to demonstrate the
superiority of the organic over inorganic iron compounds.

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.

As a food, Iron Tropon, weight for weight, is about equal to beans and
a little better than flour, although it contains a larger percentage
of protein than either. In the dose stated, an invalid would get
about 50 calories, or about 1/40 the necessary nourishment for a day.
Tests have also shown that the albumin is difficult of digestion.
In spite of this fact, the advertisement of Iron Tropon states: “A
patient who takes Iron Tropon receives not only the benefit of iron
medication, but at the same time his economy is supplied with perfectly
assimilable albumin in sufficient quantity.” It will thus be seen that
the claim for pepsin in this preparation has been abandoned, that the
statement as to the iron being in organic form has been modified, and
that the food value of the albumin is exaggerated; but perhaps the
manufacturers do not expect the physician to apply his arithmetic to
such problems.--(_From The Journal A. M. A., April 23, 1910._)




                            KUTNOW’S POWDER

         Which Is It, a “Proprietary” or a “Patent Medicine”?


The term “patent medicine” has been applied, rather loosely, to those
nostrums sold and exploited directly to the public, while the name
“proprietary” has been given such preparations as are advertised only
to the medical profession. As has been many times exemplified by
reports in The Journal, the distinction is often a very fine one and
the dividing line frequently reaches the vanishing point.

It is not unusual, for instance, for “proprietary” preparations
to be foisted on the medical profession until a certain number of
testimonials (of doubtful value, it is true, but still testimonials)
have been ingeniously wheedled out of physicians and the product
rather generously prescribed. When this objective point has been
reached the manufacturer comes into the open and advertises the nostrum
to the public direct and the testimonials previously given for the
“proprietary” are used as advertising assets for the “patent medicine.”

Then again there are certain preparations which are “proprietaries”
or “patent medicines” according to the location. On one side of the
Atlantic the product is advertised to physicians only, while on the
other side it runs indiscriminately on the billboards and in the
newspapers. One of the best examples of this last class is Kutnow’s
Powder. In England, where it originated, this preparation, which
“dissolves and eliminates uric acid,” is consistently lined up with
Beecham’s Pills and Pink Pills for Pale People. Full-page newspaper
advertisements announce the fact that free samples will be

    +----------------------------+
    |  “SENT TO ALL APPLICANTS”  |
    +----------------------------+

In the United States, however, Kutnow’s have learned from their wide
advertising experience that a cheaper and surer way of introducing a
nostrum to the public is to advertise it to the medical profession
only. By means of advertisements in medical journals (whose space is
much less expensive than that of the daily papers) and the liberal
distribution of samples which are

    +----------------------------------+
    |  “SENT FREE TO PHYSICIANS ONLY”  |
    +----------------------------------+

the medical profession becomes the unpaid “barker” for the nostrum
manufacturer. At present, therefore, Kutnow’s Powder is--in the United
States--an ethical (!) “proprietary.”

[Illustration]

There exists in this country, as most of our readers know, an
organization of “patent medicine” manufacturers whose “reason for
being” is to get full value received for the $40,000,000 paid annually
in advertising nostrums in the newspapers of the country. This
organization is known as the Proprietary Association of America. The
now familiar “red clause” in the advertising contracts by which the
newspaper forfeits its contract if state laws are enacted that are
inimical to the “patent medicine” interests, is a creation of this
organization and has been most effective in making the newspapers the
unpaid lobbyists of the nostrum interests. The “silence clause” is
another “joker” in the contracts by which the agreement is canceled
if matter detrimental to the nostrum “is permitted to appear in the
reading columns” of the paper. It is little wonder that with such
weapons the “patent medicine” manufacturer has assumed an arrogance
that is as disgusting as it is serious.

Great Britain, too, has its “patent medicine” men’s organization, which
is known as the Proprietary Articles Trades Association. Of both these
honorable bodies Mr. S. Kutnow of Kutnow Brothers, Ltd., is, or was, a
conspicuous member. At a recent meeting of the British organization,
Mr. Kutnow worked himself into a fine frenzy of indignation because
of some articles that had appeared in the _Pharmaceutical Journal_ of
London on the subject of “Secret Remedies and Proprietaries.” As these
articles did not specifically mention Kutnow’s Powder, and as evidence
was directed against only those preparations as were most disreputable,
it is evident that Mr. Kutnow now appraises his own product at its face
value. He gave his opinion of the _Pharmaceutical Journal_ and told
the meeting that when the advertising man for that journal solicited
advertising he refused to have any more dealings with him owing to the
articles that had appeared in the _Pharmaceutical Journal_. He declared
that he was quite independent of any newspaper or journal, and was able
to take care of himself.

Therein Mr. Kutnow is mistaken; he is not independent of newspapers
and journals. On the contrary, he and others of his ilk are
most subserviently dependent on them. Let reputable papers and
medical journals refuse, for but one year, to carry the high-flown
advertisements of his Anglo-American Patent-Proprietary, and his firm
would perforce seek some worthier, if less profitable, line of business.

The editor of the _Pharmaceutical Journal_ resents Mr. Kutnow’s
“implied assumption that by inserting paid announcements in the
advertising columns of a newspaper, he or any one else, can dictate the
policy of that organ.”

The _Pharmaceutical Journal_, it should be said, is the official
organ of the Pharmaceutical Society of Great Britain, and is the
most influential organ of the drug trade in the British Isles. It is
refreshing to note, in these days of “canned” editorials and paid
“write-ups” masquerading as original articles, that there is still to
be found a journal that can not be bought.

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._)




             LYMPH COMPOUND R-H AND ORCHITIC FLUID TABLETS


A physician wrote The Journal:

  “I have under my care a patient with chronic parenchymatous
  nephritis. Microscopic examination shows occasional epithelial casts,
  with hyaline and granular casts. The patient feels well and appears
  to enjoy the best of health. Please give me your opinion on the
  use, in such a case, of the lymph injections put out by the Animal
  Therapy Company of Chicago, from whom I have just received a supply
  of literature.”

The Journal replied as follows:

  “The Council on Pharmacy and Chemistry took up for consideration
  the ‘Lymph Compound R-H,’ and ‘Orchitic Fluid Tablets,’ sold by the
  Animal Therapy Company and refused them recognition.

  “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!

  “If the physician to whom such a patient comes for advice, instead
  of taking the wise course of seeking reliable information, were to
  take at their face value the statements of interested commercial
  manufacturers--if he were to administer this unknown and dangerous
  remedy, the effects of which he cannot predict--he would commit a
  breach of trust more culpable than the most vicious attempts of the
  nostrum-maker to mislead the physician and the public.”--(_From the
  Journal A. M. A., Dec. 14, 1912._)




                 LYSOL-THE EVOLUTION OF A PROPRIETARY


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.

[108] The Journal A. M. A., March 25, 1911, pp. 901, 910.

[109] Pharm. Ztg., Oct. 14, 1908, p. 817.

The ill-deserved patent protection for Lysol happily expired long
ago and the product can now be made by anyone. In view of the
non-descriptive character of the name “Lysol” and the danger in using
such names in connection with potent and poisonous remedies, this
cresol-soap solution has been admitted to pharmacopeias, not under the
original name “Lysol,” but under descriptive names such as that in the
United States Pharmacopeia--“liquor cresolis compositus.”--(_From The
Journal A. M. A., Dec. 14, 1912._)




                    THOMPSON’S MALTED FOOD COMPANY

            And Its Blood, Nerve and Tissue Builder, “Hemo”


During the past eighteen months The Journal has received inquiries
from physicians in various parts of the country asking for information
regarding “Thompson’s Malted Food Company” of Waukesha, Wis., which for
some time has been selling and trying to sell its stock to physicians
and others. In reply The Journal called attention to the fallacy of any
concern trying to induce people to purchase its stock on the ground
that the Bromo-Seltzer company, the Postum Cereal company and others
had been successful.

[Illustration: A miniature reproduction of a full-page advertisement of
“Hemo” appearing in a Milwaukee paper. The original covered 341 square
inches.]

The earlier name for the Thompson concern was “American Malted Food
Company” and originally it had its office and factory in Milwaukee. Its
products are “Malted Milk,” “Malted Beef-Peptone” and “Hemo.” As long
ago as 1911 the company was sending out glowing descriptions of the
money that might be expected to be made by investing in the concern,
which was then known as the American Malted Food Company. According to
the company’s booklet it was estimated that in the United States and
Canada alone $20,000,000 worth of dry malt food products were consumed
annually. Further:

    “On the most conserving estimate the American Malted Food Company
    will supply 5 per cent. of the demand or $1,000,000 of the
    consumption from the very outset....”

At the time this was written (1911) the company claimed that its stock
had “been advanced over 100 per cent. in one year’s time” and that
even then it had “found it advisable to curtail the sale of stock so as
not to exceed the prescribed number of shares to any one person.” In
1914, however, the company still had its representatives in the field
offering stock for sale.

In November, 1913, one physician wrote that three years previously
he had purchased stock in the company and _at that time_ (1910) was
given to understand that dividends would be paid in at least a year!
He has received no dividends to date. Other physicians have written
that the company’s agents in attempting to sell stock have given the
impression that the concern either is paying dividends or is about to
pay dividends. Still other physicians say that the agents made no claim
to them that the concern was paying dividends. To quote from a few of
many letters together with the date of the communications:

    “Alluring promises of big profits in the near future have been held
    out by the canvassers....” (September, 1913).

    “No actual promise was made but it was ‘estimated’ that dividends
    would be declared ‘about the first of the year’” (November, 1913).

    “After I said I wouldn’t buy any stock was told the company was
    already paying dividends and I was turning down a good thing.”
    (March, 1914).

    “The agent gave me to understand that the profits of the company
    were enormous and that large dividends would be paid in the near
    future.” (March, 1914).

    “Mr. ---- [the agent] told me the company expected to pay dividends
    as soon as all the stock had been sold.” (May, 1914.)

    “The agent gave me to understand that they were about to pay very
    generous dividends and that it was a chance to get in on the ground
    floor on a good thing.” (May, 1914).

The price asked for stock during the past year or more has been $1.50
a share, the par value of the stock being held at $1.00. At various
times, however, the stock seems to have been purchasable from other
sources at a much lower figure. A physician writing September, 1913,
stated that he had just been solicited to purchase stock in the
Thompson Malted Food Company at $1.50 a share, and that immediately
he wrote to two firms, one in Chicago and one in Milwaukee, that sell
unlisted securities, asking the price of Thompson’s Malted Food Company
stock. Both brokers expressed the opinion, according to the physician,
that at 90 cents a share the stock would be a “good buy,” and both
offered to undertake to secure stock at that price. One of the concerns
sent a circular to the physician offering the stock at 80 cents. The
physician thereon canceled his order for stock which he had made at
$1.50 and declared that if he bought at all he would buy from other
sources.

                                 HEMO

At the present time the product that Thompson’s Malted Food Company
seems to be “pushing” is a product it calls “Hemo.” According to
advertisements, Hemo is “the food that builds up weak stomachs.” Hemo,
we are told, contains “the iron of spinach, the juices of prime beef,
the tonic properties of selected malt in powdered form and the richest
sweet milk.” Furthermore, “Hemo contains the active principle of
selected barley malt ...”--whatever the “active principle” of barley
malt may be.

According to the Thompson Malted Food Company “80 per cent. of the
American citizens” are “troubled with anemia” and it is for them that
“Hemo has been especially prepared.” In a sentence:

    “It is a well-known fact that organic iron can be obtained from
    animal life as well as from vegetable life, and as the digestive
    organs of a majority of the people are not equal to the task
    of supplying their bodies with a sufficient amount of organic
    iron to maintain a supply of a good quality blood, the lack of
    which results in numerous nervous ailments--insomnia, diabetes,
    rheumatism, anemia, tuberculosis, etc., it has been found necessary
    to secure for mankind organic iron in a form that will be
    concentrated, palatable and most easily assimilated.”

This is a sample of the farrago of pseudo-scientific nonsense sent
out by this concern in its attempt to sell “Hemo.” To continue the
quotation:

    “With this object in view, the laboratories of Thompson’s Malted
    Food Company have successfully produced and successfully tried out
    Hemo on the most desperate cases.”

In a letter addressed to a physician-stockholder, the statement is
made: “Our Hemo-Malted Milk has never had and never will have an equal
as a builder of blood, nerve and tissue ... it will build tissue, nerve
and blood in less time than any other food heretofore known.”

Disregarding the question whether or not this is a stock jobbing scheme
or whether the purchase of the stock is a good investment, there is
another side to the matter. It must be evident that the public is not
getting a square deal when physicians are financially interested in
the products they prescribe for, or recommend to, the sick. Whatever
the value of the Thompson products, the method of exploitation and
the attempts on the part of the company to get physicians financially
interested in its ventures, are to be deprecated. If laymen of a
speculative turn of mind wish to invest in the stock of companies
putting out “bottled energy,” “blood builders” and “nerve repairers”
that is their business, but it is certainly neither conducive to the
scientific practice of medicine nor to the interest of the public
for physicians to be financially interested in products of this
sort.--(_From The Journal A. M. A., Oct. 24, 1914._)




                                MANOLA

               Physicians as Unpaid Pedlers of Nostrums


One of the most disheartening features of the fight against the
proprietary evil within the profession is the slowness with which
physicians awake to their responsibilities in the matter. It is a
notorious fact, familiar to physicians against advertising men alike,
that the simplest and cheapest way to introduce a nostrum to the public
is through the instrumentality of the medical profession. Ever since
the birth of the proprietary evil in this country, shrewd manufacturers
have persuaded doctors to act as unpaid pedlers for their wretched
nostrums and to become _particeps criminis_ in the exploitation of such
wares.

Manola is an alcoholic nostrum with just enough more or less inert
medicinal products added to exempt it from the internal revenue tax,
but not enough to prevent its being used as a tipple by those who
object to taking their “toddy” in a simpler form. It is prepared by
the Luyties Pharmacy Company of St. Louis, a homeopathic concern whose
hahnemannian leanings are not so strong but that it is willing to
cater to the various sectarian schools of medicine as well as to the
regular profession. Since the promoters realize, doubtless, that to
put this stuff out under a homeopathic label might not be conducive to
stimulating physicians’ confidence, Manola is labeled: “Prepared only
by the Manola Company, St. Louis.” In other words, it is the old dodge
of forming subsidiary companies for the purpose of hiding the identity
of the real owners. In this connection, it is worth reminding our
readers, incidentally, that the Walker Pharmacal Company, St. Louis, is
another subsidiary concern of the Luyties Pharmacy Company, created for
the purpose of pushing another nostrum--Hymosa.

Manola is seldom advertised in medical journals. Instead the Luyties
Pharmacy Company has discovered a more effective method of “putting
one over” on physicians and druggists. The method which has been
pursued for years and which, under the same title and subtitle that
head this article, was exposed in The Journal as long ago as May 6,
1905, consists in sending to physicians a letter containing three
postcards--unstamped, of course. With the postcard there is a slip that
reads:

    INSTRUCTION          FOR            OBTAINING
               3 BOTTLES OF MANOLA FREE

    _Dear Doctor_: Fill out the attached cards Nos. 1 and 2. Mail No.
    1 to _us_ and hand Nos. 2 and 3 to _your druggist_. Impress upon
    him the necessity of mailing postal card No. 3 _direct_ to us, and
    _not_ to his jobber.

                             Yours truly,
                                                    THE MANOLA COMPANY.

The postcards are numbered, respectively, 1, 2 and 3. Here is No. 1:

[Illustration:

    +-----------------------------------------------------+
    | 1  Mail This Card to the Manola Co., St Louis, Mo.  |
    |                             Date____________ 19__   |
    | THE MANOLA COMPANY                                  |
    |    St. Louis, Mo.                                   |
    | Gentlemen:                                          |
    |   I have requested Mr. ________________________     |
    | druggist, to order one dozen bottles of MANOLA for  |
    | my prescription. Please include with his order      |
    | three bottles for me, as per your offer.            |
    |                                                     |
    |        DR. ____________                             |
    |                   CHICAGO ILL.                      |
    +-----------------------------------------------------+
]

Dr Ezymark writes the name of his druggist on Card 1, puts a stamp on
it and mails it to the Manola Company, alias Luyties Pharmacy Co.

Card 2, addressed to his druggist, also is filled out by Dr. Ezymark.
Here it is:

[Illustration:

    +-----------------------------------------------------+
    | 2  Please Hand This Card to Your Druggist           |
    |                                                     |
    | Mr. ____________                    Druggist.       |
    | Please order of the Manola Company, St. Louis, Mo., |
    | _1 dozen bottles of Manola_, all of which I agree   |
    | to prescribe in my practice. By filling out card    |
    | No. 3 and forwarding it to the Manola Company,      |
    | St. Louis, Mo., they will include for me, with your |
    | order, three bottles of Manola, free, for clinical  |
    | purposes.                                           |
    |                  Yours truly,                       |
    |                                 _____________ M.D.  |
    | Town ____________                                   |
    +-----------------------------------------------------+
]

Then the doctor, acting the part of errand-boy, delivers Card 2 and
also Card 3 to his druggist. Here is Card 3:

[Illustration:

    +-----------------------------------------------------+
    | 3  PLEASE FILL OUT AND MAIL THIS CARD TO THE MANOLA |
    | CO., ST.LOUIS, MO., NOT TO YOUR JOBBER              |
    |                            Date ____________ 19__   |
    |                                                     |
    | THE MANOLA COMPANY, St. Louis, Mo.,                 |
    | Gentlemen:                                          |
    | Please ship me/us as per your offer                 |
    |                                                     |
    | 1 DOZEN manola              AT $8.00 per dozen.     |
    | 1/4 dozen MANOLA, free, for Dr. ____________        |
    | Ship through my jobber:                             |
    | M ______________     Signed ____________ Druggist.  |
    | Town ___________     Town ______________            |
    | State __________     State _____________            |
    +-----------------------------------------------------+
]

This, Mr. Goat, the druggist, has to fill out, affix a stamp and send
to the Manola Company. In return for all this, Mr. Goat has his shelves
loaded up with a dozen bottles of Manola and, for that privilege
pays $8 out of his own pocket. Dr. Ezymark gets three free bottles.
Incidentally, he also gets the contempt of his druggist--and of such
patients as learn of it.

The only one who profits by all this is the Luyties Pharmacy Co., alias
the Manola Co., alias the Walker Pharmacal Company.

Evidently this method of exploitation pays; that it does pay is a
disgrace to the medical profession. To those physicians who have in the
past acted as pedlers for Manola we would say: If your patients really
need sherry wine let them purchase it under its own name and at the
ordinary market price. You will then know what they are getting and
you will be able to retain not only your own self-respect but also the
respect of your druggist and the public.


                       The Composition of Manola

Examination of Manola in the Association laboratory indicates that
its composition is consistent with its origin, for its medicinal
ingredients are present in truly homeopathic quantities. The laboratory
report follows:

  An examination of an original bottle of Manola gave the following
  results:

    Specific gravity at 25 C.            1.0329
    Alcohol                              18.00 per cent. by vol.
    Non-volatile matter
       (residue on evaporation)          15.93   gm. in 100 c.c.
    Ash                                    .96   gm. in 100 c.c.
    Phosphoric pentoxid (P_{2}O_{5})       .0668 gm. in 100 c.c.
    Total alkaloids                        .0047 gm. in 100 c.c.
    Calcium                              Traces.
    Magnesium                            Traces.
    Iron                                 Traces.
    Sodium                               Traces.
    Arsenic                              Traces.

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._)




                                MERCOL


R. Hunt and A. Seidell, Washington, D. C., report the result of an
examination of a preparation called Howell’s Mercol, manufactured by
H. B. Howell & Co., Ltd., New Orleans, and claimed to be a 1 per cent.
solution of mercuric iodid in a non-irritating neutral menstruum, and
recommended for hypodermic use in the treatment of syphilis. Their
examination indicates, as they say, “that although the manufacturers
of Mercol may have used a mercuric iodid in its preparation, they have
not succeeded in obtaining a 1 per cent. solution of this compound in
their ‘non-irritating neutral menstruum.’ It is furthermore evident
that the sample examined as above outlined contains none, or at most
only traces, of biniodid of mercury.” It is stating it mildly to
say that a manufacturer is careless who claims to make an efficient
preparation of what is almost a specific for one of the most serious of
diseases but which contains practically none of the essential active
ingredient.--(_Abstracted from The Journal A. M. A., Jan. 16, 1909._)


             The Component Parts and the Finished Product

After the appearance of the first article, a physician wrote stating
he had seen Mercol manufactured, following the process in detail and
had himself weighed out a sufficient quantity of mercuric iodid to
produce a 1 per cent. solution. He protested that the firm “had no
desire to foist on the medical profession or the public a fraud.”
With his letter he sent a sample of the particular batch of Mercol
which he had seen manufactured. This sample was analyzed with the
same care and thoroughness that the previous sample had been, and the
practical absence of mercuric iodid was again demonstrated. While The
Journal does not question the honesty and good faith of either the
manufacturers or the physician, it maintains that claims for remedial
agent should be based on the finished product rather than on the
component parts used in its manufacture. Without attempting to explain
what has become of the mercuric iodid, it insists that the important
fact, and the one that vitally concerns both patient and physician,
is that the finished product fails to contain it. If the manufacturer
has made an honest mistake in supposing he could produce a 1 per cent.
solution of mercuric iodid in liquid petrolatum, he will doubtless see
that the mistake is corrected. If, on the other hand, he is governed by
commercial considerations only, the misrepresentation will probably be
perpetuated.--(_From The Journal A. M. A., May 15, 1909._)




                           MIDOL AND NURITO

             Pyramidon Entering the Patent-Medicine Field


Repeated warnings to the public of the dangers of acetanilid, antipyrin
and acetphenetidin and the requirement in the Food and Drugs Act
which makes it obligatory to declare the presence of acetanilid
and acetphenetidin on the labels of “patent medicines,” have been
responsible for the growing unpopularity of nostrums containing these
drugs.


                                 MIDOL

During the past few months advertisements have appeared in the
newspapers of a new “headache cure,” the advertising slogan of which is
that it “contains no acetanilid or phenacetin.”

The name of this preparation is Midol and it is sold under the
following claims:

    “Instantly relieves headache, neuralgia, toothache.”

    “Has no depressing effect.”

    “More effective than antipyrin, acetanilid, phenacetin or similar
    pain-relieving products.”

    “Midol is the one safe-to-take aid of sufferers of headache.”

    “Quickly relieves pain of whatever nature.”

    “There is no cumulative action.”

    “No bad effect upon the heart or other organs.”

An original package of Midol was purchased and examined in the
Association laboratory. The chemists’ report follows:

  “Midol is sold in the form of white tablets each weighing, on an
  average, 0.425 gm. or about six and one-half grains. The tablets are
  soluble in water, chloroform or benzene to the extent of about 80 per
  cent. The soluble portion appeared to be largely composed of starch,
  with about 4.5 per cent. of some inorganic matter, probably talc. The
  chloroform soluble portion was found to consist chiefly of pyramidon,
  chemically known as dimethyl-dimethylamino-pyrazolon. Besides
  pyramidon, the chloroform soluble matter contained a small quantity
  of caffein and may have contained small amounts of other substances.

  “From examination it is concluded that Midol depends essentially on
  pyramidon for its therapeutic effect.”

Pyramidon is a proprietary preparation derived from, and having the
antipyretic and anodyne properties of, antipyrin. While some observers
have asserted that it is more likely to cause collapse than are
either antipyrin or acetphenetidin there is no positive evidence of
this assertion. That the use of pyramidon has been until recently
practically restricted to physicians may account for the fact that
its toxic effects are not as well known as are those of antipyrin,
acetphenetidin, acetanilid, etc., which for some years have been
indiscriminately used by the public. As the use of pyramidon as a
“patent medicine” now bids fair to become as general as the better
known antipyretics, it is probable that its toxicology will become
better known.

It is interesting to note that pyramidon in the form of Midol is put on
the American market by the General Drug Company, which also acts as a
distributor of salvarsan (“606”). The General Drug Company is said to
have for its president, W. M. Hoge, who was formerly employed in the
comptroller’s office during the administration of Herman A. Metz, and
the latter being employed by the Consolidated Color and Chemical Works
and being president of Victor Koechl & Co. The General Drug Company,
in its price list to physicians, lists the “ethical proprietary”
pyramidon, but contains no mention of its “patent medicine” Midol.


                                NURITO

Midol is not the only “patent medicine” in which pyramidon is the
essential drug. Nurito, which is advertised as “not a patent medicine
but a proprietary preparation,” is a nostrum put on the market by the
Magistral Chemical Co., New York. Here are some of the claims:

    “Only U. S. P. ingredients are used in Nurito.”

    “Guaranteed to relieve or your money refunded, Rheumatism,
    Sciatica, Neuritis.”

    “There is no compound known in medicine that so rationally,
    scientifically and effectively removes waste and poisons from the
    human system as Nurito.”

The Association’s laboratory recently analyzed a specimen of Nurito.
The report follows:

  A dollar-size package of Nurito was purchased and found to contain
  seven powders. The powders ranged in weight from 9 to 12 grains, the
  average weight being nearly 11 grains. The presence of pyramidon,
  phenolphthalein and milk sugar was demonstrated. Alkaloids,
  acetanilid, acetphenetidin, chlorids, bromids, iodids, heavy metals,
  starch and sulphates were absent. Quantitative examination indicated
  that the composition of Nurito is essentially as follows:

    Milk sugar                 34 per cent.
    Phenolphthalein             6 per cent.
    Pyramidon                  60 per cent.

  Each powder, therefore, contains about 2-2/3 grains of milk sugar,
  2/3 of a grain of phenolphthalein and 6-2/3 grains of pyramidon.

What was said of pyramidon in the preceding article applies equally
well here. The claim that Nurito is composed of “U. S. P. ingredients”
is evidently a falsehood. The chief therapeutic ingredients are
pyramidon and phenolphthalein, neither of which is described in the
United States Pharmacopeia.--(_From the Journal A. M. A., Aug. 10,
1912._)




                                MU-COL

                   Salt and Borax as Wonder-Workers


“Mu-col, for Cleansing Mucous Membranes” is a nostrum put on the market
by the Mu-col Company (Inc.), Buffalo, New York. As a specimen of the
claims made for the preparation, the following is typical:

    “Mu-col obtains most gratifying results in catarrhal inflammations
    of the mucous membranes. Leucorrhea, Tonsillitis, Sore Throat,
    Cystitis, Internal Hemorrhoids, Nasal Catarrh and Pus Cases respond
    at once to irrigation with Mu-col solution. Strong solutions of
    Mu-col have proven of sterling value in treating Hives, Prickly
    Heat, Ivy Poison, Sunburn, Eczema, Typhoid and Scarlet Fever.”

This, and much more Mu-col will do--according to its manufacturers!
No wonder physicians want to know the composition of Mu-col. As the
manufacturers do not give this information the aid of the Association’s
Laboratory was invoked. Let the chemists speak:

                           LABORATORY REPORT

  “The specimen examined was a white powder, and from the odor,
  thymol, eucalyptol, camphor and oil of wintergreen could be
  recognized. Qualitatively sodium, chlorid and borate were found.
  Zinc, benzoate, phenolsulphonate and sulphate could not be found.
  The solution was alkaline to litmus. Gravimetric determination of
  chlorid as silver chlorid and titration of borax by Thompson’s
  method indicated sodium chlorid (NaCl) 47.2 per cent., sodium borate
  (Na_{2}B_{4}O_{7}+10H_{2}O) 50.1 per cent.

  “It thus appears that Mu-col is a mixture of ordinary salt and borax
  in equal parts with the addition of a small amount of aromatic
  substances.”

Mu-col will do just what a solution of salt and borax will do--no more,
no less. And yet, it is claimed:

    “Mu-col has been successfully used since the year 1900 by more than
    50,000 physicians, which has proven it to be the most Efficient,
    Economical and acceptable, preparation in its field.”--(_From The
    Journal A. M. A., Feb. 7, 1914._)




                                NARKINE

            The Intangible Product of the Tilden Laboratory


A little book, published by the _Druggists Circular_, and called
“Modern Materia Medica,” gives in dictionary form the information
regarding new remedies which that journal publishes in its monthly
issues. Such information is not always acceptable to the manufacturers
of various preparations of doubtful value. A case in point is brought
to notice with reference to a remedy called Narkine, put out by the
Tilden Company of St. Louis. In this little book the following appears:

  “Narkine is described as ‘an opium preparation from which all
  deleterious qualities have been eliminated’; an unsupportable claim,
  as all opiates and other hypnotics are essentially deleterious.”

The Tilden Company wrote to the _Druggists Circular_, stating that
they guaranteed Narkine “to be absolutely free from coal-tar or opium
derivatives,” yet the “literature” of the company describes it as

    “a specially prepared product of opium devoid of the nauseating and
    disagreeable properties of this drug, yet possessing the anodyne
    and soporific principles of same in the highest degree.”

To remove from opium all its derivatives and yet retain the anodyne
and soporific principles attached to nothing in particular, indicates
a degree of pharmaceutical skill seldom attained. One is irresistibly
reminded of the Cheshire cat in “Alice in Wonderland,” whose smile
remained long after the cat had vanished.

The absurdity of the thing, however, has apparently not occurred to
many physicians, for these disembodied spirits of the pharmacologic
world are evidently being prescribed.

The _Druggists Circular_ is to be congratulated on exposing this
latest pharmaceutical freak. It does so in a rather striking manner
by means of photographic reproductions of the claims of the Tilden
Company.--(_From The Journal A. M. A., Oct. 24, 1908._)




                                PAPINE

                     A Disguised Morphin Solution


To the thinking physician it should be evident that a preparation
containing morphin must possess not only all of the valuable properties
of this drug, but also all of the objectionable ones. There are still
some physicians, apparently, who give credence to the assertions of
the manufacturers concerning the morphin preparation from which, it is
claimed, all of the undesirable morphin effects have been removed. The
following query from a correspondent illustrates this fact:

  “Will you inform me as to the contents of ‘Papine’? I have a case of
  chronic interstitial nephritis, and my consultant insists on giving
  this preparation. I asked him if he knew what drugs it contained
  and his answer was ‘one-eighth of a grain of morphin with the
  objectionable parts of the drug removed.’”

The query was referred to the Association Laboratory, which submitted
the following report:

  For many years Papine has been advertised by its makers, Battle
  & Company, St. Louis, as an anodyne. In the circulars Papine is
  described in part as follows:

    “Papine represents in pharmaceutical form the purely anodyne
    principles of opium freed from the narcotic and tetanising
    constituents.”

    “Papine is the anodyne or pain-relieving principle of opium, the
    narcotic and convulsive elements being eliminated. One fluid drachm
    is equal in anodyne power to one-eighth grain of morphin.”

    “Through special methods of preparation, the anodyne and analgesic
    principles of _Papaver somniferum_ are so extracted as to free
    them of the narcotic and convulsive elements that ever have been,
    and must ever continue to be serious objections to the use of
    opium and its common derivatives.... No demand is more regularly
    made on the physician than that for the relief of pain, and to be
    able to afford it promptly and completely, without the slightest
    deleterious action, is an advantage that cannot be overestimated.”

    “Unlike most derivatives and preparations of opium, Papine neither
    nauseates nor constipates; nor does it inhibit the secretory
    functions of the body.”

    “In conditions of extreme nervousness, especially in women,
    recourse to morphin is attended by the very real danger of the
    formation of a habit. Lastly, opium and its alkaloids must not be
    administered to persons whose kidneys are not in good working order
    on account of the risk of toxic accumulation.”

    “No such restriction exists in respect of Papine, its action being
    exerted exclusively on the element pain; in other words, it is
    purely anodyne.”

    “Papine does not nauseate, constipate nor create a habit.”

[Illustration: The Papine label before (on left) and after (on right)
the passage of the Food and Drugs Act. And the exploiters of this
morphin solution have the effrontery to claim that it does not create a
habit!]

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.

[110] Narcotin is now known to possess very little physiologic effect.

[111] Of the opium alkaloids, laudanin and thebain possess the most
powerfully tetanizing properties, but they are present in opium in too
small quantities to produce any noticeable effect. Neither of these
alkaloids is removed by the usual processes for “denarcotizing” opium.

From Papine, however, the morphin has not been removed, for _since the
passage of the Food and Drugs Act_ the label has to admit that Papine
contains 1 grain of morphin in each ounce!

A specimen of Papine was examined and found to be nothing more than a
simple aqueous-alcoholic solution of morphin, containing glycerin. The
preparation is flavored to imitate cherry and colored with cochineal.
With the exception of morphin, neither narcotin, codein nor other
opianic alkaloids were found, while meconic acid, a characteristic
constituent of opium, was absent. Since Papine is claimed not to cause
constipation, and as is well known, this condition is frequently
produced by morphin, it seemed possible that Papine might contain
laxative substances. On examination, however, no cascara, rhubarb,
phenolphthalein or laxative salts were found.

While Battle & Co. have persistently exploited Papine as being an
opium preparation having none of the objectionable qualities of opium,
the analysis shows that the paradoxical claims made for it cannot be
substantiated. In prescribing morphin there is an abundance of official
preparations to choose from, and there certainly is no necessity or
excuse for resorting to the much more expensive and in no way superior
Papine.--(_From The Journal A. M. A., April 29, 1911._)




                             PASADYNE[AW]

[AW] See also report on Passiflora and Daniel’s Tincture, p. 156.


A physician asks: “Can you tell me the formula of a preparation on the
market called Pasadyne, put up by John B. Daniel, Atlanta, Georgia?”

According to the manufacturer Pasadyne is a tincture of passion-flower.
Formerly this nostrum was sold under the title “Daniel’s Concentrated
Tincture of Passiflora Incarnata.” While the manufacturer claims
marvelous virtues for this preparation, made from “the fruit, roots and
vines of the passion-flower or May-pop,” passiflora (passion flower) is
now generally recognized as being of little if any value.

A circular makes the following absurd statement:

    “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.”

The reasons why the drug passiflora was not deemed of sufficient
value and hence, along with the Daniel preparation, was refused
recognition, are given in a report of the Council on Pharmacy and
Chemistry.--(_Abstracted from The Journal A. M. A., March 8, 1913._)




                               PAS-AVENA

             How Its Formula Evades the Food and Drugs Act


Pas-Avena is a widely advertised “nerve sedative and hypnotic.” The
preparation is put on the market by the Pas-Avena Company of New York
City. As a headliner the advertisements of the remedy state that
the formula has always been on every bottle, and this, The Journal
states, has a twofold object: It aims to give the impression that the
preparation is non-secret, and it is calculated to inspire confidence
in the--apparently--scientific nature of the product. As a matter of
fact, it should do neither. The preparation is essentially secret in
its composition because of the presence in the formula of an unknown
quantity and the liability to change of formula at the whim of the
manufacturer. On the bottles some time ago the following formula was
given:

    Each tablespoonful contains:
    Passiflora                                 20 minims.
    Avena sativa                               10 minims.
    Somnalgesine (C_{30}H_{28}N_{5}O_{6})       2 grains.

The first two ingredients are plants in whose therapeutic value but
little confidence is placed. Somnalgesine, the third constituent, is
a secret preparation, the chemical formula of which the manufacturers
were kind enough to add. To a chemist, however, the formula is absurd
and impossible, and is included either because of the manufacturer’s
ignorance or because of an intent to deceive the profession. Since the
Food and Drugs Act became law, the label of Pas-Avena has been changed
to read:

    Alcohol                       8.37 per cent. by volume.
    Anilipyrine                  16.00 grains per fluid ounce.
    Guaranteed under the Food and Drugs Act of June 30, 1906.

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._)


           Proprietary House Insolvent--and Physicians Lose?

The Pas-Avena Chemical Company, whose product, Pas-Avena, was exposed
in The Journal a few months ago, has recently failed, according to our
pharmaceutical exchanges. In recording the fact, one journal says:

    “It is reported that considerable stock of this company had been
    sold to physicians.”

At this time, when physicians are importuned daily to invest money in
various wildcat pharmaceutical concerns, this sentence might well be
used “to point a moral or adorn a tale.”




                               PERTUSSIN


Dr. L. A. Roberts, Dorchester, Mass., writes: “Please tell me what the
composition of Pertussin is.”

Pertussin is a proprietary whooping-cough remedy manufactured by the
Kommandantan Apotheke, Berlin. A “physician’s sample” bottle of this
preparation sent out by Lehn & Fink bears a label on which appears the
following:

    “100 parts Pertussin contains:
       1/2 Ol. Thymi, et Thymol
    21-1/2 Ext. Thymi ‘Taeschner’
    50     Saccharum
     2     Glycerinum
     6-1/4 Alcohol
    19-3/4 Aqua Destillata”

While it never has had much vogue in this country it has been and still
is used in Germany. It belongs to that class of vegetable preparations
which, since they contain no distinctive principle, are difficult to
analyze--particularly as concerns the “joker” in the formula, in this
case “Ol. Thymi, et Thymol” and “Ext. Thymi ‘Taeschner’”--hence there
has been much dispute in Germany as to the composition of this nostrum.
In general, it appears that whatever virtues it has are due to some
preparation of common thyme in a menstruum containing water, sugar and
alcohol. At one time the preparation was found to contain potassium
bromid; but tests recently made in the A. M. A. Chemical Laboratory
indicated the absence of either bromids or iodids.--(_From The Journal
A. M. A., March 8, 1913._)




                   PHENALGIN--A TYPICAL EXAMPLE[AX]

[AX] For reports and articles on other coal-tar preparations, see
pp. 9, 115, 244, 268, 305.


Last June[112] we devoted considerable space to the extravagant
therapeutic claims made for “Phenalgin” by its venders. At this time
we propose to refer to the misinformation--to use a conservative
term--that the Etna Chemical Company has promulgated regarding the
composition of their preparation.

[112] See The Journal A. M. A., June 24, 1905, p. 1997.

In June, 1905, the Council on Pharmacy and Chemistry officially
published to the medical profession of the United States the
information that repeated examinations showed that “Phenalgin” is
a simple mixture of acetanilid and sodium bicarbonate or ammonium
carbonate. So far as we know, no direct denial of the truth of this has
been made. There has appeared what we presume is meant as an answer; it
is couched in this sentence,

    Phenalgin is just what we have always said it to be.

From this expression--which has been repeated in bold, black letters in
practically all the advertisements since last June--we presume that we
are to understand that in the past they have stated what it is.

It would have been just as easy and more satisfactory if the Phenalgin
people, instead of saying: “Phenalgin is just what we have always said
it to be,” had said what it is, since the average physician has neither
the time nor the inclination to look up their literature.

For the benefit of those who desire to know what the venders of
Phenalgin “have said it to be,” we have gone over their advertising
literature of the past, with the following results, which are in the
form of quotations from their advertisements:

    An American Coal-Tar Product--Phenalgin--the only synthetic
    stimulant, non-toxic, antipyretic, analgesic and hypnotic.

    Phenalgin is the ONLY ammoniated Synthetic Coal-Tar Product made
    from Chemically Pure Materials [What have the Ammonol people to say
    to this?--Ed.]

    A synthetic Coal-Tar Product of the Amido-Benzine series,
    containing Nascent Ammonia.

    These two chemicals [“stimulant ammonia of coal-tar origin” and
    “chemically pure phenylacetamid”] combine under certain conditions
    so as to obtain a produce which he [Dr. Cyrus Edson] named
    Phenalgin or Ammoniated Phenylacetamide.

    Phenalgin is a compound of peculiar character which can not be
    extemporaneously made into tablets from the powdered drug, without
    seriously changing and impairing its medicinal qualities.

We believe these quotations are sufficient to show what the Etna
Chemical Company has “always said it to be.” In going over the
literature for several years past we find the above stated in the same,
or similar, words in nearly all of it. From the above four statements
may be deduced: 1. They have stated that Phenalgin is a synthetic[113]
preparation; 2, they have conveyed the impression that Phenalgin is a
chemical compound; 3, they have announced repeatedly that it is the
“only” preparation of the kind, and 4, they have claimed that Phenalgin
is non-toxic.

[113] Dunglison’s Dictionary: “Synthetic--In chemistry the formation
of a more complex body by the union of simpler bodies.” Dorland’s
Dictionary: “Synthesis--The artificial building up of a chemic compound
by the union of its elements.” “Union” is not mixing.

We believe that these four statements represent in plain English what
the above quotations mean. They are all absolutely false. Phenalgin
is not synthetic; it is not a chemical compound; it is not the only
ammoniated phenylacetamide, or the only acetanilid mixture containing
carbonate of ammonium--and it is most positively toxic.

In one place it is stated that Dr. Cyrus Edson

    Employed his great facilities for chemical research and
    opportunities for chemical experiment for the purpose of producing
    a formula for a combination of stimulant ammonia of coal-tar origin
    (sic) and chemically pure phenylacetamide, also a coal-tar product
    ... which he named phenalgin, or ammoniated phenylacetamide.

In another place we read that Phenalgin is made

    Under the immediate personal supervision of the original inventor
    of ammoniated coal-tar products.

By comparing this last quotation--which is from a
current--1905--advertisement--with the preceding one it will be
noticed that we are asked to believe that Phenalgin is made “under the
immediate supervision of” Dr. Cyrus Edson--and yet Dr. Cyrus Edson died
Dec. 2, 1903. This is equal to Lydia Pinkham’s prescribing for the
suffering women of America when the dear old soul had been dead for
over twenty years.

We have before us a full-page advertisement taken from a recent number
of a weekly medical journal, which possibly is meant as an answer
to the announcement of the Council on Pharmacy and Chemistry that
Phenalgin is a simple acetanilid mixture. The advertisement is divided
into two parts; the first part is as follows:

    +-----------------------------------------------------------+
    |     FACTS ABOUT ACETANILIDUM       (ANCIENT HISTORY)      |
    |                                                           |
    | It has long been recognized that Acetanilidum and most    |
    | other coal-tar products are apt to exert a depressing     |
    | influence upon the heart, but there has never been any    |
    | doubt about its great value as a pain reliever and        |
    | temperature reducer. Its therapeutic value has, however,  |
    | been practically nullified by the danger of cyanosis and  |
    | other evils caused by its well-known depressant action    |
    | and the difficulty of obtaining it in a pure state. It    |
    | being known that certain deleterious substances are often |
    | to be found in Commercial Acetanilidum and that much of   |
    | the injurious effect attributed to this drug is entirely  |
    | traceable to these impurities.[114]                       |
    +-----------------------------------------------------------+

[114] This sentence is not complete, but, of course, this is
immaterial. Little things like an incomplete sentence do not count.

The above are also falsehoods. The therapeutic value of acetanilid is
not “practically nullified ... by the difficulty of obtaining it in
a pure state.” Neither is it true that “much of the injurious effect
attributed to this drug is entirely traceable to these impurities.”
While deleterious substances may be found in _commercial_ acetanilid,
they are not found in the substance offered as medicinally pure
acetanilid by reputable firms. Pure medicinal acetanilid is a cheap
article, costing less than 30 cents a pound, for it is a substance
that is easily and cheaply purified. It is a fact that the injurious
effects are in the acetanilid itself and not in the impurities it may
occasionally contain.

The second half of the advertisement in part is as follows:

    +-----------------------------------------------------------+
    |     FACTS ABOUT PHENALGIN          (MODERN SCIENCE)       |
    |                                                           |
    | More than a decade ago the late Dr. Cyrus Edson, then     |
    | Health Commissioner for New York City and New York State, |
    | recognizing the value of chemically pure Acetanilidum as  |
    | a therapeutic agent, if it could be deprived of its       |
    | depressant quality, employed his great facilities for     |
    | chemical research and opportunities for chemical          |
    | experiment for the purpose of producing a formula for a   |
    | combination of Stimulant Ammonia of coal-tar origin and   |
    | chemically pure Phenylacetamide, also a coal-tar product. |
    | These two chemicals combine under certain conditions so   |
    | as to obtain a product which he named Phenalgin or        |
    | Ammoniated Phenylacetamide.                               |
    +-----------------------------------------------------------+

There is more of the same character. In the first place, we call
attention to the fact that “Phenylacetamide” is substituted for
“Acetanilidum” when it is to go into Phenalgin. To mystify is one of
the “tricks of the trade.” Few physicians keep up with chemical terms
and, therefore, are not supposed to know that Phenylacetamide is one of
the chemical names for Acetanilid.

The reference here to Dr. Cyrus Edson brings up another fact, and
that is that the Etna Chemical Company tries to convey the idea that
Dr. Edson was the originator of Phenalgin. We have always understood
that Dr. Cyrus Edson had something to do with pushing Ammonol and, if
we remember rightly, got into some trouble thereby. We do not know
the exact facts, but the following letter shows that he had a leaning
toward another “ammoniated phenylacetamid.” The letter is dated “New
York, Oct. 6, 1894,” and is addressed to the “Ammonol Chemical Company.”

    “During the past six or eight months I have used Ammonol
    extensively in my private practice. I have found it excellent
    in the treatment of neuralgias and for rheumatism. I have also
    verified your statement in two cases that were suffering from
    alcoholism. My experience justifies me in saying that it is the
    safest and best of the analgesic coal-tar derivatives.

                          “Very truly yours,
                                                     Cyrus Edson, M.D.”

It may be of interest to know that the principal member of the firm
of the Etna Chemical Company was at one time a member of the Ammonol
Company, and it is usually understood, we believe, that Phenalgin
is practically the same as Ammonol--in fact, the analyses published
regarding the two preparations show this to be a fact.

We must make one more quotation:

    It makes little difference to a physician whether Phenalgin is
    a mixture or a compound or a synthetic, with a name that would
    destroy the orthographic balance of the universe, provided it is
    just what he has always found it to be.

Very complimentary to the intelligence and common sense of physicians,
is it not?

Suppose some fellow should get up a scheme to exploit a mixture of
quinin and some cheap, harmless substance, say, starch--equal parts of
each. Suppose he gives it a fanciful name, puts it on the market at a
high price, say $1.25 an ounce, and announces it as a new synthetic
with wonderful therapeutic qualities. Suppose that the schemer then
adopts the nostrum vender’s methods of fooling physicians into using
his product by getting some to give testimonials, others to furnish
write-ups, and then subsidizes medical journals through liberal
advertising to print both the testimonials and the write-ups. The
preparation would, of course, prove to be a good thing if it were used
in liberal quantities where quinin would ordinarily be used, and some
patients using it would get well even if quinin were not indicated.
Then with the psychologic effect of the testimonials, the write-ups,
and good, strong claims rightly pushed, unthinking physicians would do
the rest. And then, after a while, when the schemer had gotten to the
point where, each year, he was making a fortune out of his preparation,
suppose some “self-appointed chemists” should examine into the
preparation and discover that it was nothing but quinin and starch, and
so announce to the doctors of the country; what would the doctors say?
That it makes little difference “provided it is just what he has always
found it to be!”

This analogy is not far-fetched, for it is practically what has been
done with Phenalgin. One difference is that since quinin costs as much
per ounce as acetanilid does per pound, the profits on the acetanilid
mixture would be sixteen times greater than that of our imaginary
preparation. Another difference is that acetanilid is really a
dangerous drug, unless used with care, both in its immediate and in its
remote effects; quinin is far less so.

“Little difference” indeed, whether we are being buncoed or not!
Evidently!

In conclusion, we charge the Etna Chemical Company with intentionally
misleading and deceiving the members of the medical profession, in that
the said company has in its literature and its advertisements conveyed
the impression (whether directly stated or not): First, that its
preparation, Phenalgin, is a synthetic compound; second, that Phenalgin
requires special skill in its preparation; third, that Phenalgin
has therapeutic values which it does not possess; and, fourth, that
Phenalgin is non-toxic.

We also charge that on account of these and other misrepresentations,
this company has inveigled physicians into prescribing and using a
simple mechanical mixture of common well-known cheap drugs--for which
an extravagantly high price is charged--under the supposition that
this combination of cheap drugs is a chemical compound of special and
peculiar merit as a therapeutic agent, and, therefore, worthy of their
confidence.

Our object in again giving space to this preparation--and practically
all we have said applies to the other acetanilid mixtures that are
exploited under fictitious names or as chemical compounds (such as
ammonol, antikamnia and salacetin or sal-codeia--Bell)--is to impress
on physicians, by a typical example, the shamefulness of the deceptions
practiced on them by nostrum manufacturers to the great injury of the
public and of the medical profession.


           A Pharmaceutical Secret Which Should Not Be Lost

Dr. Gregory Costigan, New York City, writes under date of January 21,
as follows:

  “I have been carefully reading and enthusiastically approving your
  articles on the nostrum evil, and have been impressed more than usual
  on the existence of quack advertising in medical journals as set
  forth in last paragraph and quotation on page 206, bottom of first
  column, of your issue of Jan. 20, 1906.

  “In _Merck’s Archives_, page 11, we are told in an advertisement on
  ‘Phenalgin’ that it ‘is a compound of peculiar character which cannot
  be extemporaneously made from powdered drug’ and ‘our process of
  manufacturing tablets is coincident with the manufacture of Phenalgin
  and is the result of a long series of careful experiments by which
  we are able to produce tablets of Phenalgin in a friable condition
  without losing any of its _volatile_ constituents or undergoing
  chemical changes from heat or moisture’! Inasmuch as Phenalgin
  tablets are not covered with a waterproof coating I think this is
  a remarkable statement to make, and the manufacturing of a drug
  coincident with the manufacture of a tablet must be a very remarkable
  performance, especially because it ‘retains the full therapeutic
  value of the drug unimpaired’ while the advertisement asserts that no
  other manufacturer is cognizant of this wonderful method. This ad. is
  for the perusal of physicians only. The Etna Chemical Company owes it
  to the medical and pharmaceutical world not to let this secret die
  with the company’s dissolution. It owes it as a duty to the coming
  generations of science immediately to jot down the full data of this
  wonderful performance, to put it away in an age-proof safe and not
  allow it to be lost to humanity as were a great many other arts that
  were well known to the ancients. Let them keep it secret now and
  profit by it, but do not let it be lost to posterity.”--(_From The
  Journal A. M. A., Jan. 13, 1906, and Jan. 29, 1906._)

         An Ethical (?) Proprietary Exploited Under Fraudulent
                           and Lying Claims

    +-------------------------------------------------------------+
    |               “PHENALGIN IS JUST WHAT WE HAVE               |
    |                    ALWAYS SAID IT TO BE.”                   |
    |                       --_Etna Chemical Co. in 1905._        |
    |                                                             |
    | “Phenalgin is a synthetic   “Unlike the coal-tar synthetic, |
    | coal-tar product.”          phenalgin is a stimulant        |
    | --_Etna Chem. Co. in 1898._ rather than a depressant.”      |
    |                             --_Etna Chem. Co. in 1910._     |
    |                                                             |
    |        TEMPUS           OMNIA            REVELAT!           |
    +-------------------------------------------------------------+

“Phenalgin is a synthetic coal-tar product”--thus ran the
advertisements some years ago, when the medical profession was willing
to take--or was compelled to take--the word of the manufacturer of
proprietary remedies at its face value. Then the Council on Pharmacy
and Chemistry was brought into existence. One of the first pieces of
work done by the Council was the publication of the results of a number
of analyses of headache powders. Phenalgin was among them. Analysis
showed that Phenalgin was not a synthetic but a simple mixture of the
following ingredients in the proportions given:

    Acetanilid                   57 parts
    Sodium bicarbonate           29 parts
    Ammonium carbonate           10 parts

The Etna Chemical Company, which puts out this product, was
considerably disturbed by the Council’s exposure. It “came back” at the
American Medical Association with the slogan “Phenalgin is just what we
have always said it to be.” What, up to that time, the Etna Chemical
Company had “always said” Phenalgin to be, was:

    1.--Phenalgin is a synthetic.
    2.--Phenalgin is the only preparation of the kind.
    3.--Phenalgin is non-toxic.

These, in brief, were the three things that Phenalgin had been asserted
to be. Each statement has been proved to be a definite and unequivocal
falsehood. Phenalgin is not and never was a “synthetic.” Phenalgin
is not and never was the only acetanilid mixture containing carbonate
of ammonium. Phenalgin is not and never was in any sense of the word
non-toxic. Phenalgin, in short, possesses the properties--both good
and bad--that are common to acetanilid. It is a mixture that the
merest tyro in pharmacy could dispense and for which any sophomore
medical student could write a prescription without stopping to think.
Acetanilid sells at 8 cents an ounce wholesale; Phenalgin at $1.00 an
ounce, wholesale.

All these facts and many more were given to the profession by the
Council on Pharmacy and Chemistry in The Journal more than six years
ago--before even the Food and Drugs Act came into effect. After that
law became operative, the Etna Chemical Company was compelled to say
something on the label that it had never said before, namely, that
Phenalgin contained 50 per cent. acetanilid. But the law not only
required them to add a fact to their label, but it also compelled
them to remove a falsehood. When the pure food law went into effect,
Phenalgin was labeled a “malaria germicide.” It is not a malaria
germicide and never was a malaria germicide, and the Etna Chemical
Company dared not risk taking the question into court so it removed the
statement.

Unfortunately the Food and Drugs Act exercises no control over the
lying statements that may be made for drugs elsewhere than on the
label. So it is that physicians within the last two or three weeks have
received a booklet on Phenalgin containing the following assertions for
this acetanilid mixture:

    “Without the slightest harm, injury or depressing effect.”

    “Is never followed by depression.”

    “Its prolonged administration does not give rise to destructive
    blood metamorphosis.”

    “Is of great value in the treatment of neuralgia (especially in the
    anemic.)”

    “Freedom from the deleterious action or habit-forming tendencies of
    the opiates.”

    “It aids in destroying the malarial parasite.”

    “Safest and most dependable of analgesics.”

It will be seen by this that while the Food and Drugs Act has forced a
certain degree of truthfulness on the Phenalgin labels, the advertising
matter is as fraudulent and as untruthful as ever it was. It is true
that the assertion that it is a synthetic is no longer made, possibly
because the medical profession has been so thoroughly enlightened
on the much-overworked “synthetic” fraud that the falsehood is no
longer profitable. In other respects, the assertions are just as
false as ever. It is said to have no depressing effect--and yet
it is acetanilid. It is said to produce no habit--and yet it is
acetanilid. It is said to have no injurious effect on the blood--and
yet it is acetanilid. It is said to be the safest analgesic--and yet
it is acetanilid. How long will the medical profession continue to be
hoodwinked by means of such transparent falsehoods?

The Phenalgin concern takes much credit to itself because on the
cartons in which the bottles of Phenalgin come, it is stated that
the product is “for dispensing purposes only.” Yet, as a matter of
fact, practically any layman can go to any drug store and obtain
this product, for the druggist appraises this spectacular piece of
Pecksniffian virtue at its face value--a joke. Why, if intended only
for physicians, would it be necessary to include with every bottle
a circular naming the diseases, for which this acetanilid mixture
is supposed to be good--“headache,” “colds,” “lumbago,” “scanty
menstruation,” “pain in any part of the body”--and why is the name of
the product and of the firm making it blown into the bottle?

To sum up then, Phenalgin is as big a humbug as Peruna ever was. It
is sold to-day under claims that are just as false as those used six
years ago. The Etna Chemical Company is perpetrating a stupendous fraud
on the medical profession to-day and it is doing it not only through
the agency of the United States mail, but with the aid and support of
the following medical journals--and others--in which the Phenalgin
advertisement appears:

  _Medical Record_
  _New York Medical Journal_
  _Pediatrics_
  _Lancet-Clinic_
  _American Journal of Surgery_
  _International Journal of Surgery_
  _American Medicine_
  _American Journal of Obstetrics_
  _Medical Century_
  _Pacific Medical Journal_
  _Dietetic and Hygienic Gazette_
  _Medical Standard_
  _Eclectic Medical Journal_
  _Am. Jour. of Clinical Medicine_

It is conceivable that in some cases it is not easy for those editors
and publishers of medical journals who insist on relying on their
own judgment to satisfy themselves that certain preparations are not
worthy of being advertised. No such difficulty occurs in the case of
Phenalgin. Here the issues are clear cut. The product is exploited
under claims that are both false and vicious and their falsity and
viciousness are perfectly evident to any freshman medical student.
The only charitable explanation of the appearance of the Phenalgin
advertisements in the medical journals listed is that the editors and
publishers have not given the subject the attention it deserves and
to which their readers are entitled. Perhaps it would help if their
attention were called to the matter by their subscribers.--(_From The
Journal A. M. A., Jan. 27, 1912._)




                             PHENO-BROMATE


An analysis of this preparation made at the instance of the New Haven
Medical Association, by its chemist, and sent by Dr. Charles J. Foote
of New Haven to The Journal is in part as follows:

  The package was marked “Sample package, Pheno-Bromate. The
  Pheno-Bromate Company, New York, U. S. A.” The box contained a number
  of tablets and a package of powders in papers marked, “Physicians’
  10 grain powders, Pheno-Bromate.” The substance in the papers was a
  white crystalline powder not homogeneous. It was completely soluble
  in hot water. The hot water solution on cooling yielded a mass of
  thin crystalline plates. This material was found to melt at 113.5 C.
  It gave no color with ferric chlorid and a positive isonitril test.
  The portion insoluble in ether amounted to 49.8 per cent. of the
  powder and consisted of potassium bromid. Quantitative determinations
  of potassium and bromin in the original solution confirmed this
  result. In my opinion, the powder consists of approximately equal
  quantities of acetanilid and potassium bromid. Qualitative tests of
  the tablets indicated that they had the same composition except for a
  small quantity of some excipient not entirely soluble in water. Yours
  truly,

                                                      Herbert E. Smith,
                                 Chemist New Haven Medical Association.

Before the Food and Drugs Act Pheno-Bromate was advertised as “a
synthetic combination of the phenetidin and bromid groups, and not,
as is the case with many analgesics and antipyretics, a mixture of
various coal-tar derivatives” and as “the safest and best of all
sedatives.” The dose recommended in most cases is 20 grains--equal to
10 grains each of acetanilid and potassium bromid. Since the Food and
Drugs Act has gone into effect its label states that it is “a perfect
combination of a phenol and bromin derivative containing 282 grains of
acetphenetidin, U. S. P., per ounce.” What a boon it was to mendacious
manufacturers that the patent rights on phenacetin expired before the
Food and Drugs Act went into effect.--(_Abstracted from The Journal
A. M. A., July 14, 1906, and April 18, 1908._)




                            PHENOLPHTHALEIN


Phenolphthalein has long been used as an indicator in chemical
reactions, but its use as a therapeutic agent[115] is comparatively
new. When its laxative properties were first discovered it was
exploited as a proprietary in Germany, and it was not long before the
enterprising manufacturers in this country saw in it a potential gold
mine and now nearly every proprietary drug manufacturer in this country
has coined a proprietary name for it and is exploiting it, either alone
or in combination with one or more other laxatives, and with more or
less unwarranted claims.

[115] Those who wish to study the action and use of this drug further
will find references to articles in The Journal as follows: The
Journal, Jan. 5, 1907, pp. 64 and 70; March 30, 1907, p. 1133; April
20, 1907, p. 1351; Nov. 21, 1908, p. 1782; Nov. 28, 1908, p. 1886. The
first page mentioned discusses the introduction of phenolphthalein into
medicine.

Phenolphthalein itself has certain pretty well defined properties, but
when a little of some other drug has been added wonderful therapeutic
possibilities are claimed for the combination. The drug also has a
definite market value and the pure substance in the form of powder,
tablets or pills could not be sold at a price greatly in excess of the
market value. Thus manufacturers, from business policy, add to it other
drugs. There are now on the market numerous more or less secret and
“fancy” preparations of phenolphthalein for which a price is charged
out of all proportion to the value of the preparation. Among these are:

  Phenolphthalein Laxative (_El Zernac Co._).
  Exurgine (_Bischoff & Co._).
  Probilin (_Schering & Glatz_).
  Prunoids (_Sultan Drug Co._).
  Laxine (_Columbus Pharmacal Co._).
  Phenolax Wafers (_Upjohn Co._).
  Laxaphen (_Parke, Davis & Co._).
  Phenalein (_Pax Chemical Co._).
  Thalosen (_Abbott Alkaloidal Co._).
  Laxothalen Tablets (_Pitman-Myers Co._).
  Veracolate (_Marcy Co._).

And additional preparations are still coming out! Some of the
preparations contain only the phenolphthalein with a coined
non-descriptive proprietary name attached, but most of them contain
in addition one or more of such drugs as cascara, sulphur, prune,
senna, salicylic acid, ipecac and aromatics. The exploitation of
phenolphthalein in this way gives opportunity to the manufacturers to
make all sorts of strong claims, some of them directly contradictory,
for their preparations. For instance, Phenolax, which is said to
contain phenolphthalein and cane sugar, is claimed to be “a great
success for all forms of constipation, intestinal atony and hepatic
torpor.” Of Laxothalen, which is said to contain phenolphthalein,
aromatics and sugar, it is stated that “its action is confined to the
bowel and it has practically no hepatic action.” Of Prunoids, which
is said to contain phenolphthalein, cascara, de-emetized ipecac and
prunes, we have the old familiar statement that “the harmonious
blending of the several ingredients will give results that cannot be
obtained through their use separately, nor will their use be followed
by after-constipation.”

At the time phenolphthalein was beginning to be exploited in this
country The Journal[116] suggested that physicians who wished to try
the remedy should prescribe it under its own name and not under fancy,
coined names. Since phenolphthalein occurs in the form of an insoluble
and tasteless powder there is no reason why special pharmaceutical
preparations of it should be placed on the market. It can be prescribed
in powder form, in pills, capsules or tablets. Thus given, the true
therapeutic action of the drug would be apparent and its actual value
arrived at.

[116] The Journal, March 30, 1907, p. 1133.

The vice of this unscientific habit of prescribing names instead of
drugs is stated in a forcible way in a letter received from Dr. V. E.
Simpson, a teacher of materia medica and therapeutics in the medical
department of the University of Louisville. He says:

  “Recently P. D. & Co.’s representative left on my desk a sample
  labeled ‘Laxaphen.’ The formula given is: phenolphthalein, gr. viii;
  salicylic acid, gr. 3/5, in each fluidounce, ‘incorporated in a
  palatable chocolate base.’ Now, in the first place, this name is one
  that the public will easily learn and will soon call for; in the
  second place, it is not a name that carries with it even a suggestion
  of its contents; and, finally, the physician acquires the habit of
  mechanically prescribing names instead of drugs, and in the burdening
  of his memory with the myriad of fantastic labelings he finds it
  impossible to remember even the drugs any one contains, much less the
  exact proportions of those drugs. Then suppose that a consultation
  is had; the consultant asks what is being given and the attendant
  answers that he is giving ‘laxaphen.’ The consultant, perhaps, has
  not been sampled and inquires about it; the attendant must answer.
  ‘Oh, it contains some phenolphthalein and a salicylate, but I have
  forgotten the exact proportions. I have the literature on my desk.’
  Had he used U. S. P. and N. F. remedies, which the consultant and
  every other doctor in the land has access to and should have some
  knowledge of, this embarrassment would not occur.”

All of the above should remind the physician that he should write
simple prescriptions, for drugs whose action he knows, adapted to the
particular case and not for money-making combinations under fanciful,
non-descriptive names exploited by the proprietary manufacturers. In
this way he will not only save money for himself and his patients, but
he will be giving them exact and effective treatment, he will know
exactly what he is giving and learn for himself its effect, and he
will be following the only method which entitles him to be called a
scientific physician.--(_From The Journal A. M. A., April 30, 1910._)




                   MIXED VACCINE AND PHYLACOGENS[AY]

[AY] A reprint of articles on the subject of Phylacogens originally
published in The Journal is issued under the title “The Phylacogens: A
Menace to Rational Therapy.”


The noted advance in therapeutics shown in the development of vaccine
therapy has brought with it grave dangers as well as advantages.
We have, on a number of occasions, discussed in special articles
and in editorials the dangers which threatened from the rapid
commercialization of this new method. The unscientific character of
mixed vaccines and of the mixed filtered products of a number of
vaccines marketed as “Phylacogens” has been especially emphasized and
the danger from their indiscriminate use pointed out. A little over
a year ago we published a series of articles dealing with the whole
subject in which the nature of mixed vaccines was described[117] as
follows:

[117] Bacterial Vaccine Therapy: Its Indications and Limitations,
p. 37, reprinted from The Journal A. M. A., April 26 June 28, 1913,
price 10 cents.

  “The mixed stock vaccine of commerce is a makeshift. It is offered
  as a substitute for correct diagnosis. Like all such makeshifts
  in science, it is doomed to failure.... A burden is being forced
  on the profession which will speedily assume the proportions
  attained by proprietary drug combinations. The menace cannot be
  counteracted unless physicians will accept the guidance of unselfish,
  non-commercial interests and refuse to purchase and use mixed
  commercial vaccines.”

This admonition to seek the guidance of unbiased scientific observers
is deserving of special emphasis at the present time. Five weeks ago we
published the address of the chairman of the Section on Pharmacology
and Therapeutics, Dr. John F. Anderson,[118] one of our foremost
workers in this branch of biologic science, in which attention was very
forcibly drawn to the dangers involved in the use of biologic products
of non-specific character. He says:

[118] Anderson, John F.: Some Unhealthy Tendencies in Therapeutics, The
Journal A. M. A., July 4, 1914, p. 1.

  “Bacterial therapy undoubtedly in some cases is a most valuable
  method of treatment; but when the claim is made that a combination
  of the dead bodies or the filtered products of a number of different
  bacteria are useful for the treatment of certain diseases with a
  different specific cause, it would seem that the suggestion closely
  approaches quackery.”

Further he says:

  “Aside from the doubtful practice of the indiscriminate use of
  unproved methods of treatment, it has seemed to me that a great
  injustice is done the patient by their use, since some of the
  preparations that have been widely exploited have been shown to
  be harmful in certain instances and even to have caused death. So
  the first step in attempting to remedy conditions is to awaken the
  physician to the importance of ignoring the claims of those who are
  pushing these new methods until their usefulness and harmlessness has
  been clearly demonstrated by those best in a position to do so.”

As a result of scientific methods in teaching therapeutics, physicians
have gradually given up almost entirely the use of “shotgun”
prescriptions and now prescribe a drug or a combination of a few drugs,
each given for the purpose of exerting a definite action. On the other
hand, the purveyors of bacterial vaccines have gradually increased
the number of different bacteria in their mixed vaccines until some
of those now advertised for sale contain as many as seven different
kinds of bacteria, and some of the “Phylacogens” contain the filtered
products of at least eleven bacterial species!

Under the present federal laws there does not seem to be any way in
which the federal government can do more than is being done at present.
It is a case in which the physician becomes the sole guardian of the
patient committed to his care. He is the one and the only responsible
individual. He cannot throw the blame for bad results back to the
manufacturer. When he subjects his patient to the possibility of harm
by the use of these unscientific and dangerous preparations, the
physician assumes the responsibility, whether he wants to or not.

If physicians would report their failures when these vaccines are used,
and especially report the fatalities consequent on their use, with the
name of the manufacturer of the particular product used, we are quite
sure there would result lessening in the enthusiasm of the purveyors of
these products.

When tempted by the optimistic statements of the interested
manufacturer of these mixtures to give them a trial the physician
should remember that the warnings of disinterested scientists are
of far more value than uncritical clinical reports put out under
commercial auspices.

This we quote from a recent book by Victor C. Vaughan,[119] President
of the American Medical Association:

[119] Vaughan, Victor C.: Protein Split Products in Relation to
Immunity and Disease, 1913, p. 226.

  “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.”

Such a warning as this quotation contains, from a man so eminent as Dr.
Vaughan, merits and should receive the careful attention of medical
men; at least it should have as much weight as the “clinical evidence”
spread broadcast among our profession by commercial houses.--(_From The
Journal A. M. A., Aug. 29, 1914._)




     THE DANGER IN PROTONUCLEIN, A PREPARATION CONTAINING THYROID


Protonuclein was the subject of a little article in our Queries and
Minor Notes Department, Nov. 16, 1912, page 1812. Dr. Reid Hunt,
Washington, D. C., writes:

  “_To the Editor_:--I have been requested by a physician to call your
  attention to certain statements which might well have been added
  to your reply to J. A. C. in regard to Protonuclein. Dr. Seidell
  and I examined several samples of Protonuclein some time ago[120]
  and by chemical and physiologic tests found that they contained the
  equivalent of 10 per cent. thyroid of 0.1 per cent. iodin strength
  (the actual amount of thyroid may have been greater or less for
  we did not know the percentage of iodin in the thyroid used). The
  dose recommended on the bottle was 6 to 12 grains every three or
  four hours; this represents from 0.6 to 1.2 grains of some of the
  commercial thyroid powders, and is sufficient to cause pronounced
  thyroid effects in many conditions. Protonuclein was advertised as a
  ‘perfectly harmless antitoxin, tissue-builder,’ etc., although the
  dose of thyroid did not differ materially from that in ‘Rengo’ and
  ‘Marmola,’ two anti-fat nostrums which we examined at the same time.
  We called attention to the danger of using thyroid, the most powerful
  tissue-destroying drug known, in cases of typhoid, phthisis, etc.,
  for which protonuclein was recommended, though these are conditions
  in which the physician is supposed to be exerting every effort to
  build up the tissues.

  [120] Hunt, Reid, and Seidell, Atherton: Commercial Thyroid
  Preparations and Suggestions as to the Standardization of Thyroid,
  The Journal A. M. A., Oct. 24, 1908, p. 1385.

  “You also speak of the ‘high’ nuclein content (0.28 per cent.
  phosphorus): the largest recommended dose would contain only about
  1/3 grain of nucleic acid--an amount which probably has not the
  slightest effect, especially when given by the mouth.

  “A sample of ‘Protonuclein Special’ was found to have twice as much
  thyroid as the ordinary Protonuclein; this also was stated to be
  ‘perfectly harmless.’”--(_From The Journal A. M. A., Feb. 1, 1913._)




                                PURGEN


The physicians of the United States are receiving a neat package
containing samples of a German proprietary--Purgen. The container is
an ingenious one and, besides the tablets, includes a circular in
English, although mailed in Europe, describing the remarkable virtues
of this “new synthetic aperient.” It has been considered strange that
this proprietary, which has been advertised so thoroughly in Europe,
Australia, etc., should not have made its appearance in this country.
Now it is here, and it is well that physicians should know what Purgen
is and not be mystified and misled by the literature that they may
receive regarding the preparation.

The following appeared in The Journal, Jan. 5, 1907, page 64, and is
reprinted now as being especially timely:

  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.”

As explanatory to the last sentence, it should be stated that in Europe
Purgen is put up in three dosage forms, “infant Purgen for children,”
containing 3/4 of a grain; “adult Purgen for chronic constipation,”
containing 1-1/2 grains, and “strong Purgen for invalids,” containing
7-1/2 grains. The form in which it is being sampled in this country is
in the medium dose, 1-1/2 grains.

Physicians should remember that the promoters of Purgen are simply
introducing a chemical well known to laboratory workers for the
last twenty years, which has been recognized as an aperient for at
least seven years, and which can be purchased for 40 cents an ounce,
whereas an ounce of phenolphthalein in the form of Purgen will cost
$3.20 wholesale. The enthusiastic praise of the remedy, found in the
advertising circulars, should be subjected to critical judgment on
account of its source and motives.

It is undoubtedly true, however, as we have previously stated,
that phenolphthalein is worthy of a trial. In the _British Medical
Journal_, Oct. 18, 1902, F. W. Tunnicliffe speaks of the virtues of
phenolphthalein, and the conclusions reached by him were that it is
a useful aperient, without irritating action on the kidneys, and
is especially valuable in jaundice, its depressing action on the
circulation being less than sulphate of magnesia.

Phenolphthalein is not in the Pharmacopeia, but has been included
in “New and Nonofficial Remedies” by the Council on Pharmacy and
Chemistry. From this we quote:

  _Actions and Uses._--Phenolphthalein acts as a purgative, but appears
  to possess no further physiologic action. A case of poisoning from
  taking 1 gm. (15 grains) is reported. _Dosage._--For adults the
  average dose is 0.1 to 0.2 gm. (1.5 to 3 grains) given as powder, in
  cachets, capsules or pills. It may be given with safety in doses of
  0.5 gm. (8 grains), and these doses seem to be necessary to secure
  its effects in bedridden patients or in obstinate cases.

We have gone into this matter again so that our readers may have some
knowledge of this remedy, and we hope that if they conclude to try it
they will use the chemical itself and under its own name.--(_From The
Journal A. M. A., Sept. 14, 1907._)




                              PYO-ATOXIN


  “_To the Editor_:--I am sending you a sample of a proprietary
  preparation that for the past two or three years has been largely
  retailed in the South and Southwest as a new combination that
  liberates larger amounts of formaldehyd, etc., in the genito-urinary
  tract than any known agent, that it is a methylene-formate, entirely
  new, etc.

  “I asked the representative why he had not submitted a specimen to
  the Council, and his reply was that like Wyeth and others they did
  not get a fair report, or something to this effect. My reasons for
  trying to find the truth for their claims is that quite a number of
  general practitioners have asked me regarding this Pyo-Atoxin.

                                  “W. P. Dey, M.D., Jacksonville, Fla.”

Dr. Dey sent with the foregoing letter a box of Pyo-Atoxin which bore
this label:

                           Pyo-Atoxin
                    Reg. in U. S. Pat. Office
                           (Capsules)
                    (Pheno-Methylene-Formate)
                            “Hurley”
                 An Antitoxic Agent Indicated in
               Gonorrhoea, Cystitis, Pyelitis and
                     Bacteriuric Conditions.
           DOSE: One capsule four to six times daily,
                Followed by large glass of water.
                          Guaranteed by
                          H. O. Hurley,
                    Manufacturing Pharmacist,
                         Louisville, Ky.
           Under the Food and Drugs Act, June 30, 1906
                        Serial No. 1710.

The pseudoscientific synonym “pheno-methylene-formate” carries the idea
that Pyo-Atoxin is a definite chemical substance. It is unnecessary
to say that the term “pheno-methylene-formate” is a meaningless one
and its use reminds one of those preparations exploited seven or
eight years ago before the Council began to expose these mixtures
masquerading as definite chemical compounds.

The chemical laboratory was asked to investigate this preparation and
the following is a report of the chemists:

  “The box contained thirty gelatin capsules coated with some black
  substance giving them the appearance of some of the popular gonorrhea
  nostrums. When the capsules were opened they were found to contain
  a powder--about 0.35 gm. or 5 grains per capsule--composed of large
  white or colorless crystals mixed with a smaller amount of a fine
  dark powder. The crystals when separated out and dissolved yielded
  the characteristic tests for hexamethylenamin. A solution of the
  entire capsule content was deep blue and responded to the U. S. P.
  tests for methylene blue.

  “As a result of these and other tests it was concluded
  that Pyo-Atoxin consisted essentially of two pharmacopeial
  drugs--hexamethylenamin and methylene blue. A quantitative
  determination of the constituents was considered unnecessary. From
  its general appearance and properties, however, the hexamethylenamin
  probably constitutes approximately from 60 to 80 per cent. of the
  preparation.”

It thus appears that the capsules contain a mixture consisting
essentially of two well-known official substances, the value and
particularly the limitations of which should be known by physicians by
this time. This nostrum is simply another example of how physicians are
being humbugged.--(_From The Journal A. M. A., Feb. 14, 1914._)




                                RESINOL


The Philadelphia branch of the American Pharmaceutical Association
issued a pamphlet some two years ago in which the following appeared
relative to Resinol and similar products:

[Illustration]

  “Within recent years there have been introduced a number of compound
  ointments that in their supposed range of therapeutic usefulness are
  scarcely equaled and certainly not excelled by the magic unguents
  of the quacks and charlatans of continental Europe, who, several
  centuries ago, essayed to cure all manner of disease by inunction or
  the simple application of compound ointments of secret composition.

  “As typical of this modern class of panaceas we may mention
  Resinol. This preparation is being widely advertised at the present
  time in the daily papers as a valuable adjunct to Resinol Soap
  in the treatment of all kinds and varieties of diseases of the
  skin. The makers of this particular mixture, in the form of an
  ointment, modestly assert that it will cure all skin diseases, and
  is also ‘Specific for Pruritus Ani, Itching Piles, and Pruritus
  Vulvæ.’”--(_From The Journal A. M. A., Nov. 6, 1909._)




                             RESOR-BISNOL


Resor-Bisnol was considered by the Council and refused recognition.
The following formula for Resor-Bisnol was at one time given in
advertisements in a number of medical journals:

    “A scientific combination, in nicely balanced proportions of
    Bismuth Salts of antiseptic acids of the aromatic series, and
    Resorcin.

    “Each 100 parts contains 20 parts Resorcin, and 52 parts Bismuth
    Oxid, combined with antiseptic acids.”

Besides this formula other “formulas” equally indefinite, vague
and misleading have been given in lieu of an actual statement of
composition, thus:

    “---- is a mixture of resorcin and bismuth salts of phenic acids
    such as salicylates, etc., and an aromatic alcoholate. Its
    composition is as follows.

    Bismuth salts of phenic acids       60 per cent.
    Aromatic alcoholate of bismuth      20 per cent.
    Resorcin                            20 per cent.”

The product was recently analyzed in our chemical laboratory. The
chemists report as follows:

  “A specimen of Resor-Bisnol examined by us consisted of a light
  brown powder possessing a characteristic odor and a taste at first
  sweetish and then bitter. It was found to be only partially soluble
  in water. The examination indicates that Resor-Bisnol is probably a
  mixture consisting essentially of a basic bismuth salicylate (bismuth
  subsalicylate), a basic gallate of bismuth (bismuth subgallate),
  a basic compound of beta-naphthol (bismuth betanaphtholate) and
  resorcinol (resorcin).”

It thus appears that Resor-Bisnol is probably a simple mixture of
well-known substances. In other words, the Resor-Bisnol advertising and
literature are typical of that issued by various nostrum houses: it
conceals the truth in a mass of semi-scientific verbiage, and while not
frankly false, it deceives by what is left unsaid rather than by what
is said.--(_From The Journal A. M. A., June 1, 1912._)




                          ROBINOL AND SEVETOL

         Revamping Discarded Theories for Commercial Purposes


It is astonishing how rapidly medical hypotheses become theories and
theories are accepted for established facts, when such alleged facts
are favorable to commercial enterprise. Yet, as a matter of fact, the
manufacturers of proprietary preparations are under a moral obligation,
at least, to tell the truth with reference to the scientific basis for
their claims. To draw from exploded theories reasons for the use of
proprietary preparations is reprehensible, not only because it may lead
physicians to use preparations which are worthless, but also because
it tends to confirm in the physician’s mind opinions which science has
discarded.


                                Robinol

John Wyeth and Brother put up a mixture of glycerophosphates which they
call Robinol. In their description of the properties of this mixture
they say:

    “Phosphorus exists in the brain, nervous system, and vital organs
    as lecithin, of which glycerophosphoric acid is the most important
    constituent and is essential to the vital processes for the
    reproduction of life and maintenance of metabolism in old age,
    impotence, etc.”

The first impression on reading this sentence is that it suggests that
_glycerophosphates_ are essential to the vital processes, although the
statement strictly applies to phosphorus. The next sentence confirms
this impression and the mind glissades from the accepted fact of the
existence of phosphorus in nervous tissue to the unfounded hypothesis
that the glycerophosphates are necessary to supply the essential
element. In the next sentence the circular continues:

    “In nervous and general debility the glycerophosphates as exhibited
    in Robinol, are preferable to the mineral phosphates as they
    contribute the essential constituent of nerve tissue and are
    absorbed by the cells more readily than any phosphate of vegetable
    or inorganic origin.”

This statement is utterly unfounded. It is in direct opposition to the
conclusions of pharmacologists. The glycerophosphoric acid radical is,
to be sure, found in the lecithin of nervous tissues, but its source
is not known. There is no evidence either that it must be present in
the food or that it must be taken as medicine in order that the brain
and nervous tissues shall be nourished. When the glycerophosphates are
taken there is no evidence that they enter into the composition of the
brain or nervous tissue. They are excreted in the urine and feces as
phosphates. It has never been shown that glycerophosphates are absorbed
any more readily than other phosphates.

But the advertising circular has still more information to impart to
physicians:

    “In that group of maladies characterized by faulty nutrition, due
    to the excessive elimination of phosphorus from the body, as is
    evidenced by the fatigue and weakness following acute attacks and
    present in many chronic affections, during the course of fevers and
    in the later stages of phthisis and all diseases of the nervous
    system, physicians will find the tonic chalybeate properties of the
    glycerophosphates of great value.”

Physicians know, if the nostrum makers do not, how difficult it is
to determine whether there is an excessive elimination of phosphorus
from the body. The bulk of the phosphates found in the urine are
derived from the food and so little comes from the metabolism of the
nervous system that it is not easy to prove that any disease is due
to excessive elimination of phosphorus from the body. That fatigue
and weakness are due to such a loss of phosphorus is mere assumption,
a convenient theory for the exploiters of glycerophosphates. But
admitting that nervous waste or faulty nutrition is characterized by
the loss of phosphorus, it is easier, cheaper and more rational to
supply such loss by the use of phosphorus-containing foods, such as
milk and eggs, and there is not the slightest evidence that the loss of
phosphorus will be influenced in any way by giving a supply in the form
of glycerophosphates. Thus, in order to bolster up the sale of a simple
solution of glycerophosphates, vague theories and improbable hypotheses
are dressed in all the dignity of scientific facts.


                                Sevetol

There was a time, perhaps a generation ago, when physiologists taught
that fats were absorbed into the blood in the form of a fine emulsion.
This theory has been definitely disproved and it is now known that fats
enter the blood only after a chemical splitting into glycerol and fatty
acids, the latter being, to a large extent, combined with alkalies in
the form of soaps.

“Sevetol,” another Wyeth preparation, is presented to the profession
under the claim that it is a very fine emulsion of fats, every portion
of which “is readily absorbed through the intestinal wall.” To quote:

    “The administration of Sevetol, therefore, does not tax the
    digestive power of the patient, for it is absorbed with very
    little effort on the part of the digestive apparatus; and even
    if the organs of digestion be involved, neither the weakness
    of the patient nor the severity of the symptoms necessarily
    contra-indicates its use. The amount ingested is limited only by
    the power of assimilation exhibited in the tissues, and it may
    be given in large doses for a continued period of time, or until
    symptoms of overfeeding are produced, such as coated tongue,
    anorexia, constipation, headache and lassitude. When these symptoms
    appear, the administration of Sevetol should be temporarily
    discontinued and a mild but effective laxative given for several
    days, after which its use may be resumed.”

While the language just quoted is a little more exalted and dignified
than that found in typical “patent medicine” advertisements, the
thought it expresses qualifies it for a place in the “Lydia Pinkham”
or “Peruna” class. Every sophomore medical student knows, if he gives
the matter any thought, that Sevetol must undergo the same process of
digestion as any other fat. It must be broken up into a fatty acid
and glycerol, and saponified before it can be absorbed. It is plainly
evident that the amount of Sevetol which can be taken is limited
not only by the power of assimilation, but also by the power of
digestion. The symptoms mentioned in the advertisement and ascribed to
overfeeding, are the symptoms, not of a system saturated with absorbed
fat, but of digestive organs rebelling against an unusual diet.

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


Some time ago we wrote to Messrs. Bell & Co., calling their attention
to the fact that we had made an examination[121] of their product,
salacetin, and that as a result of such examination it was found to
be a mixture, which did not coincide exactly with their description
of it. They replied: “Our description of salacetin is correct and we
have nothing more to impart except that anyone publishing any different
formula from that given in our circulars will be held responsible by
us.”

[121] The Journal A. M. A., June 3, 1905; reproduced on page 10 of this
book.

The description they give is as follows:

    Prepared by the interaction, with heat, of salicylic acid, glacial
    acetic acid, and purified phenylamine.

This sounds very scientific, but when we remember that acetanilid
is a result of the action of glacial acetic acid on phenylamine
(anilin) their description is cute, to say the least. Of course, there
is “interaction with heat” when salicylic acid is combining with
bicarbonate of sodium to form salicylate of sodium. Further, there is,
no doubt, some “interaction with heat” when the substances are rubbed
together in mixing them and when they are going through the mill to
form tablets, not to mention the heated imagination of the promoters of
this “synthetic.”

The following taken from the advertising literature furnished by the
manufacturers and distributed by them, is quoted to show the claims
made for this preparation:

    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.

Of course, it is well understood that acetanilid is a valuable
remedy in many instances, if used with caution and when indicated.
It certainly has some therapeutic value. There is no doubt that it
relieves pain of various kinds. It is to be presumed that combining
salicylate of sodium with it will have certain beneficial effects
in certain rheumatic conditions, on the supposition that salicylate
of sodium and acetanilid are both used with more or less success in
certain of these conditions. Also, the combining of bicarbonate of
sodium, carbonate of ammonium, caffein, citric acid, one or several of
these, may result in a fairly good combination, but these combinations
can be found in the list of preparations of all our large manufacturing
pharmaceutical houses, which supply them at one-tenth of the cost of
these secret remedies. The physician in using these preparations put
out by reputable recognized manufacturing pharmaceutical houses not
only is prescribing preparations that are non-secret, but is using
remedies that cost one-tenth as much as the secret preparations,
which are exploited under fanciful names and pushed by ridiculous
claims.--(_From The Journal A. M. A., July 1, 1905._)




                           SAL-CODEIA--BELL


According to the advertisements “Salacetin”

    “... is a combination with heat of salicylic and glacial
    acetic acids with phenylamine, the irritating, depressing and
    blood-corpuscle destroying elements removed.”

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:

    ℞ Acetanilid                       Ʒ i    4|
      Sodii bicarbonatis              Ʒ ss    2|
      Sodii salicylatis               Ʒ ss    2|
      Codein sulph.                 gr. vi     |4
    M. et div. chart No. xxiv.

This will make five-grain powders which may be put in papers, capsules,
cachets or tablets. Each will contain 2-1/2 grains (0.15 gm.) of
acetanilid and 1-1/4 grains (0.075 gm.) each of sodium salicylate and
sodium bicarbonate, with 1/4 grain (0.015 gm.) of codein.

The doses of acetanilid and of codein approximate the average adult
doses, but the sodium salicylate, to have any appreciable effect, must
be increased, for 1-1/4 grains of salicylate of sodium in a dose is
insignificantly small. Sodium salicylate with acetanilid makes a fairly
good combination in certain rheumatic troubles, but it is not indicated
by any means as a cure-all, as one would judge from the literature sent
out by the Sal-Codeia-Bell people.--(_From The Journal A. M. A., Nov.
4, 1905._)




                               SANATOGEN

              Cottage Cheese--The New Elixir of Life[AZ]

[AZ] See also Medical Journals and Sanatogen, p. 431.


The psychology of advertising is nowhere better exemplified than in
the “patent medicine” and proprietary fields. The reason is evident.
Knowing that the general tendency of the human organism is toward
health rather than toward disease and that the “healing power of
nature”--_vis medicatrix naturæ_--will account for a large proportion
of recoveries from sickness, it is not to be wondered at that thousands
of preparations sold for medicinal purposes receive credit that is
entirely undeserved. The awarding of such undeserved credit is largely
due to the universal tendency of those who are not trained in science
to apply the _post hoc, ergo propter hoc_ argument in all matters
relating to health and disease.

John Smith suffers from a passing indisposition. When he recovers he
credits his recovery to whatever he may have done just preceding that
recovery. If he has received medical attention, the physician gets
the credit; if he has taken “absent treatment,” Christian Science is
responsible; if he has taken sugar pills, “Prof.” Munyon gets the
praise--while, as a matter of fact, if he had taken none of these he
would have recovered since he was only temporarily indisposed.

Nor are laymen the only ones that fall into such errors. Many
physicians who prescribe new, widely-advertised preparations are likely
to give those products credit for whatever favorable change may take
place in their patients’ condition. This failing is not a modern
one. In 1842 Dr. Benjamin Brodie wrote: “We have no doubt that many
well-instructed medical practitioners have not sufficiently considered
what course a given disease would take if it were left to itself;
and as to others, it is not possible that they should have any real
knowledge on the subject. With the majority of persons a recovery will
generally pass for a cure.”

[Illustration: Greatly reduced photographic reproduction of a full-page
Sanatogen advertisement appearing in the London _Graphic_. The
_Graphic_ was one of the London magazines that refused to accept an
advertisement of the book issued by the British Medical Association,
exposing “patent-medicine” frauds.]

                       THE POWER OF ADVERTISING

While every physician is perfectly familiar with the facts just
stated, it seems worth while to give them as a probable explanation of
what is to follow. Within the last few years the medical profession
and the public of this country have been asked to believe that a
combination of cottage cheese--or its equivalent--with a small amount
of glycerophosphates is capable, when sold under a proprietary name and
with the right kind of advertising, of producing physiologic effects
that are little short of marvelous.

The name of this elixir of life is Sanatogen, and it is doubtful if
the history of modern advertising furnishes any more notable example
of the commercial potentialities of publicity than that exhibited in
the exploitation of this product. The Sanatogen advertising campaign
is probably the most skilful piece of work of its kind ever done.
On both sides of the Atlantic, every effort has been made to endow
the advertisements with a dignity which, to those who know the very
ordinary nature of the product advertised, is grotesquely out of
keeping. Only the highest-class magazines and newspapers have been
patronized; the “copy” has been so written as to appeal not to the
ignorant but to the intelligent. Testimonials from men whose names are
well known, even though by training and education they are incompetent
to pass judgment on a product of this kind, and fulsomely laudatory
letters from men whose education and training should have taught them
better--both have been used with all the skill of the trained publicity
man. In short, Sanatogen stands as a monument to the power of printers’
ink.

The claims for this product have already been referred to in The
Journal, but it will do no harm to bring them again before our readers.
Here are some taken from advertisements:

    “The Re-Creator of Lost Health.”

    “Sanatogen is ... a rebuilding food.”

    “... revitalizes the overworked nervous system.”

    “Specific nerve tonic action.”

    “Most reliable and scientific of all nutrients.”

    “... _in certain diseases_ it exerts a _specific action_ which
    renders it a valuable adjunct to other curative measures.”

    “It stimulates metabolic activity of tissue cells and secures more
    complete oxidation of energy-yielding elements.”

    “Sanatogen nourishes the system in a persistent, gradual,
    cumulative way, so that its best effects unfold themselves in a
    systematic, substantial progression to health and strength. It
    follows that a regular and prolonged administration of Sanatogen is
    necessary for the attainment of lasting results.”

    “Sanatogen is a scientific compound, every particle of which
    represents the finest concentrated, tissue-constructing nutriment,
    endowed with unique revitalizing and rejuvenating powers.”

    “Sanatogen contains over 700 per cent. more tissue-building, life
    sustaining nourishment than wheat flour.”

Truly a wonderful preparation--if these statements are true! But they
are false--most of them at least. And in that many who can ill afford
it may be led to pay a ruinously high price for a very ordinary food,
the statements are viciously and cruelly false.

In view of the properties with which Sanatogen is credited, its
composition is naturally a matter of more than ordinary interest. What
is this life-giving product? A package of Sanatogen was purchased and
subjected to examination and analysis in the Association’s laboratory.
Our chemists report:

                           LABORATORY REPORT

  Sanatogen is a fine, nearly white powder having a faint yellowish
  tinge. A circular which is enclosed in the package states:

    “Sanatogen is a definite organic combination of 95 per cent.
    of pure, specially prepared casein and 5 per cent. of sodium
    glycerophosphate,...”

Qualitative tests indicated the presence in Sanatogen of casein,
sodium, a phosphorous compound and glycerin or a glycerin compound.
Starch and sugars were absent. Quantitative analysis showed that the
composition of the specimen was essentially as follows:

    Water (loss at 130 C.)                                  8.60
    Ash                                                     6.23
    Casein and other proteins (N × 6.38)                   83.10
    Casein (N in precipitated casein × 6.38)               80.57
    Proteins other than casein (by difference)              2.53
    Sodium glycerophosphate (NaC_{3}H_{7}O_{6}P) (P in
      filtrate from casein precipitation × 6.79)            5.59
    Insoluble matter                                        0.84
    Undetermined                                            1.87

While these results show that the claims concerning the composition of
Sanatogen are not entirely correct, they indicate that the essential
element in Sanatogen is casein.

The slight variation between the composition claimed for Sanatogen
and the composition as determined by chemical analysis is of minor
importance. Whether there is 83 per cent. of casein as found by the
Association’s chemists or 95 per cent. as asserted by the manufacturers
matters little. The important fact is that casein makes up about
nine-tenths of the preparation and, as must be perfectly evident,
Sanatogen derives whatever food value it may have from that casein.
Casein is known in its commonest form as the curd in milk, or as
“cottage cheese.” After the cream has been separated, the milk which
remains contains nearly all the casein and milk sugar originally
present but practically none of the fat.

                        WHY NOT COTTAGE CHEESE?

Whence comes the stimulation of metabolic activity, the wonderful
nourishment of the system, the marvelous revitalizing and rejuvenating
power claimed for Sanatogen? Not from the sodium glycerophosphate,
for the consensus of opinion among leading physiologists indicates
that phosphorus in the form of glycerophosphates has little influence
on metabolism. Not from the glycerin, surely, for even granting that
glycerin has food value the amount present is so small as to be
negligible. The real source of energy in Sanatogen, then, lies in the
casein which comprises about nine-tenths of its ingredients.

    =======================+=========+==============+============
                           |         |    Cost of   | Calories.
    Kind of Food Material  |Price per|1,000 Calories|Energy for
                           | Pound   |    Energy    | One Dollar
    -----------------------+---------+--------------+------------
    Sanatogen              | $4.54   |    $3.01     |     332
    Celery                 |   .05   |      .77     |   1,300
    Eggs ($0.36 per doz.)  |   .24   |      .16     |   6,300
    Milk ($0.07 per qt.)   |   .035  |      .11     |   8,850
    Pork, loin roast       |   .12   |      .10     |  10,350
    Butter                 |   .30   |      .09     |  11,250
    Mackerel, salt dressed |   .10   |      .08     |  11,850
    Beef, stew meat        |   .05   |      .07     |  15,300
    Wheat bread            |   .06   |      .05     |  20,000
    Rice                   |   .08   |      .05     |  20,250
    Sugar                  |   .06   |      .03     |  29,200
    Pork, fat salt         |   .12   |      .03     |  29,500
    Potatoes               |   .01   |      .03     |  29,500
    Beans, white           |   .05   |      .03     |  30,400
    Oatmeal                |   .04   |      .02     |  45,000
    Cornmeal               |   .025  |      .02     |  65,400
    Wheat flour            |   .025  |      .02     |  65,400
    -----------------------+---------+--------------+------------

Of course Sanatogen, being composed largely of casein, has some food
value. What that food value is may be seen by the accompanying table
which compares the yield of energy for Sanatogen with that of a number
of staple food products, the figures for the latter having been adapted
from Professor Atwater’s calculations. This table shows that, from
the standpoint of economy in the purchase of energy, no other food
in the list is so poor as Sanatogen. While the manufacturers claim
that “Sanatogen contains over 700 per cent. more tissue-building,
life-sustaining nourishment than wheat flour,” the table shows that one
dollar’s worth of wheat flour contains as much energy as one hundred
and ninety-seven dollars’ worth of Sanatogen!

                              AN INQUIRY

Like all “patent medicines,” Sanatogen is exploited by the testimonial
route. Actors, authors, politicians and not a few physicians--the
latter, to the credit of the American profession, be it said, being
chiefly Europeans--have testified to the wonderful properties of
this product. Believing that it would be of interest to learn what
scientific men thought of Sanatogen a letter of inquiry was written
to several men whose training particularly fits them to express an
impartial opinion on a question of this kind. The following inquiry,
expressed in practically the same words, was propounded:

Is it possible for a product, even if it has the composition claimed
for Sanatogen, to have properties as a food and medicine which are
claimed for this preparation?

The replies to this inquiry are interesting and instructive, although
they are what might have been expected from men whose judgment has not
been warped by the glittering claims of the Sanatogen publicity agents.

[Illustration: Some of the reasons for the sale of Sanatogen! A few
specimen advertisements of Sanatogen’s enormously expensive advertising
campaign.]

                              THE REPLIES

Dr. Lewellys F. Barker, professor of medicine, Johns Hopkins
University, medical department, says in part:

  “If Sanatogen consists simply of casein and sodium glycerophosphate,
  it is pretty obvious that all of its good effects (except perhaps
  the psychic influence of taking an expensive and, to the layman,
  mysterious remedy) can be gotten by including milk and eggs in the
  food....

  “The objection to Sanatogen lies, it seems to me, not in the
  assertion of its proprietors that it is a ‘food and a tonic,’ but
  in the misleading of the public and physicians into the belief that
  it possesses extraordinary powers which make it worth while to pay
  the price charged for it in order to get it. Very extravagant claims
  are being made for it in advertisements in the lay press. If just as
  much, and more, good in the form of ‘food and tonic’ can be obtained
  from a dollar’s worth of milk and eggs as from a dollar and ninety
  cents’ worth of Sanatogen, it is surely the duty of the medical
  profession to inform the public of that fact.”

Dr. Frank Billings, professor of medicine and head of the Department of
Medicine, University of Chicago, expresses his opinion thus:

  “Of course, the thing is a fraud both as a food and as a tonic. Even
  if it met all the requirements of the statements made of it by the
  makers, it would not be any more of a food than as much casein taken
  in milk and probably not as good; or any more than some other albumin
  taken in some other form. I do not know just what pharmacologists
  say of the glycerophosphate of soda, but so far as my own clinical
  observations go I never saw any result from its use that could be
  called specific, that is, due to the drug.”

Dr. Richard C. Cabot, assistant professor of clinical medicine, Harvard
Medical School, says:

  “In reply to your letter respecting the properties of Sanatogen, I
  would say that in my opinion it is vastly improbable that it has the
  properties claimed for it in the advertisements which you enclosed to
  me. I have no doubt that it is a fairly good food. I see no reason to
  believe that the phosphorus that it contains has any special action.”

Otto Folin, professor of biological chemistry, Harvard Medical School,
expresses himself thus:

  “For myself, or for any one who would take my advice, I would prefer
  a glass of milk to Sanatogen when hungry and plain glycerophosphate
  to Sanatogen when in need of a tonic.

  “Medicated feed used to be sold for horses. To me the ‘food tonic’
  combination represents one of the most unscrupulous fake ideas used
  by manufacturers of patented articles to fool the public.”

Ludvig Hektoen, professor of pathology, University of Chicago, says in
part:

  “In my opinion, no attention whatsoever should be paid to the claims
  advanced in favor of ‘Sanatogen’ as food and as medicine, because
  the statements made in the advertisements of this product are
  extravagant, misleading and quackish.”

J. H. Long, professor of chemistry and director of chemical
laboratories, Northwestern University Medical School, expresses the
following opinion:

  “With every reading of the advertising literature of the Sanatogen
  Company I am more and more impressed by the gross exaggeration of the
  claims made for this mixture of casein and sodium glycerophosphate.
  Cow’s milk contains 3-1/2 to 4 per cent. of casein, associated with
  soluble phosphates. It is absurd to think that this casein after
  precipitation from the milk has a greater nutritive value than it has
  in its native condition. Casein, at best, is probably less valuable
  as a food than are certain other proteins, because of its lack of
  some of the amino groups essential in tissue building, and the
  addition of a glycerophosphate cannot supply this deficiency.

  “This is not the first attempt to exploit casein preparations. The
  earlier efforts failed in practice because they were based on a wrong
  conception concerning the physiologic value and importance of this
  protein. The assumption that in the case of Sanatogen a ‘definite
  organic combination’ with the glycerophosphate is formed cannot be
  taken seriously by chemists. We have witnessed many such efforts to
  palm off mixtures as definite organic compounds, and in this way to
  claim for them a value in excess of that which they actually possess.”

[Illustration: WHAT ONE DOLLAR WILL BUY IN FOOD ENERGY! A COMPARISON
OF THE CALORIC VALUES OF SANATOGEN, COW’S MILK, SUGAR AND WHEAT FLOUR.
BASED ON THE TABLE ACCOMPANYING THIS ARTICLE.]

Graham Lusk, professor of physiology, Cornell University Medical
College, after calling attention to the falsity of the claim that
Sanatogen is “a life-sustaining agent in disease,” says:

  “If one considers the casein content alone, the dose of Sanatogen
  recommended in the circular would furnish, at best, about what is
  contained in a pint of milk, or one-fourth of the total of the
  protein necessities of the body--using a low protein requirement.
  That sodium glycerophosphate has any distinctly beneficial
  physiologic action has never, to my knowledge, been shown.

  “It is a great pity that the public does not realize the splendid
  and economical value of milk, bread and the ordinary vegetables,
  cereals and meats, as true ‘tonic food stuffs,’ in contradistinction
  to prepared nostrums whose sale depends on a psychic stimulus applied
  to a susceptible populace.”

H. Gideon Wells, associate professor of pathology, University of
Chicago, says:

  “There is nothing in my knowledge of physiologic chemistry which
  would lead me to believe that a mixture of chemically isolated casein
  and sodium glycerophosphate would possess any effect more favorable
  than that of a corresponding amount of milk. I can easily believe
  that it would be less valuable than milk. The successful practice
  of many commercial houses, of isolating one of the constituents of
  our food, and ascribing to it marvelous nutritive or therapeutic
  properties, is one of the most telling bits of evidence of the
  inadequacy of the education of the medical profession in physiology
  and physiologic chemistry that can be conceived.”

The consensus of opinion thus expressed is only what might have been
expected from men who could discuss the problem in a purely judicial
spirit and with a freedom from that bias which seems to be inseparable
from the consideration of the simplest of mixtures that have been
glorified by a proprietary name.

                         THE TYRANNY OF WORDS

Herr Teufelsdröckh was right when he panegyrized clothes. And the
worship of clothes is carried to the extreme nowhere so much as in
the case of word-clothes. The most plebeian things when bedecked in
sufficiently imposing word-finery are endowed with the attributes
of royalty before which the average intellect bows down. Neither
cottage-cheese nor glycerophosphates, when exposed naked to the world,
commands any overweening respect; combined and dressed in the magic
word “Sanatogen,” they receive the homage of those whose judgment is
blinded by the glittering trappings of word-finery. Some day, possibly,
there will be a democracy of intellect which will refuse to prostrate
itself before mere word-raiment and will insist on appraising things
at their naked worth. When that day comes, proprietary humbugs like
Sanatogen will have become as extinct as the dodo and the great
auk.--(_From The Journal A. M. A., April 20, 1912._)


                 The Bauer Chemical Company’s “Reply”

_To the Editor_:--Our attention has been called to a most unfair
and unwarranted attack on Sanatogen which appears in your esteemed
publication [April 20, p. 1216]. The article is such a perversion of
the actual facts, and so completely--if not intentionally--misleading
that we request, as a matter of common justice, that you give this
reply equal publicity to your attack. The admiration and respect
we have felt for your journal and our appreciation of the place
it holds in the field of medical journalism, made your attack on
a product like Sanatogen, representing so definitely the most
painstaking and scientific research, the last thing expected. Indeed,
it seems inconceivable that a journal apparently so alive to its
responsibilities could publish broadcast an article so calculated to do
harm, without first giving those whose interests are most at stake an
opportunity to substantiate their claims.

There never has been a time that we have not been ready to meet any
request from The Journal, or the respected gentlemen composing the
Council on Pharmacy and Chemistry, for all information and data
concerning Sanatogen. Had we had the slightest inkling that our
product--or the claims made for it--were open to question or criticism,
we would gladly have submitted all of the evidence, clinical,
experimental, and theoretical, on which every statement, however
simple, has been based.

To make a response is difficult, because your article is not written
in a fair, unprejudiced spirit. In fact, although one would expect a
sober, serious consideration of a matter so fraught with importance
(if your contention is right) your whole attitude is one of ridicule
and jocularity. Is it right to present scientific material in such
a way and show so little respect for those who have offered you no
affront or done you no injury? A little investigation would have shown
you that the statements we have made about Sanatogen are based on the
experiences and opinions of such men as von Noorden, C. A. Ewald,
Duhrssen, Eulenburg, Neisser, Binswanger, von Leyden, Krafft-Ebing,
Tillmanns, Tunnicliffe, and thousands of other earnest, reputable
physicians. Any one might differ with their conclusions, but is it
courteous or decent to hold them up to ridicule and contumely?

Can a discussion thus conducted hope to solve a scientific problem or
accomplish any real good?

It would hardly seem so, and with all due respect we cannot help but
feel that the situation has its analogy in the legal doctrine, “when
you have no evidence, ridicule and abuse your opponent and his client.”

Sanatogen is a definite organic combination of (in round numbers)
95 per cent. casein and 5 per cent. glycerophosphate of sodium. The
analysis as published in The Journal fails to show that this statement
is untrue. The slight deviation as to the amount of casein present is
explained by the fact that The Journal’s figures include the moisture,
while ours are on the dry substance. Inasmuch as nearly all the
moisture is absorbed after the product leaves the laboratories and is
therefore added weight, the figures should be on the dry substance.
It is hinted in the article that Sanatogen is a mere mixture of
ingredients, in fact one of the gentlemen you quote openly intimates
so. To this we say most emphatically that _anyone asserting Sanatogen
to be a mere mechanical mixture of ingredients and not a definite
chemical compound either wilfully misstates the facts or does not
know_. Sanatogen represents a new idea or discovery in the domain of
invalid dietetics and as such its process of manufacture as well as the
product are protected by U. S. Letters Patent.

Assuredly it is the definite chemical combination found in Sanatogen
on which the special value of this product as a medicinal food and
tonic depends. A mere mixture of ingredients would represent only the
sum-total of their individual virtues, but a definite combination of
such ingredients means the formation of a new compound with properties
of its own which far transcend those of any simple mixture of the
original ingredients.

To compare Sanatogen to cottage cheese is the height of absurdity--as
it was probably intended to be. The casein of Sanatogen is perhaps
the most carefully purified milk protein available, and this fact
is of essential importance when considering the value of Sanatogen
as a medicinal food. To compare the casein of Sanatogen with crude
commercial casein or with cottage cheese is as ridiculous as to compare
a crude drug with the refined element. The same applies to the matter
of cost. We suggest that an attempt be made to prepare purified casein
according to Hammarsten’s method, if one wishes to determine what labor
and expense is involved in the operation. Possibly it will be found
cheaper to buy Hammarsten’s casein in the open market where the price
is $3.50 per pound wholesale! And it is not a proprietary product,
either.

Further, to compare the economic value of Sanatogen on the basis of
calories is as unscientific as it is deliberately misleading. If the
caloric standard only counted, a pound of oleomargarine would be as
valuable as fifty eggs, a pound of laundry soap as valuable as a
pound of choice beef. Sanatogen is not intended or recommended to
replace ordinary foodstuffs. It is not recommended as a caloric or
heat producer, but as a food-tonic supplying the essential elements of
tissue construction and cell-repair in easily and perfectly assimilable
form.

Digestibility, ease and completeness of assimilation count a great
deal, and are the sole determining factors in cases of illness. Again,
starch and fat are not essential substances to life. Without protein we
cannot live. Exclude everything else from a patient’s dietary, and he
will live. Exclude protein and it is only a question of time before he
dies. It is evident, therefore, that to measure the value of a given
food in calories only is misleading and dangerous, and an editorial in
your valuable publication of November 4 last distinctly points this
out.

[Illustration: Specimens of Sanatogen advertising--(1913).]

According to the most careful and extensive experiments, covering
a large number of scientifically studied cases, Sanatogen is not
approached in the matter of rapidity of digestion and absorption by
any other known foodstuff. That such a product does exert a definite
stimulating or activating effect on the digestive and assimilative
functions, thus promoting the digestion and appropriation of nutritive
material has been demonstrated over and over again. That the organic
phosphorus of Sanatogen is almost completely retained and assimilated
has been proved beyond doubt by carefully conducted metabolism
experiments. That from this, and from the stimulating action on
phosphorus and nitrogen metabolism, a favorable effect on the nervous
system could result, is conceivable. That such an effect does actually
take place has been demonstrated clinically in literally thousands of
cases.

As to our advertisements and literature: Every claim made emanates
from the freely recorded statements of competent observers, checked
and rechecked by men who have been absolutely free from all bias or
prejudice. And these opinions, moreover, are not the superficial,
passing views of a few physicians. Instead our claims are based on
the voluntary, unbiased written reports of clinical experiences by
over 15,000 practicing physicians--among whom a goodly proportion
are members of your esteemed Association--and on over 150 published
articles in the leading medical journals of the world, some of which
your journal has considered of sufficient importance to present to
its readers in abstract form, suppressing, it is true, all mention of
Sanatogen, although thereby the original was sadly emasculated, if not
actually falsified.

Among the physicians who have carefully tested Sanatogen and determined
its dietetic and therapeutic properties are many men of truly
international reputation, men who are as far above suspicion as was
Caesar’s wife. At least one of these men was the honorary guest of your
Association a few years ago.

It is such men that your article holds up to contempt and dishonor when
you allow the false inference to go forth that Sanatogen is a mixture
of casein and glycerophosphates. It is such men’s careful researches
and experience that you attempt to offset by the snap judgment of men
whom we claim, without the slightest intent of disparaging them, to
be in the present instance unfitted to give an opinion on Sanatogen
inasmuch as they--with perhaps one honorable exception--have never
tested or used the product. Their lack of definite knowledge of
Sanatogen is shown by their persistent references to casein and the
glycerophosphates, as though these two ingredients were separate and
not chemically combined. To consider Sanatogen a mixture is to lose the
vital detail of its specific value.

Now after all, is this a fair, judicial spirit, is this true scientific
enquiry? Are we to accept offhand judgments in preference to the
opinions of those who speak from years of observation of the effects of
Sanatogen? In the name of justice and fair play, is it right for the
great Journal of the A. M. A. to ignore and suppress the accumulated
evidence in favor of Sanatogen and cite instead the cursory opinions
of men who have never seen Sanatogen, tested or observed its effect,
who by the very nature of your enquiry must have been influenced
subconsciously in favor of your side of the matter.

[Illustration: The above is a reduced reproduction of a full-page
advertisement in a magazine devoted to pseudo-scientific fads. The
advertising pages of this magazine reek with frauds.]

During the twelve years Sanatogen has been used, prescribed and
recommended by thousands of competent physicians, it has been free from
all secrecy. The truth has been told at all times. From the first we
have cooperated with the profession. Never have we failed to safeguard
the doctor’s interests. Never have we suggested by word or inference
that any person should employ Sanatogen to the exclusion of medical
treatment. Not a day passes but we refer people who inquire about this
or that bodily ill, to their physicians for advice.

We regret the length of this letter but feel that the scientific
character of Sanatogen, its well-defined chemistry and the respect we
owe to the men who have not hesitated to give their honest opinions
concerning its food and tonic effects, make it imperative that we
refute at once errors and misleading statements, and correct to the
best of our ability the wrong impression you have allowed to go forth.
The clinical reports and statements and the scientific evidence on
which we have based our claims are constantly available and may be
examined by any responsible person for verification or any other
legitimate purpose.

We have tried to make this article temperate, fair and free from ill
temper and ill feeling. We only ask for justice and feel that you will
be willing--possibly anxious--to correct, so far as you can, the great
wrong you have done us.

                                                 The Bauer Chemical Co.
                                   By F. W. Hehmeyer, Resident Manager.

[Comment: We devote considerable space to the above free advertisement
of Sanatogen, as The Journal does not want to be accused of being
unfair, even to patent medicine venders. As our readers will recognize,
the above is simply a reiteration of the statements that have been
published in the advertisements of Sanatogen. The song that runs
through all the advertising matter is that Sanatogen is a chemical
compound, and since it is a chemical compound it therefore possesses
properties not to be found in the ordinary mixture. It is the old, old
story; the “synthetic” argument is as hoary as the nostrum business
itself but fortunately the medical profession is no longer easily
fooled by it.

As a matter of fact, even assuming for the sake of argument that the
casein and glycerophosphate in Sanatogen are in chemical combination,
it would be a union of the loosest kind, which on entering the
digestive tract must be broken up into its more stable components,
casein and glycerophosphate. To claim that Sanatogen possesses any
properties not possessed by its essential constituents is a silly piece
of pseudo-scientific claptrap.

Of the testimonials on Sanatogen we shall at this time have nothing to
say; The Journal has in the past repeatedly shown the worthlessness of
this kind of evidence.

We have nothing to retract, rather we would emphasize and, had we
space, enlarge on what we have already published, for we believe that
a large and unfortunate portion of the public, that can ill afford
it, is paying a ruinously high price for a substance having a very
mediocre food value. That indigent consumptives, for instance, should
be led by glittering falsehoods to squander on Sanatogen money that
should go for “food tonics” of infinitely greater value, such as eggs,
milk, vegetables and meats, is not only economic waste but inhuman
cruelty.--Ed.]--(_From The Journal A. M. A., May 18, 1912._)


                      The Sanatogen “Grand Prix”

A number of letters have been received recently expressing surprise
that Sanatogen had been granted a “grand prix” at the Exhibition of
Medical and Surgical Material held in London at the same time that the
Seventeenth International Congress of Medicine was in session. The
correspondents have asked what such an “honor” meant. The company which
exploits Sanatogen in the United States has not been slow to apprise
the American public of the award. It has gone further and has written
the advertising managers of magazines--including those that had refused
Sanatogen advertisements--directing their attention to the fact that
Sanatogen was awarded a “grand prize” and opining that “this unusual
distinction” should make plain “the desirability of the presence of
Sanatogen in the advertising columns of your esteemed publication.”

Those familiar with the methods of awarding prizes, medals and
certificates to commercial firms and their products at expositions and
exhibitions attach little weight to the “honors” thus conferred. It
is a fact that most purchasers of large--and expensive--exhibit space
at such exhibitions receive some kind of award which, it is tacitly
understood, will be a useful advertising asset. Every one can call to
mind many food products of mediocre quality that have flaunted on their
labels the gold medals received at various expositions.

Nevertheless, it seemed worth while to find out just what the
connection was between the commercial exhibition at which Sanatogen
received the grand prize and the Seventeenth International Congress of
Medicine. The following facts were developed: The commercial exhibition
was entirely distinct and separate from the scientific exhibit of the
Congress. It was managed and conducted by a British drug journal which
had been giving annual “exhibitions” of its own for some years past,
and this took the place of its regular exhibition. Immediately after
the awards were made public the advertising pages of this drug journal
were filled with full-page advertisements of the various products
that received prizes. It may interest our readers to know that while
the cottage-cheese-glycerophosphate product Sanatogen received a
“grand prize” two other proprietary cottage-cheese-glycerophosphate
products received “gold medals” at the same time. In the pharmaceutical
department of the exhibit a widely--and fraudulently--advertised
“patent medicine” received a silver medal! From the facts given
it should not be difficult to appraise at its right value the
“honor” conferred on Sanatogen. The fact that the exploiters of
this preparation are trying to make capital out of this “award” is
significant.

[Illustration: Nor is even the Asiatic neglected in the Sanatogen
advertising campaign. Here is reproduced an advertisement appearing
in an Asian sporting newspaper published in India. The original
advertisement was 10 inches by 15 inches.]

Among the members of the Award Jury whose names were given by this
drug journal were three men of prominence in Great Britain, to whom
we have written. A reply has been received from one, Dr. Stephen
Paget, who says: “I was not on the jury, nor do I know anything about
the matter.... I had nothing whatever to do with the awarding of
prizes.”--(_From The Journal A. M. A., Oct. 11, 1913._)


                       A Restatement of the Case

The case against Sanatogen has been pretty plainly given at different
times in The Journal, but the sale of the stuff goes on--thanks to
the power of advertising. One criticism that has been made of this
patent medicine is the exorbitant price charged for it. This objection,
although but an incidental one, is the one that apparently appeals to
the layman more strongly than the much more serious criticism, fraud
in exploitation. You arrest the attention of the average man when
you appeal to his purse; he resents paying an exorbitant price for
anything. This probably accounts for the fact that this particular
criticism has apparently hurt the sale of Sanatogen to a greater
degree than the more serious objections made to the preparation. This
also accounts, doubtless, for the fact that the attempts to answer
The Journal criticisms, by those who are selling Sanatogen, have been
largely devoted to the one point--its outrageously high price.

The fundamental objection to Sanatogen is not its high price, but the
attempt to ascribe to a mixture of casein and glycerophosphates powers
not possessed by these ingredients--in other words, the misleading and
fraudulent claims made for it. Even if it were sold at cost price, the
stuff, as at present advertised, would still be a fraud. The nub of
the whole matter is: The claims made for Sanatogen are unwarranted,
misleading and fraudulent.

                        SOME FRAUDULENT CLAIMS

The constituents of Sanatogen are casein and sodium glycerophosphate.
These two very ordinary substances possess, so the Sanatogen people
would have us believe, peculiar properties when they are brought
together in chemical combination. Sanatogen, they claim, is a
chemical combination of these constituents. The claim may be a good
“selling-point,” but it cannot be, and is not, seriously taken by
chemists. But even supposing, for the sake of argument, that sodium
glycerophosphate and casein could be combined, there is not a scintilla
of evidence to show that such a combination could survive the
destructive influence of digestion and be absorbed. Whether Sanatogen
is a chemical combination of casein and sodium glycerophosphate or a
mere mechanical mixture of these two substances is really immaterial.
In either case, it would be separated into its constituent parts
by the digestive juices and would have the properties of sodium
glycerophosphate and casein, and nothing more.

Remembering this, let us examine once more some of the claims made for
this patent medicine:

    “Sanatogen is a nerve and tissue food for which the brain, spinal
    cord and the nerves have a special predilection.”

    “... practically identical with the main ingredient of nerve and
    muscle cells....”

    “Sanatogen stands pre-eminent in its power to feed the nerve
    centers, to promote healthy digestion, to give strength and
    endurance to the entire system.”

    “... food for tired nerves....”

    “... a rational, scientific nerve-food.”

To the physiologist, the term “nerve-food” is an absurdity. The
processes of digestion reduce the albuminous substances (proteins, such
as casein) of the food to simpler forms. This is true no matter what
may be their source. Whether the proteins are derived from the gluten
of wheat, the casein of milk or the albumin of egg, one will “feed the
nerves” just as well as the other. And Sanatogen “feeds the nerves”
no more than, in fact not as much as, do bread and meat and eggs. Of
course, the casein in Sanatogen has food-value, but so has ordinary
casein--cottage cheese, “pot cheese,” or the German _Schmierkäse_, for
instance--and it is both false and fraudulent to claim for the casein
in Sanatogen any greater nutritive value than that possessed by the
casein in ordinary milk. To pretend that there are wonderful properties
in the protein of Sanatogen when just as good protein can be purchased
(for much less money) from the milkman, is to perpetrate a fraud on the
purchaser. Here are some more claims:

    “... marvelous revitalizer of nerve health.”

    “... Sanatogen has positive reconstructive force in neurasthenia.”

    “If You need New Strength and Vitality You should at once get
    acquainted with Sanatogen.”

Strangely like the “lost manhood” advertisements, this last. And this,
also:

    “... has brought new strength, new vitality and new relish of life
    to thousands upon thousands who suffered from starved nerves....”

    “Countless people ... have regained fresh health and vigor through
    the vitalizing and invigorating effects of Sanatogen.”

Of course Sanatogen is not sold as a “consumption cure.” No such crude
claims as these emanate from the skilled advertising agents employed
by the Sanatogen people. If they did they could not get space in
high-grade magazines! As a preventive of consumption, however, we find:

    “Sanatogen ... creates new tissue and nerve capital ... This nerve
    capital will ... save the individual from attacks of acute disease.
    Against tuberculosis it is an excellent investment.”

Also, it is a pick-me-up! Thus:

    “Sanatogen promises to pick you up when run down--_it does so_.”

Most people are under the necessity of working for a living. If we are
to believe the Sanatogen advertisements, it seems remarkable that the
human race has managed to jog along for so many centuries without this
product, for we read:

    “It is practically indispensable to all who are unable to take
    prolonged rest....”

Naturally we do not expect to find the coarse, “free-to-you-my-sister”
type of claims in Sanatogen advertisements. Nevertheless:

    “Women ... find in Sanatogen a genuine sustaining agent.”

[Illustration: Sanatogen is advertised heavily in the British Isles.
Here are some greatly reduced advertisements appearing in British
magazines. The three largest advertisements shown here measured in the
original 10 inches by 14 inches, each.]

Finally, we would respectfully direct the attention of those gentlemen
of the medical profession who have so far forgotten the dignity of
their calling as to give fulsome puffs for this casein-glycerophosphate
product to the following claims and ask whether they really subscribe
to them:

    “... it revivifies the nerves, promoting sleep and helping
    digestion....”

    “... it builds up the blood, creating new strength and the power to
    do and accomplish.”

    “... Sanatogen is a _natural_, healthful food and tonic....”

    “... a health and strength giving food and tonic composed of those
    very elements which make cell and tissue grow.”

    “Blood and tissues alike hunger for Sanatogen as their concentrated
    nourishment.”

    “Sanatogen is the one food tonic that commands your absolute
    confidence.”

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!

In closing, let us reiterate: The objections to Sanatogen are primarily
the objection to any fraud. It is being sold under unscientific,
misleading and fraudulent claims; moreover, although this is of
less importance, the purchaser pays an extraordinary price for a
most ordinary product. We believe the time will come when even the
artificial stimulus of vast advertising appropriations will be
insufficient to overcome the inertia inherent in a product of small
merit. When that time comes, Sanatogen will die a natural death. In
the meantime, its exploiters are reaping a golden harvest, of which no
small part is being divided among publishers, medical and otherwise.
And the credulous among the sick and suffering pay the bills!--(_From
The Journal A. M. A., Dec. 6, 1913._)




  SANATOGEN: A SCIENTIFIC INVESTIGATION OF ITS ALLEGED ACTION ON THE
                   RECUPERATING POWERS OF THE BLOOD


Sanatogen, the new elixir of life compounded of casein and
glycerophosphates, has been noticed in _The Journal_ from time to time.
It will be remembered that, while it has been claimed that “Sanatogen
contains over 700 per cent. more tissue-building, life sustaining
nourishment than wheat flour,” the facts are that one dollar’s worth
of wheat flour contains as much energy as one hundred and ninety-seven
dollars’ worth of Sanatogen! To this the manufacturers rejoin, in
effect, that the casein and glycerophosphates in Sanatogen, being
in chemical combination, possess a mystical and esoteric virtue not
measurable in terms of the food-value of the several ingredients. The
fact is, of course, that even assuming, for the sake of argument, that
the ingredients of Sanatogen are in chemical combination, the compound
cannot have any effect on the organism different from that of the
uncombined casein and glycerophosphate, for the union must be of the
loosest kind and must be broken up as soon as the preparation enters
the digestive tract.

Testimonials are published in the Sanatogen “literature” which show
results in a variety of conditions; cerebral concussion, alcoholic
gastritis, anemia, etc. The patient is given a chance to recover with
rest, proper diet--and Sanatogen. And the recovery which ensues is
attributed to Sanatogen!

Not all of these testimonials are as naive as that of the Right
Reverend the Bishop of Bath and Wells, who contributes the following
bit of second-hand testimony:

    “You may like to hear that I am informed by my private secretary
    that a member of his family has derived _very remarkable benefit_
    from using Sanatogen.”

[Illustration: Above is a photographic reproduction of one of the
exhibits made at Atlantic City at the last annual meeting of the
American Medical Association.

Jar 1 contains 3-1/3 ounces of the casein-glycerophosphate combination
made abroad and sold under the name “Sanatogen;” it costs One Dollar.

Jar 2 contains 2 pounds 13-1/2 ounces of a casein-glycerophosphate
combination made by an American casein company; it costs One Dollar.
For the same money, then, one gets nearly 15 times as much of this
casein-glycerophosphate combination made in America as when the
casein-glycerophosphate combination is sold under the name “Sanatogen”
and manufactured abroad.

Jar 3 contains one dollar’s worth of pure casein. The casein entirely
fills the jar, although the weight of the material is the same as the
weight of the casein-glycerophosphate combination in Jar 2. Pure casein
is more bulky than the casein-glycerophosphate combination.

Again we would emphasize that the chief objection to Sanatogen is not
its high price, but the fraudulent claims under which it is sold.]

The following selections perhaps fairly represent the value to science
of the clinical evidence offered. Describing a case of vomiting from
cerebral concussion:

    “I ordered an ice-bag to the head, a mustard leaf to the
    epigastrium, absolute recumbency in bed and small feeds of
    Sanatogen with water. This diet was continued for three days, but
    the vomiting ceased the second day.”

And here a case of “hungry tired nerves”:

    “I have just had a recovery in a remarkable case which scores a
    victory for Sanatogen. The patient, a man 63, had been treated for
    some years past for heart trouble. When he came to me, however,
    I diagnosed his trouble as ‘hungry tired nerves.’ I put him on
    Sanatogen and eupeptics. In a month he was much improved.”

In a serious case of the “American disease”:

    “I tried Sanatogen on a woman suffering from extreme neurasthenia
    and debility. For the past six weeks I have had, and still have,
    her under rest-cure treatment, during which time I have given her
    Sanatogen. I have been very much elated with the treatment.”

Anemia in a girl of 23 working in a bookbindery:

    “I promptly decided to use Sanatogen. In addition, I was able to
    secure the girl’s absence from work so that she had the advantage
    of outdoor life and sunshine. Improvement was rapid.... Both a
    priori and from results obtained it seems almost justifiable to
    speak of Sanatogen as a specific in ordinary uncomplicated anemia.”

Note that in all these cases two or more remedial factors were
introduced, yet any favorable result is promptly ascribed to only
one factor, Sanatogen! And the factor of spontaneous improvement
irrespective of all remedial measures is also ignored.

                      A “SCIENTIFIC” TESTIMONIAL

Every physician knows that the kind of evidence just quoted has
the same scientific value as that of the average “patent medicine”
testimonial--none whatever. The exploiters of Sanatogen put forward
some testimony, however, that purports to have a certain authority.
This is a statement to the effect that “Sanatogen acts as a strong
stimulus as far as the recuperative powers of the blood are concerned.”

This claim is based on biologic experiments carried out by two
physicians, Drs. G. Mann and J. G. Gage, the record of whose work was
published in the _Lancet_, Oct. 19, 1912. The article of Mann and Gage
was gone over with some care and the experiments there described did
not seem to justify the conclusions reached by the authors. As it had
been published in the _Lancet_, a medical journal of standing, whose
publishers apparently thought it of sufficient importance to warrant
the expense of a colored plate insert, it seemed worth while to have
the work of Mann and Gage reviewed and its conclusions checked by
parallel experiments. A. J. Carlson, professor of physiology at the
University of Chicago, was asked to do this work and kindly undertook
it. His report follows:


                      Report of Professor Carlson

I am asked to review the work done by Drs. G. Mann and J. G. Gage, from
which they draw the following conclusions:

    “Sanatogen [sodium caseinogenate glycerophosphates] further
    stimulates blood cells to undergo nuclear division, which during the
    early period is mostly amitotic.... Therefore, it is evident that
    Sanatogen acts as a strong stimulus as far as the recuperative powers
    of the blood are concerned.”

  Three series of experiments were made and reported by Drs. Mann and
  Gage, comparing the histology of the blood in starvation and during
  the height of digestion. The experiments of the first series were
  made on six students, the starvation period being thirty-six hours,
  ordinary food being taken after the thirty-six hours’ fast, so far as
  can be gathered from Dr. Mann’s report. It was found that during the
  height of digestion the nuclei of the lymphocytes and leukocytes stain
  more deeply, and that there is a slight decrease in the cytoplasm and
  consequent diminution in the size and number of the granules of the
  neutrophil and the eosinophil cells, in comparison with the blood
  during fasting.

  The experiments of the second series were made on 100 frogs that had
  starved for months, blood-films being taken at varying periods after
  feeding 1 gm. Sanatogen. The changes noted in the white blood-cells
  of the frogs were practically identical with those described in the
  case of the six students. Increased cell division is stated to occur.
  The nuclei of the erythrocytes stain more deeply and the cells are
  increased in size, and exhibit increased cell division twenty-four
  hours after the feeding.

  The third series consisted of one experiment on Dr. Mann himself. He
  fasted twenty hours and then took 15 gm. of Sanatogen in a cup of
  water. Practically the only change noted in the blood after the feeding
  was a deeper staining of the nuclei of the white cells. To quote:

    “The changes in the granules of the polymorphonuclear leukocytes
    and in the eosinophils were much less marked than in the specimens
    supplied by the students, and the diminution in the size of the
    white cells was so insignificant as to be hardly noticeable.”

  Assuming that the blood-changes reported are correct, is the conclusion
  warranted that Sanatogen is a powerful recuperative stimulant to the
  blood?

  In the first place, it remains to be proved, for there is as yet
  positively no evidence, that the deeper staining of the nuclei during
  digestion and absorption of a protein meal represents “recuperative
  power of the blood” or processes of “feeding” on the part of the white
  cells. The actual significance of these changes requires further
  investigation. The increased division of the blood-cells described by
  Dr. Mann in the frogs was not observed by him in man. This phenomenon
  in the frogs is, in all probability, associated with the extraordinary
  length of the starvation period (months) and the well-known seasonal
  variations in the physiology of this species.

  In the second place, waiving for the moment the question of the
  significance of the blood-changes observed, the evidence, so far as it
  goes, points to the conclusion that the greater affinity of the nuclei
  of the white cells for the stain is brought about by the feeding of any
  protein food. The experiments do not demonstrate any different or more
  marked effect from Sanatogen than from other protein foods.

  The test on the six students with ordinary food can be considered
  as a control on the single Sanatogen test on Dr. Mann himself. The
  blood-changes in the students were more marked than in Dr. Mann.

  Although Mann and Gage say that six frogs were used as controls, they
  do not say how the controls were treated, or draw any comparisons
  between the controls and the frogs fed with Sanatogen. So far as the
  report goes, therefore, the only basis for comparison is afforded by
  the work of one of Dr. Mann’s pupils, H. G. Butterfield. This worker,
  as quoted by Mann, found that on feeding newts after two weeks’
  starvation with a worm the size of a wooden match, the nuclei of all
  tissues (excepting nerve cells) take a much deeper stain than in the
  control animals. To pronounce Sanatogen, on the basis of the facts
  reported, a “powerful stimulus” to blood-formation is a piece of
  special pleading, if not of downright disingenuousness. Considered on
  its own merits, the work would not have appeared to me worthy of being
  repeated for the purpose of checking up such obviously unwarranted
  conclusions. In order to comply with the request made of me, however, I
  have repeated Dr. Mann’s experiments:

                   EXPERIMENTS BY PROFESSOR CARLSON

  I. TESTS ON MAN (A. J. C.)

  1. Thirty-six hours’ fast followed by a meal of 25 gm. Sanatogen in
  water.

  2. Thirty-six hours’ fast followed by a meal of 25 gm. casein in
  water.

  3. Thirty-six hours’ fast followed by a meal of 200 c.c. of milk.

  II. TESTS ON RATS

  1. Four animals, seventy-two hours’ fast followed by a meal of
  Sanatogen in water.

  2. Two animals, seventy-two hours’ fast followed by a meal of
  crackers and milk.

  3. Two animals, seventy-two hours’ fast followed by a meal of
  casein in water.

  4. Two animals, seventy-two hours’ fast followed by a meal of
  casein and sodium glycerophosphate in water.

  Blood-films were taken at intervals during the fasting period and for
  twenty-four hours after feeding was resumed. The technic of fixing and
  staining given by Drs. Mann and Gage was followed in every detail in
  order to make my results comparable with their findings.

                                RESULTS

  My results may be summarized as follows:

  1. The only change in the blood-cells that could be detected with
  certainty in rats or in man, after feeding with Sanatogen or after
  feeding with other foods, was a deeper staining of the nuclei of the
  white cells in the films taken after feeding as compared with the
  films taken during fasting. This difference is generally distinct,
  and unmistakable, although individual cells can always be found in
  the fasting and the feeding preparations that show no difference in
  affinity for the dyes. To this extent my results confirm those of Mann
  and Gage. I was not able, however, to make out any constant difference
  in the size of the cells, quantity of cytoplasm, or size and number of
  cytoplasmic granules similar to those reported by Mann and Gage.

  2. There was no difference in the affinity for stains on the part of
  the white blood-cells in films taken after feeding Sanatogen and those
  taken after feeding milk, crackers, casein, and casein and sodium
  glycerophosphate. This is true for the tests both on man and on rats.

  3. The above-mentioned difference in the staining of the cell nuclei
  was somewhat more marked in the tests on rats than in the tests on man,
  probably owing to the longer starvation period in the case of rats.

  It has already been stated that the significance of this increased
  affinity for dyes in the nuclei of the white blood-cells must be
  determined by further investigation. It may be related to the change
  in the titration alkalinity of the blood rather than an evidence of
  “recuperative power” on the part of the blood, as it is well known that
  starvation induces acidosis, while during digestion the alkalinity of
  the blood is distinctly increased. If we assume that increased staining
  reaction during digestion indicates “increased recuperative power of
  the blood” it follows that such common and inexpensive foods as milk,
  crackers and casein are just as “powerful stimuli” to this recuperation
  as Sanatogen.

  The extensive researches of Mendel and Osborne have shown that casein
  is in a certain sense a perfect food in that it is, in normal animals,
  capable of promoting growth and maintaining nitrogenous equilibrium,
  at least for long periods of time. The burden of proof, however, rests
  with the promoters of Sanatogen to show that the casein in Sanatogen is
  superior to the natural product of the cow.


                              Conclusion

  From the findings in Professor Carlson’s report on this disguised puff
  of a mendaciously exploited proprietary, about all that remains to be
  said is that it is humiliating to find such pseudo-science, not only
  built up by members of a profession trained in science, but also given
  currency and authority by a medical journal of high standing.--(_From
  the Journal A. M. A., Sept. 26, 1914._)


                            As to Sanatogen

For several years it has been known by physiologists that all proteins
taken into the stomach are disintegrated into their fundamental
components, the amino-acids, and that they are not absorbed at all as
proteins, except in most minute amounts under exceptional conditions.
Therefore, no matter what protein is taken as food, the material
obtained from this protein by the body is a group of amino-acids,
always pretty much the same except in relative proportions, whatever
the food. A few proteins lack certain essential amino-acids, but
any ordinary diet supplies enough, and more than enough, of each and
every amino-acid. Furthermore, since the proteins are completely
disintegrated before absorption, it follows that any adventitious
chemical substance that is bound to a protein taken in the food does
not enter the blood and circulate in the body in the same protein
compound.

All the facts stated above are elementary, and should be known by any
and every physician who pretends to keep even approximately abreast
of the science of medicine. If there are any who do not know these
fundamentals, and from certain unwelcome evidence we fear there are,
they must be resigned to being told just where they stand. Certainly
they have no good excuse for their lack of information, for the
physiologists and biochemists have informed them of modern advances
in innumerable ways. For ten years and more these facts have been
discussed and demonstrated in societies and in medical publications.
And yet--there is Sanatogen, prescribed by Geheimrats, Hofrats and
also by doctors, and testimonialed as abundantly by men with medical
degrees as Duffy’s whisky is by centenarians. One can merely throw up
his hands. If, as the exploiters of Sanatogen declare, the product
“has been endorsed by von Noorden, Ewald, Duhrssen, Eulenburg, Neiser,
Binswanger, Leyden, Krafft-Ebing, Tillmanns, Tunnicliffe and thousands
of other earnest, reputable physicians,” we can only say that their
earnestness has not been in the direction of grasping fundamental
advances in medical sciences, however great the reputation they have
gained may be.

The article by John Phillips Street that follows is another report of
exact experimental observation which shows, as was obvious beforehand,
that Sanatogen has the properties of its constituents, namely, casein
and glycerophosphates. Nothing more nor nothing less could be the
case. Bottling dried cottage cheese plus some glycerophosphates, and
raising the price many times, may increase its psychic effect, but it
will not alter its physiologic action. These facts we have presented
often enough, but the amount of paid advertising the proprietors
of this compound find it profitable to carry in the United States
makes us feel obliged to give them this bit free. That laymen may be
persuaded to purchase Sanatogen in the belief that it possesses some
occult powers not to be found in its constituents is not surprising.
By blatant and persistent advertising, the public can be fooled into
buying any product--however valueless--for which medicinal claims are
made. But that physicians should prove equally gullible is a sorry
commentary on the scientific attainments of the followers of a learned
profession.--(_Modified from Editorial in The Journal A. M. A._, Nov.
21, 1914._)




  THE FEEDING VALUE OF SANATOGEN COMPARED WITH COMMERCIAL CASEIN
                WITH RESPECT TO MAINTENANCE AND GROWTH

                      John Phillips Street, M.S.
          Chemist Connecticut Agricultural Experiment Station
                           NEW HAVEN, CONN.


The proprietary preparation “Sanatogen” is claimed to consist of about
95 per cent. casein and 5 per cent. sodium glycerophosphate. The
analysis of C. B. Morison[122] is as follows:

[122] Morison, C. B.: Rept. Conn. Agri. Exper. Station, 1912, p. 197.

  Water                                 9.97
  Total nitrogen                       12.81
  Nitrogen, ppt. by acetic acid        12.54
  Casein                               80.01
  Ether extract                         0.11
  Ash                                   5.59
  Sulphur, total                        0.73
  Sulphur in casein                     0.64
  Phosphorus, total                     1.49
  Phosphorus in casein                  0.69
  Phosphorus in inorganic form          0.11

In connection with the above analysis it was demonstrated that
sodium glycerophosphate was present. Sanatogen, therefore, consists
essentially, on the water-free basis, of about 90 per cent. casein
and 5 per cent. sodium glycerophosphate, with a small amount of
an unidentified nitrogenous compound containing both sulphur and
phosphorus, and a small amount of phosphorus in organic combination.
The manufacturers claim that the two essential ingredients exist in
Sanatogen as a definite chemical compound. Certain authorities, on the
other hand, have insisted that the casein and glycerophosphate have
not been chemically combined and that Sanatogen is simply a mechanical
mixture of the two. Which claim is correct we will not consider here,
for indeed it is of little importance, for whether or not chemically
combined the action of the digestive fluids of the body would speedily
break down the alleged compound into its constituents, and the body
would have casein and the glycerophosphate offered for its use, just
the same as though they had been offered as a mere mechanical mixture.

It being apparent that Sanatogen consists almost entirely of casein and
sodium glycerophosphate, the former well-known ingredient making up
nine-tenths of its weight, the question naturally arises how a mixture
of these two common substances can acquire, simply by that admixture,
unusually valuable properties not possessed by the two components.
Leading physiologists quite generally agree that phosphorus in the form
of glycerophosphates influences metabolism very little. Furthermore,
it is obvious that the food value of the small amount of glycerin
present must be slight. It is apparent therefore, that whatever
nutriment or energy Sanatogen supplies must be dependent on its main
constituent casein.

Sanatogen is commonly sold at retail in 100 gm. or 200 gm. packages for
$1 and $1.90, respectively. It is possible that in larger quantities
these prices might be shaded somewhat, but the fact remains that the
ordinary retail purchaser of Sanatogen pays for it about 1 cent per
gram, or about $4.50 per pound. If the value of Sanatogen depends on
its casein, one might ask, in all fairness, why should the patient pay
$4.50 per pound for Sanatogen when he can secure ordinary commercial
casein for 8.5 to 10 cents per pound! (The Casein Mfg. Co. of New York
quoted to me their No. 60 casein at 10 cents per pound in 5-pound lots,
8.5 cents per pound f. o. b. Bainbridge, N. Y., in 100-pound lots, and
8.5 cents per pound, freight paid, in 500-pound lots.) I have purchased
Sanatogen from a wholesale druggist at the rate of $2.75 for 400 gm.,
or $3.12 per pound, so that under the most favorable conditions the
cost of Sanatogen is more than thirty times as great as the commercial
casein in question.

Is the consumer justified in paying this exceedingly high price for
purified casein? The following feeding experiments were carried out to
answer this query.

                          FEEDING EXPERIMENTS

White rats were chosen for the experimental animals because of
their adaptability for tests of this kind, as shown by the extended
successful experience of Osborne and Mendel, and also because, by using
white rats, I could take advantage of the equipment and the experience
of my colleagues, Dr. T. B. Osborne, Prof. L. B. Mendel and Miss Edna
L. Ferry.

The value of Sanatogen as compared with commercial casein was studied
from two points of view:

1. Its value in maintaining the weight of mature rats.

2. Its value in promoting the growth of young rats.

              I. THE MAINTENANCE OF WEIGHT OF MATURE RATS

  The Sanatogen used contained 12.88 per cent. of nitrogen, and the
  casein, 12.82 per cent., so that from the point of view of nitrogen
  content they were practically equivalent, gram for gram.

  Six healthy male animals were selected, Rats 1, 2 and 3 being
  fed the casein ration and Rats 4, 5 and 6 the Sanatogen ration.
  At the beginning of the experiment the casein rats were 257, 360
  and 376 days old; the Sanatogen rats, 249, 321 and 275 days old,
  respectively. These weight conditions, if anything, slightly favored
  the Sanatogen rats, as they were slightly less mature, and a greater
  growth might naturally be expected.

  The rations fed had the following percentage composition:

              Ration 1                    Ration 2
    Casein                  20    Sanatogen                20
    Protein-free milk[BA]   28    Protein-free milk[BA]    28
    Lard                     8    Lard                     14
    Unsalted butter         18    Unsalted butter          18
    Corn starch             26    Corn starch              20

  [BA] Osborne and Mendel: Feeding Experiments with Isolated Food
  Substances, Carnegie Inst. of Washington, Publ. 156, 1911, Part 2,
  p. 80.

  The rats were weighed twice a week for nine weeks, a record of the
  food consumed also being kept. Table 1 shows the weekly weights of
  the casein rats, the weekly gain or loss, and the weekly consumption
  of food. Table 2 gives similar data for the Sanatogen rats.

[Illustration: Chart 1.--Growth curves of Rats 1, 2 and 3, on Ration 1:
Casein.]

[Illustration: Chart 2.--Growth curves of Rats 4, 5 and 6, on Ration 2:
Sanatogen.]

Certainly the above data show no superiority of Sanatogen over
commercial casein. In fact the results might be taken to suggest a
slight advantage for the cheaper article, if one were warranted in
drawing fine distinctions from a limited number of animals.

To conclude, _a comparative feeding of six male white rats during nine
weeks showed no nutritive superiority of Sanatogen, costing $3.12 per
pound, over commercial casein costing 10 cents per pound_.

               II. THE PROMOTION OF GROWTH IN YOUNG RATS

  In the second series of experiments ten male rats were used with
  four different rations. In these, casein and Sanatogen were
  compared, using both Osborne and Mendel’s “protein-free milk” and
  their “artificial protein-free milk IV.”[123] Butter fat was also
  substituted for the unsalted butter used in Rations 1 and 2.

[123] Osborne and Mendel: Jour. Biol. Chem., 1913, xv, 317.

  The percentage composition of the rations fed was as follows:

              Ration 3                    Ration 5
    Casein                 20   Casein                    20
    Protein-free milk      28   Artificial p.-f. milk IV  29
    Lard                    8   Lard                       8
    Butter-fat             18   Butter-fat                18
    Corn starch            26   Corn starch               25

              Ration 4                    Ration 6
    Sanatogen              20   Sanatogen                 20
    Protein-free milk      28   Artificial p.-f. milk IV  29
    Lard                   14   Lard                      14
    Butter-fat             18   Butter-fat                18
    Corn starch            20   Corn starch               19

  Two male rats were used with each of Rations 3 and 4, and three with
  each of Rations 5 and 6. They were all healthy young rats ranging
  from 57 to 71 days old. As in the first series of experiments
  the rats were weighed twice a week and a record kept of the food
  consumed. Rations 3 and 4 were fed for seventy-seven days, Rations 5
  and 6 for thirty-five days.

  Table 3 shows the weekly weights and gains or losses of the rats fed
  Rations 3 and 4.

  Rat 8 suffered more or less from diarrhea during a considerable part
  of the experiment, covering a period from March 16 to April 9, and
  from April 13 to May 11. The food intake correspondingly decreased
  during those periods.

          TABLE 1.--WEIGHTS OF CASEIN RATS, ON RATION NO. 1,
                    OVER A PERIOD OF NINE WEEKS[BB]

  =======+====================+====================+=====================
         |        Rat 1       |        Rat 2       |        Rat 3
         +-------+-----+------+-------+-----+------+-------+-----+-------
   Date  |Weight,|Gain |Food  |Weight,|Gain |Food  |Weight,|Gain |Food
         |  gm.  | or  |Eaten,|  gm.  | or  |Eaten,|  gm.  | or  |Eaten,
         |       |Loss,| gm.  |       |Loss,| gm.  |       |Loss,| gm.
         |       | gm. |      |       | gm. |      |       | gm. |
  -------+-------+-----+------+-------+-----+------+-------+-----+-------
    1/2  | 240.0 |  -- |  --  | 264.6 |  -- |  --  | 314.1 |  -- |   --
    1/9  | 250.8 |+10.8|  73.7| 270.9 | +6.3|  85.2| 314.6 | +0.5|   95.7
    1/16 | 264.3 |+13.5|  89.3| 284.9 |+14.0|  99.2| 308.7 | -5.9|  117.9
    1/23 | 274.9 |+10.6|  90.7| 293.5 | +8.6| 107.7| 313.8 | +5.1|  116.5
    1/30 | 278.6 | +3.7|  80.2| 304.5 |+11.0| 100.5| 322.2 | +8.4|  116.7
    2/6  | 278.3 | -0.3|  82.4| 294.2 |-10.3|  97.0| 311.2 |-11.0|  119.9
    2/13 | 288.7 |+10.4|  85.5| 281.5 |-12.7|  94.2| 308.2 | -3.0|  125.6
    2/20 | 286.4 | -2.3|  86.1| 293.3 |+11.8|  86.8| 309.0 | +0.8|  126.8
    2/27 | 287.6 | +1.2|  81.1| 297.6 | +4.3| 100.7| 303.4 | -5.6|  129.3
    3/6  | 292.6 | +5.0|  80.1| 307.4 | +9.8| 103.1| 292.4 |-11.0|  101.0
  Total  |  --   |+52.6| 759.1|  --   |+42.8| 874.4|  --   |-21.7|1,049.4
         |       |     |      |       |     |      |       |     |
  Average|       |     |      |       |     |      |       |     |
  per    |       |     |      |       |     |      |       |     |
  week   |  --   |+ 5.8|  84.3|  --   |+4.8 |  97.2|  --   |-2.4 |  116.6
  -------+-------+-----+------+-------+-----+------+-------+-----+-------

[BB] The growth curves of Rats 1, 2 and 3 are given in Chart 1.

          TABLE 2.--WEIGHTS OF SANATOGEN RATS, RATION NO. 2,
                    OVER A PERIOD OF NINE WEEKS[BC]

  =======+====================+=============+======+=======+=====+======
         |        Rat 4       |        Rat 5       |         Rat 6
         +-------+-----+------+-------+-----+------+-------+-----+------
   Date  |Weight,|Gain |Food  |Weight,|Gain |Food  |Weight,|Gain |Food
         |  gm.  | or, |Eaten,|  gm.  | or  |Eaten,|  gm.  | or  |Eaten,
         |       |Loss |  gm. |       |Loss,| gm.  |       |Loss,|  gm.
         |       | gm. |      |       | gm. |      |       | gm. |
  -------+-------+-----+------+-------+-----+------+-------+-----+------
    1/2  | 251.8 | --  |  --  | 290.6 |  -- |  --  | 294.0 |  -- |  --
    1/9  | 257.1 |+ 5.3| 73.4 | 297.2 |+ 6.6|  86.3| 289.1 |- 4.9|  58.4
    1/16 | 262.4 |+ 5.3| 89.8 | 292.4 |- 4.8|  88.9| 286.1 |- 3.0|  76.8
    1/23 | 274.4 |+12.0| 97.3 | 295.7 |+ 3.3|  92.8| 287.6 |+ 1.5|  85.8
    1/30 | 282.7 |+ 8.3| 95.5 | 299.5 |+ 3.8|  92.3| 298.6 |+11.0|  90.9
    2/6  | 279.8 |- 2.9| 97.7 | 284.2 |-15.3|  87.7| 292.9 |- 5.7|  89.8
    2/13 | 271.2 |- 8.6| 96.1 | 280.0 |- 4.2|  94.9| 295.1 |+ 2.2|  99.7
    2/20 | 257.5 |-13.7| 91.6 | 274.9 |- 5.1|  96.4| 296.0 |+ 0.9|  93.9
    2/27 | 258.0 |+ 0.5| 93.5 | 273.0 |- 1.9| 103.3| 295.0 |- 1.0|  95.1
    3/6  | 270.9 |+12.9| 94.8 | 278.1 |+ 5.1|  94.9| 306.3 |+11.3|  89.4
  Total  |  --   |+19.1|829.7 |  --   |-12.5| 837.5|  --   |+12.3| 779.8
         |       |     |      |       |     |      |       |     |
  Average|       |+ 2.7|      |       |     |      |       |     |
  per    |       |     |      |       |     |      |       |     |
  week   |  --   |     | 92.2 |  --   |- 1.4|  93.1|  --   |+ 1.4|  86.6
  -------+-------+-----+------+-------+-----+------+-------+-----+------

[BC] The growth curves of Rats 4, 5 and 6 are given in Chart 2.

       TABLE 3.--COMPARATIVE WEIGHTS OF RATS FED RATIONS 3 AND 4

  =====+=============================+=============================
       | Weights of Rats, Ration 3,  | Weights of Rats, Ration 4,
       |Casein, Protein-Free Milk    |Sanatogen, Protein-Free Milk
       +-------------+---------------+-----------------------------
       |    Rat 7    |     Rat 8     |    Rat 9     |   Rat 10
  Date +-------+-----+-------+-------+-------+------+-------+------
       |Weight,|Gain |Weight,|Gain   |Weight,|Gain  |Weight,|Gain
       |  gm.  | or  |  gm.  | or    |  gm.  | or   |  gm.  | or
       |       |Loss,|       |Loss,  |       |Loss, |       |Loss,
       |       | gm. |       | gm.   |       | gm.  |       | gm.
  -----+-------+-----+-------+-------+-------+------+-------+------
  3/9  | 142.2 |  -- | 108.0 | --    | 127.8 | --   | 107.0 |  --
  3/16 | 152.8 |+10.6| 120.3 | +12.3 | 129.1 |  +1.3| 116.0 |  +9.0
  3/23 | 165.7 |+12.9| 135.1 | +14.8 | 144.6 | +15.5| 134.5 | +18.5
  3/30 | 178.6 |+12.9| 140.4 |  +5.3 | 160.0 | +15.4| 149.8 | +15.3
  4/6  | 187.8 | +9.2| 148.8 |  +8.4 | 173.1 | +13.1| 143.8 |  -6.0
  4/13 | 198.5 |+10.7| 157.6 |  +8.8 | 185.6 | +12.5| 166.1 | +22.3
  4/20 | 204.6 | +6.1| 164.6 |  +7.0 | 194.8 |  +9.2| 179.4 | +13.3
  4/27 | 210.3 | +5.7| 167.2 |  +2.6 | 204.6 |  +9.8| 191.0 | +11.6
  5/4  | 223.0 |+12.7| 179.6 | +12.4 | 222.9 | +18.3| 204.7 | +13.7
  5/11 | 223.6 | +0.6| 191.6 | +12.0 | 236.4 | +13.5| 210.8 |  +6.1
  5/18 | 231.5 | +7.9| 203.6 | +12.0 | 240.0 |  +3.6| 218.6 |  +7.8
  5/25 | 237.4 | +5.9| 213.9 | +10.3 | 247.3 |  +7.3| 226.7 |  +8.1
  Total|  --   |+95.2|  --   | +105.9|   --  |+119.5|  --   |+119.7
  -----+-------+-----+-------+-------+-------+------+-------+------

The difference in the gains in weight shown by the four rats are not
great and certainly do not warrant the conclusion that Sanatogen
possesses any marked superiority over the commercial casein in
promoting growth. The slightly increased gains shown by Rats 9 and
10 are entirely incommensurate with the cost of the Sanatogen. All
of the rats showed a vigorous growth and exceeded the average weight
expected for rats of their respective ages, based on the long series of
observations of Osborne and Mendel, as shown in Table 4.

[Illustration: Chart 3.--Growth curves of Rats 7, 8, 9 and 10 on
Rations 3, Casein, protein-free milk, and 4, Sanatogen, protein-free
milk.]

     TABLE 4.--WEIGHT OF RATS 7 TO 10 COMPARED WITH AVERAGE WEIGHT
                          OF RAT OF SAME AGE

  =======+==============+==============+==============
         |              |              |Average Weight
    Rat  | Age in Days  | Final weight,|  for rat of
         |              |     gm.      | Same Age, gm.
  -------+--------------+--------------+--------------
     7   |     148      |     237      |      204
     8   |     138      |     214      |      201
     9   |     145      |     247      |      204
    10   |     134      |     227      |      197
  -------+--------------+--------------+--------------

[Illustration: Chart 4.--Growth curves of Rats 11, 12 and 13, on Ration
5: Casein, artificial protein-free milk.]

[Illustration: Chart 5.--Growth curves of Rats 14, 15 and 16, on Ration
6: Sanatogen, artificial protein-free milk.]

      TABLE 5.--WEIGHTS OF RATS FED RATION 5, CASEIN, ARTIFICIAL
                         PROTEIN-FREE MILK[BD]

  =====+==================+==================+==================
       |       Rat 11     |      Rat 12      |      Rat 13
       +--------+---------+--------+---------+--------+-------
  Date | Weight,|Gain or  | Weight,|Gain or  | Weight,|Gain or
       |  gm.   |Loss, gm.|  gm.   |Loss, gm.|  gm.   |Loss, gm.
  -----+--------+---------+--------+---------+--------+---------
  3/9  |  132.1 |    --   |  110.0 |    --   |   99.0 |   --
  3/16 |  130.4 |   -1.7  |  116.8 |   +6.8  |  110.3 | +11.3
  3/23 |  136.8 |   +6.4  |  130.8 |  +14.0  |  108.6 |  -1.7
  3/30 |  137.1 |   +0.3  |  138.0 |   +7.2  |  100.2 |  -8.4
  4/6  |  127.1 |  -10.0  |  143.9 |   +5.9  |   95.5 |  -4.7
  4/13 |  112.4 |  -14.7  |  143.6 |   -0.3  |   90.0 |  -5.5
  Total|   --   |  -19.7  |   --   |  +33.6  |   --   |  -9.0
  4/20 |  146.7 |  +33.7  |  170.7 |  +27.1  |  104.0 | +14.0
  -----+--------+---------+--------+---------+--------+---------

[BD] Date 4/20 covers use of mixed food.

Rat 13 suffered more or less from diarrhea throughout the whole
experiment, and Rat 16 suffered similarly during the first two weeks.

The results secured by Rations 5 and 6 compared with Rations 3 and 4,
the only difference being that natural protein-free milk was used in
the latter and artificial protein-free milk in the former, are most
striking. Such results were anticipated from the experience of Osborne
and Mendel in feeding similar materials. All of my rats, except Rat 13,
a casein rat, showed a decided loss in weight after five weeks’ feeding
on rations containing artificial protein-free milk. These losses
amounted to 19.7, 9.0, 23.1, 6.7 and 27.6 gm., whereas rats fed on the
same rations, except for the form of protein-free milk, gained, during
the same period of five weeks, 56.3, 49.6, 57.8 and 59.1 gm. The fact
that one casein

    TABLE 6.--WEIGHTS OF RATS FED RATION 6.--SANATOGEN, ARTIFICIAL
                         PROTEIN-FREE MILK[BE]

  =====+==================+========+=========+========+=========
       |      Rat 14      |      Rat 15      |     Rat 16
       +--------+---------+--------+---------+--------+---------
  Date | Weight,|Gain or  | Weight,|Gain or  | Weight,|Gain or
       |  gm.   |Loss, gm.|  gm.   |Loss, gm.|  gm.   |Loss, gm.
  -----+--------+---------+--------+---------+--------+---------
  3/9  |  118.4 |    --   |  111.3 |    --   |  101.3 |    --
  3/16 |  126.2 |   +7.8  |  116.2 |   +4.9  |  100.0 |   -1.3
  3/23 |  126.6 |   +0.4  |  123.4 |   +7.2  |   98.0 |   -2.0
  3/30 |  124.7 |   -1.9  |  123.3 |   -0.1  |   98.7 |   +0.7
  4/6  |  110.2 |  -14.5  |  112.3 |  -11.0  |   88.7 |  -10.0
  4/13 |   95.3 |  -14.9  |  104.6 |   -7.7  |   73.7 |  -15.0
  Total|    --  |  -23.1  |    --  |   -6.7  |    --  |  -27.6
  4/20 |  130.3 |  +35.0  |  135.3 |  +30.7  |  106.4 |  +32.7
  -----+--------+---------+--------+---------+--------+---------

[BE] Date 4/20 covers use of mixed food.

rat fed on the artificial protein-free milk showed a substantial
gain is without significance, as such exceptions to the general rule
occur occasionally, and, furthermore, this rat also during the last
week of the experiment likewise lost weight. The extent of these
losses compared with what the average normal male rat weighs at a
corresponding age is shown in Table 7.

    TABLE 7.--WEIGHT OF RATS 11 TO 16 COMPARED WITH AVERAGE WEIGHT
                          OF RAT OF SAME AGE

  =====+===========+===============+================
       |           |               | Average Weight
   Rat | Age, Days | Final Weight, |  of Rat of
       |           |      gm.      | Same Age, gm.
  -----+-----------+---------------+----------------
   11  |    106    |     112       |      167
   12  |    106    |     144       |      167
   13  |     99    |      90       |      162
   14  |    106    |      95       |      167
   15  |     92    |     105       |      153
   16  |     96    |      74       |      158
  -----+-----------+---------------+-----------------

That these losses in weight were not due to any inherent weakness in
the rats is shown by the fact that by feeding Rats 11 to 16 for one
week after the termination of the experiment with Osborne and Mendel’s
“mixed food” (a mixture of dog bread, sunflower seeds, vegetables and
meat) very large gains were secured in every instance, ranging from 14
to 35 gm.

The growth curves for Rats 7 to 16 are shown in Charts 3, 4 and 5.

To conclude, A COMPARATIVE FEEDING OF FOUR MALE WHITE RATS DURING
ELEVEN WEEKS, SHOWED, IF ANYTHING, A SLIGHTLY GREATER, BUT
INSIGNIFICANT, INCREASE IN WEIGHT FOR SANATOGEN OVER COMMERCIAL CASEIN.
IN A RATION IN WHICH ARTIFICIAL HAD BEEN SUBSTITUTED FOR NATURAL
PROTEIN-FREE MILK, SANATOGEN SHOWED NO ADVANTAGE OVER COMMERCIAL CASEIN
IN CHECKING THE FAILURE IN WEIGHT OF THE RATS.--(_From The Journal
A. M. A., Nov. 21, 1914._)




                  POEHL’S SPERMIN IN ARTERIOSCLEROSIS


A physician addressed the following inquiry to The Journal:

  “In a recent number of the _Gazette méd. belge_, I read a detailed
  report of five cases of arteriosclerosis in which the patients were
  all markedly improved and some of them apparently cured by a course
  of ‘Sperminum Poehl,’ an advertised remedy which I have always
  distrusted and never prescribed. I am now suffering myself from a
  somewhat advanced case of arteriosclerosis and would like to try this
  remedy if the Council has learned anything in favor of it and if
  there is no reason to fear bad effects from it.”

                                                               X. Y. Z.

The Journal replied:

Apparently the exploitation of Poehl’s spermin passed several years ago
from the domain of experimental medicine to that of nostrums advertised
to the laity. So far as we know, it has received no recent discussion
from reliable clinicians or experimenters. In some medical journals,
as also in lay journals, it is true, one still reads that Poehl’s
spermin is successfully applied in “neurasthenia, senile marasmus,
anemia, rachitis, gout, chronic rheumatism, syphilis, hysteria,
tuberculosis, typhus, diseases of the heart, nephritis, tabes dorsalis,
paralysis, neurasthenic impotence, overwork, acute diseases, and for
convalescents.” Few quack advertisements would differ much from this
puff of Poehl’s spermin. So far as we know, there is no reason to fear
injurious results from the use of the remedy; neither might any good
be expected from its use in arteriosclerosis.--(_From The Journal
A. M. A., April 15, 1911._)




                      SYRUP OF COCILLANA COMPOUND


A physician in a small town in Nebraska writes: “In looking over a
prescription file not long ago I found a prescription which I copied
and am sending to you. It is a good example of shotgun prescribing. I
do not give the name of the prescriber, and you will please not mention
from whence this comes. The doctor who wrote this has had about ten
years’ experience.”

Here is the prescription given exactly as transmitted by our
correspondent:

    Sp. sticta                                 Gtt xv
    Sp. ipecac                                 Gtt x
    Sp. bryonia                                Gtt x
    Sp. macrotys                               Ʒi
    Bromoform Bronchial Anodyne                ℥ii
    Syrup Cocillana Comp. q. s. ad             ℥vi
        Teaspoonful every two or three hours.

It is evident that the prescriber is an eclectic. As a matter of fact,
in a second letter from the physician who forwarded the prescription,
we are informed that the prescriber is a graduate of an eclectic
institution not a thousand miles from where he practices. The “Sp.”
in the prescription does not mean “Spiritus,” but specific tincture.
The prescriber is an advocate of specific remedies, one of which
should fit the condition, but he is broad-minded enough to call help
from the outside, and so adds fifteen other remedies to the specific
selected, including alcohol. The inability of one mind to remember
all the ingredients of so complex a mixture will explain the fact
that ipecac is duplicated, occurring both as a specific tincture and
as an ingredient of Bromoform Bronchial Anodyne. The latter, the
manufacturers tell us, contains in one fluidounce:

    Alcohol                        5 per cent.
    Bromoform                      8 drops
    Ipecac                       1/2 gr.
    Ammonium bromid               24 grs.
    Benzoin                        1 gr.

Syrup Cocillana Comp., one of the “elegant specialties” of Parke Davis
& Co., of which they certainly ought to be very proud, contains, we are
told, in one fluidounce:

    Alcohol                                5 per cent.
    Heroin hydrochlorid                 8/24 gr.
    Tinct. of euphorbia pilulifera       120 min.
    Syrup of wild lettuce                120 min.
    Tinct. of cocillana                   40 min.
    Syrup of squill comp.                 24 min.
    Cascarin, P. D. & Co.                  8 grs.
    Menthol                            8/100 gr.

This “elegant specialty” of Parke, Davis & Co. is not only a shotgun
prescription, but has as one of its ingredients a mixture itself
containing three ingredients, namely: Syrup Squill Comp. (Coxe’s Hive
Syrup), making ten in all--a beautiful example of scientific pharmacy.

We wonder if our eclectic brother really appreciated that his
prescription, written out, would be as follows:

    Sp. sticta                           Gtt xv
    Sp. ipecac                           Gtt x
    Sp. bryonia                          Gtt x
    Sp. macrotys                          Ʒi
    Alcohol                                5 per cent.
    Bromoform                              8 drops
    Ipecac                               1/2 gr.
    Ammonium bromid                       24 grs.
    Benzoin                                1 gr.
    Alcohol                                5 per cent.
    Heroin hydrochlorid                 8/24 gr.
    Tinct. of euphorbia pilulifera       120 min.
    Syrup of wild lettuce                120 min.
    Tinct. of cocillana                   40 min.
    Fluidextract of squill                60 min.
    Fluidextract of senega                60 min.
    Antimony and potassium tartate         1 gr.
    Cascarin, P. D. & Co.                  8 grs.
    Menthol                            8/100 gr.

To use a slang expression, this is certainly going some!--(_From The
Journal A. M. A., March 18, 1911._)


                    “A Cough Syrup with a History”

The following letter was received from Dr. Geo. P. Tolman, Watsonville,
Cal.:

_To the Editor_:--The enclosed advertisement was underscored and
mailed to me by my druggist. The properties of cocillana are similar
to ipecac. The dose of the fluidextract is from 10 to 20 minims. Each
fluidounce of the extraordinary (!) dark-colored cough marvel of P. D.
& Co. contains 40 minims of the tincture. If the tincture of cocillana
is 10 per cent. (the average tincture strength) you can see that to get
a minimal dose of the drug you would have to take 2-1/2 fluidounces of
the syrup.

“Query: Can we still hang on to the old-fashioned cough mixtures
freshly compounded by our druggists or shall we put our shoulders to
the wheel and help P. D. & Co. save the nation and make a few dollars
for the druggist?”

“The secret of its prompt recognition lay in its unusual composition.”
Nay; its prompt recognition lay in liberal and persistent advertising.
“It quickly made a ‘hit’ with physicians”--because too many physicians,
like other human beings, are susceptible to the psychology of
advertising. Here is the “unusual composition,” as given by the
manufacturers:

    “Tinct. Euphorbia pilulifera, 120 mins.; Syrup Wild Lettuce, 120
    mins.; Tinct. Cocillana, 40 mins.; Syrup Squill Compound, 24 mins.;
    Cascarin (P. D. & Co.), 8 grs.; Heroin hydrochloride, 8-24 gr.;
    Menthol, 8-100 gr.”

The following is a reproduction of the advertisement referred to:

[Illustration:

    +------------------------------------------------------------+
    |               A cough syrup with a history.                |
    |                                                            |
    | =Syrup Cocillana Compound= established itself with the     |
    | medical profession in a single season. It was introduced   |
    | in 1906. The secret of its prompt recognition lay in its   |
    | unusual composition. The formula showed a rare combination |
    | of astringents and sedatives. It quickly made a “hit” with |
    | physicians. The name “Syrup Cocillana Compound” soon began |
    | to appear on prescriptions. Today this agent is the most   |
    | widely prescribed of all preparations for cough.           |
    |                                                            |
    | =Syrup Cocillana Compound= is a profitable product for     |
    | the druggist to sell. It commands a good price. Being      |
    | totally unlike the common, ordinary dark-colored “cough    |
    | mixtures” it does not enter into competition with them.    |
    | Be prepared to dispense it.                                |
    |                                                            |
    |       Supplied in pint, 5-pint and gallon bottles.         |
    |                                                            |
    | Home Offices and Laboratories,       PARKE, DAVIS & CO.    |
    |   Detroit, Michigan.                                       |
    +------------------------------------------------------------+
]

As we have said above, Parke, Davis & Co. should be proud of this
“elegant specialty.” It would be hard to find a better specimen of a
shotgun prescription; not only does the prescription contain eight
ingredients, but one of these ingredients (compound syrup of squill)
itself contains three.

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:

    “The physiologic action of this syrup is that which would be
    suggested by the constituents. Because of its activity the
    most prominent action would be that characteristic of heroin
    hydrochlorid.”

Without doubt the important ingredient, from the point of view of
therapeutic potency, is the heroin; and it is this drug doubtless,
that makes the mixture a good “repeater.” Syrup Cocillana Compound
is a nostrum sailing under false colors. Whether its continued use
is due to its mysterious, meaningless, misleading name or merely to
insistent and persistent advertising methods of Parke, Davis & Co. is a
question. Neither explanation is any credit to the medical profession
which tolerates it, or to the physician who prescribes it.--(_From The
Journal A. M. A., Feb. 15, 1913._)




                   AUBERGIER’S SYRUP OF LACTUCARIUM


That clause in the Federal Food and Drugs Act which requires certain
potent drugs to be declared on the label of the proprietary mixtures
containing them has been responsible for clearing up many mysteries.
Physicians have frequently wondered why they were unable to obtain from
the syrup of lactucarium, U. S. P., the therapeutic results which they
were able to obtain from a proprietary product known as Aubergier’s
Syrup of Lactucarium, sold by Fougera & Co. at an exorbitant price
and put up in “patent-medicine” style. The milk-juice of lettuce once
bore the reputation of being a soporific--a reputation that has been
artificially maintained largely through the effects of the Aubergier
preparation. With the advent of the Food and Drugs Act the secret
of the soporific effect of the Aubergier product was explained--it
contains morphin.[124]

[124] Technically, this is incorrect, as the company had
inconspicuously stated in the “literature”--not on the label--that the
preparation contained “extract of opium.”

The practical difficulties of making a satisfactory syrup of
lactucarium are not realized by most physicians. To such the following
note, presented at a meeting of the Pennsylvania Pharmaceutical
Association by Mr. Louis Emanuel, president of the Pennsylvania
Pharmacy Board, will prove enlightening:

  “Did you ever make a syrup of lactucarium direct from the crude drug?
  If you did, shake hands, and let me hail you as a brother, a brother
  pharmacist in fact worthy of the title. If you did not, I am sorry
  for you; you have missed something worth knowing.

  “The _American Journal of Pharmacy_ tells us that in 1851 ‘Aubergier
  cultivated lactuca and poppy on a larger scale, in order to
  obtain lactucarium and opium. Please note the latter for further
  reference. In lactucarium he found lactucin, mannite, resin, cerin,
  asparmid, brown coloring-substance and oxalic acid.’ In 1860, in
  the same publication, Proctor says: ‘The attention of the medical
  practitioners has of late been turned to the syrup of lactucarium,
  and the preparation sold usually by apothecaries in this city is
  that known as Aubergier’s, a French preparation, made by dissolving
  30 parts of alcoholic extract of lactucarium in 500 parts of boiling
  water, straining the liquor and adding 15,000 parts of boiling simple
  syrup, which is kept boiling, and albuminous water added from time to
  time until it is clarified.’ In ’66, ’77, ’78, ’82 and ’84 various
  writers produced elaborate dissertations on the supposed improved
  methods of making this syrup, but not one has had the temerity of
  inquiring into the therapeutic value of this preparation, or to
  examine the French preparation to ascertain whence comes its vaunted
  superiority.

  “The French, it is said, are an impressionable people, but they
  appear to have a limit; they do not take any chances on _plain_ syrup
  of lactucarium. Theirs contains the added product, extract of opium.
  This implies a lack of faith in soporific properties of lactucarium,
  and displays a recklessness in regard to cost and labor.

  “The National Dispensatory, fifth edition, says:

    “The utility of retaining lactucarium as an official medicine is
    very doubtful. It may possibly be desirable as a hypnotic for very
    impressionable persons, with whom faith in a remedy supplies its
    want of intrinsic efficiency.”

  “The official modus operandi for making this syrup looks laborious,
  but the innocent-looking task of reducing the drug to a coarse powder
  is a revelation to the uninitiated.

  “It was {a} hot day in July and it took my 175-pound clerk and me all
  that day to reduce 50 gm. of lactucarium to a satisfactory condition.
  The stuff looked like old pieces of discarded rubber shoes, and it
  really appeared to act like rubber. After perspiring all day with the
  Pharmacopeia and iron mortar, imagine our disgust, if you can, on
  reading in the National Dispensatory the following:

    “This alcoholic preparation of lactucarium is quite as valueless
    and more objectionable than the syrup of the same drug.”

  “Moral: Why pay $6.50 a pound for material that has no medicinal
  value, and is so hard to manipulate as lactucarium when decrepit
  rubber shoes are so cheap? You can have just as much fun on a hot
  summer day in reducing the latter to a coarse powder with clean sand
  in an iron mortar as you can with the more expensive material.”

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._)


                         A Protest and a Reply

Three months after publishing the foregoing we received a nine-page
communication from Comar & Co. of Paris, the promotors of Aubergier’s
Syrup of Lactucarium, in which they took issue with some of the
statements in our article. The company claimed that a possible reason
for the difficulty experienced by Mr. Louis Emmanuel in trying to make
the Syrup of Lactucarium from the crude drug is that he did not use
the same variety of Lactucarium that it employs. Furthermore, it said
that the presence of morphin in the product was acknowledged before
the passage of the Food and Drugs Act. On more careful investigation,
we find that this is true--that the presence of “a certain proportion
of extract of opium” in the preparation was mentioned even before
the federal Food and Drugs Act compelled the morphin content to be
published on the label. Technically, then, The Journal was incorrect
in making the implication that the medical profession was not apprised
of the fact that Aubergier’s Syrup of Lactucarium contained morphin;
practically it was right. The information that Comar & Co. gave to
physicians was buried in its advertising “literature” so that it is
fair to assume that not one physician in ten thousand knew--previous to
the Food and Drugs Act--that Aubergier’s Syrup of Lactucarium contained
morphin.--(_From The Journal A. M. A., Nov. 9, 1912._)




                             TARTARLITHINE


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._)




                                THOXOS


Thoxos is a “specialty” of John Wyeth and Brother. From an advertising
circular we learn that it “offers to the physician a rational treatment
for Rheumatism, both the Subacute and Chronic forms, Lithemia,
Rheumatic Arthritis, Gout, Sciatica and the various manifestations of
uric diathesis,” and that “it is a palatable solution of Strontium and
Lithium soluble salts, thirty-two grains, combined with twenty-four
minims Wine of Colchicum Seed and a vegetable alterative, in each
fluidounce, flavored with aromatics.” This “formula” does not
indicate the acid with which the metals strontium and lithium are
combined, or what the “vegetable alterative” is; it is essentially a
secret preparation. To learn what the missing and presumably active
ingredients are an analysis was made by our chemists.

                           LABORATORY REPORT

  One original bottle of Thoxos, John Wyeth and Brother, Philadelphia,
  was purchased and submitted to analysis. The bottle contained a
  brown liquid having an aromatic odor and a sweet taste. The specific
  gravity of the liquid was 1.118 at 15 C. (60 F.) The solution
  was acid to litmus. Qualitatively the following constituents
  were detected: strontium, potassium, sodium, lithium, ammonium,
  salicylate, iodid, glycerin, alkaloid, alcohol and water. By the
  smell and taste, oil of wintergreen, or methyl salicylate, and oil
  of sassafras were recognized. Positive tests for a saponin-like body
  indicated the probable presence of sarsaparilla.

  Quantitatively the following results were obtained:

    Ammonia (NH_{3})                  0.006 per cent.
    Lithium (Li)                      0.13  per cent.
    Sodium (Na)                       0.03  per cent.
    Strontium (Sr.)                   1.03  per cent.
    Iodid (I)                         0.46  per cent.
    Salicylate (C_{6}H_{4}.OH.COO)    4.19  per cent.
    Glycerin                         19.2   per cent.

  From the analytic results it would appear that the preparation
  contains approximately potassium iodid, 0.67 gm. per hundred c.c., or
  3 grains per fluidounce; lithium salicylate [Li(C_{7}H_{5}O_{3})],
  0.9 gm. per hundred c.c., or 4 grains per fluidounce; strontium
  salicylate [Sr(C_{7}H_{5}O_{3})_{2}-2H_{2}O], 5.75 gm. per hundred
  c.c., or 26 grains per fluidounce, and some salicylic acid combined
  with sodium and also in the free state. The total salicylate found is
  equal to 5.47 gm. of sodium salicylate per hundred c.c., or 25 grains
  per fluidounce.

As strontium salicylate and lithium salicylate are now generally
considered to differ but slightly, if at all, in their action from
that of sodium salicylate, each dose of Thoxos, 1 teaspoonful or 4
c.c., may be considered the equivalent of 0.2 gm. or 3 grains of sodium
salicylate with a fractional dose of colchicum. Hence this nostrum--for
this is the correct definition--is a mixture of no more value than a
prescription of sodium salicylate with a fractional dose of potassium
iodid and colchicum, one that any doctor could write and any druggist
dispense. Yet it is doubtless prescribed by physicians under the belief
that it possesses some occult power not to be found in ordinary drugs
and their combinations. To prescribe Thoxos is to prescribe a name, and
the patient who takes it would be as well off if he went to the nearest
drug store and purchased a bottle of any of the thousand and one
rheumatism cures with which the country is flooded.--(_From The Journal
A. M. A., March 21, 1914._)




                               TRYPSOGEN


Besides exploiting a clay poultice--“Antithermoline”--the G. W.
Carnrick Company appears to be chiefly concerned in the promotion
of “internal secretion” specialties; a class of preparations the
therapeutic value of which is problematical. Thus it markets the
diabetes remedy, “Trypsogen” tablets, said to contain “the enzyme of
the islands of Langerhans with the tryptic and amylolytic ferments of
the pancreas” along with gold bromid and arsenic bromid; Secretogen
Elixir, said to be “prepared from gastric secretin obtained from the
pyloric antrum and pancreatic secretin from the duodenum, combined with
the enzymes of the peptic glands, and one-twentieth of one per cent.
HCl”; Secretogen Tablets, said to be “prepared from prosecretin and
succus entericus obtained from the epithelial cells of the duodenum,
combined with pancreatic extract”; Kinazyme, “a preparation of extract
of spleen, reinforced with trypsin, amylopsin and calcium lactate.”

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.

Furthermore, if pancreas were really efficacious in the treatment of
diabetes mellitus, the addition of arsenic, of gold, of bromid would be
entirely unnecessary.

Even were it granted that pancreas extracts are valuable in the
treatment of diabetes, and that gold and arsenic also have beneficial
effects, it is our opinion that Trypsogen should be considered an
unscientific shotgun mixture, because fixed combinations of remedies
of different potencies, such as arsenic, gold, bromid and pancreas,
are therapeutically erroneous, as they do not permit of that accurate
adjustment of dosage of each ingredient that is indispensable to obtain
maximum benefit with minimum danger of poisoning.

Antithermoline and Trypsogen were at one time described in New and
Nonofficial Remedies. These preparations were omitted when the
Council’s rules were revised some years ago.

When the Council was first organized it undertook only the correction
of the most serious abuses that had become a part of the proprietary
medicine business, and paid less attention to the therapeutic worth
of a remedy; thus at that time it admitted both Antithermoline and
Trypsogen to New and Nonofficial Remedies. Since then the Council has
modified its rules to exclude unscientific mixtures marketed under
names that are misleading or therapeutically suggestive. Accordingly
it rescinded the acceptance of Antithermoline, which was essentially
the official clay poultice, Cataplasma Kaolini, U. S. P. For similar
reasons and because the therapeutic claims were held unwarranted
Trypsogen has been omitted from New and Nonofficial Remedies.

It is to be regretted that the progress of research should be hindered
and the value of genuine products of internal secretion be depreciated
by confusion with such shotgun mixtures and asserted remedies, whose
claims have received no scientific confirmation.--(_From The Journal
A. M. A., Nov. 1, 1913._)




                     TYREE’S ANTISEPTIC POWDER[BF]

 Now Advertised Direct to the Public as the “Best Preventative Known”

[BF] See also report, p. 21.


When the history of the “patent medicine” business comes to be written
impartially and fairly, it will be realized that we, the medical
profession, have been in no small degree responsible for its growth.
Not a few widely advertised nostrums owe their commercial success
solely to the ill considered use accorded them by physicians, to whom
they were first exploited. As a well-known and brilliant advertising
man once said:

    “The patent medicine of the future is one that will be advertised
    only to doctors. Some of the most profitable remedies of the
    present time are of this class. They are called proprietary
    remedies. The general public never hears of them through the daily
    press. All their publicity is secured through the medical press,
    by means of the manufacturer’s literature, sometimes gotten out in
    the shape of a medical journal, and through samples to doctors....
    The medical papers will reap the harvest and the physician himself,
    always so loud in the denunciation of ‘patent medicines,’ will be
    the most important medium of advertising at the command of the
    proprietary manufacturer. In fact, he is that to-day.”

[Illustration: Advertisement from a newspaper--Tyree’s Powder as a
“Patent Medicine” of the “Preventive” Type.]

Of the conditions here described probably no better example can be
found than Tyree’s Antiseptic Powder. For years this preparation was
advertised to the medical profession under claims that were fraudulent
as to both composition and therapeutic effect. Analysis published
in The Journal[125] proved that the formula given out by Tyree was
absolutely false and that the preparation was, essentially, nothing but
a simple mixture of sulphate of zinc and boric acid.

[125] Oct. 20, 1906, and May 18, 1907.

From the first it would seem that the manufacturers of this mixture
had for their objective point that period when, thanks to the use of
the nostrum by physicians, it would be widely purchased by the public.
Lavish advertising was done in medical journals and Tyree’s Antiseptic
Powder gained admission to the pages of even those journals which
required the publication of a “formula”--for a formula was forthcoming.
The Journal itself, until seven years ago, carried the advertisements
with a “formula” until chemical examination proved the falsity of
the formula, and of the therapeutic claims made for the product. The
medical profession in its turn prescribed the nostrum and the “original
package” scheme did the rest.

[Illustration: Advertisement from Medical Journal--Tyree’s Powder as a
Highly Respectable “Ethical Proprietary.”]

Now, it seems, Tyree considers his preparation so well known that he
can be independent either of the assistance of the physician or of
his good-will. For Tyree’s powder now goes to the public direct and
newspaper readers find it advertised as:

    “Ideal for douche.”
    “Unequalled as a douche.”
    “Best preventative known.”
    “Unequalled as a preventative.”
    “Has no equal as a preventative.”

And the following, whose very truth must bring the blush of shame to
all physicians who have the interest of scientific medicine at heart:

    “Prescribed by physicians all over the world for twenty-one years.”

    “Ask your doctor or send for booklet.”

    “Used by doctors for the last twenty-one years.”

    “One of the highest tributes paid Tyree’s Antiseptic Powder is the
    fact that the most successful physicians have been using it for the
    last twenty-one years.”

Not that Tyree has entirely forsaken the medical journals, although he
seems to be dropping them one by one. At the beginning of this year at
least fifteen medical journals were carrying the Tyree advertisement;
by March the number had fallen to seven, while in June the only
journals carrying it were:

    _Medical Record
    American Journal of Obstetrics
    Chicago Medical Recorder
    Pacific Medical Journal_

Those who answer the newspaper advertisements receive a free sample of
the powder and several leaflets and circulars giving the various uses
(?) of the nostrum. Incidentally these leaflets advertise, in addition,
Tyree’s “Elixir Buchu and Hyoscyamus Comp.,” which is recommended, in
various combinations, for such conditions as acute nephritis, epilepsy,
neurasthenia, gonorrhea and delirium tremens.

Bearing in mind the claim that is made in the newspaper advertisements
that Tyree’s Antiseptic Powder is the “best preventative” known, it is
interesting to see what Tyree has to say to those druggists whom he
offers to supply with circulars for free distribution:

    “As these circulars deal with the care of rubber goods, for both
    medicinal and toilet purposes, they are of great value to the
    customer and will be retained for further reference. They are
    boosters for your rubber goods sales, too.”

That a nostrum of this sort should go to the public is not surprising,
but that it should have reached the public through the instrumentality
of the medical profession is a serious reflection on the judgment of
physicians. But the incident has a bright side. That the exploiters of
this nostrum no longer find it profitable to use medical journals as a
means of getting their stuff to the public but must needs use the more
expensive newspaper advertising, is cause for optimism. It means that
physicians are no longer prescribing, indiscriminately, proprietary
products and that they are refusing to be, what they have been in the
past, the unpaid distributing agents for nostrum venders.--(_From The
Journal A. M. A., Aug. 24, 1912._)




                            VAPO-CRESOLENE


Vapo-Cresolene has been examined in the American Medical Association’s
laboratory and the chemists’ report follows:

  According to the statements on the trade package, Vapo-Cresolene “is
  a product of coal-tar possessing far greater power than carbolic
  acid in destroying germs of disease.” It is recommended as a remedy
  for a number of diseases, including croup, catarrh and diphtheria.
  According to the manufacturers, it should be used only in “the
  Cresolene vaporizer,” which makes it “unequaled for the disinfection
  of sick rooms” and the “safest and simplest method of destroying
  infection and purifying the air.” From the examination we conclude
  that Vapo-Cresolene is essentially cresol and corresponds in every
  respect to cresol U. S. P. (Physician’s Manual, page 36).

This report indicates that Vapo-Cresolene is a member of that class
of proprietaries in which an ordinary product is endowed, by the
manufacturer, with extraordinary virtues. The type is so common and has
been referred to so frequently that but for the dangers attendant on
the inhalation of any of the phenols, this particular product need not
have been mentioned.--(_From The Journal A. M. A., April 4, 1908._)




                        VASOGEN AND IODOVASOGEN

            Another Case in Which Independent Analyses and
                    Manufacturers’ Labels Disagree


Vasogen, a product of Pearson & Company, Hamburg, Germany, has been put
on the market under the various designations, “oxygenated vaseline,”
“water-soluble hydrocarbon” and “oxygenated carbon.” The manufacturers,
and also their American agents, Lehn & Fink, claim that by a special
process the apparent impossibility of saponifying petrolatum has been
overcome with Vasogen as the result. Disinterested chemists who have
analyzed Vasogen find that the product consists essentially of an
ammonium soap and petrolatum--practically an ammonia liniment mixed
with petrolatum.

Just as petrolatum under its various trade names was at one time
recommended as a universal ointment base, so vasogen is recommended
promiscuously as a vehicle for remedies applied externally and even
for internal medication--needless to say in many cases in which it is
directly contra-indicated.

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.

As Iodovasogen and Vasogen in various combinations are being advertised
to the physicians in the United States, the above information from
our German exchanges is worthy of consideration.--(_From The Journal
A. M. A., Feb. 13, 1909._)




                 VIBURNUM COMPOUND--AND OTHER NOSTRUMS


A number of drugs have some reputation for therapeutic value without
there being any particular evidence to substantiate the claims.
Viburnum, concerning which we recently received the following letter,
is one of these drugs:

  _To the Editor_:--Have you made an analysis of Viburnum Compound?
  Extravagant claims are being made for it and I cannot put my hand on
  any data. A patient has asked me concerning it and I wish to advise
  her honestly. I do not know but that there may be several “viburnum
  compounds.” I rarely use any of these “put-up” preparations, and
  hence know but little about them.

                                    A. J. Hesser, M.D., Pittsburgh, Pa.

No analysis of Hayden’s Viburnum Compound, to which our correspondent
refers, has been made in the Association laboratory. According to
advertising circulars, the preparation contains American skullcap
(_Scutellaria lateriflora_), cramp-bark (_Viburnum opulus_) and wild
yam (_Dioscorea villosa_). Since these drugs contain no well-defined
therapeutically active ingredients, an analysis of the preparation
would necessarily be unsatisfactory.

A number of drugs have in some way obtained a reputation as being
valuable in the treatment of diseases of women, without their
therapeutic claims ever having been proved. It is said that some
were used by the aborigines for such affections and we find a
considerable number of them combined in various nostrums (sometimes
with therapeutically active drugs) and exploited for the cure of
female disorders, under most extravagant and usually absurd claims.
Thus “Pierce’s Favorite Prescription” is advertised as containing
black cohosh, blue cohosh, goldenseal, lady’s-slipper and false
unicorn-root; “Dioviburnia” (Dios Chemical Co.) as containing American
skullcap, cramp-bark, wild yam, blue cohosh, black haw, star-grass,
trailing arbutus and false unicorn-root; “Viburnumal” (Louisville
Pharmacal Works) as containing American skullcap, cramp-bark, wild yam,
star-grass and motherwort.

Most pharmaceutical houses, following the lead of nostrum-makers,
put similar mixtures on the market; for example: “Elixir of Viburnum
Compound” (Nelson, Baker & Co.) is said to contain cramp-bark, American
skullcap and wild yam; “Elixir of Hydrastis and Viburnum Compound”
(Smith, Kline & French Co.), cramp-bark, goldenseal, Jamaica dogwood
and pulsatilla; “Elixir of Hydrastis and Cramp Bark Compound” (Parke,
Davis & Co.), cramp-bark, hydrastis, Jamaica dogwood and pulsatilla;
“Fluid Extract of Cramp Bark Compound” (H. K. Mulford Co.), American
skullcap, cramp-bark and wild yam; “Mother’s Cordial” (Eli Lilly &
Co.), cramp-bark, blue cohosh, false unicorn and squaw vine; “Uterine
Sedative Elixir” (Eli Lilly & Co.), cramp-bark, goldenseal, Jamaica
dogwood and pulsatilla; “Vibutero” (Fred. Stearns & Co.), cramp-bark,
wild yam, black haw, squaw vine, Jamaica dogwood, saw palmetto and
pulsatilla. Practically all of these drugs except goldenseal are
ignored in the standard works on pharmacology. Further, the results of
careful examination by the Council on Pharmacy and Chemistry of the
therapeutic claims made for most of them shows that these claims are
not sustained by reliable clinical experience.

The fact is that the popularity of preparations of this kind is
purely an artificially created one. A nostrum containing, let us say,
extractives of some little-used or worthless drugs is put on the market
and heavily advertised. Should it be advertised in a manner to make it
sell, a host of imitations appear and the large pharmaceutical houses
put out substitutes for it. The uncritical physician does the rest. He
prescribes it indiscriminately in the class of cases for which it is
advertised. Naturally, a certain proportion of the patients who take
it recover, and the recoveries are credited to the nostrum. A vicious
circle is thus established and the demand for the stuff increases. Its
sale, together with the sale of similar products, continues until the
overwhelming experience of those who have prescribed it proves its
uselessness. In the meantime the manufacturers have reaped a harvest,
at the expense both of the public and of the medical profession. And
the manufacturers’ excuse for putting such absurd “specialties” on the
market is that physicians prescribe them!--(_From The Journal A. M. A.,
Aug. 31, 1912._)




                       WHEELER’S NERVE VITALIZER


Names of nostrums often mislead by the use of fake nomenclature giving
erroneous ideas regarding the composition of the preparation or
misrepresenting the true action of the nostrum. As an example of the
latter class Wheeler’s Nerve Vitalizer was examined in the Association
laboratory and found to be not a vitalizer, as the name implies, but
rather a nerve sedative. The results of the examination follow:

  Wheeler’s Nerve Vitalizer was packed in a carton bearing the name
  of the preparation, its manufacturers, “The J. W. Brant Co., Ltd.,
  Albion, Mich.,” and an exhaustive list of the diseases for which
  the product is intended, besides the general statement that it is
  a cure for “all nervous diseases.” The “Vitalizer” is a brown,
  syrupy liquid having a peculiar salty taste partially masked by
  licorice. Qualitative tests showed the presence of sodium, potassium
  and bromin, and no other acid radicals except small quantities of
  chlorin. It was decided therefore that the preparation contained a
  mixture of sodium and potassium bromids. In order to separate the
  chlorin and bromin the preparation was evaporated, charred, extracted
  with water and acetic acid and potassium permanganate added and the
  mixture distilled with steam until all the bromin had been distilled
  over, thus leaving the chlorin in the distilling flask. The solution
  in the distilling flask was then treated with silver nitrate and
  the chlorin estimated in the usual way. The quantity thus obtained
  was subtracted from the total silver bromid and chlorin obtained by
  precipitating a solution of the preparation with silver nitrate and
  the remainder calculated to bromin.

  By this method several samples of 5 c.c. each of the preparation
  yielded an average of 0.0059 cm. silver chlorid or 0.0012 gm. per
  c.c. The total silver haloids obtained by direct precipitation of the
  diluted preparation was found to be 0.3158 gm. per c.c., thus leaving
  0.3146 gm. silver bromid to be calculated to bromin.

  The total sodium and potassium was obtained in the usual way and
  the potassium determined as the chlor-platinate and the sodium
  calculated from the difference. By this method the quantity of sodium
  found calculated to sodium bromid gave the following results: (a)
  0.0629 gm. and (b) 0.0632 gm., or an average of 0.063 gm. per c.c.
  From the potassium estimations the following were calculated: (a)
  0.1264 gm. potassium bromid and (b) 0.1259 gm. potassium bromid per
  c.c., an average of 0.1261 gm. potassium bromid per c.c.

  The bromids calculated from the sodium and potassium determinations
  were found to be 0.0630 gm. sodium bromid and 0.1261 gm. potassium
  bromid per c.c., the equivalent of 0.3139 gm. silver bromid. The
  total silver bromid obtained was 0.3146 gm., showing practical
  agreement with the total bromids calculated from the sodium and
  potassium determinations.

  The preparation contained then 6.30 gm. sodium bromid and 12.61 gm.
  potassium bromid per 100 c.c., or 9.73 grains of potassium bromid and
  4.86 grains sodium bromid, a bromid content equal to 15.35 grains
  potassium bromid per fluid dram.




                               ZYMOTOID

           A Fraud of the Liquozone-Oxytonic-Septicide Type


Dr. Arnold’s Zymotoid, a nostrum manufactured by Arnold’s Zymotoid
Company, Rockford, Ill., is claimed to be an “antiseptic, germicide and
antiphlogistic” which “has absolutely no peer in medicine.” According
to the statements of the manufacturer, Zymotoid is “successfully
employed not only as an external dressing on all wounded and diseased
surfaces, but in all zymotic conditions wherein a reliable antiseptic
and germicide is needed internally.” And in telling physicians of the
great value of Zymotoid the company says:

    “We assured them that if they would simply place Zymotoid ‘next’
    to any wounded surface--and nothing else--they would have no
    inflammation, no suppuration, no infection or blood poison. Its
    prompt use in all cases where such trouble arises gives immediate
    and certain relief.”

This is a large contract to be undertaken by Zymotoid--or any other
preparation--which, as will be shown, consists principally of boric
acid and water. The company also appends to its announcement concerning
Zymotoid a number of the usual testimonials and a lot of alleged “case
reports.”

Zymotoid seems to be exploited principally by circulars addressed to
physicians and by agents who attempt to sell it to physicians. They
also try to work factories and other large employers of labor. In their
circular to physicians they claim that “Zymotoid is strictly ethical.”
And “we publish its composition.” The composition given is: “sulphur,
niter, cinnamon and boric acid in gaseous solution.” It is also claimed
to be “a chemical compound--not a mixture--which is wholly non-toxic
and can be used as freely as desired internally absolutely without harm
to the smallest child.” On the label of the Zymotoid package is the
following:

    “Zymotoid is a concentrated chemical compound consisting of the
    solids and gases of sulphur, potassium nitrate, cinnamon and carbon
    held in a solution of boric acid.”

A specimen of Zymotoid was examined by our chemists and their
report follows. As will be seen, it is simply another fraud of the
Liquozone-Oxytonic-Septicide type.

                     LABORATORY REPORT ON ZYMOTOID

  Zymotoid is a pale yellow liquid having a strong odor like sulphur
  dioxid. No odor suggestive of cinnamon was observed even after
  the sulphur dioxid had been fixed by the addition of an alkali.
  Qualitative tests indicated the presence of boric acid, sulphuric
  acid, sulphur dioxid and traces each, of a nitrate, potassium
  and some unidentified organic matter. Alkaloids, cinnamic acid,
  glycerin and soaps were absent. From the results of the quantitative
  examination it is concluded that the composition of Zymotoid is
  essentially as follows:[126]

[126] Details of the analysis appear in the annual reports of the
Chemical Laboratory.

    Boric acid (H_{3}BO_{3})           0.637 gm.
    Sulphur dioxid (SO_{2})            0.129 gm.
    Sulphuric acid (H_{2}SO_{4})       0.048 gm.
    Potassium nitrate                  trace
    Unidentified organic matter        trace
    Water (by difference) to make      100 c.c.

The analysis shows that but for the presence of boric acid the
composition of Zymotoid is similar to other fraudulent “microbe
killers” which have been exploited in recent years and of which some
have been declared misbranded by the federal government. For example,
“Radam’s Microbe Killer”[127] was found by the federal chemists to be
composed of water, containing small quantities of sulphur dioxid and
sulphuric acid. “Liquozone,” another nostrum which was widely exploited
a few years ago, is said to have a similar composition.[128] According
to an analysis made at the North Dakota Agricultural Experiment
Station,[129] “Oxytonic” has a similar composition. The nostrum
“Septicide,” was found by the federal chemists to be composed of water
with small quantities of sulphur dioxid, sulphuric acid and a trace of
a nitrate.--(_From The Journal A. M. A., April 6, 1912._)

[127] The Journal A. M. A., July 16, 1910, p. 235.

[128] The Journal A. M. A., March 28, 1908, p. 1065.

[129] The Journal A. M. A., Jan. 1, 1910, p. 63.




                                PART IV

         CONTRIBUTIONS FROM THE JOURNAL: MISCELLANEOUS MATTER




         ACETPHENETIDIN AND PHENACETIN--THEIR RELATIVE PURITY


Until six years ago the chemical product known as phenacetin was
patented both as to process and to product. As the patent ran out at
that time, anyone, of course, could manufacture it. It was placed
in the Pharmacopeia under the name “acetphenetidin.” It is on the
market now under both names, “phenacetin” and “acetphenetidin.” The
price of the former is five times[130] that of the latter, hence it
is rather important to know whether or not one is, in any way, better
or purer than the other. The original patentees or manufacturers, the
Farbenfabriken of Elberfeld Company, market the product under the
name “phenacetin” and also under the official name “acetphenetidin,”
the former at about 33 cents an ounce and the latter at about 6 or 7
cents an ounce. Evidently these people believe that acetphenetidin is
all right since their price-list says: “Our product is of the highest
standard of purity,” and in another place: “On account of the low
price of acetphenetidinum, U. S. P., it is especially suitable for the
manufacture of medicinal specialties, such as headache powders, etc.”
Remember that it is the manufacturers of phenacetin who say this.

[130] Phenacetin is listed at 33 cents an ounce, acetphenetidin at 98
cents a pound in quarter-pound lots.

The question arose whether or not phenacetin differs from
acetphenetidin. If it does, then physicians should know it. An inquiry
was addressed to Farbenfabriken of Elberfeld Company and also to Lehn
& Fink, two firms which market the product in this country under both
names, asking in what respect the two products differ. No answer was
received from either firm. With the object of answering the question
our chemists have investigated the preparations on the market, both
those sold under the name “phenacetin” and those under the official
title “acetphenetidin.” The following is a summary of their report:[131]

[131] Full details of analysis are published in Volume V of the annual
report of the Chemical Laboratory.

                         THE CHEMISTS’ REPORT

  _Physical Appearance._--All the specimens were found to be fine
  white crystalline powders, differing somewhat in appearance
  as follows: Four specimens--Acetphenetidin (Farbenfabriken),
  Phenacetin (Specimen 1[132]--Farbenfabriken), Phenacetin (Specimen
  2[132]--Farbenfabriken) and Acetphenetidin (Squibb)--appeared very
  much alike, each being a very fine crystalline powder, differing
  only slightly as to fineness. Five other specimens--Phenacetin
  (Lehn & Fink), Acetphenetidin, U. S. P. (Lehn & Fink),
  Acetphenetidin (Merck), and two specimens of Acetphenetidin
  (Powers-Weightman-Rosengarten), had the same general appearance,
  each consisting of a fine crystalline powder containing a
  considerable proportion of large rectangular plates. Three
  specimens--Acetphenetidin (Mallinckrodt) and two specimens of
  Acetphenetidin (Powers-Weightman-Rosengarten)--had the same general
  appearance, being a moderately fine and homogeneous crystalline
  powder. When examined microscopically with a low-power lens the
  Mallinckrodt product appeared to consist principally of rectangular
  prisms and the Powers-Weightman-Rosengarten product to be made up
  largely of plates.

  [132] “Specimen 1” is a specimen of the product regularly sold in
  this country. “Specimen 2” is a specimen of a product sold in England
  and whose resale in this country was prohibited by the manufacturers.

  _Identity._--All of the specimens when tested side by side
  responded to and complied with the identity tests of the United
  States, British, German, Swiss, Dutch, Swedish, Spanish, and Danish
  pharmacopeias. The reactions given by the several specimens were all
  the same, showing no difference in any case.

  _Melting-Points._--As a further proof of identity and similarity
  the melting-points of the different specimens were taken and found
  to be: Acetphenetidin (Farbenfabriken), 134.2 C.; Phenacetin
  (Specimen 1--Farbenfabriken) 133.7 C.; Phenacetin (Lehn & Fink),
  134.7 C.; Acetphenetidin (Lehn & Fink) 134.9 C.; Acetphenetidin
  (Powers-Weightman-Rosengarten), (1) 134.3 C., (2) 133.6 C., (3) 134.7
  C., (4) 134.7 C.; Acetphenetidin (Squibb) 134.2 C.; Acetphenetidin
  (Merck), 134.8 C., and Acetphenetidin (Mallinckrodt), 134.2 C. The
  melting-point is given as 135 C. in the British, French and Spanish
  pharmacopeias, and as 134 to 135 C. in the United States, German,
  Swiss, Danish, Swedish and Dutch pharmacopeias. Thus all comply with
  the standard given in our pharmacopeia and most foreign pharmacopeias
  with two exceptions and those respectively only 0.3 C. and 0.4 C. low.

  _Absence of Acetanilid._--The absence of acetanilid in all the
  specimens was indicated by the bromin test of the United States,
  British, German, Swiss, Dutch, Swedish and Danish pharmacopeias.

  _Absence of Carbonizable Matter._--The absence of carbonizable matter
  was shown in all specimens by the sulphuric acid test of the United
  States, British, German, French, Swiss, Dutch, Swedish and Spanish
  pharmacopeias.

  _Water-Soluble Matter._--All specimens when tested for excess of
  water-soluble matter came well within the limit (0.50 per cent.) set
  by the French pharmacopeia, the greatest amount being 0.20 per cent.

  _Ash._--When heated, all the specimens were found to yield
  practically no ash, the residues from 1 gm. samples weighing in no
  case more than 0.0004 gm.

  _Absence of Paraphenetidin._--When tested by the methods of the
  United States, British, German and French pharmacopeias, the absence
  of an impurity of paraphenetidin was shown in all specimens, with the
  exception of one specimen obtained from Powers-Weightman-Rosengarten
  Co., which gave a positive, though not strong, reaction and two other
  specimens of the same firm which reacted still more faintly.

       TABLE SHOWING RESULTS OF ANALYSES OF VARIOUS SPECIMENS OF
                   ACETPHENETIDIN AND PHENACETIN[BG]

  COLUMN HEADINGS:
  A = Melting Point (Corr.) C.
  B = Water-Soluble Matter in, per Cent.
  C = Ash,  per Cent.
  D = Paraphenetidin, U. S. P. Test[BH]
  E = Paraphenetidin, Swiss Test[BH]
  ================+==================+=======+======+======+=====+====
                  |    Physical      |       |      |      |     |
      Name        |   Appearance     |   A   |   B  |   C  |  D  |  E
  ----------------+------------------+-------+------+------+-----+----
  Acetphenetidin  | Very fine        | 134.2 | 0.17 | 0.02 |  -  |  +
  (Farbenfabriken)|  homogeneous     |       |      |      |     |
  (1)             |  crystalline     |       |      |      |     |
                  |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Phenacetin      | Very fine        | 133.7 | 0.06 | 0.00 |  -  |  +
  (Farbenfa-      |  homogeneous     |       |      |      |     |
  briken)         |  crystalline     |       |      |      |     |
                  |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Phenacetin      | Fine crystalline | 134.7 | 0.11 | 0.02 |  -  |  +
  (Lehn & Fink)   |  powder, not     |       |      |      |     |
                  |  uniform         |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Fine crystalline | 134.8 | 0.13 | 0.00 |  -  |  +
  (Lehn & Fink)   |  powder, not     |       |      |      |     |
                  |  uniform         |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Homogeneous      | 134.3 | 0.19 | 0.03 |  +  |  +
  (P. W. R.) (1)  |  crystalline     |       |      |      |     |
                  |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Homogeneous      | 134.7 | 0.16 | 0.02 |  +  |  +
  (P. W. R.) (2)  |  crystalline     |       |      |      |     |
                  |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Homogeneous      | 134.7 | 0.14 | 0.02 |  +  |  +
  (P. W. R.) (3)  |  crystalline     |       |      |      |     |
                  |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Fine crystalline | 133.6 | 0.20 | 0.01 |  -  |  -
  (P. W. R.) (4)  |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Fine crystalline | 134.3 | 0.19 | 0.00 |  -  |  +
  (Squibb)        |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Fine crystalline | 134.8 | 0.15 | 0.03 |  -  |  -
  (Merck)         |  powder          |       |      |      |     |
                  |                  |       |      |      |     |
  Acetphenetidin  | Fine crystalline | 134.2 | 0.11 | 0.01 |  -  |  -
  (Mallinckrodt)  |  powder          |       |      |      |     |
  ----------------+------------------+-------+------+------+-----+----

[BG] In all cases identity was confirmed; acetanilid was absent;
carbonizable matter was absent.

[BH] In this column plus indicates presence; minus, absence.

  While this firm’s product alone gave any reaction whatever
  when the U. S. P. test for paraphenetidin was applied with
  the test of the Swiss pharmacopeia, all but Acetphenetidin
  (Mallinckrodt), Acetphenetidin (Merck) and one specimen of
  Powers-Weightman-Rosengarten Co. gave positive, though very faint,
  reactions, indicating that the majority of specimens, including
  those of the original manufacturer, contain a minute trace of this
  impurity.

  Our findings regarding the product of Powers-Weightman-Rosengarten
  Co. having been communicated to this firm, their correctness was
  acknowledged. At the same time the firm wrote: “All that we have on
  hand now gives negative tests for paraphenetidin, and we believe our
  present records are correct when we state that all lots which we are
  supplying now, and have been supplying for some time past, answer all
  U. S. P. requirements.”

This examination appears to demonstrate that the chemical substance,
para-acetphenetidin, whether sold as acetphenetidin, U. S. P., or as
phenacetin, is practically identical. The impurity of the product of
some of the specimens coming from Powers-Weightman-Rosengarten Co. is
too slight to be considered dangerous. Furthermore, a comparison of the
“lot numbers” indicates that this firm has been improving its product
steadily so that in the future its assurances of an unimpeachable
product may be relied on. Inasmuch, therefore, as acetphenetidin
complies with all the pharmacopeial requirements as to identity and
purity, in just the same way as phenacetin, which sells for as high as
five times the price of acetphenetidin, physicians need not hesitate in
using the title of the U. S. P. “acetphenetidin” when prescribing this
produce.--(_From The Journal A. M. A., March 16, 1912._)


                     Acetphenetidin and Phenacetin

A physician-pharmacist writes: “If a prescription calls for
‘phenacetin,’ should the pharmacist dispense ‘phenacetin-Bayer’--that
is, the phenacetin manufactured by the original patentee--or would he
be justified in dispensing the official acetphenetidin, manufactured by
any reliable chemical or pharmaceutical house?”

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.

In view of these facts--and also bearing in mind the findings of the
Association’s Chemical Laboratory (The Journal, March 16, p. 801)
that the preparations on the market under the title “acetphenetidin”
are of equal quality with the preparations sold under the name
“phenacetin”--the pharmacist should recognize that acetphenetidin is
identical with phenacetin, is prescribed, provided, of course, that no
special brand of phenacetin is ordered.

It is the physician’s privilege, of course, to specify the goods of a
particular manufacturer, but in view of the fact brought out above that
all brands of this chemical have tested up to the U. S. P. standard,
it is placing an unnecessary burden on the pharmacist to require him
to have on hand many different brands of one substance. The physician
should save this privilege for use when prescribing some product that
differs materially in its various forms on the market, as for example
in the case of certain fluidextracts.

Physicians will doubtless find that the above comments will interest
their local pharmacists. It is of mutual value for physicians to
talk these matters over with their pharmacists.--(_From The Journal
A. M. A., Oct. 5, 1912_).




                           CLEAN ADVERTISING


It is individual effort that counts for most in every movement for
better things--socially, economically or politically. Realizing this,
The Journal repeatedly urges physicians who write regarding various
fraudulent advertisements to enter their individual, personal protest
against the continuation of such advertisements.

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._)




                         LIPPINCOTT’S MAGAZINE

               Its Advertising--a Protest and an Excuse


A few days ago a physician wrote to The Journal enclosing two
advertisements taken from the current issue of _Lippincott’s_ magazine.
One of these was a half-page advertisement of that outrageous fraud,
the “Oxydonor;” the other was a full-page advertisement of J. B.
Lippincott Company, Philadelphia, calling for salesmen “to present
standard medical books to physicians only.”

The physician sending in this material asked us to send to
_Lippincott’s_ a pamphlet showing the fraudulence of the Oxydonor.
Instead of doing so, we sent the pamphlet to the physician and
suggested that he write a personal letter in the belief that individual
missionary work is the most effective way of fighting fraud.
Accordingly the doctor wrote to _Lippincott’s_ and received in reply
this letter from the advertising department of that publication:

  “Your letter of the 23d received, and in reply beg to say that we
  do not approve of fraudulent advertising, and we have never before
  been advised that the advertisement to which you call our attention
  was objectionable. _In fact, we know nothing whatever about it._
  [Italics ours.--Ed.] It came to us, as do most of the others, through
  an advertising agency, and while we do not willingly publish anything
  that is fraudulent or objectionable, _it is not our custom to verify
  the claims of advertisers_ [Italics, again, ours.--Ed.] especially
  when the same copy is being run in almost every other high-grade
  publication.

  “We have a very high regard for the American Medical Association,
  and they undoubtedly are doing a splendid work in ridding the
  country of fake medical preparations, but the mere fact that they
  condemn some of our advertisers is hardly sufficient proof for us to
  refuse the advertising, because, _if the advertiser desires to do
  so, he can make us prove in the courts that he is a faker, or claim
  damages from us for refusing to publish his advertisement_. [Our
  italics.--Ed.] If the American Medical Association will guarantee
  to protect the publishers against loss from damage suits brought by
  advertisers whose business they refuse to accept, then, we believe
  that the publishers would gladly reject them, but not many of the
  publishers are in a position to investigate the merits of all the
  advertising that is offered, especially when the claims are backed up
  by affidavits of reputable people who believe themselves to have been
  cured by the preparation.

  “We certainly do not wish to jeopardize our medical publications by
  advertising fake schemes or propositions of any kind, and we thank
  you for writing us concerning the matter and will now look into this
  particular case.”

[Illustration: Photographic reproduction (much reduced) of two
advertisements from January, 1914, _Lippincott’s_. One of a fraudulent
quasi-medical device, the “Oxydonor”; the other, calling for salesmen
to introduce “standard medical books to physicians.”]

This letter discloses the workings of the brain of an advertising man
of the old school. The principles enunciated therein are those that
dominated the advertising field until quite recently. They represent
the _laissez faire_ doctrine as applied to advertising. At that time
the only unacceptable advertising copy was that which would debar
the publication using it from the United States mails. This was the
yardstick by which all advertising was measured at that time.

The economic conscience has since awakened. There are few reputable
magazines today, we venture to believe, that would be willing to go on
record to the effect that it is not their “custom to verify the claims
of advertisers.” The modern, progressive advertising man recognizes not
only the responsibilities his profession imposes, but also realizes
that, from the narrower view of enlightened self-interest, the
greatest menace to the future of modern advertising is the fraudulent
advertisement.

The claims on the part of the advertising department of _Lippincott’s_
that it dares not refuse to accept fraudulent advertisements because
the advertiser might bring suit against it for refusing to accept his
advertisement is a statement whose falsity is exceeded only by its
silliness. Equally preposterous is the statement that _Lippincott’s_
will willingly refuse to accept fraudulent advertisements provided the
American Medical Association will guarantee to protect the Lippincott
Company against loss from damage suits that may be brought by the
exploiters of the frauds whose advertisements are refused.

It may be news to _Lippincott’s_ to learn that there are a score and
more of newspapers and magazines that are accepting the findings of
the American Medical Association on medical frauds and rejecting
advertisements of such frauds. There are many newspapers that send us
the medical advertising “copy” submitted to them and ask for an opinion
on it. When that opinion is unfavorable, these papers refuse such
advertisements. This is being done daily. We have yet to hear of any
“patent medicine” faker or quack even threatening to bring suit because
his advertisements have been rejected.

The advertising department of _Lippincott’s_ may therefore take
heart. When an advertisement of an outrageous fake like the Oxydonor
is submitted to it, instead of accepting the money for it, meantime
muttering an inaudible protest at the unfortunate position in which
it has been placed, it may look the fraud in the eye and say Boo! The
faker will not bite.

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._)




                      MEDICAL JOURNAL ADVERTISING

             And Methods of Obtaining Paid-Up Subscribers


Time was when the postal authorities were lenient with publishers.
The names of individuals who had ever subscribed for publications
of a certain class were carried on the books indefinitely, whether
they paid their subscriptions or not. This permitted a padding of the
circulation figures. Of late years, however, the postoffice department
requires publishers to have bona-fide paid-up subscriptions if they
wish their publications to be carried at the low second-class rate.
Certain medical journals have been hard put to it to get a circulation
that would be at all attractive to the advertisers, on whose money they
depend for continued existence.

Many and various have been the schemes devised whereby the dwindled
circulation might be “boosted.” Subscriptions could not be given away
because the postal laws forbade it. One ingenious method of obviating
this difficulty is worked in this fashion: Dr. John Doe writes an
article that appears in a reputable medical journal. A few days after
its appearance, Dr. Doe receives a letter from the editor and publisher
of a medical journal that is in need of a subscription list. He is
told that the editor has read his article with much interest and would
appreciate receiving from Dr. Doe a brief abstract of it. He does not
expect the doctor to go to the trouble of making this abstract for
nothing. He will, therefore, on receipt of the abstract credit Dr.
Doe with three years’ subscription for himself or for one year for
himself and one year for each of any other two doctors he may name.
For every doctor that bites on this scheme the publisher increases his
circulation by three copies and the federal officials are assured that
they are paid-up subscriptions--not paid for in cash, it is true, but
in “abstracts.”

All of this preliminary to a letter recently received:

  _To the Editor_:--Enclosed find letter which speaks for itself.
  Now what I should like to know from you is the following: Is the
  _Charlotte Medical Journal_ all it should be? Should a doctor
  contribute to a journal--thereby adding to its prestige and
  circulation--that carries questionable matter in the advertising
  pages? If the above journal is off color, does that act as a bar for
  good men to contribute?

                           Very truly yours,
                                  L. J. Genella, M.D., New Orleans, La.

The letter which our correspondent encloses is on the stationery of the
_Charlotte Medical Journal_ and signed by the editor of that journal.
Here it is:

  “My Dear Doctor Genella:--I have just looked over an article of yours
  published in the _New Orleans Medical and Surgical Journal_ entitled
  ‘Clinical Studies in Pituitary Irritation, with Report of Case.’ I
  would be very glad indeed to have you send me a manuscript or article
  for the _Charlotte Medical Journal_. Your style of writing is very
  attractive.

  “If you will send me an article for the journal, I will be glad to
  publish same and will place your name on my complimentary mailing
  list. Under separate cover I am sending you a copy of the journal.

  “Of course I will expect the article to be typewritten.”

Whether or not this is a modification of the “abstract” scheme or an
attempt to boost the circulation of the _Charlotte Medical Journal_
are questions we shall not attempt to answer. As to the questions
propounded by our correspondent, they have been answered many times
in these pages. We turn to one of the recent copies of the _Charlotte
Medical Journal_ and examine its advertising pages. On one of the first
we find Anasarcin, a product whose fraudulent character was described
at some length in The Journal, May 4 and 11, 1907. On another page we
find Tongaline, which has also come in for a fair share of attention
(see The Journal, Sept. 23, 1906, and May 10, 1913). A little farther
over we find a half-page advertisement of Bannerman’s Intravenous
Solution, a nostrum first exploited as a “consumption cure” and now as
a cure-all (see The Journal, May 31, 1913). Cactina Pillets (see The
Journal, March 12, 1910), Hagee’s Cordial of the Extract of Cod-Liver
Oil (see The Journal, Oct. 13, 1906), Burnham’s Soluble Iodin (see The
Journal, March 28, 1908), Ecthol (see The Journal, March 13, 1909),
Bromidia (see The Journal, April 21, 1906), Papine (see The Journal,
April 29, 1911), Phenalgine--two advertisements (see The Journal,
Jan. 13, and 27, 1906, and Jan. 27, 1912) and Sal Hepatica (see The
Journal, March 26, 1910) are some more products which have attained
unenviable notoriety but found a safe haven in the advertising pages of
the _Charlotte Medical Journal_. Neither must we fail to refer to the
advertisement of Duffy’s Malt Whiskey (see The Journal, Nov. 23, 1912),
which looks thoroughly at home.

Does our correspondent--in fact, does any conscientious physician
having the interest of scientific medicine at heart--want to do
anything that will tend to perpetuate therapeutic fraud? Subscribing
for or contributing to medical journals whose income is largely derived
from nostrums that are as vicious as many of the “patent medicines”
advertised in the daily press hampers the medical profession in its
fight for honesty in therapeutics and renders largely abortive its
fight against fraudulent “patent medicines.” So long as the accredited
organs of the medical profession tolerate fraudulent “ethical
proprietaries” in their advertising pages, just so long will the
protests of physicians against the swindling advertisements of “patent
medicines” in the daily press fall largely on deaf ears--and justly
so.--(_From The Journal A. M. A., Oct. 11, 1913._)


   A Physician Places the Responsibility for Fraudulent Advertising
                           Where It Belongs

  “_To the Editor_:--The Journal has had much to say in recent years
  regarding the ethics, or lack of same, in advertising matter
  exploited by its contemporaries. It has been criticized by many for
  the stringency of its attack; it has been criticized by very few
  because it did not go far enough. Is it not about time to get to the
  root of the matter?

  “In the last number [see p. 426, this book] dissatisfaction is
  expressed with the advertising policy of the _Medical Times_.
  Nothing finer! Go to it! But is the method of attack right? I have
  before me a sample copy of the _American Journal of Surgery_. Among
  other articles is one on diseases of joints and the bone marrow by
  a man very favorably known in Denver. He was ‘ethical’ enough to
  be accorded a place on the program in the Section on Medicine at
  Minneapolis. Another contributor from Baltimore remarks that he took
  a patient to the University Hospital. Can it be possible that Johns
  Hopkins is admitting men to its wards and clinics that are below par
  in professional morals? Another article appears from a well-known
  orthopedic man of Washington, D. C. Personally, I see very little
  to commend in the advertising columns of the _American Journal of
  Surgery_.

  “I, who confess to a state bordering on youth, may be very wrong;
  but I believe that the trouble will be solved only when men who
  claim to have any professional distinction refuse to contribute to
  journals whose pages are not clean from cover to cover. Pardon the
  presumption, Mr. Editor, but were you ever tempted to print anything
  like this:

  “‘Last week’s issue of the _New York Medical Squall_ contains an
  article on “Duodenal Ulcer” by John Doe, the well-known Chicago
  surgeon. Dr. Doe doubtless knows as well as any one the disreputable
  character of the _Squall’s_ advertising matter, but like most of
  our great men, is unable to restrain his appetite for journalistic
  publicity.’

  “Physicians read medical journals because they contain literature
  that is worth while. Jump on your erring editorial brethren, Mr.
  Editor, but please remember that the problem of eliminating bogus
  advertisements will be solved when the so-called leaders of our
  profession show enough manhood to refuse literary support to
  publications whose columns are in disrepute. While castigating the
  little sinner, please don’t let the big sinner go scot free.

                             “Clinton E. Harris, M.D., Grinnell, Iowa.”

Dr. Harris sums up the situation correctly. No small degree of
responsibility rests on the prominent members of the medical profession
who lend their support either as subscribers for or contributors
to those medical journals whose advertising pages are a stench in
the nostrils of thinking physicians. Dr. Harris asks why The Journal
does not condemn the advertising columns of the _American Journal of
Surgery_. The Journal has done so more than once and in no uncertain
terms, both in the Propaganda department and editorially. At one time
it said:

  “In circular letters and in an editorial announcement in its
  December issue, the _American Journal of Surgery_ ‘features’--to use
  a newspaper term--some of the contributors to its January issue.
  The list comprises men who hold, or have held, high offices in the
  American Medical Association. Presidents, vice-presidents, chairmen,
  secretaries and members of sections of the Association--these
  are some of the men whose names appear as contributors to this
  nostrum-promoting publication. Is it any wonder that the proprietors
  of the _American Journal of Surgery_ assume an attitude of
  indifference to the class of proprietary preparations which they
  admit to the pages of their publication?”

What was the result of The Journal thus directing the attention of its
readers to the _American Journal of Surgery_? In the next issue of the
_American Journal of Surgery_ appeared a seven-column editorial tirade,
entitled “An Unwarranted Attack on the President and Other Eminent
Members of the American Medical Association and on the Leading Medical
Journals of the Country.”

On many and various occasions has The Journal called attention to the
very evils that Dr. Harris deplores, and for the benefit of those who
care to look up the matter these references to some of the articles are
appended:

  “The Mote and the Beam,” editorial, Nov. 18, 1911.

  “Activity or Passivity--Sympathy or Sacrifice,” editorial, Dec. 9,
  1911.

  “Cui Bono,” editorial, Dec. 16, 1911.

  “Medical Journals and the Great American Fraud,” Propaganda
  Department, Dec. 16, 1911.

  “The Profession Must Apply the Penalty,” editorial, Jan. 13, 1912.

  “Fraudulent Advertising in High-Class Medical Journals,” editorial,
  Jan. 4, 1913.

  “Demand Clean Advertising,” editorial, Jan. 4, 1913.

  “Medical Journals and the Great American Fraud,” editorial, Jan.
  18, 1913.

  “A Good Principle to Apply,” editorial, May 13, 1913.

  “Medical Journal Advertising,” Propaganda Department, Oct. 11, 1913.

  “Medical Journals and the Great American Fraud,” Propaganda
  Department, Oct. 18, 1913.

  “Medical Journals and the Great American Fraud,” Propaganda
  Department, Nov. 1, 1913.

  “The Medical Times’ Advertisements,” Propaganda Department, Nov. 8,
  1913.

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._)




             MEDICAL JOURNALS AND THE GREAT AMERICAN FRAUD

 How the Medical Times Aids and Abets Quackery, with the Moral Support
                 of Members of the Medical Profession


Two letters have been received, both from physicians. One comes from
New York City and the other from Alexandria, Va. Each letter contained
an advertisement of the Kellam Hospital, Richmond, Va., cut from the
_Medical Times_. Here is the New York letter:

  “_To the Editor_:--I am enclosing an advertisement clipped from the
  _Medical Times_. It seemed to me an especially flagrant example
  of what may happen in the absence of proper supervision of the
  advertising pages of a medical magazine. The condition would seem
  all the worse in this instance as among the ‘Board of Contributing
  Editors’ are listed men like Howard Lilienthal of New York and Almuth
  C. Vandiver, who is Counsel for the Medical Society of the County
  of New York. The _Medical Times_ is sent to two of the physicians
  who live at this address without charge and without solicitation.
  Many advertisements of proprietary preparations are inserted in type
  indistinguishable from that of the body of the magazine and it is of
  course possible that its financial backing comes entirely from the
  manufacturers of these drugs.”

[Illustration: Fig. 1.--Photographic reproductions from the _Medical
Times_. Do the gentlemen whose names appear in the list of the “Board
of Contributing Editors” realize that they are lending an air of
respectability to an otherwise disreputable business?]

And this is from Virginia:

  “_To the Editor_:--The statements made in the advertisement of the
  Kellam Hospital in the October number of the _Medical Times_ are so
  out of the ordinary that I ask you to tell us something if you can
  of their institution and its methods of cure. Can such things as are
  stated in this advertisement be true? ‘Physicians Treated Free?’
  ‘Endorsed by the Senate and Legislature of Virginia?’ What can all
  this mean to the sufferer from cancer? If true, let the whole world
  of sufferers know the glorious news.”

_Collier’s_ paid its respects to the Kellam concern some time ago and
we cannot do better than quote from its pages. Thus:

[Illustration: Fig. 2.--One way of drumming up trade in the “cancer
cure” business! The Kellam Hospital sends letters like this to the
postmasters of small towns asking these government officials to furnish
it with what, in the parlance of quackery, is known as a “sucker list.”
A delightful business, isn’t it? And this, gentlemen of the “Board of
Contributing Editors,” is the sort of thing to which you are lending
your influence and good names!]

  “Grief is the portion of the Kellam Cancer Hospital, of Richmond,
  Virginia, because in these editorials it has been grouped with other
  exemplars of the Great American Fraud. It offers the invariable
  and hollow mockery of testimonials and endorsements, which, as has
  been repeatedly shown, can be wheedled, browbeaten or bribed out
  of the victims of any form of quackery. It, of course, courts the
  fullest investigation, and desires that we send a representative to
  investigate whether its claims are not well founded. Unsuspected
  by the Messrs. Kellam, our representative has already investigated
  their claims, notably their statement that they are endorsed by the
  Legislature of the State of Virginia. Upon request for a copy of
  the endorsement they forwarded a weak subterfuge, and finally, on
  pressure, admitted that they could not produce the proof they had
  boasted. For their further consideration we present a brief parallel:

      FROM THE KELLAM CIRCULAR           FROM A KELLAM LETTER

    The Cancer is removed without   We do not claim to “_cure them
    the use of the knife or X-Ray   all_.” We go further, and on
    ... No roots or fibers left;    our part, we agree to treat, free
    _hence it can not return_.      of charge, any patient _who
                                    suffers a recurrence after having
                                    been treated by our method_.

  “The italics are our own, but we cheerfully present them for
  elucidation to the Kellam Hospital. A little careful thought devoted
  to reconciling the irreconcilable may help them to forget their
  woe. Meanwhile, they make themselves out worse than they really are
  by pretending to withhold from the bitter need of humanity a true,
  non-surgical cure for cancer. If this were true; if, indeed, they had
  solved the problem which has baffled the greatest minds of modern
  science; if, having a genuine cure for the dreadful ailment which
  claims its increasing thousands of tortured victims yearly, they
  secrete their discovery for the sake of a few paltry dollars, then
  they are as cold-hearted as the sailors who pass within fair hail of
  the naked island on which some shipwrecked crew is starving, and keep
  their stony eyes on the compass. They have not even the excuse of the
  fanatical among the Christian Scientists who, denying the existence
  of pain, refuse to take measures to ease the cancer victim’s
  suffering even at the last. Human nature is seldom so callous.”

As for the _Medical Times_: This publication for years contained
comparatively little advertising. Then it came into the hands of
Romaine Pierson, who also owns the _Practical Druggist_. Mr. Pierson is
not a physician and to him the medical profession is but a commercial
problem. He is publishing a medical journal for the money there is in
it, and for this he is not to be censured. Questions of advertising
policy, in such circumstances, are determined on a commercial basis.
When an advertising contract is submitted, for a product that
physicians would know to be fraudulent, the question that arises is,
“Can it be put over?” Manifestly, a medical journal published purely
as a business venture would not dare long to fly in the face of the
opinions of those from whom it received its support--its subscribers
and contributors. If our correspondents will go through the advertising
columns of the _Medical Times_ they will find many, many other
frauds, less cruel perhaps than the Kellam advertisement, but no less
disreputable or discreditable to the medical profession.

After all is said and done, it is enlightened public opinion that
is causing publishers of lay magazines and newspapers to eliminate
fraudulent “patent medicine” and quack advertisements. Until the
medical profession takes an equally enlightened stand, physicians may
expect to be afflicted with such commercial medical journals as the
_Medical Times_, the _International Journal of Surgery_, the _American
Journal of Surgery_, _American Medicine_, and several other papers that
are published primarily in the interest of the advertiser. When such
journals as these find they cannot get a circulation among physicians
so long as they carry advertisements similar to many now appearing in
their pages, these advertisements will be eliminated, but not before.
Many physicians are receiving such journals at a nominal price or, as
one of our correspondents notes, free. The physician who permits such
journals to come to his office must share with the paid subscribers the
responsibility for the low standard of medical journalism.--(_From the
Journal A. M. A., Oct. 18, 1913._)


            Two Physicians Express Themselves on the Ethics
                         of Medical Journalism

After the preceding article was in type, we received, in the same mail,
two letters that are so apropos that we reproduce them. The first was
from a town in Illinois, and was dated October 11. Here it is:

  _To the Editor_:--About two weeks ago, a representative of the
  Surgery Publishing Company, New York, N. Y., came to ---- Ill.
  soliciting subscriptions for the _American Journal of Surgery_.
  Together with numerous others I subscribed--chiefly on the strength
  of the contributors whose articles appeared in the sample numbers
  shown by the agent.

  Since receiving the first number (October) one look at the
  advertising pages has shown me why the subscription price for a year
  and a quarter is one dollar. Anasarcin, Tongaline, Cactina Pillets,
  Hagee’s Cordial of Ext. Cod Liver, Burnham’s Soluble Iodin, Papine,
  Phenalgine, Anusol, etc., etc.

  I have written to the Surgery Publishing Company, telling them in
  no uncertain language that there is no room on my reading desk for
  such. Have you ever exposed this journal, and the attitude of our
  big, brilliant, eminent men in permitting their articles--presumably
  original--to fill space in such a journal? [Yes! The Journal,
  Dec. 16, 1911, pp. 2,000 and 2,013.] This letter is not for
  publication--at least not with name of city. Keep up the good work....

The other, dated October 10, follows:

  _To the Editor_:--That little story about medical journal advertising
  and methods of obtaining paid-up subscribers, in this week’s Journal
  makes me blush (p. 422, this book). I am guilty. Unlike Dr. Genella,
  I swallowed the bait--but the bait was even more tempting in my case;
  the flattering “editor” offered me twenty-five subscriptions to
  distribute among my friends, all for an “abstract.” Thank goodness,
  I only accepted five subscriptions, but worse luck, I sent them
  to young men by preference. So I am a deep-dyed offender indeed.
  Extenuating circumstances affected my susceptibility somewhat,
  however. I have noticed that prominent men like Beverly Robinson,
  A. Rose, Tom A. Williams, Wayne Babcock, and Morris--the latter, at
  least, a really able man and a brilliant writer--contribute to these
  peanut journals occasionally. If they do, why not I? There’s nothing
  like being in big company, you know.

  So far as I know, my “abstract” has not yet been published. On
  looking over the sample copy of this monthly I found an advertisement
  printed right in the list of contents--in fact, it was the second
  “original article” in the issue, as brave and respectable as you
  please! Then, with characteristic Hibernian impetuosity I got out my
  machine and pounded that editor a strong protest with a dire command
  not to use my “abstract” in his miserable organ. But I have never
  received the manuscript, nor any reply to my stern rebuke. I wish I
  had been cautious like Dr. Genella.

                                         Wm. Brady, M.D., Elmira, N. Y.
  --(_From The Journal A. M. A., Oct. 18, 1913._)


                   The Responsibility of Physicians

The responsibility of medical journals for the continued existence
of at least a part of the “great American fraud,” has been referred
to in these pages many times. Within the past few weeks The Journal
has called attention to the inconsistency of reputable physicians
of high ideals lending their moral, and often financial, support to
those medical journals whose advertising pages are a disgrace to the
profession. Specifically, the _Medical Times_--originally a homeopathic
medical journal--has been referred to, among others, as an example
of this type of journalism. It must, however, be regarded simply as
a type, for it is no better and no worse than many other medical
journals. Several letters have been received on the subject, some
of which we reproduce. The first one is from Dr. George G. Ross of
Philadelphia:

  “I was very much jarred on receiving the last issue of The Journal
  to find under the Propaganda for Reform an article concerning the
  _Medical Times_, among the list of whose contributing editors my name
  appears. I enclose you herewith a copy of my letter of resignation to
  the _Medical Times_. I have a very dim recollection of what occurred
  at the time that I was asked to give my name as a contributing
  editor. As I recollect it, however, at that time the journal was a
  respectable and ethical publication. I had been asked by a friend of
  mine to write an article giving my opinion of the effects of college
  athletics on undergraduates. This was at the time that Dr. Stokes had
  issued his order about athletics at Annapolis. I want personally to
  thank you and the committee for the exposure of this journal and for
  having drawn my attention to the fact that I was unwittingly aiding
  and abetting such a journal. I trust that if you have space in some
  future number of The Journal, you will do me the justice to publish
  all or part of this letter.”

Because he feels that he has “unwittingly been put in an unfavorable
light,” Dr. James A. Babbitt, also of Philadelphia, sends The Journal a
copy of a letter written by him to the editor of the _Medical Times_.
Here it is:

    “For reasons of which you are probably cognizant, I deem it
    advisable to resign from the board of contributing editors of the
    _Medical Times_, and desire that this resignation be accepted at
    once and my name not appear in further issues.”

What shall be done, asks Dr. Sidney Thompson of Humboldt, Tennessee, in
such cases as the following? Says Dr. Thompson:

  “In the Propaganda for Reform, in The Journal, October 18, 1913, in
  closing your article on ‘Medical Journals and the Great American
  Fraud,’ you say: ‘The physician who permits such journals to come to
  his office must share with the paid subscribers the responsibility
  for the low standard of medical journalism.’ Now I agree with you in
  everything you have said about the _Medical Times_, but what I want
  to know is how to keep such journals from coming into your office.
  The _Medical Times_ has been coming to me for a number of years with
  repeated duns for the subscription price. I have written to them
  several times that I did not want the journal and never expected to
  pay for it, but still it comes. I have a vague recollection that I
  bit at an offer to send it three or four months free, not knowing
  what it was, but I never authorized them to enter my name as a
  regular subscriber.”

The simplest course in such a case as that described by Dr. Thompson,
is to write on the unwelcome publication the word “refused” and either
drop it in the nearest mail-box or hand it back to the postman. The
courts have held that a person who continues to accept publications is
legally liable for the payment of such publications. The postoffice
department, however, has ruled that a magazine--either monthly or
weekly--may not be sent at second-class rates for more than one year
after the expiration of a bona fide subscription. At the expiration
of that time, stamps must be affixed and the publications sent at
third-class postal rates.--(_From The Journal A. M. A., Nov. 1, 1913._)


                  Medical Journals and Sanatogen[BI]

[BI] See also Sanatogen, p. 358.

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 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._)


                   THE ARMY AND NAVY MEDICAL RECORD

    A Fraudulent Publication Whose Editorial Opinions Are for Sale

Whenever a business assumes certain proportions, subsidiary businesses
spring up to cater to the needs of the larger enterprise. For some
years the nostrum business has grown so large that it has furnished
a more or less precarious life for many individuals who have catered
to it. There are, for instance, men whose trade it is to obtain
testimonials; others, claiming a long string of imposing degrees,
will furnish fake reports and bogus analyses; still others issue at
irregular intervals publications with high-sounding names which sell
editorial indorsement to the products of concerns such as are willing
to pay the price asked. “Journals” of this type have been called to
the attention of our readers at different times; the _New York Health
Journal_ and the _United States Health Reports_ come to mind at this
moment. Both of these had their day and died a natural death, as all
such publications must when once the public is cognizant of their true
character.

                              TWO LETTERS

More recently the attention of _The Journal_ has been called to a
publication calling itself the _Army and Navy Medical Record_. A
physician in the South sends a letter he has received from the _Army
and Navy Medical Record_ reading as follows:

    “We have had many favorable reports reach us relative to your most
    excellent institution, and, as you are doubtless aware, we come
    in direct contact with a large number of Army and Navy and other
    government attachés who have sons that they desire to provide with
    a medical education combined with the higher course included in
    your up-to-date laboratory methods and the sciences incidental to
    clinical medical practice.

    “If you will regard the proposition as confidential, we will agree
    to carry a one-fourth page advertisement of your university at the
    nominal rate of $38 per year, provided this amount is forwarded in
    advance at the time copy is furnished; and _we will further promise
    to editorially indorse and recommend your school and its methods
    without qualification or exception_. [Our italics.--Ed.] This
    article you should be able to use (and are authorized to do so)
    after publication for advertising purposes.

    “We will also be able, and are willing, to furnish you with a
    desirable list of probable candidates from time to time.

    “Kindly let us hear from you at once, if interested, and oblige,

                       “Yours with best wishes,
                                     “The Army and Navy Medical Record,
                                    “Arthur G. Lewis, Managing Editor.”

The physician to whom this was addressed made a notation on the letter
to the effect that “this looks crooked.” A few weeks later, Dr. V. C.
Vaughan, dean of the University of Michigan, Department of Medicine and
Surgery, sent in a letter from the _Army and Navy Medical Record_ which
he had received in his official capacity at the university. Here is the
letter; again the italics are ours:

    “We are gratified to advise you that in our efforts to select a
    strictly ethical and high-grade institution of medicine that this
    magazine could consistently indorse and recommend, we have decided
    on the University of Michigan, Department of Medicine and Surgery,
    as the institution in your territory to whom our special publicity
    concession will be made this year.

    “You are doubtless aware that we come in direct contact with a
    very large number of Army and Navy and other government attachés,
    also physicians in private practice who have sons that they desire
    to provide with a medical education, combined with the higher
    courses included in your up-to-date methods.

    “For personal reasons we are particularly anxious to favor your
    institution, and frankly believe that we can prove of material
    service to you. The special proposition, to be regarded by you as
    strictly confidential, is that we will publish a full one-half page
    announcement of your institution for the term of one year, you to
    merely pay a nominal expense charge of $38 for the year’s service.
    As our regular rate is $125 per annum for this service, _the
    necessity of regarding the matter between ourselves is apparent_.
    [Transparently so.--Ed.] We further propose, without expense to
    you, to editorially indorse and recommend your institution and
    its methods without qualification or exception. An electrotype
    illustration may be used, without charge.

    “It is important, however, that we hear from you promptly. Awaiting
    your immediate reply, we are, with best wishes,

                          “Yours faithfully,
                                     “The Army and Navy Medical Record,
                                    “Arthur G. Lewis, Managing Editor.”

Dr. Vaughan, in forwarding the matter to The Journal, wrote that on
receipt of the offer just given, he “was uncertain whether its writer
was a knave or a fool.” After inquiring into the matter somewhat
thoroughly, he concluded that “the managing editor of the _Army and
Navy Medical Record_ is both a knave and a fool.”

                      THE ARMY AND NAVY MAGAZINE

The Journal had the _Army and Navy Medical Record_ under investigation
before these two letters were received and, as a result, the following
facts seem to be pretty well substantiated. Herbert C. Lewis, with his
brother, Arthur G., conducted from Washington, D. C., a publication
called the _Army and Navy Magazine_. In The Journal’s nostrum file
there is a booklet put out by the Renova Distributing Company
describing the wonderful virtues of its product, “Anti-Jag,” which, as
its name might intimate, is a “liquor cure” of the fake variety. One
page of this booklet is given over to what purports to be “A Letter
from a Great Magazine Editor.” The letter is dated June 19, 1900,
from Washington, D. C., and says that “the editor of the _Army and
Navy Magazine_ takes pleasure in stating that from his own personal
knowledge he has found ‘Anti-Jag’ to be one of the most reliable
medicines ever introduced for the permanent cure of drunkenness.”
And more to the same effect. The letter is signed “Herbert C. Lewis,
editor.”

The publishing offices of the _Army and Navy Magazine_ are at 606 F
Street, N. W., Washington, D. C. The building at this address is known
as the Baltic Building. Herbert C. Lewis is said to be a printer by
trade.

The _Army and Navy Medical Record_ seems to have been started within
the last few months by Arthur G. Lewis. It does business from two
addresses, the Baltic Building, Washington, D. C., and the Maple Villa
Sanitarium, Hammonton, N. J. Lewis is said to have purchased the Maple
Villa Sanitarium recently, but apparently his chief source of income
is the _Army and Navy Medical Record_. He is alleged to have claimed
that some medical officials of the government are interested with him
in this publication but that these officials do not wish their names
known. We do not blame them.

[Illustration: Photographic facsimile of a letter sent by the _Army and
Navy Medical Record_ to the dean of University of Michigan, Department
of Medicine and Surgery, offering one hundred and twenty-five dollars’
worth of advertising space for a “nominal” thirty-eight dollars--with
editorial indorsements and recommendations thrown in for good measure!]

                     ADVERTISEMENTS AS EDITORIALS

A glance through two issues of the _Army and Navy Medical Record_ makes
perfectly plain the character of the publication. The January-February,
1913, number leads off with articles by well-known medical officers
in the Army, the Navy and the Public Health Service. These have been
copied from other publications. Then comes an editorial entitled “A
Much Needed Dietary Reform,” devoted to the laudation of “Postum,” the
widely advertised coffee substitute. Following this is an editorial
on “The Philosophy of Hypnotics” in which aconitine, saline laxative
and digitalin are each given a “boost.” Then comes an “original
article” (save the mark!) entitled “The Physiological Pathology of
Consumption.” This is by “Alfred S. Gubb, M.D., L.R.C.P., London,
M.R.C.S., Eng., D.P.H., etc. etc., Aix-les-Bains, Savoie, France.”
Two pages are devoted to this. The “joker” appears in the third
paragraphs from the end--Fellows’ Syrup of Hypophosphites. Dioxogen
receives more than three pages of editorial mention under the
caption “The Sterilization of Milk with Dioxogen.” Under “Another
New Electrical Wonder--Magnified Sound,” the “Acousticon” is given
a two-and-a-quarter page write-up. “What Wise Men Wear” is the
title of a four-page article--unsigned--devoted to the laudation of
suspensories in general and the “O-P-C Suspensory” in particular. Dr.
H. F. Boatman, Los Angeles, contributes a short article on “A Case of
Advanced Pulmonic Tuberculosis Treated with Injections of Dioradin,”
while our good old friend Willard H. Morse, M.D., “F.S.Sc. (Lond.),”
the champion fake-testimonial-giver of the country, writes more or
less entertainingly on “Putting on a Mustard Plaster.” The article
has nothing to do with mustard plasters but has a good deal to do
with “Zumota,” a nostrum recommended as a substitute for the mustard
plaster. These are but a few of the nostrums to which the editorial and
reading pages of the _Army and Navy Medical Record_ are devoted.

In the June-July issue, Arthur G. Lewis becomes bolder. The leading
article is entitled “First Aid in the Navy,” by C. F. Stokes,
Surgeon-General, United States Navy. There is nothing to indicate
that this article was not contributed to the _Army and Navy Medical
Record_ by its author. As a matter of fact, it originally appeared in
an official publication, the _United States Naval Medical Bulletin_ for
January, 1913, and was reprinted by Lewis without credit and without
permission. Following the article by Dr. Stokes is another, unsigned,
entitled “The Passing of ‘The Pie Habit.’” This describes the surprise
of the students of Harvard University at being served breakfast cereals
instead of pie at their noonday meal and suggests that “Shredded Wheat
Biscuits” make a “delicious dessert.” A two-and-a-half page article on
the “Danger of Corrosive Sublimate in Vaginal Douche” is reprinted from
the _Lancet-Clinic_ of September, 1903. The reason for resurrecting
this ten-year-old article becomes apparent before one gets half through
it. It deals not so much with the danger of corrosive sublimate as with
the marvelous--alleged--properties of Tyree’s Antiseptic Powder. Dr.
Claude C. Keeler, Denver, has a three-page article on the “Medical
Treatment of Pulmonary Tuberculosis.” The “medical treatment” referred
to is Waterbury’s Compound. An editorial entitled “One Notch Ahead
of Morphin” is devoted to that vicious morphin solution sold under
the proprietary name “Papine.” Another on “The Treatment of Catarrh
by Palliatives and Curatives” deals with a widely advertised “patent
medicine,” “Kondon’s Catarrhal Jelly.” What appears to be a contributed
article by Charles Wardell Stiles of the United States Public Health
Service on “Country Schools and Rural Sanitation” has really been
“lifted” from an official publication without credit and, needless to
say, without Dr. Stiles’ permission.

But medicinal preparations are not the only things to which the _Army
and Navy Medical Record_ gives editorial indorsement. All advertising
matter, apparently, is grist to its mill. Sandwiched in between
articles on “Public Health Administrations” and “Important Army Medical
Lectures” is a dissertation on “The Millennium of Shirt Construction,”
in which are sung the virtues of the tailless shirt! A little farther
along the Hawaiian pineapple is extolled, while the last pages of the
issue are devoted to various banking concerns.

In addition to the advertisements appearing throughout the reading
and editorial pages of these two issues of the _Army and Navy Medical
Record_, there are a number of display advertisements. There is
no reason to suppose, at least in the majority of cases, that the
advertisers had the slightest reason to suspect the nature of the
_Army and Navy Medical Record_. Several pages are devoted to financial
advertisements, there being more than forty banks that have “fallen
for” the wiles of Arthur G. Lewis. In view of the letters received by
the deans of medical colleges and other educational institutions, the
display advertisements of schools and colleges have a special interest
to physicians. Schools for girls, polytechnics, colleges of music,
veterinary, dental and medical schools--all are to be found in this
cosmopolitan publication.

Among the therapeutic products advertised--in the advertising
pages--are:

    Fellows’ Syrup of Hypophosphites    1   cover page
    Kondon’s Catarrhal Jelly            1/2 page
    Expurgo Anti-Diabetes               1/2 page
    Laxol                               1/2 page
    Campho-Phénique                     1/2 page
    Palpebrine                          1/2 page
    Zumota                              1/2 page
    Sanmetto                            1/4 page

While in the reading pages the following products are puffed:

    Tyree’s Antiseptic Powder.
    Waterbury’s Compound.
    Papine.
    Kondon’s Catarrhal Jelly.
    Ranier Natural Soap.
    Iodia (Battle).
    Creo-Derma.
    Fellows’ Syrup of Hypophosphites.
    Tannalbin.
    Expurgo Anti-Diabetes.
    Zumota.
    Sulfothen.
    Dioxogen.
    Palpebrine.
    Bannerman’s Intravenous Solution.
    Daniel’s Concentrated Tincture of Passiflora.
    Peacock’s Bromides.
    Aletris Cordial Rio.
    Gonosan.
    Digipuratum.
    Dioradin.
    Pepto-Fer.
    Lactol.
    Campho-Phénique.

Summed up: The _Army and Navy Medical Record_ is but another of the
parasites of quackery. It is not entered as second-class matter and
it has probably no bona-fide circulation. While it is claimed to be
“Devoted to the Interest of the Medical and Surgical Corps of the
Army and Navy, the Public Health Marine Hospital Service and the
Red Cross Society” it is actually devoted to none of these. It is
devoted to the exploitation of the advertising public for the special
financial benefit of the man who calls himself its editor--Arthur G.
Lewis. Advertising contracts are obtained under false and fraudulent
pretenses. In brief, Arthur G. Lewis is using the good name of the
various medical services of the United States government to further his
swindling operations. He has written letters to honorable physicians
making dishonest and insulting propositions to deceive and defraud the
public. Editorial indorsements of the _Army and Navy Medical Record_
mean nothing except that money has been paid for them. In short, the
_Army and Navy Medical Record_ is a fraud, and its “editor,” Arthur G.
Lewis, a faker.--(_From The Journal A. M. A., Oct. 25, 1913._)




                   THE MEDICAL TIMES ADVERTISEMENTS

             In Which Are Discussed Some “Oversights” and
                       the Ethics of Journalism


Two or three weeks ago we published letters from two physicians calling
attention to an advertisement of a “cancer cure” hospital appearing in
the _Medical Times_. As a result of The Journal’s comments, some of the
physicians who were listed as “contributing editors” of the _Medical
Times_ wrote that they had requested that their names be withdrawn from
this list. In reply to at least some of these letters, the editor of
the _Medical Times_ wrote asking them to reconsider their decision and
offering as an excuse the statement that the appearance of the “cancer
cure” hospital advertisement was an oversight. In this connection the
following letter from the _Medical Times_, addressed to The Journal of
the American Medical Association, is pertinent:

    “_Gentlemen_:--We note in your issue of October 18 an article
    calling attention to an advertisement which appears in the columns
    of this journal, and to which your editor rightly objects.

    “The advertisement in the _Times_ was the result of an oversight,
    and it will not reappear.

    “While we are indebted to you for thus bringing the matter to our
    attention, we cannot but feel that a letter written to us would
    have been more in keeping with the ethics of journalism.

                          “Very truly yours,
                                                    The Medical Times.”

It will be noticed that this letter, like the letters sent to other
physicians, ignores altogether the most important point made by The
Journal in its criticism of that publication’s advertising policy. The
Journal said in this connection:

  “If our correspondents will go through the advertising columns of the
  _Medical Times_ they will find many, many other frauds, less cruel
  perhaps than the Kellam advertisement, but no less disreputable or
  discreditable to the medical profession.”

The _Medical Times_ apologizes for the advertisement of the Kellam
Cancer Cure Hospital but ignores altogether the fact that the hospital
advertisement was but one of many equally discreditable. We turn to
recent issues of the _Medical Times_ and we find it fairly reeking with
advertisements of proprietary preparations that are a disgrace to the
medical profession, many of them having been repeatedly exposed in The
Journal. We find, for instance, a quarter-page advertisement of the
Expurgo Manufacturing Company. “Expurgo Anti-Diabetes,” we are solemnly
told in the pages of the _Medical Times_ is:

    “The only reliable and thoroughly tested remedy for the cure of
    Diabetes Mellitus and Insipidus.”

This wretched fraud, which also is advertised in true “patent medicine”
style direct to the public, is presented to a presumably intelligent
profession as a “cure” for a disease which so far has baffled the best
brains in the scientific world.

“Expurgo Lapis” we are told, also via the _Medical Times_ is:

    “The only known cure for gall-stones, kidney and bladder stones,
    gravel and all kidney trouble arising from uric-acid origin.”

Did Kilmer’s Swamp-Root ever claim more? “Diabetes is no longer an
incurable disease” runs the advertisement of the Jireh Diabetic Food
Company, yet the editor of the _Medical Times_ must know that in The
Journal[133] and in the reports of state chemists the Jireh diabetic
foods have been shown time and again to be among the most dangerous and
fraudulently exploited products sold to the unfortunate diabetic.

[133] The Journal A. M. A., Dec. 14, 1912, March 22, 1913, and April 5,
1913; see also p. 451, this book.

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] Sanatogen[143]
and Sal Hepatica.[144]

[134] Pages 10 and 335, this book.

[135] Page 240, this book.

[136] Page 11, this book.

[137] Page 40, this book.

[138] Page 330, this book.

[139] Nostrums and Quackery, Ed. 2, p. 589; page 31, this book.

[140] Page 36, this book.

[141] The Journal, March 29, 1913, p. 1013.

[142] Page 178, this book.

[143] Nostrums and Quackery, Ed. 2, p. 470; page 358, this book.

[144] Nostrums and Quackery, Ed. 2, p. 639; page 179, this book.

What excuse can the _Medical Times_ offer for the presence of these
frauds in its pages? Are these, too, “the result of an oversight”?
Presumably for thus bringing to its attention these various other
disreputable advertisements, The Journal will be accused again
of violating “the ethics of journalism.” If calling attention to
fraudulent advertisements is out of keeping with the ethics of
journalism, what, pray, must be said of publications that are willing
to share in the profits of such fraudulent exploitation? But, and
we cannot repeat it too often, the _Medical Times_ is but one of a
class, neither worse nor better than many other medical journals whose
financial support comes from the proprietary interests rather than from
the medical profession. The responsibility for the existence of these
journals really rests not on the business men who conduct them on a
commercial basis, but on the physicians who tolerate or encourage them
in any way.--(_From The Journal A. M. A., Nov. 8, 1913._)




                          CAUSE FOR OPTIMISM

        A Clean Medical Journal--the South Texas Medical Record


Fortunately, there are forces at work in the medical profession that
make for optimism. An editorial in the last issue--April, 1915--of the
_South Texas Medical Record_, the official organ of the South Texas
District Medical Association, is especially significant. While not a
large journal, the _South Texas Medical Record_ could well stand as an
example to medical publications of a much more pretentious character.
Its advertising pages are above reproach and the journal is a credit
alike to its editors and to those members of the profession whose
support makes its existence possible. In the editorial referred to,
entitled, “Honest Advertising--Let Us Cleanse Our Own Linen First,” the
editor-in-chief, Dr. W. Burton Thorning, says:

  “A recent editorial, entitled ‘Honest Advertising,’ in a daily
  newspaper, furnished the occasion for an editorial comment in the
  January number of the _Southwestern Hospital Reporter_. The latter,
  while taking the ground that the newspaper was inconsistent in
  uttering high editorial sentiments and in adjoining columns printing
  patent medicine advertisements, implied that newspaper men should be
  allowed some latitude in the matter of accepting advertising, on the
  plea of being laymen and therefore not expected to possess the same
  amount of information concerning patent ‘dope’ that medical men have.

  “It would appear to be a fair assumption that a layman, even though a
  highly educated and able editor of a great newspaper, does not know,
  and cannot be expected to know, the depth of depravity to which the
  consumption cure faker and the cancer quack can descend.

  “Granting that the newspaper man accepts the advertisements through
  ignorance of the facts concerning their possibilities for evil,
  what can be offered in defense of the medical editor who accepts
  advertising matter equally pernicious in its influence?

  “Indeed, it is not so many years since many of the so-called ethical
  medical journals carried the ads of some of the most notorious quacks
  this country has ever known.

  “Doubtless there are few, if any, who do so at the present time,
  but, on the other hand, there are only a few who do not advertise
  unethical institutions, and questionable proprietary medicines. As a
  matter of fact some of the most widely advertised patent medicines of
  today were formerly advertised as ethical proprietaries in medical
  periodicals, the great majority of which are still serving as a sort
  of preparatory school for advertisements that will presently appear
  in the lay press.

  “What shall be offered in defense of the medical publication
  which continues to publish the advertising matter of hundreds of
  proprietaries which the Council on Pharmacy and Chemistry of the
  American Medical Association has shown to be either generally
  worthless or an out and out fake?

  “Can the medical editor plead ignorance? Hardly. To do so would be to
  admit utter incapacity. There is only one inference to be drawn; the
  publication needs the money and is not overparticular regarding its
  source.

  “There is a remedy, however, a remedy absolutely certain in its
  results. If every physician in the United States for a period of
  three months would positively refuse to receive at his desk a medical
  journal containing questionable advertising, this blotch on medical
  journalism could be erased.

  “It is true that many of them would sink, never to rise again, but
  the profession would be better off without those whose existence
  depends upon ‘phoney’ advertising. There are, unfortunately, several
  American journals whose reading pages are well and carefully edited
  and a credit to medical literature, whose advertising pages carry
  such undesirable matter that the educated physician can only feel a
  sense of disgust.

  “Such journals could very well succeed on the quality of their
  reading matter and undoubtedly would increase their circulation
  enough to more than offset the loss in advertising.”--(_From The
  Journal A. M. A., May 29, 1915._)




          THE COMPARATIVE NUTRIENT VALUE OF COD LIVER OIL AND
                      COD LIVER OIL CORDIALS[BJ]

                      John Phillips Street, M.S.
         Chemist, Connecticut Agricultural Experiment Station
                           NEW HAVEN, CONN.

[BJ] See also reports on Hagee’s Cordial, pp. 51, 289; Wampole’s
Preparation, pp. 52, 442, and Waterbury’s Compound, pp. 54, 57, 291.


For a long time cod liver oil has been recognized as an easily
assimilable nutrient and reconstructive and of special value in
wasting diseases. The unpalatability of the oil, however, has led to
various devices to make it tasteless or to render it more acceptable
to the stomach. Emulsions containing the oil in mixture with other
substances were exploited, and doubtless served a useful purpose.
The oil, however, but imperfectly concealed, was still disagreeable
to many, and other preparations began to appear on the market, which
claimed to retain the therapeutic virtues of cod liver oil without its
disagreeable characteristics. This practice has been carried so far
that now we find for sale cod liver oil preparations from which the oil
has been removed in its entirety, and only the name remains. Certain
of these products claim to “represent” the oil and to retain all its
virtues; others are said to contain oil, while still others claim “all
the valuable constituents” of the oil without the oil itself.

In the past, cod liver oil has been considered a food rather than
a medicine, and its value attributed to the easily digestible and
metabolizable oil it contains. This position, however, has been
disputed. By some its therapeutic value has been attributed to the
small amount of iodin present in the oil, but in recent years the
suggestion has been made that its special potency depends on its
peculiar fatty acids. In this connection the U. S. Dispensatory[145]
says:

[145] U. S. Dispensatory, Ed. 19, p. 860.

  “Other oleaginous substances, certainly not less nutritious, have not
  been equally efficient, though taken in much larger quantities. If
  this be the true explanation, persons living chiefly on milk, which
  abounds in oil, or on fat pork, ought to show a special exemption
  from scrofulous complaints. The probability appears to us to be that,
  in consequence of some peculiar principle or principles it contains,
  it exercises a stimulant and alterative influence on the processes
  of assimilation and nutrition, thereby aiding in the production of
  healthy tissue.”

Indeed, Osborne and Mendel[146] have shown in their experiments on
albino rats that by substituting cod liver oil for a portion of the
lard in their standard diets, growth was resumed after failure on foods
containing commercial lard alone as the source of fat. Similar results
were secured with butter-fat and egg yolk fat.

[146] Osborne, T. B., and Mendel, L. B.: Jour. Biol. Chem., 1914, xvii,
401.

In the light of the theories advanced for the therapeutic value of
cod liver oil, and the results secured by Osborne and Mendel with
the oil itself; it seemed a profitable study to examine some of the
prominent “oilless” preparations on the market to determine whether
or not the claims made for them as nutrients were justified. Certain
of the so-called cod liver oil preparations are termed “extracts” of
cod liver oil, and are not made from the oil, but from the cod livers
instead. As has been well said,[147] “They are preparations, which, if
honestly made, might be worthy of trial, but they are improperly called
‘extracts’ of cod liver oil, since they do not contain the fat, which
is the active constituent of the oil, but the extractives from the
liver, which may or may not possess therapeutic virtues. So far as we
know, however, no satisfactory evidence is forthcoming to indicate that
such extractives have any therapeutic value.”

[147] Fraud and Deception Connected with So-Called Cod Liver Oil
Preparations, The Journal A. M. A., Oct. 13, 1906, p. 1207.

It was with preparations of this class that our experiments were made.
Four of the more extensively advertised brands were selected, as they
represent rather distinct types of this class of products, as the
following claims of their label will show:

    _Hagee’s Cordial of the Extract of Cod Liver Oil,
    Compound._--“Tonic, stimulant, alterative, reconstructive,
    nutritive and digestive.” “Each fluid ounce represents the extract
    obtainable from 1/3 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.”

    _Vinol._--“The modern tonic reconstructor containing the medicinal
    extractives of fresh cod livers with peptonate of iron.” “When the
    blood is poor, when more fresh blood is needed, when the weak need
    strength, when the throat and lungs are affected, TAKE VINOL.”

    _Wampole’s Perfected and Tasteless Preparation of an Extract of
    Cod Liver._--“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, quinine and strychnine).”

    _Waterbury’s Compound, Plain._--“Made from cod liver oil, digestive
    ferments, malt extract unfermented, hypophosphites comp. special,
    ext. cherry, eucalyptus, aromatics, etc.”

    Thus we have represented in our experiments an “extract” with
    hypophosphites, one with peptonate of iron, one with malt extract
    and hypophosphites and the alkaloids quinin and strychnin, and one
    with malt extract and hypophosphites without alkaloids.

    In order to prepare a dry ration of suitable keeping properties,
    it was necessary to remove the alcohol and water from the various
    preparations. This was done by evaporation under reduced pressure
    at from 40 to 55 C. (104 to 131 F.). In the case of Hagee’s Cordial
    it was claimed that one fluidounce of the preparation represented
    1/3 fluidounce of cod liver oil, and in the subsequent substitution
    for cod liver oil in our rations, this ratio was used for all four
    products.... These are very dissimilar preparations, the alcohol
    ranging from 7.50 to 18.69 per cent., the extract from 8.72 to
    39.53 per cent. (10.81 of the 13.18 gm. of extract in Hagee’s
    Cordial being glycerin), the ash from 0.305 to 1.967 per cent.,
    the reducing sugars from 1.35 to 17.10 per cent., and the glycerin
    from a trace to 10.81 per cent. Wampole’s contained quinin and
    strychnin, the others no alkaloids; salicylates were present in
    all but Wampole’s; saccharin in Hagee’s. The Pettenkoffer test for
    biliary acids gave a negative result in Hagee’s and Wampole’s; in
    Vinol and Waterbury’s, small amounts of fatty acids were obtained,
    amounting to 0.016 and 0.032 gm. per hundred c.c., respectively,
    quite insignificant amounts.

The feeding experiments were made on albino rats of both sexes,
which were placed, when about 6 weeks old, on a standard ration, No.
7, and after several months, when a failure to maintain weight was
indicated,[148] an amount of dealcoholized cordial extract equivalent
to 18 per cent. of cod liver oil was substituted for a portion of the
lard, the cordial extract later being replaced by an equivalent amount
of cod liver oil.

[148] Osborne and Mendel have shown (Jour. Biol. Chem., 1913, xv, 311)
that mixtures of purified protein, lard, starch and protein-free milk
have been singularly efficient for a time in promoting growth of young
rats. In from sixty to 100 days or more, however, normal growth stops;
the animals may remain at constant weight for a few days, or grow very
slowly, and then suddenly decline and die unless a change is made in
the diet. The substitution of butter-fat, egg yolk fat, or cod liver
oil for a portion of the lard in the ration, in the experiments of
these authorities, brought prompt recovery and continuation of normal
growth.

                                SUMMARY

Table 11 gives a summary of the actual gains of the fifteen rats on the
four rations, compared with the gains shown by cod liver oil and those
shown by normal rats at the same period of their life history.

                   TABLE 11.--SUMMARY OF RESULTS[BK]

  =====================+========+========+=========+=========
                       | Total  | Total  | Average | Average
       Rations         | Normal | Actual | Normal  | Actual
                       | Gain,  | Gain,  | Gain,   | Gain,
                       |  Gm.   |  Gm.   |  Gm.    |  Gm.
  ---------------------+--------+--------+---------+---------
  Hagee ration         |   24   | -36.2  |   6     |  -9.1
  Cod liver oil ration |  114   | 156.4  |  28.5   |  39.1
                       |        |        |         |
  Vinol ration         |   42   |  -1.5  |  10.5   |  -0.4
  Cod liver oil ration |   42   |  87.5  |  10.5   |  21.9
                       |        |        |         |
  Wampole ration       |   83   |  51.4  |  20.8   |  12.9
  Cod liver oil ration |   62   |  81.5  |  15.5   |  20.4
                       |        |        |         |
  Waterbury ration     |   32   |   0.3  |  10.7   |   0.1
  Cod liver oil ration |   42   |  87.4  |  14     |  29.1
  ---------------------+--------+--------+---------+---------

[BK] In this table are given the totals and averages of the figures
already presented in Tables 4, 6, 8 and 10.

In considering the effect of these preparations as general medicines,
their alcohol content must not be overlooked. Hagee’s Cordial contains
7.50 per cent. of alcohol by volume, Vinol 18.60 per cent., Wampole’s
Preparation 16.59 per cent., and Waterbury’s Compound 11.25 per cent.
Full strength whisky contains 50 per cent. of alcohol by volume.
By following the doses prescribed by the manufacturers of these
preparations, the user would consume daily the following equivalents of
full strength whisky:

    In Hagee’s Cordial              0.24 fluidounce
    In Vinol                        0.8  fluidounce
    In Wampole’s Preparation        0.7  fluidounce
    In Waterbury’s Compound         0.6  fluidounce

These amounts of alcohol are by no means negligible and doubtless
explain to a considerable extent the source of the alleged tonic
virtues of these preparations.

The results of the experiments may be summarized as follows:

Hagee’s Cordial failed to sustain rats during periods of seven and
fourteen days, the rats showing a loss in weight of 36.2 gm., instead
of the normal gain of 24 gm.

Vinol in two cases sustained and in two cases failed to sustain growth
during periods of from eleven to thirty-five days, the net loss in
weight of the four rats being 1.5 gm., instead of the normal gain of
42 gm.

Wampole’s Preparation in three Cases sustained and in one case promoted
growth in rats during periods of eighteen and thirty-nine days,
showing, however, only 51.4 gm. gain in weight instead of the normal
83 gm.

Waterbury’s Compound in two cases sustained and in one case failed to
sustain rats during periods of fourteen and thirty days, the net gain
in weight, however, being but 0.3 gm. instead of the normal 32 gm.

Cod liver oil showed a gain of 42.4 gm. over the normal, while with
the same rats Hagee’s Cordial showed a loss of 60.2 gm. Cod liver
oil showed a gain of 45.5 gm. over the normal, while with the same
rats Vinol showed a net loss of 43.5 gm. Cod liver oil showed a gain
of 19.5 gm. over the normal, while with the same rats Wampole’s
Preparation showed a loss of 31.6 gm. Cod liver oil showed a gain of
45.4 gm. over the normal, while with the same rats Waterbury’s Compound
showed a net loss of 31.7 gm.

_Not only did cod liver oil show a marked superiority as a source
of nutriment over Hagee’s Cordial, Vinol, Wampole’s Preparation and
Waterbury’s Compound, but it also showed a remarkable reconstructive
and recuperative power in its ability to enable rats to gain weight
rapidly and steadily after having suffered from a deficiency in
nutriment when fed the four preparations named above._--(_Abbreviated
from The Journal A. M. A., Feb. 20, 1915._)




         DIABETIC FOODS OFFERED FOR SALE IN THE UNITED STATES

                         A Preliminary Report

                      John Phillips Street, M.S.
         Chemist, Connecticut Agricultural Experiment Station
                           NEW HAVEN, CONN.


Recent references in The Journal to gluten flours and certain other
foods offered for the use of diabetics suggest that a preliminary
report of an investigation just about completed in my laboratory by
Prof. L. B. Mendel and myself might be useful to many diabetics and to
physicians who are called on to arrange their dietaries.

In 1906 this laboratory, then under the direction of Dr. A. L.
Winton, who is now with the Department of Agriculture, made its first
examination of commercial diabetic foods. In nearly every year since it
has analyzed various other brands as they appeared on the market. The
demand for the reports on these foods and the many inquiries directed
to us have led us to make a more extensive review of the situation,
and to collect as far as possible all information as to the quality of
the so-called “diabetic” foods offered to the American public. That
the present state of the market is unsatisfactory is well known, and
the inferiority (from the diabetic’s point of view) of many of the
products at present offered is unfortunately familiar to all careful
dietitians. The most dangerous feature of the present situation is
that the unsuspecting patient is led to purchase foods, generally at
an exorbitant price, which are not only misrepresented but which may
be positively harmful to him. In this day of self-medication this
condition is all the greater menace to the diabetic.

Without any attempt to suggest methods of treatment for diabetes, which
is the province of the physician, I may say that it is well recognized
that diabetes is primarily a disturbance of nutrition, in which the
normal ability of the body to make use of carbohydrates is more or
less completely impaired. All recent authorities agree in placing the
chief emphasis on the role of diet in the management of this disease.
Janeway, Benedict, Joslin, Futcher, Falta, Strauss, von Noorden and
other writers on diabetes could be quoted at length in support of this
view. The importance of a restriction of the carbohydrates in certain
cases and certain aspects of diabetes is admitted by practically
all competent authorities. In order to prescribe a starch-free and
sugar-free dietary, which at times is necessary, and to know accurately
the actual amount of these carbohydrates contained in the various
available foods, the physician must rely on the cooperation of the
chemist to furnish this requisite information. This is our excuse, if
any be needed, for our present investigation.

There seems to be some uncertainty as to what sort of preparation is
entitled to be sold as a “diabetic” food. Granting the desirability
of feeding the patient all the carbohydrate he can tolerate, and
recognizing the possible value of the oatmeal, potato, rice and other
treatments, in which a relative abundance of carbohydrate is fed for a
limited period, it would seem that a low percentage of carbohydrates
should be a requisite for a “diabetic” food. Certainly no special food
containing nearly as much carbohydrate as a normal food of the same
class should be entitled to this appellation. Flours, breads, biscuits,
chocolates, breakfast-foods, macaroni, etc., containing only a slightly
lowered percentage of carbohydrates, are no more entitled to be called
“diabetic” foods than the normal foods themselves. It is true that,
when a patient’s carbohydrate tolerance is well established, the use
of foods containing 20, 25 and even 35 per cent. of carbohydrates
might be permissible, when used under the direction of a competent
physician; but when a strict diet is necessary, such as is required to
determine this tolerance, even these relatively low percentages are
objectionable, if not dangerous.

It has been our purpose to include in this investigation, as nearly as
possible, all available data on the composition of all diabetic foods
sold in America. Our report, therefore, will be in part compiled, but
in greater part will consist of our original analyses. It will show 539
analyses of about 400 brands, 200 of which are our own new analyses and
110 those made in this laboratory in previous years.

While the purpose of this preliminary note is to call attention to the
better preparations rather than to emphasize those which are obviously
objectionable and fraudulent, it may not be out of place to summarize
briefly our findings in general. The full details of the investigation
are now being prepared for publication and will shortly be issued as a
report from the Connecticut Agricultural Experiment Station.

One hundred and eight samples of sixty-eight brands of flours and meals
are included in the report. Sixty-seven of these were sold as “gluten”
flours, twenty of which did not even satisfy the low government
standard of 35 per cent. protein. Twelve samples contained less than 13
per cent. carbohydrates, while the remaining gluten flours ranged from
28 to 76 per cent.

The soy bean flours contained from 23 to 26 per cent. of carbohydrates,
the almond meals 17 per cent., and a cotton-seed flour 21 per cent.
Other “diabetic” flours, not specifically sold as “gluten” flours,
contained from 67 to 80 per cent.

The purchaser of gluten flours at the present time may obtain
preparations containing from 87 to 11 per cent. of protein and from 4
to 76 per cent. of carbohydrates, at a cost of from 9 cents to $1.56
per pound.

In view of the government’s low standard for gluten flour, and because
of the wide variations in composition found in the brands at present
on the market, proper protection of the diabetic demands that the
manufacturers of these flours should be required to state on the label
the guaranteed percentages of both protein and carbohydrates.

Three samples of American soft gluten breads contained from 35 to 37
per cent. of carbohydrates; two other brands contained 49 and 54 per
cent., little, if any, lower than found in ordinary wheat bread.

One hundred and forty-eight analyses of 112 brands of hard breads,
biscuits, rusks, cakes and other bakery products are included. Eight
brands of _Luftbrot_, or aerated bread, are reported; two of these
contained from 9 to 12 per cent. of carbohydrates, one 20 per cent.,
two from 31 to 33, and the other three from 44 to 54 per cent.

A number of the brands of rolls, biscuits, breads, etc., showed
satisfactorily low percentages of carbohydrates, thirty-five samples
containing from 1 to 25 per cent., forty-four samples containing from
35 to 55 per cent., and forty-one over 55 per cent., seven of the
latter exceeding 72 per cent.

The cost of the _Luft_ breads ranged from 71 cents to $2.33 per pound.
Biscuits, containing 11 per cent. or less of carbohydrates, cost from
72 cents to $3 per pound. A number of brands, containing from 43
to 77 per cent., cost from $3 to $3.60 per pound. Even the cheaper
preparations, containing from 50 to 77 per cent., no better, and in
some cases even worse, for the diabetic’s use than ordinary bread, cost
from 30 to 41 cents per pound.

Fourteen samples of breakfast-foods were analyzed, five of which
contained from 44 to 54 per cent. of carbohydrates, somewhat lower
percentages than normal. Seven of the ten brands of recommended
macaroni, noodles, etc., contained over 70 per cent. of carbohydrates,
the other three from 42 to 51 per cent.

The analyses are given of fourteen samples of peanut butter, five of
almond paste and butter, two of pine-nuts, one of almonds and ten
of miscellaneous nut foods. As was to be expected, most of these
preparations proved to be suitable diabetic foods. The peanut butters
contained from 12 to 20 per cent. of carbohydrates, with an average
of 15 per cent. The three almond pastes contained from 30 to 40 per
cent., one showing an addition of 11 per cent. cornstarch. The two
almond butters contained only 7 and 8 per cent., the pine-nuts from 3
to 8 per cent., and the almonds 16 per cent. The other nut preparations
contained from 6 to 44 per cent. carbohydrates.

Seven brands of diabetic chocolates contained from 10 to 50 per cent.
carbohydrates, while four cocoas contained from 21 to 51 per cent. The
chocolates cost from $1.63 to $2.06 per pound, and the cocoas were
similarly expensive.

Two sugar-free milks were examined which were true to name, containing
only the merest traces of carbohydrates. One “diabetic” baking-powder
examined contained no starch, another brand from 14 to 16 per cent.
Various jams, preserves and other fruit products were examined which
contained from 1.24 to 7 per cent. of invert sugar, percentages far
below the normal. A currant-juice contained only 0.85 per cent. of
invert sugar. Four of the fruit preparations were artificially colored
with a coal-tar dye--a permitted color to be sure, but seemingly quite
out of place in foods intended primarily for the use of invalids.

As already stated, the main purpose of this investigation was not
so much to detect fraud as to secure information which would be of
benefit to the diabetic and to the physician who seeks foods suitable
for a low carbohydrate diet. In the accompanying tabulations a summary
is given of the brands, _sold as diabetic foods_, which showed less
than 35 per cent. of carbohydrates, arranged in the order of their
carbohydrate[149] content. A date in parentheses following a brand name
signifies that the brand named showed variations in different years; in
other cases, in which the agreement was close, the results have been
averaged.

[149] In the tables “carbohydrates” is used as synonymous with
“nitrogen-free extract.”

           BRANDS SHOWING UNDER 5 PER CENT. OF CARBOHYDRATES

                                                  Per Cent.
    Casoid Baking Powder                              .0
    Dr. Bouma Sugar-Free Fat-Milk                     .0
    Whiting’s Sugar-Free Milk                         .0
    Rademann’s Currant Juice “ohne Zucker”           0.9
    Kalaria Batons (1909)                            0.9
    Glidine                                          1.0
    Casoid Sugarless Marmalade                       1.2
    Casoid Sugarless Jam                             1.5
    Kalari Biscuit                                   1.7
    Casoid Dinner Rolls                              2.1
    Casoid Flour                                     2.2
    Jireh Diatetic Pine Nuts                         3.4
    Rademann’s Preserved Fruits, “entzuckert”        3.5
    Kellogg’s Protose                                3.6
    Barker’s Gluten Food “A”                         4.1
    Kellogg’s Pine Nuts                              4.2
    Kellogg’s 80 Per Cent. Gluten Biscuit            4.4
    Bischof’s Gluten Flour                           5.0

        BRANDS SHOWING FROM 5 TO 10 PER CENT. OF CARBOHYDRATES

                                                  Per Cent.
    Casoid Biscuits No. 2                            5.6
    Rademann’s Preserved Fruits “in eigenen Saft”    5.7
    Barker’s Gluten Food “B”                         5.9
    Kellogg’s Nuttolene                              6.3
    Nashville Sanitarium Nutcysa                     6.3
    Huntley and Palmer’s Akoll Biscuit               6.5
    Nashville Sanitarium Nutfoda                     6.8
    Rademann’s Preserved Fruits “ohne Zucker”        7.0
    Muller’s Tomatoes für Diabetiker                 7.3
    Barker’s Gluten Food “C”                         7.7
    Kalari Batons (1913)                             7.7
    Casoid Biscuits No. 3                            7.8
    Kellogg’s 80 Per Cent. Gluten (1912)             7.9
    Casoid Biscuits No. 1                            8.0
    Kellogg’s Almond Butter                          8.2
    Fromm’s Uni Bread                                9.0
    Metcalf’s Vegetable Gluten (1913)                9.8

        BRANDS SHOWING FROM 10 TO 15 PER CENT. OF CARBOHYDRATES

                                                  Per Cent.
    Kellogg’s Pure Gluten Biscuit (1906)            10.2
    Health Food Pure Washed Gluten Flour (1913)     11.1
    Health Food Alpha Diabetic Wafers               11.3
    Loeb’s Imported Gluten Flour                    11.8
    Health Food No. 1 Proto Puffs                   11.9
    Kellogg’s Potato Gluten Biscuit (1906, 1909)    11.9
    Kellogg’s Nut Meal                              12.1
    Kellogg’s 80 Per Cent. Gluten (1909)            12.5
    Nashville Sanitarium Nut Butter                 13.0
    Kellogg’s Nut Butter                            13.9
    Bischof’s Diabetic Gluten Bread                 14.3
    Jireh Diabetic Baking Powder                    15.0
    Peanut Butter (range from 12 to 20)             15.0

        BRANDS SHOWING FROM 15 TO 20 PER CENT. OF CARBOHYDRATES

                                                  Per Cent.
    Casoid Chocolate Almonds                        16.1
    California Paper Shell Almonds                  16.3
    Callard’s Cocoanut Biscuit                      16.4
    Rademann’s Diabetiker-Chokolade                 16.9
    Health Food Almond Meal                         16.9
    Callard’s Ginger Biscuit                        18.1
    Callard’s Prolactic Biscuit                     19.3

        BRANDS SHOWING FROM 20 TO 25 PER CENT. OF CARBOHYDRATES

                                                   Per Cent.
    Callard’s Almond Shortbreads                     20.7
    Callard’s Casoid Rusks                           20.8
    Rademann’s Diabetiker-Makronen                   20.8
    Health Food Protosoy Diabetic Wafers             21.2
    Jireh Patent Cotton-Seed Flour                   21.3
    Casoid Lunch Biscuit                             21.6
    Rademann’s Diabetiker-Chokolade Biscuit          21.9
    Cereo Soy Bean Gruel Flour                       23.7
    Health Food Salvia Sticks                        24.0
    Health Food Protosoy Soy Flour                   24.5
    Metcalf’s Soja Bean Meal                         25.0

        BRANDS SHOWING FROM 25 TO 35 PER CENT. OF CARBOHYDRATES

                                                   Per Cent.
    Jireh Soja Bean Meal                             25.8
    Brusson Chocolat with Added Gluten               26.4
    Rademann’s Diabetiker-Stangen                    27.0
    Rademann’s Diabetiker-Dessert-Gebäck             27.5
    Nashville Sanitarium Malted Nut Food             27.5
    Metcalf’s Vegetable Gluten (1906)                28.1
    Health Food Pure Washed Gluten Flour (1906)      29.5
    Fromm’s Luft Bread                               30.7
    Spencer’s Almond Paste                           31.6
    Fromm’s Conglutin-Diabetiker-Schokolade          32.7
    Health Food No. 2 Proto Puffs                    33.3
    Ferbuson Gluten Bread                            33.6
    Gum Gluten Breakfast Food                        34.2

--(_From The Journal A. M. A., June 28, 1913._)




                    THE JIREH DIABETIC FOOD COMPANY

  The Company Rises to Explain in a Brief Note of One Thousand Words


Exploiters of fraudulent and dangerous pharmaceutical products have
no love for The Journal. When such products are exposed in these
pages, their manufacturers seldom reply to the criticisms except
through indirect channels. Then the replies are frequently replete
with billingsgate and denunciation of The Journal and its editor, the
Association and the medical profession generally.

We have, at different times, had to call the attention of the public
and the medical profession to the fraudulence and dangers of some of
the products of the Jireh Diabetic Food Company. We have shown that
the Jireh company lied boldly and directly so long as it could do so
without getting into the courts, and that it lies inferentially still;
we have shown that Jireh flour had practically as much carbohydrate
as ordinary flour; we have shown that, probably to escape prosecution
under the Food and Drugs Act, the Jireh concern has coined the word
“diatetic” and substituted it for the word “diabetic,” which used to
appear in its advertisements; we have shown that the claim made for
the Jireh products that they are “starch-changed” was a false one, and
that the company has modified this to “starch-treated,” presumably to
avoid being haled into the courts under the “pure food law;” we have
shown, in short, the unreliability both of the Jireh concern and of its
products.

Two or three weeks ago a New York physician wrote to The Journal for
information regarding the Jireh products. We sent him such matter as
had been published on the subject, and he showed this material to
a patient who was using the Jireh products. The patient, in turn,
expressed her opinion of the product to the retailer from whom she
had been purchasing it. A day or two later she received a letter from
the Jireh Diabetic Food Company, which, in spite of its length and
discursiveness, we publish in full, so that physicians may know just
what this company thinks of them. The letter, which is dated Nov. 20,
1913, really belongs in the “Knocks and Boosts” department, but its
length prevents its use there. Here it is:

    “We learned through Mess. Cushman Co. that you are a constant user
    of Jireh Foods for some time past, and that recently a certain
    derogatory statement was brought to your attention relative to our
    product. We feel an explanation is due you for two reasons.

    “First, because we want you to continue using Jireh Foods and thus
    receive the benefits of the same; and second, that the remarks
    called to your attention are not only libelous, but are in no way
    pertinent enough to detract from the value of our product. In
    the first place, we want to state that the particular journal in
    question has been endeavoring to injure our business for some time
    past and that we are not the only descent [_sic_] manufacturers of
    foods that are suffering in this way at the hands of the editors
    of this particular magazine. Since you are interested in the Jireh
    Foods, you may be more interested to learn why this particular
    magazine is so anxious to injure our reputation. The reason is very
    obvious if you will take into account the fact that this magazine
    is the official journal of the medical association of this country
    which is known as the backer of the medical trust. It is very clear
    to you, no doubt, that there are some physicians, particularly
    those that are associated with the magazine, who are anxious to
    stamp out of existance [_sic_] such concerns that offer a bona fide
    product, a meritorious product which actually produces the required
    results, without the aid of medicine.

    “For the particular maladies for which we offer our foods, we
    have been very successful, consequently the antagonism on the
    part of this particular journal is the logical thing. In addition
    to this, however, and perhaps more important to us, is the fact
    that the editors of this magazine have made it known to us that
    they will not approve of our product until such time that we
    care to be dominated by the moving influence of the magazine in
    question. They want us to supply them with the private formula
    which we use for manufacturing our foods and to enlighten them
    and show them the various processes applied to our products to
    produce the required results. As a bona fide and ethical business
    house, we absolutely and unqualifiedly refuse to comply with this
    wish, and will always refuse to do so, no matter how often they
    may attack us. We stand strictly on principle in this matter and
    propose to run our business in our own way, and will not, under any
    circumstances, allow a magazine or anybody else dictate to us under
    what conditions we are allowed to do our business.

    “The remarks which they make would perhaps hurt us some if they
    emanated from a source that was qualified to judge the merits of
    our food. The absurd side of the issue, and perhaps the comical
    side of it, is the fact that the honorable gentlemen who assume
    to condemn a product, know less about the disease for which the
    product is offered, and much less about diet and foods than the
    average layman. Consequently, we consider it simply absurd to allow
    them to step into our business and dictate policy to us. This is
    the jist [_sic_] of the discontent that prevails between the
    magazine editors and ourselves, and as long as we refuse to comply
    with their wish, we certainly cannot expect them to speak well of
    us. It has become a notorious fact in the medical profession that
    their criticisms are almost valueless, inasmuch as they stop at
    nothing in order to create sensationalism, and have attacked not
    only ourselves, but every bona fide manufacturer of foods and drugs
    in this country who has refused to fall in line with them.

    “This explanation, we trust, will appeal to your good judgment and
    will convince you of what is said about us is untrue. Furthermore,
    our business has grown to colossal proportions, notwithstanding
    their endeavors to crush us. We call your attention to a most
    peculiar fact: that is, that they make no comment whatsoever as
    to the product and its therapeutic value in the treatment of
    diabetes. You notice they make an awful play on our literature,
    which was changed merely to suit conditions in business. We also
    wish to call your attention to another peculiar fact, and that
    is that a great majority of the physicians who are in with this
    magazine readily recommended our foods, and we also believe that
    your physician, after reading this letter, will feel the same way
    as most physicians do in relation to our foods. We believe that
    your physician is perfectly willing to be convinced that our foods
    are as represented to be, and the very best clinical evidence as
    this is the effect our foods have had upon you. Finally, if the
    foods are palatable and wholesome and have alleviated the annoying
    symptoms of Diabetes, then why should you be guided by the opinions
    of demagogues and yellow journalists?

    “You may be pleased to learn that our foods have received the
    attention of Dr. Wiley, the well-known chemist and food scientist
    of this country, and we have now in our possession his reports
    showing the very high standard of our foods. This, in our opinion,
    is of more consequence than all the harangue which those venerable
    gentlemen of the magazine may indulge in.

    “We want to convince you without an atom of doubt that we are
    honest and bona fide in everything we say, and we extend to you a
    hearty invitation to call at the first opportunity and shall be
    glad to tell you anything you may wish to know. Thus awaiting the
    pleasure of this visit, we beg to remain

                          “Yours very truly,
                                              “Jireh Diabetic Food Co.”

We learn from this letter that The Journal’s “remarks” on the Jireh
product are “libelous.” We have made them many times and for several
years past; if libelous, the manufacturer has excellent grounds for
damages. We learn, too, that our remarks “are in no way pertinent
enough to detract from the value” of the Jireh products. Why, then,
take any notice of them? We learn, moreover, for the hundred-and-first
time, that The Journal is the official organ of the “medical trust,”
and we are told that “there are some physicians” that are opposed to
the Jireh Foods because these products cure diabetes without the use of
medicine! The Journal, so the company says, wants the Jireh Diabetic
Food Company to supply its “private formula” and to show the “various
processes” by which the Jireh products are made. Such statements
indicate that the Jireh Diabetic Food Company does not confine its
mendacity to the mere advertising of its product, where the necessity
for lying is naturally great.

The ambiguous remarks regarding Dr. Wiley are evidently intended to
convey the idea that the doctor approves of the Jireh products. Dr.
Wiley was sent a copy of the Jireh letter and his attention directed to
the statements appearing therein regarding himself. He replied:

  “In regard to the Jireh products and their claims that our reports
  show the very high standing of their foods, I would say that I
  consider such a claim entirely false.... We did examine five or six
  products in our own laboratory, however, and found them to be of very
  fair composition per se, but _not of a composition that afforded any
  legitimate basis for their claims_. _We entirely disapproved ...
  three of the products making special claim as to their fitness for
  diabetics._ [Italics ours.--Ed.] These were the Wheat Nuts, the Jireh
  Flour and the Patent Barley. Two of the other products were passed
  with a non-committal rating, which means that they are not actually
  disapproved, but the star marking is not accorded. These products
  were the dietetic Rusks and the Macaroni. For the latter especially
  no specific claims seem to be made. We called attention, however, to
  the generally objectionable juggling of terms indulged in by this
  company....”

The Jireh concern says that in spite of the efforts of The Journal to
“crush” it, “our business has grown to colossal proportions.” Of this
the New York physician who sends us the letter says: “Their ‘colossal
proportions’ must have received a slight jar or they would not have
taken time to write such a letter.”--(_From The Journal A. M. A., Dec.
20, 1913._)




         THE NAME “EPINEPHRIN” VERSUS THE NAME “ADRENALIN”[BL]

[BL] A reprint of the letter from Parke, Davis & Co. referred to in
this article, together with the discussion thereof, will be sent on
receipt of a 2-cent stamp.


There are thirty or more different brands of the blood-pressure-raising
principle of the suprarenal gland on the market, five being in this
country alone. These products are identical so far as their chief
constituent is concerned; they differ, however as to the solvent and
preservative used. The processes of manufacture of some of them are
patented; all of them are sold under trade names.

Until two years ago there was no common name applicable to this active
principle; whenever reference was made to it a trade name had to be
used. At that time the Council on Pharmacy and Chemistry, realizing
the need of a generic term, adopted “epinephrin” as such a term. This
name was selected in part because Abel had adopted it in 1899; in part
because, so far as could be discovered, it was the name under which,
through Abel’s publications, the substance first appeared in medical
literature; and in part because it seemed to be the only suitable one
not already appropriated by some commercial firm.

After the publication of the Council’s report, The Journal began
gradually to use the term in those cases in which it seemed clear that
the proprietary term was used in a generic sense. The substitution
of the name “epinephrin” for “adrenalin” in the abstracts of certain
foreign articles caused Parke, Davis & Co. to write a letter of
protest which called forth the discussion appearing in the Propaganda
Department of this issue.

The amount of space devoted to this matter may be criticized and
considered unwarranted by those who do not realize the importance of
the subject. The criticism is to a certain degree, just. The somewhat
inordinate length of the article is due in part to the unfortunate fact
that, in availing themselves of the courtesy extended by The Journal,
Parke, Davis & Co., in their reply, have injected into the discussion
side-issues, such as the priority of discovery, the superiority of
their product, etc., whereas the question under discussion is simply
that which relates to the name. It is, however, not altogether a matter
for regret that the discussion has been thus broadened, for it brings
before our readers many facts regarding the discovery of an important
medicinal agent that are not generally known, at least by physicians.

Whether or not “adrenalin” is superior to “adrin,” “suprarenalin,”
“suprarenin,” “adnephrin,” or to any other of the preparations is
entirely immaterial in this connection. The point is that the active
principle of the suprarenal gland is on the market under various trade
names, and that a name common to all has been selected to be used
when no particular brand is referred to. The fact that “adrenalin” is
regarded by many, both here and abroad, as a common, generic name does
not alter the fact that it is claimed as a trade name by a commercial
house and, therefore, presumably at least, cannot be used except as
such.

Among the facts brought out in this discussion, one stands out clearly:
that Abel deserves as much credit for the discovery as any other man,
if not more. Credit belongs to Takamine for making use of reactions
which were already well known. His work was a step in the progress
of knowledge of the substance, but it was a step which he could not
have taken but for what others, Abel especially, had accomplished and
published. Abel’s magnificent work, covering several years, deserves
as much credit, to say the least, as that of Takamine. And it should
be kept in mind that the former worked in the interest of science,
and published his results for the benefit of all. He had no hope of
pecuniary reward, asked for none, and received none.

Let us repeat, however, that these are side issues; the question
is simply that of name. It cannot be too strongly emphasized that
“epinephrin” is a true scientific name for the active principle of the
suprarenal gland, and that it should be used on all occasions when
the active principle and not some particular firm’s make is referred
to.--(_From The Journal A. M. A., March 25, 1911._)




                          THE HORD SANITARIUM


    “_Propaganda for Reform Department_:--One often hears it declared
    that the present time is the worst ever known for a young man to
    make a fortune or get a start to one.

    “All a mistake, as the enclosed letter from the Hord Skinatarium
    will certify. At $25 this equals $2,500 for 100 cases, $25,000 for
    1,000 cases, and all any young doctor needs is a little push to be
    as rich as J. D. in a few months. If you know of any cases send ’em
    in and get your $25. “K. T. Crossen, M.D., Carbondale, Ohio.”

With his letter Dr. Crossen encloses a circular letter from the Hord
Sanitarium, “For Liquor and Drug Habits, A Cure Positively Guaranteed,”
and an unsigned check on the Farmers National Bank, Shelbyville,
Indiana, for $25 payable to himself. Printed on the check in large red
letters is the statement:

“THIS CHECK WILL BE COUNTERSIGNED UPON YOU BRINGING OR SENDING US A
PATIENT.”

[Illustration: Fig. 1.--Photographic reproduction of the unsigned check
that the Hord Sanitarium sends to physicians.]

[Illustration: Fig. 2.--Part of the letter that accompanies the check
for twenty-five dollars.]

The Journal has received these circular letters and unsigned checks
by the hundreds from physicians who have expressed very frankly their
contempt of the kind of business the Hord Sanitarium is engaged in.
These correspondents seem to have overlooked the fact that The Journal
has already commented editorially on this particular insult to the
medical profession. For this reason we reprint the editorial note,
“Ethics!” from The Journal, Sept. 27, 1913:

  “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 GERMAN PROPAGANDA FOR REFORM

               Appreciation by a German Lay Publication


Of all those interested in the reform of the proprietary drug business,
the patient has the most at stake--and the public is beginning to
understand this fact. If physicians are slow in recognizing the
necessity for improvement, laymen will eventually demand reform in
their own interests. The movement, therefore, will not be halted by the
indifference of the unprogressive element of the medical profession.
New evidence of this fact is furnished by a recent editorial comment by
the German lay periodical, _Wohlfahrt und Wirtschaft_ (Public Welfare
and Economics), on the Arzneimittel-Kommission, a German organization
resembling in purpose if not in scope the Council on Pharmacy and
Chemistry of the American Medical Association.

  “One would suppose,” says this lay journal, “that medicinal
  preparations which did not win the approval of scientific medicine
  would not be used by any physician, but the contrary is the case. In
  fact, those new medicinal preparations or old ones with new names
  that flood the market far surpass the actual demand according to the
  judgment of all authorities. The impartial advisers in this field,
  practitioners and members of medical faculties, demand, as a matter
  of public welfare that this overproduction should be regulated in
  the interests of the sick, the consumers; but, unfortunately, a
  medical man, like any one else, is impressed by the suggestion from
  advertising done on a large scale.”

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._)

The movement for reform in Germany has apparently gathered sufficient
impetus among the laity to go on of its own momentum, even though,
with one exception, German medical journals, reluctant to lose the
advertising of drug houses by publishing criticisms of their wares,
have become lukewarm, if not antagonistic, to the efforts of the
ArzneimittelKommission. The one exception is the _Therapeutische
Monatshefte_, which, in its May issue, quotes in full the editorial
just referred to and makes the following comment: “These lines reveal
such intimate knowledge and correct judgment of existing conditions
that the suggestions advanced in regard to possible reforms deserve
serious consideration. For us physicians the editorial is important in
that it recognizes that the efforts of the profession to accomplish
the reforms aimed at are rational and beneficial from the standpoint
of general economics and the public welfare.”--(_From The Journal
A. M. A., June 13, 1914._)




             THE GERMAN COUNCIL ON PHARMACY AND CHEMISTRY


At the meeting of the German Congress for Internal Medicine in 1911, a
German council on pharmacy and chemistry, Die Arzneimittelkommission
des Kongresses für innere Medizin, was organized, with purposes
similar to those for which the Council on Pharmacy and Chemistry
of the American Medical Association was created. As practically
nothing has been done to restrict the advertising of proprietaries
in Germany, the task of the commission was tremendous. Its work has
been noted in The Journal from time to time.[150] A review of what has
been done up to the present is given by Heubner,[151] and indicates
some differences between conditions in Germany and this country.
The members of the commission found confronting them the same evils
that met the early efforts of the American council, namely, dominant
proprietary interests, a subservient and financially interested
medical press and an indifferent profession. Moreover, the pecuniary
interest of the editors of German medical journals in the profits
of advertising seems to be more direct and more important than in
America. The German commission, in Heubner’s opinion, was placed at a
disadvantage compared with the American council from the first. Funds
for investigation were lacking, and the commission had no journal in
which its objects could be presented to the medical profession. At the
beginning of its work the commission established rules very similar to
those of the American Council on Pharmacy and Chemistry. It listed the
articles advertised in German medical journals in three groups: (1)
those which conformed to the rules of the commission in the method of
advertising; (2) those which violated the rules, and (3) those whose
classification could not be determined. This amounted to an attack
on advertising in medical journals and was undoubtedly premature. It
aroused at once the antagonism not only of the proprietary interests
but also of the medical press.

[150] A German Council on Pharmacy and Chemistry, Propaganda, The
Journal A. M. A., July 27, 1912, p. 291; Current Comment, Aug. 10,
1912, p. 452. Reform in the Advertising of Proprietary Medicinal
Articles, Berlin Letter, Dec. 7, 1912, p. 2081. Heubner, W.: Wünsche
zur Reform des Arzneivertriebes, Therap. Monatsh., 1912, xxvi, No. 11;
abstr., The Journal A. M. A., Dec. 14, 1912, p. 2195.

[151] Heubner: Die Arzneimittelkommission des deutschen Kongresses für
innere Medizin, Therap. Monatsh., 1914, xxviii, 185.

  “The establishment of the lists of medicines encountered opposition
  or hindrance from three sources,” says Heubner, “first, from the
  pharmaceutical and chemical manufacturing interests; second, from
  the medical press, and third, from the medical profession itself.
  The ‘trade’ naturally was irritated at any attempt to interfere with
  ‘business,’ and brought forward a number of reasons why the procedure
  adopted by the commission was especially calculated to injure the
  ‘general welfare.’ This opposition was to be expected and might be
  disregarded. The extent to which the medical press was dependent on
  the drug trade, however, had not been foreseen. The same journals
  in which for many years all sorts of articles on the evils in the
  trade in medicines had appeared showed themselves decidedly cool or
  emphatically critical toward the accomplished fact of the ‘lists of
  remedies.’ In hastily written articles a whole series of mistakes
  in general and in particular were published.... One thing, however,
  was not explicitly stated--namely, that in any event the lists of
  remedies must be rejected, and for this the cogent reason was anxiety
  in regard to advertisements. The editors had been sufficiently
  warned. The _Therapeutische Monatshefte_, which had not submitted to
  the wish of a great industrial firm in another matter, was punished
  for this offense by the withdrawal of all its advertisements. None of
  the other publishers wanted to risk such a reduction in income, and
  none of the editors was willing to undertake the risk to the extent
  of a conflict with his publisher. Curiously, the idea does not seem
  to have arisen that if the threatened publishers had made common
  cause they might have freed their editors from the distressing burden
  of improper advertisements with scarcely any risk at all.”

Heubner believes that another motive influencing the editors was the
fact that their efforts in behalf of reform, sporadic and ineffective
at the best, had been replaced by the propaganda of the commission. It
seems clear that the opposition from the press was due not to principle
chiefly but to financial pressure. The editors, however unworthy their
motives, nevertheless exerted, as in other cases, a powerful influence
on public opinion. Among the medical public, opposition was encountered
because many physicians were interested--sometimes financially--in one
or more of the discredited remedies. The mass of the profession either
were not interested or misunderstood the position of the council.

Despite the obstacles encountered and the difficulties involved,
the council and the Congress of Internal Medicine have not wavered.
Heubner, however, sums up the work of the council in a rather
pessimistic tone, as follows:

  “What are the results of the great amount of labor, self-sacrifice,
  hopeful courage and wasted money? Two journals pretend to be doing
  wonders in that they are eliminating some of the worst misstatements,
  distortions, obscurations and concealments of truth in the
  advertisements. Physicians at certain intervals receive lists of
  preparations, the manufacturers of which as a rule do not need to
  pay any attention to the council because their dealings are directly
  with the public, because their advertisements are usually made to
  physicians by word of mouth, or their preparations have already a
  sufficient reputation--no matter for what reason....

  “There is little doubt that the results have not paid for the
  efforts expended. There is no doubt that the whole enterprise will
  amount to nothing more than a splash in the water if the work is not
  extended, just as a preliminary skirmish must remain without effect
  unless followed up by the main army. The main army in this case is
  the German medical profession. However gratifying the progressive
  attitude of some individuals and, in fact, of some associations, such
  as that of Wurtemburg, may be, the fact remains that the profession
  [in Germany] is not advancing but rather tends to retrograde. The
  support which the executive committee of the Aerztevereinsbund at
  first accorded to the efforts of the council was later limited. All
  further progress depends on the developments of the near future. Will
  sufficient power be given to the German medical profession after
  settlement with the insurance societies to permit them to follow the
  example of their American colleagues?

  “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._)




                  GRAND PRIX AND GOLD MEDALS FOR SALE

           Max Kaiser Offers to Procure “Awards of Merit” at
               Various International Exhibitions--Price,
                         Four Hundred Dollars


There was a time when the manufacturer who could point to the “Grand
Prix” or the “Gold Medal” his product had been awarded at some
exhibition was considered to have a valuable advertising asset.
Possibly there was a time when medals and prizes were awarded with an
eye single to the excellencies of the goods and bore no relation to the
amount of money paid by exhibitors to the organizers of the exhibition.
Possibly there are, even today, occasional awards made on a basis of
pure merit, but they are probably few and far between. The matter which
follows throws an interesting light on this subject. Within the past
two months manufacturers have received a letter on the stationery of
the “International Exhibition, Paris, 1914.” The letter came from the
“Commissioner-General” of the exhibition, one Max Kaiser, 24 Holborn,
London, E. C. Here it is:

    “_Dear Sirs_:--I beg to draw your attention to the great
    INTERNATIONAL EXHIBITION of Alimentation, Pure Food, Hygiene,
    Beverages, Drugs and allied trades, which will be held at Paris
    in March, 1914, inviting you to partake with your manufacture at
    this INTERNATIONAL EXHIBIT. I beg to point out that the aim of this
    Exhibition is to introduce Foreign Manufactured Goods, Proprietary
    Articles, Patents, etc., to the French and Foreign Markets, and to
    open up or extend new channels for such goods.

    “A Commercial Office at the Exhibition Building, under the
    Commissioner General’s own supervision, with a well-trained staff,
    will do everything required in the interest of Exhibitors, such as
    effect sales by circularizing, or inviting prominent buyers to call
    at your particular stall to judge for themselves the merits of your
    Exhibit, and in this way bring the American Manufacturers in direct
    touch with the Foreign Markets and the Buying Public.

    “This Commercial Office will also negotiate with the
    Representatives on your behalf: at the same time undertaking to
    arrange your Exhibit, supply all necessary fittings, decoration,
    the display, maintenance, repacking and returning of the Exhibit,
    and also to represent you before the Public and Jury in such a
    manner as to make certain that your Exhibit shall be awarded first
    honors (GRAND PRIZE OR GOLD MEDAL).

    “You will understand that such an award obtained at this
    INTERNATIONAL EXHIBITION means an everlasting advertisement as
    an official acknowledgment and convincing proof to the Superior
    Quality of your goods, and will certainly put you in front of your
    competitors on the home market, and naturally increase your sales
    considerably.

    “I might mention here that many a big business has been built up
    and small concerns been prominently brought to the notice of the
    Public by Exhibiting. In many cases I have been able to interest
    Authorities and Reigning Houses in Exhibits under my care, and I
    have opened up or extended markets for firms Exhibiting under my
    direction.

    “I enclose herewith a list containing some of the most prominent
    American and English Firms whom I have represented at European
    Exhibitions and for whom I achieved splendid results.

    “I could arrange your Exhibit for the amount of $400, to be paid
    one-half on allotment and the balance on receipt of an award (Grand
    Prize or Gold Medal).

    “Trusting that this will be of interest to you, I shall be pleased
    to receive your reply by return mail, and give you any further
    particulars you may desire. Yours faithfully,

                                              The Commissioner General.
                                                   (Signed) Max Kaiser.

    “I can also accept Exhibits on exactly the same terms for the
    INTERNATIONAL EXHIBITION, Rome, 1914.”

[Illustration: Photographic reproduction (reduced) of the letter-head
of the stationery on which Max Kaiser offers to “make certain”
that those who exhibit their products under his direction--price,
$400--shall receive a Grand Prix or Gold Medal.]

The list Mr. Kaiser enclosed with his letter was a printed sheet,
giving the names of a number of American and British manufacturers
whom Kaiser claims to have “represented” at various “International
Exhibitions.” The majority of the concerns named are breweries, but
there is a good sprinkling of “patent medicine” companies and a few
miscellaneous manufacturers. In the American list there are two nostrum
concerns named that will be more or less familiar to our readers. They
are:

_Alonzo O. Bliss Company_, Washington, D. C. This company sells “the
Great Blood Purifier, Kidney and Liver Regulator” known as “Bliss’
Native Herbs.” According to Max Kaiser, the Alonzo O. Bliss Company
obtained one Grand Prize and one Gold Medal.

_Waterbury Chemical Company_, Des Moines, Iowa. This company exploits
what used to be known as “Waterbury’s Cod-Liver Oil Compound,” which,
from its lack of cod-liver oil,[152] was impelled to change its name
to “Waterbury’s Compound.” Kaiser states that the Waterbury Chemical
Company received four Grand Prix and four Gold Medals.

[152] See Waterbury’s Compound, pp. 54, 57 and 291.

Briefly the proposition submitted by Max Kaiser is this: For $400 he
will make all arrangements for a manufacturers’ exhibit at one of
the numerous “International Exhibitions.” Further, he practically
guarantees that this exhibit will receive either a “grand prize” or a
“gold medal”; in fact, the manufacturer need not complete the payment
of Kaiser’s charges until the prize or medal has been awarded!

The value of “awards” obtained in this way is, of course, evident. As
the public becomes better informed on the subject of international
exhibitions, the grand prix, gold medals, and other “awards” made at
such exhibitions will be appraised at their true value.--(_From The
Journal A. M. A., March 14, 1914._)




                       THE HYPOPHOSPHITE FALLACY

    An Example of the Perpetuation of a False Theory by Advertising


A false therapeutic notion born of speculation soon dies a natural
death if exposed unsupported to the cold world of facts, but when
nursed by commercial interests it may be kept alive for generations.
Interesting examples of this, to name but two or three, are the
misconceptions perpetuated during the past half century concerning
“lithia,” the “natural” salicylates and the hypophosphites.

Take, for instance, the lithia delusion. The supposed solvent powers
of lithium compounds for uric acid were soon disproved to the
satisfaction of scientists, but proprietors of lithia waters and
nostrums for gout and rheumatism still harp on the old string and
utilize long-exploded theories. Take, again, the alleged superiority of
“natural” to “synthetic” salicylates. In spite of experimental proof
to the contrary, proprietary interests have been able for twenty years
to persuade a large part of the medical profession that the effects of
pure salicylic acid made artificially differ from the effects of the
same substance obtained from natural sources.

The altogether undeserved continued popularity of hypophosphites
affords a striking example of the influence of advertising in
perpetuating therapeutic error, for hypophosphites are given on a
theory long since disproved. It may be interesting to trace the origin
and history of the theory on which the practice of prescribing the
hypophosphites is founded. The early part of the last century was
prolific in chemical discoveries, and, as a corollary, in chemical
theories of disease. Many of the theories arose from the hasty
application of the chemical properties of new elements and compounds
to the explanation of the processes in the living body, without due
consideration of the conditions prevailing in the animal organism.

                        THE ELEMENT PHOSPHORUS

The element phosphorus is eager for oxygen and readily oxidizable. When
taken into the system it acts as a violent poison, and, in view of
this, it was at first supposed--although the supposition was based on
no scientific data--that it would prove to be a powerful therapeutic
agent when given in minute doses. In its elementary form, phosphorus
is difficult to handle, and therefore not convenient for use. Hence it
was natural that a compound should be sought which could be used as a
substitute for the element.

Broadly speaking, phosphorus forms three classes of salts varying in
the degree of oxidation: the phosphates, containing the most oxygen,
the phosphites, containing less, and the hypophosphites, least of the
three. The phosphates, being saturated with oxygen, undergo little
change in the body, and because of this were thought to be of little
value in therapeutics. The phosphites contain less oxygen, are unstable
and are not used in medicine. The hypophosphites, containing still
less oxygen, stand nearest to elementary phosphorus and are easily
decomposed and readily oxidized to phosphates. Hence the theory that
the hypophosphites would furnish an admirable source from which to
obtain the action of the element phosphorus.

                          CHURCHILL’S THEORY

The hypophosphites were introduced into medicine about 1855, as a
substitute for elementary phosphorus by a Dr. Churchill of Paris, and
later of London, who advocated their use as a specific remedy for
consumption. Churchill conceived the theory that phthisis is caused by
a lack of oxygen in the tissues; he therefore sought an agent capable
of increasing oxidation. He was led to the use of hypophosphites
for this purpose on the supposition that phosphorus exists in the
organism as a biologic element in a lower degree of oxidation than
the phosphate. He supposed that this form of phosphorus acts by its
chemical affinity as an initiatory agent in attracting and utilizing
the inspired oxygen. He believed that when this form of phosphorus,
which he called the “phosphide element,” is deficient in quantity
(because it had been oxidized into phosphate, or because the supply
from natural sources was deficient), the degree of oxidation of
the tissues is less than normal. Therefore he advocated the use of
hypophosphites to supply the lacking oxidizing constituent. He believed
this “phosphide element” not only to be essential for the oxidation of
the tissues, but also to be the source of energy of the nervous system.

                               THE FACTS

The theory was a pretty one; the facts, however, did not support it.
Subsequent investigations indicate that instead of consumption being
due to a lack of oxygen, there is in that disease really an increased
oxidation; in other words, the respiratory exchanges in this disease
are exaggerated. The existence in the system of a form of phosphorus
less highly oxidized than the phosphates is unproved. No evidence
has been produced to show that phosphorus acts as an energizer of
oxidation. There is no proof that the hypophosphites enter into general
metabolism or affect disease processes in any way. Not only is there no
scientific evidence for the utility of the hypophosphites, but science
has long since demonstrated their worthlessness.

In 1895 Boddaert[153] published researches showing that hypophosphites
are rapidly eliminated through the kidneys unchanged. Similar
results have been reached by Paquelin and Joly, who attributed to
the hypophosphites only the action of diuretics. In 1901 Massol and
Gamel[154] found by animal experimentation that the hypophosphites did
not act as diuretics, but that the hypophosphorous acid was completely
eliminated in the form of sodium hypophosphite. The urea was not
increased and the relation of urea to total nitrogen remained the same.
Their results indicated no increase of oxidizing actions within the
system. Finally, Massol and Gamel examined the urine of patients taking
hypophosphites and found the same conditions: the results were the same
as in the experiments on animals.

[153] Boddaert: Arch. de pharmacod., 1895, 2.

[154] Massol and Gamel: Jour. de pharm. et de chem., 1901, xiv, 337.

                       PROPRIETARY THERAPEUTICS

In spite of these facts the hypophosphites continue to be employed
by many practitioners. Why? Because the theory, being plausible at
the time when such chemical theories were popular, gained a certain
recognition and was accepted without scientific investigation. Thus
the hypophosphites came into use. It was not long before they were
taken up by certain manufacturers, and the theory on which their use
was based became a commercial asset. As a result the theory, which
uncommercialized would have died of inanition, was kept alive by
continued advertisement.

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._)




                         BUFFALO LITHIA WATER

       Contains One-Fifth as Much Lithium as Potomac River Water


Some years ago, Alexander Haig evolved the theory that most diseases
are due to uric acid. The data on which he founded his theory were
not corroborated by scientific men, and investigation showed that his
methods were unreliable. In spite of the fact that Haig’s theories are
utterly discredited, and have been for years, the uric acid fallacy
still persists, although it is now largely confined to the public.
Shrewd business men, especially those who are more intent on making
money than they are concerned with the manner in which that money is
made, owe much to Haig’s theory. As a business proposition, uric acid
has been one of the best-paying fallacies on the market--and possibly
still is. It is only necessary to refer to The Journal’s recent
article[155] on the Turnock mail-order medical fraud to emphasize this
fact.

[155] The Journal A. M. A., May 23, 1914, p. 1675.

[Illustration: Showing how “Buffalo Lithia Water” in the course of time
became “Buffalo Lithia _Springs_ Water.” The government has shown that,
to obtain a therapeutic dose of lithium from Buffalo Lithia Springs
Water, it would be necessary to drink 200,000 gallons of the water. The
government also declared that Potomac River water contained five times
as much lithium as does Buffalo Lithia Springs Water.]

Contemporary with, and to a certain extent a corollary of, the uric
acid fallacy was another, _viz._, that lithium would eliminate uric
acid. This at once gave a good working principle for the proprietary
men. Uric acid, we were told, causes disease; lithium, we were also
told, would eliminate uric acid; therefore, lithium is the new elixir
of life! Could anything be simpler?

Accepting this theory, it was inevitable that mineral waters containing
lithium salts should become highly popular. Many exploiters of mineral
waters began to place most emphasis on the lithium salts in their
waters even in those cases in which lithium was present in such
infinitesimal amounts as to render its detection impossible by any but
spectroscopic methods.

One of the best known, because most widely advertised, of the so-called
lithia waters is Buffalo Lithia Water--or what used to be called
Buffalo Lithia Water. After the Federal Food and Drugs Act came into
effect, by which falsification on the label was penalized, the name of
Buffalo Lithia Water was changed to Buffalo Lithia Springs Water. The
reason for this change was that when Buffalo Lithia Water was subjected
to examination by the government chemists it was found to contain so
little lithium that the amount present was unweighable--it could be
demonstrated only by the spectroscope. It was evidently, therefore, not
a lithia water in that it did not contain--at least in quantities that
could be consumed--an amount of lithium that would give the therapeutic
effects of lithium: Possibly the company imagined that by changing the
name from “Buffalo Lithia Water” to “Buffalo Lithia Springs Water” it
had cleverly evaded the federal law. Their argument was to this effect:
The springs from which this water is taken are known as Buffalo Lithia
Springs; therefore, it is not a misstatement of facts to call this
Buffalo Lithia Springs Water.

                        WHAT IS A LITHIA WATER?

The Supreme Court of the District of Columbia, holding a district
court, has recently given an opinion on the Buffalo Lithia Springs
Water case. The findings of the court are refreshingly simple,
and characterized by that broad commonsense view that is becoming
increasingly more common among modern jurists. Read Judge Gould’s
opinion as to what constitutes a lithia water:

  “Speaking generally, and as an individual of average intelligence and
  information, it would seem that if one were offered a water which the
  vendor told him was a ‘lithia’ water, one would have the right to
  expect enough lithium in the water to justify its characterization
  as such, thus differentiating it from ordinary potable water; and
  this amount would reasonably be expected to have some effect on the
  consumer of the water by reason of the presence of the lithium.”

Certainly a reasonable attitude, and one which the man in the street
not only can understand but will agree with. Then came the question as
to the actual lithium content of Buffalo Lithia Springs Water, and the
court said:

  “For a person to obtain a therapeutic dose of lithium by drinking
  Buffalo Lithia Water he would have to drink from one hundred and
  fifty thousand to two hundred and twenty-five thousand gallons of
  water per day. It was further testified, without contradiction, that
  Potomac River water contains five times as much lithium per gallon as
  the water in controversy.”

                           SOME TESTIMONIALS

Here, then, is a water that has for years been advertised first, in
medical journals, and later, in lay publications, as a “lithia water”
yet, actually, it contains less lithium, five to one, than is to be
found in ordinary river water. This is a point for physicians to ponder
well over. Turn to the back volumes of medical journals and read, both
in the advertising and reading pages, the elaborate testimonials,
given by men high in the medical profession, on the marvelous effects
obtained by the use of Buffalo Lithia Water. Read the following in
light of the fact that the water from the Potomac River contains five
times as much lithium as Buffalo Lithia Water:

    “In the class of cases in which lithia, soda and potash are
    regarded as most specially indicated, I have obtained far better
    results from the Buffalo Lithia Waters than from any of the
    preparations of the lithium salts of the Pharmacopeia.” (_Statement
    by a member of the Faculty of Medicine of Paris, France_, _etc._)

    “Its [Buffalo Lithia Water] therapeutic effects, in my practice,
    have been vastly superior to those obtained from Lithia Tablets or
    other Lithia preparations.” (_Statement by an ex-president of the
    University College of Medicine, Richmond, Va._, _etc._)

    “It [Buffalo Lithia Water] is strikingly superior to emergency
    solutions of lithia tablets and pure water, even where the said
    solution is an exceedingly strong one.” (_Statement by a former
    Professor of Clinical Medicine of the College of Physicians and
    Surgeons, New York, and vice-president of the American Medical
    Association_, _etc._)

    “When Lithia is indicated, I prescribe Buffalo Lithia Water in
    preference to the Salts of Lithia, because it is therapeutically
    superior to laboratory preparations of Lithia.” (_Statement
    by a former professor in the Medical College of Virginia and
    ex-president of the Medical Society of Virginia_, _etc._)

    “Buffalo Lithia Water ... by its richness of composition of Lithia,
    is of marvelous efficacy, in cases of gout, of chronic, articular,
    and muscular rheumatism ...” etc. (_Statement by former Physician
    in Ordinary to the Pope; Member of Academy of Rome_, _etc._)

    “I have tried carbonate of lithia dissolved in water in various
    proportions; but it certainly does not have the same effect as
    Buffalo Lithia Water.” (_Statement by a former Surgeon-General of
    the U. S. Army_, _etc._)

These are but a few of many testimonials from physicians that might
be quoted. They are interesting from many points of view. They show
the worthlessness of testimony of this sort--no matter from what
source--and the fallacy of that based on so-called clinical evidence.

To go back to the court’s findings: In the case of the government
against Buffalo Lithia Springs Water, one other judicial opinion is
worthy of attention, that referring to the attempt on the part of the
exploiters of the water to circumvent, on a technicality, the evident
intent of the Food and Drugs Act. Said Judge Gould:

  “The argument seems to be that if Buffalo Lithia Springs are falsely
  named, being called ‘Lithia’ Springs, when they do not flow water
  containing lithium, therefore the proprietors have the right to sell
  the product as being Buffalo Lithia Springs Water, thus perpetuating
  on the public the misnomer connected with the origin of the water. It
  is not apparent how the deceit practiced on the public by the label
  is mitigated by carrying it back to the designation of the spring
  from which the water comes.”

For years no one, apparently, ever criticized the claims made for
this product. Finally, we got the Food and Drugs Act and the federal
officials, acting under the authority vested in them by that law, in
December, 1910, declared Buffalo Lithia Water misbranded. Thus this
old established vested interest was attacked. The company, of course,
fought. It first demurred to the charge brought, and in April, 1912,
the demurrer was sustained. At the same time an amended libel was filed
by the government, which the company again demurred to. This demurrer
was overruled in June, 1912, whereon the company in December, 1912,
filed an answer denying that the water was misbranded. The question has
now (1914) been finally decided by the court sitting as a jury, the
matter having been submitted by agreement to the court.

Buffalo Lithia Water has been sold since 1878. During this period
undoubtedly many physicians have prescribed enormous quantities of
this water, and many more laymen have taken the water on their own
initiative, based on the advertised claims made for it. Practically
all who purchased the water, whether directly or on the advice of
physicians, did so in the belief that they were getting lithium. Had
they known that, to get a therapeutic dose of lithium they would have
had to drink 200,000 gallons of Buffalo Lithia Water, they would have
felt, and rightly so, that they were the victims of an expensive
hoax.--(_From The Journal A. M. A., June 13, 1914._)




                   MEAT EXTRACTS AND MEAT JUICES[BM]

                 Their Composition and Relative Values

[BM] See Report of the Council on Pharmacy and Chemistry on “Meat and
Beef Juices,” p. 123.


The Bureau of Chemistry of the Department of Agriculture has recently
given in Bulletin No. 114 much new and valuable data regarding the
commercial meat products. The work contained in this bulletin is
practically an elaboration or continuation of that published in The
Journal of May 11, 1907, p. 1612. It was taken up to determine the
condition and quality of meat preparations in general and from the
results obtained to prepare tentative standards for the preparation
and composition of such meat preparations. The results as well as
the methods of analysis of many meat products are given, showing
the composition and relative value of the various preparations. The
comments of many investigators regarding the food value of such
products is also a valuable contribution to the knowledge of meat
extracts, and will help in deciding the real value of the preparations.

The preparations taken up are divided into three general classes (1)
Solid and Fluid Meat Extracts; (2) Meat Juices; (3) Miscellaneous
Preparations. For each of these the tentative standards submitted
by the Committee on Food Standards of the Association of Official
Agricultural Chemists are given along with the tabulated results of
the chemical analysis. The preparations examined showed, for the most
part, that they conformed to the standards, and only those which are at
variance in one or more particulars will be mentioned in this review.

                          SOLID MEAT EXTRACTS

For solid meat extracts the following are the requirements:

  “Meat extract is the product obtained by extracting meat with boiling
  water and concentrating the liquid portion by evaporation after
  removal of fat, and contains not less than 75 per cent. total solids
  of which not over 27 per cent. is ash and not over 12 per cent. is
  sodium chlorid (calculated from the total chlorin present), not over
  0.6 per cent. is fat and not less than 7 per cent. is nitrogen. The
  nitrogenous compounds contain not less than 40 per cent. of meat
  bases and not less than 10 per cent. of kreatin.”

With the above as the standard, several of the solid meat extract
preparations examined were not up to grade on one or more points,
though in some cases it is true they were very slightly below the
standard set. The following products were found wanting in some
respects and the requirements which they failed to meet are given:

  “REX” BRAND BEEF EXTRACT (Cudahy Packing Co., Omaha) contained 26.50
  per cent. water instead of the standard 25 per cent.

  EXTRACT OF BEEF PREMIER (Libby, McNeil & Libby, Chicago) contained
  30.92 per cent. of ash instead of the standard 27 per cent.; 18.32
  per cent. of sodium chlorid (standard, 12 per cent.); 6.02 nitrogen
  (standard, 7 per cent.).

  BEEF EXTRACT (Swift & Co., Chicago) contained 13.51 per cent. sodium
  chlorid (standard, 12 per cent.); 6.60 per cent. nitrogen (standard,
  7 per cent.).

  BEEF EXTRACT, COIN SPECIAL (G. H. Hammond Co., Hammond, Ind.)
  contains 13.25 per cent. of sodium chlorid (standard, 12 per cent.);
  and 6.86 per cent. nitrogen (standard, 7 per cent.).

With these few exceptions, the solid meat extracts were found to comply
with the standards given.

                          FLUID MEAT EXTRACTS

For fluid meat extract the following standards have been suggested:

“Fluid meat extract is identical with meat extract except that it is
concentrated to a lower degree and contains not more than 75 per cent.
and not less than 50 per cent. of total solids.”

According to this standard all excepting one of the fluid meat extracts
examined were found to be below grade in one respect, that of solids.
The following are preparations examined and the percentage of solids
found:

                                                    Per cent.
    CONCENTRATED FLUID BEEF EXTRACT
       (Armour & Co., Chicago)                        42.25
    MEAT JUICE
       (Valentine’s Meat Juice Co., Richmond, Va.)    42.36
    BEEF JUICE
       (John Wyeth & Bro., Philadelphia)              41.16
    VIGORAL
       (Armour & Co., Chicago)                        50.06
    “REX” FLUID BEEF EXTRACT
       (Cudahy Packing Co., Omaha)                    44.01
    FLUID EXTRACT OF BEEF
       (Cibilis Co., New York)                        35.37
    FLUID BEEF JELLY
       (Mosquera-Julia Food Co., Detroit)             31.03

Special notice is directed to the price of some of these preparations,
which in spite of their large water content, are higher priced than
some of the solid meat extracts.

                              MEAT JUICES

The following is given as the standard for preparations of meat juice:

  “Meat juice ... is 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 proteids.
  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 per cent. nor less than 2 per cent. of
  phosphoric acid (P_{2}O_{5}), and not less than 12 per cent. of
  nitrogen. The nitrogenous bodies contain not less than 35 per cent.
  of coagulable proteids and not more than 40 per cent. of meat bases.”

It is especially noticeable among the meat juices, so called, that none
shows any appreciable amount of coagulable proteids. Valentine’s Meat
Juice and Wyeth’s Beef Juice, besides being below the standard in total
solids as fluid extracts, are misbranded when called meat or beef
juices, as can readily be seen by comparing the results of the analyses
and the standard.

Wyeth’s Beef Juice is advertised as containing “all the albuminous
principles of beef in an active and soluble form” and “in an unaltered
form”--two statements that are on the face of them untrue and
misleading. To say that all the albuminous principles of meat are
present is to say that not only the juice of the meat but all the
fiber is present, which evidently is not true. Then again, to say
that it is present in an unaltered form is far from the facts, for,
as is stated on page 18 of the Bulletin: “It appears impracticable to
prepare a true meat juice for market, as the temperature necessary
for the preservation of food products in hermetically sealed packages
coagulates the proteids and changes the nature of the product.” On page
55: “When prepared under the best possible conditions a commercial meat
extract is, of necessity, in order that it may not spoil, deprived of
the greater part of the coagulable proteids, which constitute the chief
nutritious elements of the juice.”

On examining the tables of analysis, it is seen that Wyeth’s Beef Juice
contains but 23 per cent. of its total proteids in a coagulable form,
while the standard calls for 35 per cent., thus showing it to be no
more valuable as a food product than any other so-called meat juice,
the statements of the manufacturers to the contrary notwithstanding.

In the case of Valentine’s Meat Juice we note a large discrepancy
between the standard requirements and the results of the government
analysis, for instead of the proteid matter containing 35 per cent. in
the coagulable form, it contains but 1.6 per cent. These figures show,
then, that Valentine’s preparation contains practically no coagulable
proteids, and since the quantity of these measures the food value of
such preparations, the conclusion must be drawn that Valentine’s Meat
Juice has practically no value as a food and should certainly not be
classed as a meat juice.

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.”

Taken individually or as a class, meat extracts are not to be
considered foods, and should, therefore, not be advertised as such, a
conclusion which the government officials have come to and voiced in
the conclusion of the Bulletin as follows:

                         VALUE AND LIMITATIONS

  “It seems to be the consensus of opinion among scientific
  investigators who have studied this question that the food value of
  these meat extracts is rather limited, and although they are a source
  of energy to the body they 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. When prepared under the best possible
  conditions a commercial meat extract is of necessity, in order that
  it may not spoil, deprived of the greater part of the coagulable
  proteids, which constitute the chief nutritious elements of the
  juice.”--(_From The Journal A. M. A., Jan. 23, 1908._)




       PHARMACEUTICAL MANUFACTURERS AND THE GREAT AMERICAN FRAUD


At various times we have given more or less complete accounts of
the prosecutions the United States Government has brought against
nostrum exploiters under the Food and Drugs Act. One of the more
recent of these, while of comparatively little interest _per se_, is
of importance to the medical profession, because of certain elements
connected with it. The case is known technically as “Notice of Judgment
No. 284” and deals with the “Alleged Misbranding of Danderine.”
The gist of the case is as follows: Casks of Danderine--a widely
advertised “hair tonic”--were shipped in carload lots from Michigan
to West Virginia, where the product was bottled, labeled and put in
condition to be retailed. Danderine contains a percentage of alcohol
which, while given on the labels of the bottles in which it is sold,
was not stated on the casks in which the preparation was shipped in
bulk. The government sought to confiscate, under the Food and Drugs
Act, sixty-five casks thus shipped because the quantity or proportion
of alcohol in the casks was not stated. The Knowlton Danderine Company
resisted the confiscation and the court upheld the company’s claim.

The point in this case which is--or should be--of interest to the
medical profession is to be found in the “statement of facts” presented
by the Knowlton Danderine Company in its own defense. Here it is
said that: “Parke, Davis & Co., who are mentioned in the said libel
as shippers ... are under contract with the said Knowlton Danderine
Company ... to compound the said formula ...” Elsewhere it is stated:
“Parke, Davis & Co. were ... the manufacturing agents, under contract,
of the owner, the Danderine Company ...”

This evidently means that Parke, Davis & Co., who are generally
supposed to manufacture only “ethical” preparations--proprietary or
otherwise--and as such to desire the respect and good wishes of the
medical profession, are in the business of furnishing the supplies for
nostrum venders. What Danderine is, it is hardly necessary to specify.
The widely distributed advertisements of this “hair tonic” nostrum with
the slogan: “Danderine Grows Hair and We Can Prove It” are sufficiently
well-known to all who read to make a lengthy disquisition on the
product unnecessary.

It is interesting in this connection to note that according to
newspaper dispatches the Danderine Company has absorbed the Sterling
Remedy Company, which exploits “Cascarets.” Three years ago a
physician, who is also a pharmacist, wrote to the _Medical World_
regarding the manufacture of Cascarets:

  “... I have positive evidence, which I will gladly submit, that P.,
  D. & Co., make all of them [Cascarets], and that they have a contract
  with the Cascaret people not to make anything similar for any one
  else.”

In the circular which comes in the Danderine packages two other
“specialties” are advertised: “Neuralgine” for “sick, weak, tired
nerves” and “Drake’s Palmetto Compound” for “weak stomachs, sluggish
livers, disordered kidneys,” and various other derangements of the
system. The question naturally arises, are these, too, shipped in
casks from Parke, Davis & Co., and merely bottled and labelled in West
Virginia?

Not that the Danderine case is the first one in which Parke, Davis
& Co. have been exposed as manufacturers of nostrum supplies.
“Vitaopathy” a method of “treatment” practiced by the notorious New
York Institute of Physicians and Surgeons in the person of “Prof.”
Adkin and apparently consisting of “absent treatment” and pills, was
finally put out of business by a fraud-order from the post office
department. The concern used to advertise:

    “In Professor Adkin’s laboratory, his chemists are daily engaged
    in extracting the life-and-health-giving principle from rare
    vegetables, fruits and plants.”

“Prof.” Adkin had no laboratory; his chemists, according to the
government report, were Parke, Davis & Co., from whom he purchased the
tablets which formed part of his stock-in-trade of quackery.

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:

    “The greatest Chemical-Medical Preparation ever prepared by the
    skill of man.”

    “Nutriola and Nature are the only invincible conquerors of diseases
    ever known.”

The promoter of this scheme was one Edward F. Hanson, who was
questioned by the government inspectors regarding the manufacture of
the Nutriola nostrum. Quoting from the government report:

    “_Q._ Please name the chemists who now manufacture the remedies of
    the Nutriola Company.”

    “_A._ Parke, Davis & Company, Detroit; E. L. Patch Manufacturing
    Company, Stoneham, Mass.; Seabury & Johnson, New York.”

Not that the course pursued by Parke, Davis & Co. is by any means an
exceptional one in the pharmaceutical world. It may be recalled that
The Journal has previously referred to the fact that Sharp & Dohme are
reported to make or to have made the “Getwell Tablets” for the “patent
medicine” concern which exploits the nostrum; and that Frederick
Stearns & Co. make or did make the widely advertised “cures” Shac and
Zymole Trokeys also has been mentioned. That Seabury & Johnson made
preparations for a fake medicine concern was brought to light by Mr.
Adams in the “Great American Fraud” series. And unquestionably there
are many others. The attitude taken by such houses seems to be that
they are willing to furnish anything in the pharmaceutical line that
anyone is willing to pay for, whether it is for legitimate use of the
physician or pharmacist or for furthering the business by which the
ignorant or gullible sick are humbugged and defrauded.--(_From The
Journal A. M. A., July 2, 1910._)




                         DOWD’S PHOSPHATOMETER


Dowd’s Phosphatometer, according to its inventor, is a device
“for taking the phosphatic index or pulse of the nervous system.”
Its originator, J. Henry Dowd, M.D., Buffalo, N. Y., writes
enthusiastically of his instrument:

    “Physicians who use the Phosphatometer are sending 50 per cent.
    less patients away for consultation, getting 75 per cent. better
    results at home, because the Phosphatometer tells the cause and
    what to do, and the Comp. Phosphorus Tonic gives results in 80 per
    cent. of all conditions of illness.”

The “Comp. Phosphorus Tonic” referred to in the above quotation is a
sideline of Dr. Dowd’s, put out by the Richardson Company, of Buffalo.
The stationery of the Richardson Company gives its address as 334
Franklin Street, but directs that all communications be addressed to
40 North Pearl Street, which is the private address of J. Henry Dowd.
According to the Buffalo directories, 334 Franklin Street is the drug
store of Arthur E. Reimann.

To those who read the Dowd “literature,” the Phosphatometer will
appear to be either one of the wonders of the age or an unscientific
absurdity. To the thinking man it will be the latter. It pretends
to determine the amount of phosphates in the system. This is
accomplished--alleged--by taking the second urine passed in the morning
and mixing a portion of it in the instrument with a solution which
is the well-known magnesia mixture. The height to which the crystals
settle in ten minutes determines, according to Dowd, the amount of
phosphates! Was ever a test devised that violated more of the first
principles of quantitative chemical analysis? If so, we never heard of
it. Dowd’s system does not require any determination of the amount of
urine passed in twenty-four hours or even of the amount passed at the
second micturition in the morning.

If a patient whose urine was being “tested” by the Dowd method, should
drink two cups of coffee for breakfast instead of one, his urine might
be so dilute that the phosphates would fall below the “normal” mark.
Dowd says that his Phosphatometer “takes the pulse of the nervous
system.” What about the patient who eats several eggs or consumes a
sweetbread or other nuclein-containing articles of diet? The increased
amount of phosphates in such a diet might easily lead to an apparent
excess in the urine. Every physician, nay, every sophomore medical
student, knows that the amount and kind of food ingested governs almost
entirely the amount of phosphates excreted in the urine.

What actually does “Dowd’s Phosphatometer,” when used according to
instructions, show? It shows the _presence_ of phosphates in the urine;
it permits a guess--with not the slightest claim to accuracy--as to the
amount in the specimen tested; it gives no possible clue to the normal
or abnormal relation of the phosphates in the urine or as to whether
the source of the crystals precipitated is the nerve tissue or the
food. Yet here are some of the claims made for it:

    “The Phosphatometer shows nervous metabolism the same as the
    ureometer shows muscular; the former errs in about 3 per cent.; the
    latter in 40 per cent.”

    “The Phosphatometer shows the amount of nerve food being used and
    present in the nerve cells.”

    “Over 50 per cent. of pain and human suffering is due to the nerves
    crying for food; the Phosphatometer will show the true cause in ten
    minutes.”

    “The Index not only tells the present condition, but foretells the
    future, thus preventing serious complications which might arise.”

    “The Phosphatometer measures the amount of phosphorus in the
    system.”

    “The Dowd Phosphatometer not only takes blood-pressure, it tells
    how to regulate it.”

    “The Phosphatometer measures the amount of phosphorus in the
    nerve cells; it is as positive in nerve troubles as the x-ray in
    fractures.”

These claims are essentially false. As a matter of fact, a simple
examination of the urine for phosphates cannot tell us the condition
of the nervous system. This must be evident from the fact that only a
portion of the phosphates is excreted in the urine, a very considerable
part passing out with the feces. Further, the bulk of the phosphorus
excreted comes from the food and only a small portion from the waste of
the nervous system. The amount excreted by the urine which comes from
torn-down nerve tissue is so small that it is practically impossible to
estimate variations in it even by the most careful analytic methods.

In brief, Dowd’s “scientific method” is nothing more than unscientific
humbug.--(_From The Journal A. M. A., Dec. 20, 1913._)




                       AMORPHOUS PHOSPHORUS[BN]

              A Practically Inert Substance Introduced as
                     a Valuable Therapeutic Agent

[BN] The so-called amorphous phosphorus is in reality a crystalline
body and is more correctly called red phosphorus to distinguish it
from the ordinary or yellow phosphorus. It is the ordinary or yellow
phosphorus which is official as “Phosphorus.”


Amorphous phosphorus is a chemical anomaly contrasting markedly with
ordinary phosphorus in its physical, chemical and pharmacologic
properties. Ordinary phosphorus is soluble in certain solvents, such
as oil; amorphous phosphorus is insoluble. Ordinary phosphorus is
poisonous; amorphous phosphorus is not poisonous. Ordinary phosphorus
has been regarded as of some therapeutic value; amorphous phosphorus,
because of its insolubility and other physical properties, has never
been so regarded. Pharmacologists, therefore, have paid very little
attention to it. Some of them do not even mention it, though there are
a few accounts of experimental work.

Noé,[156] in experiments on the action of phosphorus with yeast,
found that yeast acted on ordinary phosphorus, producing PH_{3}
(hydrogen phosphid), but on amorphous phosphorus it had no action. His
experiments show that amorphous phosphorus was not toxic to animals.

[156] Noé, J.: Action comparée du phosphore blanc et du phosphore rouge
sur la matière vivante, Compt. rend. Soc. de biol., 1899, 105, i, 380.

Thornton[157] quotes Reese as publishing a report of a case in which
30 grains of amorphous phosphorus were taken by a young woman with
suicidal intent, but no toxic symptoms were manifested. Thornton found
it non-toxic to animals.

[157] Thornton, E. Q.: The Advantages of Amorphous Phosphorus over
the Official Form, Therap. Gaz., 1894, xxxv, 19. Tr. Pan. Am. Med.
Congress, 1893, Washington, 1895, p. 1,438.

  Witthaus and Becker (Medical Jurisprudence, Forensic Medicine and
  Toxicology, iv, 635) say: “The form of phosphorus is practically
  non-poisonous, probably by reason of its insolubility. It has been
  administered to dogs to the extent of 200 gm. (nearly half a pound)
  in twelve days without causing poisoning.”

  C. D. F. Phillips (Materia Medica, Pharmacology and Therapeutics,
  Inorganic Substances, Ed. 3, p. 46) makes the following statement:
  “Amorphous phosphorus has been, by some observers, credited with
  physiologic activity. Thus, Bednar used it for a long period in small
  doses, and observed symptoms of excitation, trembling and clonic
  convulsions; but as much as 1 ounce has been given to dogs without
  perceptible effect. Thompson, in twelve carefully observed cases,
  found its action nil, and plausibly attributes its supposed powers to
  a slight admixture of ordinary phosphorus (_Pharm. Jour., 1875_). I
  believe it is practically inert.”

                            HOW INTRODUCED

The foregoing represents our scientific knowledge as to the action
of amorphous phosphorus. Now, however, comes Dr. I. L. Nascher and
introduces amorphous phosphorus as a remedy of remarkable value for the
arteriosclerosis of old age. The method of introduction is somewhat
peculiar. The treatment seems first to have been brought to notice
through a printed slip sent to medical journals generally. This slip
consisted of an extract from Nascher’s book on old age, which at the
time had not been published! Nascher also published an article on
this subject in an obscure journal, the _American Practitioner_, for
December, 1913. Neither the matter copied from his book nor the article
referred to contain a single scientific fact that would warrant the
claims made for it as a therapeutic agent. No record is given of animal
experiments, and the clinical evidence presented certainly cannot be
regarded as scientific.

As already stated, this form of phosphorus has not been previously used
and has been regarded as without effect on the human system because of
its insolubility in any of the liquids of the body. Nascher himself
has not been able to find any new way to dissolve it. He says: “I made
a number of experiments to find a solvent. The only substance which
appears to dissolve it is serum, but I am still uncertain whether it is
a solution or a very fine suspension. The phosphorus is precipitated in
a few days, but the serum remains tinged.” The fact that it separates
from the serum on standing is quite conclusive evidence that it is
insoluble in that liquid. Since no way of making it soluble has been
discovered, there is no reason for expecting it to have any effect on
the system. An insoluble and non-absorbable substance can produce no
general systemic effect; if, when ingested, it produces any effect
whatever, this effect must be local and will be shown by symptoms of
gastro-intestinal disturbance. Nascher, however, took 15 grains, and
no symptoms of gastro-intestinal disturbance followed. Hence, we must
conclude that it is without effect on the gastro-intestinal mucous
membrane. While Nascher records no experiments on animals which is much
to be regretted, he did experiment on himself and says:

    “Ten grains produced a frontal headache, restlessness, excessive
    mental stimulation, ideas arising with such vividness as to appear
    as actual occurrences. There was a sense of weight or oppression
    in the stomach and priapism, the latter probably psychic, as I was
    looking for such a result. These symptoms passed away in a few
    hours.”

Without doubt his explanations of the priapism can be applied to
the whole experience; whatever symptoms there were, they were
unquestionably psychic. The consideration of these subjective
symptoms may be dismissed, since it is reasonable to assume that an
insoluble, unabsorbable substance which produces no disturbance of the
gastro-intestinal tract will have no effect on the rest of the organism.

Amorphous phosphorus did not produce such symptoms as Nascher relates
in experiments similar to his made by us. The drug was taken in
10-grain doses by six different individuals. In no case did the
symptoms described by Nascher follow; in fact, there were no symptoms
whatever.

                           NASCHER’S THEORY

Nascher, after relating his subjective experiences and those of his
patients, proceeds to build a theory to account for the unproved action
of amorphous phosphorus in disease, especially in arteriosclerosis. It
would have been more appropriate if before advancing the theory, he had
made some experiments to prove that the substance has some action. But
we give his theory as found in the quotation from his book, sent to
medical journals, as already referred to. Here it is:

    “Amorphous Phosphorus in Senile Arteriosclerosis: The author has
    used the red amorphous phosphorus in senile arteriosclerosis for
    several years. Given originally as a substitute for ordinary
    phosphorus in senile debility, it was found that it was eliminated
    as amorphous phosphate of lime and that the lime elimination
    was thereby increased. Weil’s experiments showed that the lime
    elimination in arteriosclerosis was diminished. Phosphorus has
    the property of combining with lime and increasing the lime
    assimilation. In the small doses which can be given when the
    ordinary phosphorus is employed, the phosphorus will combine with
    the lime of the food and increase the amount of lime salts in the
    body. When given as amorphous phosphorus, the dose is 2 grains
    or more several times a day, and with a lime-free diet the lime
    required for the combination necessary to secure the elimination
    of the phosphorus excess is drawn from the abnormal lime deposits.
    This appears to be the rationale of the treatment and explains the
    good results obtained from its use. From ‘Diseases of Old Age,’ by
    I. L. Nascher, M.D., to be published shortly.”

Thus, according to Nascher, the phosphorus, after being oxidized to
phosphoric acid, catches the calcium and drags it out of the system!
What are the facts? The human body contains a large store of phosphates
which are excreted in the urine in combination with sodium and
potassium--and yet these do not draw the calcium from the blood, brain
and bones! To be blunt, Nascher’s theory is absurd. The calcium in
its various deposits in the body is already combined with phosphoric
acid. Why should the phosphorus introduced take calcium from the
phosphate radical with which it is already in combination? Nascher
asserts that the phosphorus which is introduced as amorphous phosphorus
is excreted as amorphous phosphate of lime within twenty-four hours.
How does he know it is? It is, of course, very appropriate that
amorphous phosphorus should form the amorphous phosphate of lime, but,
unfortunately, phosphates made from the ordinary phosphorus also are
precipitated in the amorphous condition. By what private mark does Dr.
Nascher identify the amorphous phosphate produced by his amorphous
phosphorus? Is it not a fact that he found the urine alkaline and
detected a precipitate of amorphous calcium phosphate--always present
in alkaline urine--and concluded that this must be his particular
amorphous phosphorus in combination with calcium?

Dr. Nascher makes no record of examinations of the feces, although a
great part--sometimes the greater part--of ingested phosphorus is found
in the feces in experimental work on phosphorus metabolism. If he had
examined the feces he would doubtless have found the total quantity of
amorphous phosphorus unchanged.

Nascher refers to several cases in which he has used this remedy and
states that he had the most gratifying results. So far as we can learn,
the benefit was entirely in the subjective symptoms of the patient.
It seems evident, therefore, that his claims for the value of this
remedy rest on no better foundation than an unproved theory without
experimental basis.

                         ITS COMMERCIALIZATION

Thus far we have considered only the scientific aspects of amorphous
phosphorus therapy. It is unfortunate that we cannot stop here. Some
of our readers will have seen in recent medical journals half-page
advertisements of amorphous phosphorus reading:

The striking physical and chemical properties possessed by common
phosphorus, together with the fact that phosphorus is one of the
constituents of nerve-tissue, are probably responsible for the
reputation which this element acquired generations ago as a remedy for
sexual impotence and mental decay. Among scientific men this reputation
was a fleeting one, for, when put to the test, the product failed.
Like so many products with a similar history, the unearned reputation
it obtained from medical men survived in the minds of the laity, and,
as is always the case, the survival has been taken advantage of by
quacks. Among charlatans and nostrum makers phosphorus is still in
vogue. “Weak men’s specialists” and venders of “lost manhood” and
alleged aphrodisiac drugs “play up” the phosphorus fallacy for all it
is worth.

It is worth noting that the present exploitation of amorphous
phosphorus is following along somewhat similar lines. The asserted
actions of amorphous phosphorus are such as may be calculated to
appeal to the sexual neurasthenic. There is no doubt that the Sharp
& Dohme advertisements will bring about an extensive use of this
remedy, especially by the uncritical. The psychic element--which plays
so large a part in the sexual neurasthenic--will result in favorable
reports being given on the drug. Articles may be expected to appear in
a certain class of medical journals, telling of the marvelous results
that Dr. John Doe has had in the use of “Pill Phosphorus Amorphous S. &
D.” A luxuriant crop of testimonials may be expected to follow, and the
_tout ensemble_ will go far to sustain the Sharp & Dohme propaganda.

[Illustration: Reproduction--reduced--of half-page advertisement
appearing in medical journals.]

We are prompted to believe that Messrs. Sharp & Dohme do not fully
realize the potentialities for harm that lie in their present
exploitation of amorphous phosphorus. It hardly seems possible that
a firm of standing would knowingly put on the market and advertise
a worthless drug with an appeal to susceptible, infirm old men. The
function of introducing new remedies to the medical profession is
a responsible one, and a firm that assumes it should have among its
officers some one sufficiently conversant with pharmacologic science
to prevent such unscientific absurdities as that exhibited in the
marketing of amorphous phosphorus, especially under such claims as
those contained in the advertisements.--(_From The Journal A. M. A.,
March 7, 1914._)

Dr. Nascher’s Reply to The Journal’s Article--Comments

    _To the Editor_:--Regarding the article on Amorphous Phosphorus
    in the March 7 issue of The Journal of the American Medical
    Association, I want first of all to clear myself of the implied
    charge of commercialism in connection with the marketing of the
    Pill Phosphorus Amorphous by Sharpe & Dohme. I have never had
    anything to do with the manufacture or sale of those pills, never
    had any business dealings with Sharpe & Dohme and I have no
    commercial interest whatsoever in either this or any other drug
    or drug house. I knew nothing about the advertisement which you
    reproduced until I saw it in the medical journals. I immediately
    protested against this unwarranted use of my name and was assured
    that the statement “Made under the direction of Doctor I. L.
    Nascher, New York,” was not made for the purpose of misleading and
    that the ad. would be immediately withdrawn. I gave my approval
    to the pills made by this firm as I would give my approval to
    the pills made by any other reliable house for I claim the right
    to endorse any drug or preparation which I believe to be of
    value whether it is approved by the Council of [on] Pharmacy and
    Chemistry or not.

    In your general charge of commercialism you make it appear that the
    exploitation of amorphous phosphorus had the ulterior purpose of
    appealing to the sexual neurasthenic along the lines of the “lost
    manhood” ads. So far as this relates to Sharpe & Dohme, I have no
    interest, but you have included me in your general denunciation.
    The only reference I ever made to aphrodisiac effects of Amorphous
    Phosphorus, in all my writings, is contained in these words in
    the four-page article in the _American Practitioner_, “In a few
    cases aphrodisiac effects were noticed.” I have never recommended
    amorphous phosphorus as an aphrodisiac and in the chapters on
    “Impotence and Neurasthenia” in my book on “Diseases of Old Age,” I
    have not mentioned amorphous phosphorus at all.

    You say “the treatment seems first to have been brought to notice
    through a printed slip sent to medical journals generally.” This
    slip containing an extract from my book which was then in press was
    sent out about four months ago while I have referred to amorphous
    phosphorus repeatedly in medical articles during the past three
    years. In my paper on Senile Debility, _Medical Record_, Jan. 21,
    1911, I said amorphous phosphorus had no effect, as I was then
    looking for the usual effects of the ordinary phosphorus. In a
    paper on Senile Mentality, _International Clinics_, Vol. 4, 21st
    series, I said I was using amorphous phosphorus but had not yet
    determined its value. I recommended it in several of my papers,
    articles and lectures in 1912 and 1913 after I had found that under
    its use in some cases of senile arteriosclerosis, symptoms were
    relieved. I sent these slips to the medical journals as a general
    reply to many inquiries I received about amorphous phosphorus and I
    stated this in the letters I sent with the slips to some editors.
    Further inquiries for more information led me to write the paper
    which appeared in the December issue of that “obscure journal”
    the _American Practitioner_. I felt that a medical journal which
    carried articles by Sir James Barr, ex-president of the British
    Medical Association, Sir R. W. Philip, R. Murray Leslie, Halliday
    Sutherland, and such American authorities as Adami, Hare, Brooks,
    Hirschberg, Knopf, Starkey, Ely, Bissell, Wilcox, Col. Maus,
    U. S. A., etc., was a representative high class journal and I was
    pleased to have my paper in it.

    To take up the scientific criticism of amorphous phosphorus,
    permit me to say at the outset that I am a general practitioner,
    specially interested in geriatrics, and more concerned about
    obtaining favorable clinical results in my cases than in solving
    laboratory problems. Nevertheless I have tried for years to obtain
    the cooperation of expert laboratory workers to help me determine
    the properties, chemical, physical and physiological, of amorphous
    phosphorus. In 1909 or 1910 the Rockefeller Institute, in reply
    to my request for permission to experiment there with amorphous
    phosphorus, said it did not accept volunteer workers. Four heads
    of college laboratories could not spare the time. I asked the
    Council on Pharmacy and Chemistry last November to take up its
    investigation and was informed that it could not do so at present.
    I have been perforce compelled to depend mainly on empirical
    methods with such little experimentation as the facilities of the
    physician’s office permitted and such little literature as I could
    find.

    You reject empirical methods as being unscientific notwithstanding
    the fact that most of our therapeutic knowledge is based on
    empiricism. (I use the terms empirical and empiricism here in
    the sense of knowledge obtained from experience and observation,
    not in the bad sense in which they might be construed.) It would
    therefore be folly on my part to argue with you that I have
    obtained beneficial results from amorphous phosphorus in many cases
    of senile arteriosclerosis. I did not obtain such results from a
    single dose, but gave it in some cases for many weeks or months.
    It is unfair to judge of the value of a drug from a single dose
    or several doses unless it is a drug which is expected to show
    immediate effects. It would be greater folly on my part to pit
    my knowledge of pharmacy and chemistry against the knowledge of
    your staff of experts. I can but repeat what I have said on many
    occasions that under the persistent use of amorphous phosphorus
    in cases of senile arteriosclerosis symptoms were frequently
    relieved. I never claimed that amorphous phosphorus will cure
    arteriosclerosis. In the chapter on Arteriosclerosis in my book I
    say: “Senile arteriosclerosis being a natural, normal condition,
    is incurable in the sense that it can be neither prevented nor
    removed. The best that we can hope for is to retard its progress
    and relieve disagreeable symptoms, etc.”

    You say in reference to the elimination of the amorphous phosphorus
    as amorphous phosphate of calcium, “Is it not a fact that he
    (I) found the urine alkaline and detected a precipitate of
    amorphous calcium phosphate--always present in alkaline urine--and
    concluded that this must be his particular amorphous phosphorus
    in combination with calcium?” No. The specimens of urine were
    examined in reliable laboratories and I have reports showing acid
    and neutral urine as well as alkaline urine having the amorphous
    phosphate precipitate. Nor is the amorphous phosphate “always
    present in alkaline urine.”

    As for the theory I advanced, it is simply a theory based on
    reasoning without facts to prove it. If I had facts to prove it,
    it would no longer be a theory or open for discussion. Being a
    theory, it is the province of the wise man to ridicule it and
    call it absurd. I will confess that your criticism of it is not
    clear to me and I still do not see its absurdity. I don’t see what
    relation your argument, that the phosphates of sodium and potassium
    do not draw the calcium from the blood, brains and bones, has to
    the theory I advanced. It is true that I have no private mark by
    which I can identify the amorphous phosphate produced by amorphous
    phosphorus, but such argument is puerile. When medical science
    has so far progressed that the physician will be able to put his
    tag on the molecule of drug substance and follow it through the
    various metabolic processes to its final elimination we will not
    need any Council on Pharmacy and Chemistry to decry what it cannot
    understand. Let me say here that scientific criticism does not
    stoop to ridicule for ridicule is usually based on animus or bias.

    The conclusive proof of the value of a drug is not its action
    on the healthy dog, frog or guinea-pig but its action on the
    individual patient, and no amount of animal experimentation can
    dispose of the personal factor which is so marked in senile cases.
    This is no criticism of animal experimentation as a whole but of
    the insistence on animal experimentation to determine the value of
    a drug in a class of cases for which the healthy animal can furnish
    no comparison.

    You say amorphous phosphorus is practically inert and quote Noé,
    Witthaus and Becker, Thornton and Phillips. The quotations of
    the first three are little more than statements that amorphous
    phosphorus is non-toxic. Phillips makes two references, one of
    which is to Badner who obtained decided effects from its prolonged
    use. Thornton, whom you quote in your contention that amorphous
    phosphorus is inert, says that on prolonged use in doses of 3/10
    grains every two hours it produced headache, vertigo, mental
    excitement, priapism, etc. (See footnote under Phosphorus, U. S.
    Dispensatory). Shoemaker’s Materia Medica and Therapeutics says
    it is toxic and is called the servant-girl’s poison. Phillips
    suggested that Badner probably used an impure drug. I suggested
    that Thornton probably used an impure drug. On the other hand,
    Badner and Thornton obtained positive results from prolonged use,
    not from the single dose.

    You say it has not been used on account of its insolubility in any
    of the liquids of the body. Roscoe and Schorlemmer, quoting Neuman,
    said if injected into the blood the usual symptoms of phosphorus
    poisoning appear. In a letter from Dr. Hatcher he says Nassé
    injected 0.2 gm. of the purest amorphous phosphorus into a rabbit’s
    vein and the animal presented the usual symptoms of phosphorus
    poisoning. There are also references to amorphous phosphorus action
    in Kobert’s _Lehrbuch der Intoxicationen_, in Blythe’s Poisons, etc.

    You say of your four quotations, “the foregoing represents our
    scientific knowledge as to the action of amorphous phosphorus.” Did
    you not know of these other authorities, or are their statements
    unscientific, or were they omitted because they disprove your
    contention that amorphous phosphorus is practically inert?

    Your denunciation of ordinary phosphorus has no bearing on the
    subject as I do not recommend the amorphous phosphorus as a
    substitute for the other.

    I have worked for eight years to arouse medical and public interest
    in the aged and their ailments and I cannot afford charges of
    commercialism, foisting worthless drugs as aphrodisiacs or
    other unethical conduct to stand against me. As for the charge
    of unscientific work, I can only point to my work on Diseases
    of Old Age, and my medical papers, and express the hope that
    others better equipped for laboratory research will take up the
    laboratory investigation of amorphous phosphorus. I have faith in
    its therapeutic value and believe competent clinical observers will
    have favorable results from it in suitable cases.

                                         I. L. Nascher, M.D., New York.

Comment.--Accompanying the preceding letter was a note from Dr. Nascher
in which he says: “I want this published in full without elision or
change. If you do not intend to publish it as written, I want it
returned and enclose postage.” The letter therefore is given in full
in spite of the fact that much of it is irrelevant to the question
discussed.

Dr. Nascher’s protest to Sharpe and Dohme against the “unwarranted use”
of his name in connection with “Pill Phosphorus Amorphous, S & D” seems
to have resulted in various modifications of the phrases connecting
his name with the exploitation of this pill. What was apparently the
original advertisement, contained the phrase:

    “Made under the direction of Dr. I. L. Nascher, New York.”

Later advertisements, while identical in all other respects with the
first, had this phrase modified to read:

    “Made at the suggestion of Dr. I. L. Nascher, New York.”

Still other advertisements, also identical with the first in other
respects, are modified to read:

    “Made with the approval of Dr. I. L. Nascher, New York.”

That Dr. Nascher was directly or indirectly connected with the
commercializing of this product, The Journal has never suggested,
inferentially or otherwise. That the exploitation of amorphous
phosphorus by Sharpe and Dohme is one that appeals to the sexual
neurasthenic, no one who has read the advertisements can deny. As a
matter of fact, it would be difficult to sell phosphorus in any form as
a medicament, without appealing to the sexual neurasthenic. The word
“phosphorus” has become, in the minds of both laymen and physicians,
more or less synonymous with the treatment of so-called sexual weakness
and it is a practical impossibility to divorce the word from the idea
suggested. How true this is, Dr. Nascher himself unwittingly admits
when he tells that the result of his first experiment on himself with
amorphous phosphorus was a priapism that he acknowledges was “probably
psychic, as I was looking for such a result.” But the Sharpe and Dohme
advertisements plainly state that the amorphous phosphorus pill they
are marketing is a “new and successful method of treatment for ...
functional and senile impotence....”

Dr. Nascher’s explanation of how he came to send out the slip regarding
amorphous phosphorus to medical journals leaves him the victim of an
unfortunate coincidence. It is at least unusual for authors to send out
advance extracts from books that are about to be published, especially
when such extracts deal wholly with a drug that is coincidently
being introduced as a new proprietary product by some enterprising
pharmaceutical house.

Dr. Nascher takes exception to our statement that the treatment seems
first to have been brought to notice through the printed slip sent
to medical journals, and states that he has “referred to amorphous
phosphorus repeatedly in medical articles appearing during the last
three years.” His articles for 1912 and 1913 have been examined for
the purpose of learning when the treatment as now presented to the
profession was first announced. In his article “Errors in the Treatment
of Senile Cases,” _New York Medical Journal_, Oct. 12, 1912, he speaks
of the iodids in senile arteriosclerosis, but says nothing about
amorphous phosphorus. It may be assumed, therefore, that the treatment
had not been brought to general notice at that time. The new treatment
is very briefly described in the _New York Medical Journal_, July
13, 1913, in an article whose title, “Longevity and Rejuvenescence”
gave no indication that it dealt with amorphous phosphorus. Under the
circumstances, it is not strange that its therapeutic value was not
learned of until Dr. Nascher’s printed slips were sent out.

Dr. Nascher admits that his theory is based on empirical methods. Most
of the serious errors in therapeutics have had their origin in this
very method. It was on just such methods that physicians reported
wonderful results in the use of alleged “lithia waters” that actually
contained less lithium than ordinary river water! So unscientific
is the empirical method that it is hardly worth taking the space to
demonstrate its imperfections.

Neither is it worth while to discuss the question of a constant
occurrence of a sediment of amorphous calcium phosphate in alkaline
urine. If there are exceptions to this rule, they must be rare indeed.

In The Journal’s article authors were quoted to show that amorphous
phosphorus is regarded as inert. It was not suggested that the
authorities referred to were all that could be found. Dr. Nascher
refers to Thornton, Shoemaker, Neuman, Blythe and Kobert, and asks
whether the various statements on the subject, made by these men, are
unscientific or were “omitted because they disproved” the contention
that amorphous phosphorus is practically inert. Thornton’s article
was omitted because it is unscientific in that he does not report
experiments made by himself, but refers to an unpublished paper by
one Kelly. Who Kelly is, or was, he does not tell us. Kelly’s report,
therefore, should be and was disregarded, since it is the work of an
unknown author and there is nothing in the article to indicate that
Thornton was in any position to vouch for Kelly’s work. Incidentally,
it may be said that Kelly’s report merely recorded subjective symptoms;
Dr. Nascher himself indicates his distrust of Kelly’s alleged results
by suggesting that an impure preparation was used!

Shoemaker’s report was not given, for a similar reason. Shoemaker says:

    “Amorphous phosphorus is almost completely destitute of taste or
    odor, has no immediate caustic effect, and is claimed to be less
    toxic than white phosphorus; but in the _form of matches_ [Italics
    ours.--Ed.] has caused many deaths and is known as the ‘servant
    girls’ poison.’”

It is well known that commercial amorphous phosphorus is usually
impure, and it is more than probable that if toxic effects were
produced by the ingestion of match-heads, these matches were made
either of white phosphorus or of very impure red phosphorus. In
any case, Shoemaker’s statement has no bearing whatever on the
pharmacologic action of pure amorphous phosphorus.

The statement of Neuman quoted from Roscoe and Schorlemmer, as well as
that of Nassé, referred to by Hatcher, had no bearing on the question
at issue, as these men injected the material into the blood-stream.
If, when the amorphous phosphorus is injected into the blood, it
produces the ordinary symptoms of phosphorus poisoning, one would
naturally expect the same symptoms when the substance is given by
mouth--if amorphous phosphorus were soluble or absorbable. The fact
that such symptoms are not produced when amorphous phosphorus is
taken into the alimentary canal, sustains the views held by chemists,
pharmacologists and physicians, that the drug is practically insoluble
and unabsorbable--in other words, inert.

Dr. Nascher declares that he “never claimed that amorphous phosphorus
will cure arteriosclerosis.” Yet he insists that amorphous phosphorus
removes lime from the “abnormal lime deposits” that occur in
arteriosclerosis. What is this but claiming curative action?

Summed up, Dr. Nascher’s own admissions amply confirm the main
contentions of The Journal’s article. He admits that he has no
experimental basis for the use of this remedy; he admits that his
theory “is simply a theory without facts to prove it.” The only
conclusions that can be reached from his reply coincide closely with
the very statement made by The Journal, and which we here reiterate:

  “It seems evident, therefore, that his claims for the value of this
  remedy rest on no better foundation than an unproved theory without
  experimental basis.”--(_From The Journal A. M. A., March 28, 1914._)




                                 INDEX

     (Including References to Articles Not Contained in This Book)


The following is an index (1) to topics discussed in this volume, and
(2) to products discussed in reports and other articles not included
here:

1. The references to topics discussed or mentioned in this volume are
printed in CAPITALS.

2. The references to articles published elsewhere are printed in small
letters. These references include papers published in The Journal of
the American Medical Association, papers published in the “Annual
Reports of the Council on Pharmacy and Chemistry” and a few published
in the “Annual Reports of the Chemical Laboratory of the American
Medical Association.” A number of these papers have appeared both in
The Journal and in the Council Reports. In such cases, for the benefit
of those who may not have access to files of both The Journal and the
Council Reports, references are given to both sources. Some of this
matter is also issued in reprint form.

                                                               PAGE

  ABBOTT ALKALOIDAL COMPANY, 37, 103, 344

  ABICAN, 47

  ACETANILID, HARMFUL EFFECTS OF, 305

  ACETANILID MIXTURES, 9

  ACETPHENETIDIN AND PHENACETIN--THEIR RELATIVE PURITY, 414

  ACETPHENETIDIN, HARMFUL EFFECTS OF, 305

  ACOUSTICON, 436

  ADEPSINE OIL, 161

  ADKIN, “PROFESSOR”, 475

  ADRENALIN, NAME, VERSUS THE NAME EPINEPHRIN, 454

  ADVERTISING, CLEAN, 418

  AGAR-LAC AND AGAR-LAC, INC., 10

  Agmel (Maguey Products Co.), The Journal, Oct. 12, 1912, p. 1392.

  Agurin Tablets (Bayer Co.), Reports Council Pharm. & Chem., 1915,
    p. 162.

  AKOLL BISCUIT, 449

  ALBOLENE, LIQUID, 161

  Alborum (Whitehouse Chemical Co., Inc.), The Journal, Dec. 12, 1914,
    p. 2148; Reports Council Pharm. & Chem., 1914, p. 129.

  Aletrin, The Journal, Nov. 13, 1909, p. 1655;
    Reports Council Pharm. & Chem., 1909, p. 135.

  Aletris Compound, Elixir (Parke, Davis and Co., Ray Chemical Co.),
    Reports Council Pharm. & Chem., 1912, p. 46.

  ALETRIS CORDIAL, 46

  ALETRIS FARINOSA, 208

  Alfatone (Norwich Pharmacal Company), The Journal, Aug. 7, 1915,
    p. 548; Reports Council Pharm. & Chem., 1915, p. 62.

  ALIENIST AND NEUROLOGIST, ADVERTISING IN, 31

  Alkaline Digestine (Parke, Davis and Co.), Reports Council Pharm.
    & Chem., 1912, p. 44.

  Alkalol (Alkalol Company), The Journal, Nov. 6, 1915, p. 1665.

  ALLEOTONE, 264

  ALMOND PREPARATIONS, VARIOUS DIABETIC, 450

  AMERICAN JOURNAL OF CLINICAL MEDICINE, ADVERTISING IN, 303, 304, 342

  AMERICAN JOURNAL OF OBSTETRICS, ADVERTISING IN, 342

  AMERICAN JOURNAL OF SURGERY, ADVERTISING IN, 31, 49, 342, 424, 429

  AMERICAN MALTED FOOD COMPANY, 319

  AMERICAN MEDICINE, ADVERTISING IN, 31, 49, 131, 304, 342, 429

  VON AMERONGEN, E. M., 299

  AMILEE, 161

  Amolin Deodorant Powder (Amolin Chemical Co.), The Journal, Feb. 22,
    1908, p. 626; Reports Chem. Lab., 1909, p. 63.

  AMMONOL, 9

  AMMONOL CHEMICAL COMPANY, 338

  AMORPHOUS PHOSPHORUS, 478

  ANADOL, 246

  ANALGESIC BALM, BENGUÉ’S, 267

  ANALGESIC CREAM, STEARNS’, 267

  ANALGINE-LABORDINE, 117

  Analutos and Analutos Tablets (Royal Pharmaceutical Works, Meppel,
    Holland), The Journal, Feb. 20, 1915, p. 684; Reports Council
    Pharm. & Chem., 1915, p. 135.

  ANASARCIN, 11, 12

  ANASARCIN CHEMICAL COMPANY, 11, 18

  ANDERTON, DR. T. B., 18

  ANEDEMIN, 11, 12, 16

  ANEDEMIN CHEMICAL COMPANY, 12, 16, 18

  ANGIER CHEMICAL COMPANY, 170

  ANGIER’S PETROLEUM EMULSION, 169

  ANGIER’S THROAT TABLETS, 173

  ANGLO-AMERICAN PHARMACEUTICAL COMPANY, LTD., 58

  ANIMAL THERAPY COMPANY, 317

  Anistamina (M. Olivetti), Reports Council Pharm. & Chem., 1915,
    p. 162.

  ANNALS OF SURGERY, ADVERTISING IN, 35, 421

  ANODYNE BALM, P-M COMPANY, 267

  ANTIDIABETICUM-BAUER, 267

  ANTI-JAG, 434

  ANTIKAMNIA, 9, 268, 307

  Antikamnia and Quinin (Antikamnia Chemical Co.), The Journal,
    July 1, 1905, p. 55.

  ANTIKAMNIA CHEMICAL COMPANY, 277, 279, 307

  Antimeristem-Schmidt (Laboratorium W. Schmidt), The Journal,
    March 8, 1913, p. 766.

  ANTI-NEURALGIC OINTMENT, 267

  Antiphlogistine (Denver Chemical Manufacturing Company), The
    Journal, June 1, 1907, p. 1875.

  ANTIPYRIN, HARMFUL EFFECTS OF, 305

  ANTISEPTIC POWDER, MAIGNEN, 19

  ANTISEPTIC POWDER, TYREE’S, 21, 404, 436

  Antiseptic Tablets, Clover (Sharp & Dohme), The Journal, Aug. 26,
    1911, p. 755.

  ANTISEPTIC W-A, INTESTINAL, 103

  ANTITHERMOLINE, 403

  ANUSOL HEMORRHOIDAL SUPPOSITORIES, 227, 280, 281

  APERGOLS, 26

  Arbor Vitae, Reports Council Pharm. & Chem., 1912, p. 38.

  ARCHIVES OF PEDIATRICS, ADVERTISING IN, 31

  ARMOUR & CO., 133, 472

  ARMY AND NAVY MAGAZINE, 434

  ARMY AND NAVY MEDICAL RECORD, 292, 300, 432

  ARNOLD’S ZYMOTOID AND ARNOLD’S ZYMOTOID COMPANY, 412

  AROMATIC DIGESTIVE TABLETS, 229

  ASEPTIKONS, 26

  ASPIRO-LITHINE, 281

  ASPIROPHEN, 85

  ATLANTA JOURNAL-RECORD OF MEDICINE, ADVERTISING IN, 31, 35, 296

  ATOLEINE, 161

  ATOLIN, 161

  AUBERGIER’S SYRUP OF LACTUCARIUM, 399

  Autolysin (Autolysin Laboratory), The Journal, July 24, 1915,
    p. 336; Nov. 6, 1915, pp. 1647, 1662.

  Avenin Compound Tablets (Parke, Davis & Co.), Reports Council Pharm.
    & Chem., 1912, p. 44.


  Baby Taeniafuge Grape (Grape Capsule Co.), Reports Council Pharm. &
    Chem., 1915, p. 174.

  Bacillicide (Prophytol Products Co.), The Journal, Nov. 14, 1914,
    p. 1778; Reports Council Pharm. & Chem., 1914, p. 125.

  BAKING POWDER, CASOID, 449

  BAKING POWDER, JIREH DIABETIC, 450

  Bakurol (Sharp & Dohme), The Journal, July 10, 1915, p. 175.

  BALLARD, J. F., 112, 198

  BALLARD-SNOW LINIMENT COMPANY, 43

  BALLARD’S SNOW LINIMENT, 205

  Baneberry, Reports Council Pharm. & Chem., 1912, p. 38.

  Baptisin, The Journal, Nov. 13, 1909, p. 1655; Reports Council
    Pharm. & Chem., 1909, p. 135.

  BANNERMAN, WM., & CO., AND BANNERMAN’S INTRAVENOUS SOLUTION, 105

  BAPTISIA TINCTORIA, 209

  BARKER’S GLUTEN FOODS, 449, 450

  BATTLE & CO., 31, 81, 108, 330

  BAUER, CHARLES, 299

  BAUER, LUDWIG, 267

  BAUER CHEMICAL COMPANY, 366

  BAUME ANALGÉSIQUE BENGUÉ, 267

  Bee, Honey, Reports Council Pharm. & Chem., 1912, p. 38.

  BEEF EXTRACTS, JUICES AND PREPARATIONS, 123, 133, 471, 472

  BELL & CO., 151, 282, 356

  BELL-ANS (PA-PAY-ANS, BELL), 151, 282

  Benetol (Northern Chemical Assn.), The Journal, April 15, 1911,
    p. 1128; Reports Chem. Lab., 1911, p. 82.

  BETUL-OL, 27

  BEYER, CHARLES AND FRANK, 299

  BIOSOL, 284

  BISCHOF’S DIABETIC GLUTEN BREAD, 450

  BISCHOF’S GLUTEN FLOUR, 449

  BISCHOFF & CO., 293, 344

  BISCUIT, VARIOUS DIABETIC, 449, 450

  Bismuth Iodo-Resorcin Sulphonate, The Journal, Feb. 11, 1911,
    p. 441; Reports Chem. Lab., 1911, p. 14.

  Bismuth, Opium and Phenol Tablets (Hance Bros. & White, Wm. S.
    Merrell Chemical Co., Parke, Davis & Co., Sharp & Dohme, F. Stearns
    & Co., Truax, Greene & Co., H. K. Wampole & Co., Wm. R. Warner
    & Co.), The Journal, July 25, 1908, p. 330; Dec. 17, 1910, p. 2169;
    May 6, 1911, p. 1344; Reports Chem. Lab., 1909, p. 28; 1910, p. 85;
    1911, p. 22.

  Bitter Bark, Reports Council Pharm. & Chem., 1912, p. 39.

  Bladder Wrack, Reports Council Pharm. & Chem., 1912, p. 39.

  BLANDINE, 161

  Blandine Laxative, Mulford (H. K. Mulford Co.), Reports Council
    Pharm. & Chem., 1914, p. 136.

  Blaud Capsules and Blaud Arsenic and Strychnine Capsules, Frosst’s
    (C. E. Frosst & Co.), Reports Council Pharm. & Chem., 1915, p. 164.

  BLISS, ALONZO O., COMPANY, 463

  Blood Tonic, Alterative (Parke, Davis & Co.), Reports Council Pharm.
    & Chem., 1912, p. 47.

  Blue Cohosh, The Journal, Sept. 11, 1915, p. 972.

  BOATMAN, H. F., 436

  Boneset, Tall, Reports Council Pharm. & Chem., 1912, p. 45.

  BOONE, URIEL S., 307

  Borolyptol (Palisade Mfg. Co.), The Journal, Nov. 15, 1913, p. 1812.

  BOUMA, DR., SUGAR-FREE FAT-MILK, 449

  BOVININE, 123, 125, 126

  BOVININE COMPANY, 123

  BRADBURY’S ECZEMA LOTION, 245

  BRANT, J. W., COMPANY, LTD, 411

  BREADS, VARIOUS DIABETIC, 450

  BREAKFAST FOOD, GUM GLUTEN, 450

  BREITENBACH, M. J., COMPANY, 159

  BRISTOL-MYERS COMPANY, 87, 179

  Brobor (Gaynor-Bagstad Co.), Reports Council Pharm. & Chem., 1915,
    p. 164.

  Bromides with Cypripedium Compound (Truax, Greene & Co.), Reports
    Council Pharm. & Chem., 1912, p. 43.

  BROMIDES, PEACOCK’S, 28

  BROMIDIA, 31

  BROMIN-IODIN CHEMICAL COMPANY AND BROMIN-IODIN COMPOUND, 285

  Bromo-Mangan (Reinschild Chemical Company), Reports Council Pharm.
    & Chem., 1915, p. 165.

  Broom Corn, Reports Council Pharm. & Chem., 1912, p. 39.

  BROWN’S IRON BITTERS, 205

  BROWN’S IRON BITTERS COMPANY, 43

  Bruschettini Curative Vaccine (A. Bruschettini), Reports Council
    Pharm. & Chem., 1915, p. 176.

  BRUSSON CHOCOLATE WITH ADDED GLUTEN, 450

  BUCHU AND HYOSCYAMUS COMP., TYREE’S ELIXIR, 407

  Buchu and Hyoscyamus Compound, Tyree’s Elixir of (J. S. Tyree),
    Reports Council Pharm. & Chem., 1915, p. 167.

  Buchu and Pareira Compound Elixir (Parke, Davis & Co.), Reports
    Council Pharm. & Chem., 1912, p. 46.

  Buchu, Juniper and Acetate Potassium, Elixir of (Pitman-Moore Co.),
    Reports Council Pharm. & Chem., 1915, p. 166.

  Budwell’s Emulsion of Cod-Liver Oil, Nos. 1 and 2 (Budwell Pharmacal
    Company), The Journal, Feb. 20, 1915, p. 684; Reports Council
    Pharm. & Chem., 1915, p. 135.

  BUFFALO LITHIA WATER, 467

  BUFFALO MEDICAL JOURNAL, ADVERTISING IN, 31, 35, 300

  BURNHAM’S SOLUBLE IODINE, 110, 233

  BURNHAM’S SOLUBLE IODINE COMPANY, 110

  BUTTERS, VARIOUS DIABETIC, 450


  CACTIN (NOW CACTOID), 37

  Cactin (The Abbott Laboratories) and Cactina (Sultan Drug Company),
    The Journal, Sept. 21, 1907, p. 1021; March 21, 1908, p. 956;
    April 4, 1908, p. 1140; Aug. 6, 1910, p. 455.

  CACTINA, 36

  CACTINA PILLETS, 37

  CACTUS GRANDIFLORUS, 36

  Cactus Grandiflorus, The Journal, Sept. 21, 1907, p. 1021; Jan. 7,
    1911, p. 26.

  Calcidin Abbott and Calcidin Tablets (The Abbott Laboratories), The
    Journal, Sept. 7, 1907, p. 865; Reports Chem. Lab., 1909, p. 7.

  CALCREOSE, 40

  CALLARD’S PREPARATIONS FOR DIABETICS, 450

  CALMINE, 286

  CAMPHENOL, 287

  CAMPHO-PHENIQUE, 40, 205

  CAMPHO-PHENIQUE COMPANY, 40, 42

  CAMPHO-PHENIQUE POWDER, 41

  CANADA LANCET, ADVERTISING IN, 279, 300

  CANADIAN MEDICAL ASSOCIATION JOURNAL, ADVERTISING IN, 300

  CANADIAN PRACTITIONER AND REVIEW, ADVERTISING IN, 300

  CANCER HOSPITAL (KELLAM), 426

  Cannabis Compound, Syrup of (Pitman-Moore Co.), Reports Council
    Pharm. & Chem., 1915, p. 168.

  Captol (Mülhens & Kropff), The Journal, Sept. 10, 1910, p. 959;
    Reports Chem. Lab., 1910, p. 70.

  CARNINE, 123, 125, 128

  CARNINE COMPANY, 123

  CARNRICK, G. W., COMPANY, 185, 403

  Caroid and Essence of Caroid (Mead, Johnson & Co.), Reports Council
    Pharm. & Chem., 1914, p. 109.

  CARPANUTRINE, 133

  Casca-Aletris (Pullen-Richardson Chemical Co.), Reports Council
    Pharm. & Chem., 1912, p. 46.

  CASCARANS (BELL), 154

  CASCARETS, 475

  CASOID DIABETIC PREPARATIONS, 449, 450

  Caviblen (A. Grimme), Reports Council Pharm. & Chem., 1915, p. 176.

  Cedron Seed, Reports Council Pharm. & Chem., 1912, p. 40.

  CELERINA, 43

  CELLARIUS COMPANY, 85

  Celery and various Elixirs of Celery (Hance Bros. & White, Nelson,
    Baker Co., Parke, Davis & Co., Ray Chemical Co., Smith, Kline &
    French Co., F. Stearns & Co.), Reports Council Pharm. & Chem.,
    1912, p. 40.

  Cellasin (Mead Johnson & Co.), The Journal, Sept. 12, 1908, p. 931;
    Oct. 30, 1909, p. 1496; Reports Council Pharm. & Chem., 1905-8,
    p. 198; 1909, p. 118.

  CEREO SOY BEAN GRUEL FLOUR, 450

  CHAMAELIRIUM LUTEUM, 84

  CHAMBERLAIN, C. S., 81

  CHAMBERS, ARTHUR AND LESLIE T., 147

  CHAMBERS, J. H. AND M. E., 146

  CHAPOTEAUT’S WINE, 60

  CHARLOTTE MEDICAL JOURNAL, ADVERTISING IN, 31, 35, 422

  CHEMISCHE FABRIK FALKENBERG, 85

  CHESEBROUGH, ROBERT A., 161

  CHICAGO MEDICAL RECORDER, ADVERTISING IN, 31

  CHINOSOL, 248

  CHINOSOL COMPANY, 26, 248

  Chiodrastis (H. K. Wampole & Co.), Chionacea (Nelson, Baker & Co.,
    Inc.), Elixir Chionanthus Compound (Ray Chemical Co.), and Elixir
    Chionanthus (Special) (Parke, Davis & Co.), Reports Council Pharm.
    & Chem., 1912, p. 42.

  CHIONIA, 30

  CHLORO-PHENIQUE, 42

  CHOCOLATE, PROPRIETARY DIABETIC, 450

  CHOLOGEN, 288

  Chologestin (F. H. Strong Co.), The Journal, Dec. 11, 1915, p. 2108.

  Chromiac Tablets (Maltbie Chemical Co.), Reports Council Pharm. &
    Chem., 1912, p. 44.

  CIBILIS COMPANY, 472

  CINERARIA MARITIMA, 49

  Citarin (The Bayer Company, Inc.), The Journal, Feb. 20, 1915,
    p. 685; Reports Council Pharm. & Chem., 1914, p. 135.

  CITROCOLL, 85

  CLAUSEL, HENRY, & CO., 221

  Clover Compound, Syrup Red (Nelson, Baker & Co.), Reports Council
    Pharm. & Chem., 1912, p. 40.

  COCILLANA COMPOUND, SYRUP OF, 396

  Cod Liver Ext., Stearns’ Wine of, with Peptonate of Iron (Frederick
    Stearns & Co.). Reports Council Pharm. & Chem., 1915, p. 177.

  COD LIVER OIL AND COD LIVER OIL CORDIALS,
    COMPARATIVE NUTRIENT VALUE OF, 442

  Cod-Liver Oil, Budwell’s Emulsion of, Nos. 1 and 2 (Budwell
    Pharmacal Co.), The Journal, Feb. 20, 1915, p. 684; Reports
    Council Pharm. & Chem., 1915, p. 135.

  COD LIVER OIL PREPARATIONS, 51, 52, 54, 57, 289, 442

  Cohosh, Blue, and Fluidextract Blue Cohosh Compound (Parke, Davis &
    Co.), Reports Council Pharm. & Chem., 1912, p. 40.

  Colchi-Methyl Capsules (H. K. Wampole & Co.), Reports Council Pharm.
    & Chem., 1915, p. 169.

  COLCHI-SAL, 58

  COLLYRIUM-WYETH, 292

  COLUMBUS PHARMACAL COMPANY, 344

  COMAR & CO., 401

  Compound, Waterbury’s (Waterbury Chemical Co.), The Journal,
    March 20, 1915, p. 1016; Reports Council Pharm. & Chem., 1915,
    p. 138.

  Condurango, Reports Council Pharm. & Chem., 1911, p. 54.

  CONLEY, WILLIAM W., 49

  CONSOLIDATED COLOR AND CHEMICAL WORKS, 328

  COPELAND, B. F., 266

  Corydalis Compound, Elixir (Parke, Davis & Co.), Reports Council
    Pharm. & Chem., 1912, p. 47.

  COSMOLINE, LIQUID, 161

  Coto and Cotoin, Reports Council Pharm. & Chem., 1913, p. 39.

  COTTON-ROOT BARK, 84

  COUDREY, H. M., 119

  CRAMP BARK COMPOUND, FLUID EXTRACT OF, 410

  CRAWLEY, M., 119

  CRYSMALIN, 161

  Cuprase (in “Chemotherapy and Tumors”), The Journal, April 17, 1915,
    p. 1283; Reports Council Pharm. & Chem., 1915, p. 28.

  CUDAHY PACKING COMPANY, 471, 472

  Curare and Curarin, The Journal, Jan. 15, 1910, p. 219;
    Reports Council Pharm. & Chem., 1910, p. 7.

  CYPRIDOL CAPSULES, 59

  Cystitis Tablet (Parke, Davis & Co., Smith, Kline & French Co.),
    Reports Council Pharm. & Chem., 1912, p. 45.

  CYSTOGEN, CYSTOGEN APERIENT, CYSTOGEN-LITHIA AND CYSTOGEN CHEMICAL
    COMPANY, 60

  CYSTO-SEDATIVE, 61


  DAD CHEMICAL COMPANY, 136

  Damiana, Allan’s Compound Extract of (Allan-Pfeiffer Chemical Co.),
    The Journal, July 19, 1913, p. 211.

  DANDERINE, 474

  DANIEL, JOHN B., 332

  DANIEL’S CONCENTRATED TINCTURE OF PASSIFLORA, 156, 332

  DARPIN, 47

  DAWSON, JAMES P., 49

  DEELINE, 161

  DENSTON, J. C., 251

  DENVER MEDICAL TIMES AND UTAH MEDICAL JOURNAL,
    ADVERTISING IN, 31, 35, 49

  DETROIT MEDICAL JOURNAL, ADVERTISING IN, 300

  Diabetic Biscuit and Flour and other Foods, Jireh (Jireh Diabetic
    Food Company), The Journal, March 22, 1913, p. 922, and Dec. 14,
    1912, p. 2174.

  DIABETIC FOODS OFFERED FOR SALE IN THE UNITED STATES, 446

  Dianol I, Dianol II and Dianol III (Kalle & Co.), Reports Council
    Pharm. & Chem., 1913, p. 34.

  Diastos, Liquor (H. K. Mulford Co.), The Journal, Feb. 9, 1907,
    p. 533.

  DIATUSSIN, 293

  DIGALEN, 68

  DIETETIC AND HYGIENIC GAZETTE, ADVERTISING IN, 342

  DIGESTIVE TABLETS, AROMATIC, 229

  Digestive Tonic (Truax, Greene & Co.), Reports Council Pharm. &
    Chem., 1912, p. 44.

  Digitalis preparations, proprietary, The Journal, Dec. 4, 1915,
    p. 2024; Reports Council Pharm. & Chem., 1915, p. 89.

  Digitalone (Parke, Davis & Co.), The Journal, June 12, 1909,
    p. 1938; Dec. 7, 1912, p. 2074; Jan. 11, 1913, p. 143.

  Digitalysatum (E. Bischoff & Co.), The Journal, Feb. 15, 1913,
    p. 499; Jan. 8, 1916, p. 135; Reports Council Pharm. & Chem.,
    1915, p. 93.

  DIORADIN, 73, 436

  DIOS CHEMICAL COMPANY, 41, 139, 146

  DIOSCOREA VILLOSA, 208

  Dioscorea, various elixirs of (H. K. Mulford Co., Parke, Davis &
    Co., Ray Chemical Co., F. Stearns & Co.), Reports Council Pharm. &
    Chem., 1912, pp. 41, 46.

  DIOVIBURNIA, 139, 141, 410

  DIOXOGEN, 436

  DIURETIN, 251

  Diurol (H. K. Mulford Co.), Reports Council Pharm. & Chem., 1912,
    p. 45.

  DODGE, JOHN L., 155

  Dogwood, Flowering, Reports Council Pharm. & Chem., 1912, p. 41.

  DOMINION MEDICAL MONTHLY, ADVERTISING IN, 300

  DOWD, J. HENRY, AND DOWD’S PHOSPHATOMETER, 476

  DRAKE’S PALMETTO COMPOUND, 475

  DUBLIN JOURNAL MEDICAL SCIENCE, ADVERTISING IN, 279

  Duodenin-Armour (Armour & Co.), The Journal, Aug. 4, 1915, p. 639;
    Jan. 15, 1916, p. 178; Reports Council Pharm. & Chem., 1915,
    pp. 99, 151.

  Dyspepsia Compound, Elixir (H. K. Mulford Co.), Reports Council
    Pharm. & Chem., 1912, p. 44.

  Dyspepsia, Elixir Atonic, Phenolated (Wm. S. Merrell Chemical
    Company), The Journal, Feb. 9, 1907, p. 533.


  ECHAFOLTA, 80

  ECHINACEA, 79, 80

  ECHITONE, 81

  ECHTISIA, 81

  ECLECTIC MEDICAL JOURNAL, ADVERTISING IN, 31, 35, 49, 342

  ECTHOL, 80, 81

  ECZEMA LOTION, DR. BRADBURY’S, 245

  Edema Tablet (Parke, Davis & Co., Smith, Kline & French Co.),
    Reports Council Pharm. & Chem., 1912, pp. 41, 45.

  EDSON, DR. CYRUS, 336

  EIMER AND AMEND, 113

  EL ZERNAC COMPANY, 344

  Elder, Reports Council Pharm. & Chem., 1912, p. 41.

  Electro-Selenium (in “Chemotherapy and Tumors”), The Journal,
    April 17, 1915, p. 1283; Reports Council Pharm. & Chem., 1915,
    p. 28.

  ELLINGWOOD’S THERAPEUTIST, ADVERTISING IN, 31, 35

  Emulsio Minerolein and Emulsio Phen-Oleum (T. R. D. Barse Co.),
    Reports Council Pharm. & Chem., 1915, p. 169.

  Endotin (Morgenstern & Co.), Reports Council Pharm. & Chem., 1914,
    p. 136.

  Enesol (Fougera & Co.), The Journal, July 26, 1913, p. 293.

  ENTERONOL AND ENTERONOL COMPANY, 294

  Eosin-Selenium (in “Chemotherapy and Tumors”), The Journal,
    April 17, 1915, p. 1283; Reports Council Pharm. & Chem., 1915,
    p. 28.

  EPINEPHRIN, NAME, VERSUS THE NAME ADRENALIN, 454

  Episan (Gaynor-Bagstad Co.), Reports Council Pharm. & Chem., 1915,
    p. 164.

  ERGOAPIOL, 82

  Ergone (Parke, Davis & Co.), The Journal, Oct. 7, 1911, p. 1211;
      Oct. 14, 1911, p. 1302.

  Ergotole (Sharp & Dohme), The Journal, Oct. 7, 1911, p. 1211;
      Oct. 14, 1911, p. 1302.

  ERPIOL (DR. SCHRADER), 83

  Eryngo, Water, Reports Council Pharm. & Chem., 1912, p. 47.

  ESTILL, FLOYD, 18

  ETNA CHEMICAL COMPANY, 225, 335

  Eunatrol (C. Bischoff & Co.), The Journal, Feb. 22, 1908, p. 627.

  EUSOMA, 80

  Eusoma (Eusoma Pharmaceutical Co.), Reports Council Pharm. & Chem.,
    1912, p. 38.

  EUSOMA PHARMACEUTICAL COMPANY, 81

  EXPURGO ANTI-DIABETES AND EXPURGO MANUFACTURING COMPANY, 299

  EXPURGO LAPIS, 439

  Expurgo Lapis (Expurgo Manufacturing Co.), The Journal, Nov. 8,
    1913, p. 1733.

  EXURGINE, 344


  FALSE UNICORN, 84

  FARBENFABRIKEN OF ELBERFELD COMPANY, 311, 414

  Febrisol (Tilden Co.), The Journal, June 29, 1912, p. 2043.

  Febri-Tone (Arthur Veter & Co.), The Journal, Feb. 1, 1908, p. 379.

  FELLOWS’ SYRUP OF HYPOPHOSPHITES, 436

  FERBUSON GLUTEN BREAD, 450

  Fermenlactyl (Anglo-American Pharmacal Co., Ltd.), The Journal,
    Jan. 30, 1909, pp. 372, 397.

  Ferric Arsenite, Soluble, Reports Council Pharm. & Chem., 1912,
    p. 30.

  Figwort, Reports Council Pharm. & Chem., 1912, p. 42.

  Filudine (Geo. J. Wallau, Inc.), The Journal, Sept. 18, 1915,
    p. 1045; Reports Council Pharm. & Chem., 1915, p. 156.

  FLOURS, VARIOUS DIABETIC, 449, 450

  FOODS, DIABETIC, OFFERED FOR SALE IN THE UNITED STATES, 446

  FOODS, MEDICINAL, 131

  FORMAMINT, 303

  Formamint (A. Wulfing Co.), The Journal, Aug. 28. 1915, p. 816;
    Reports Council Pharm. & Chem., 1915, p. 64.

  Formidin (Parke, Davis & Co.), The Journal, Sept. 5, 1908, p. 818;
    Reports Council Pharm. & Chem., 1905-8, p. 192.

  FORMUROL, 85

  FORTOSSAN, 178

  FOSSILINE, LIQUID, 161

  FOUGERA, E. & CO., 10, 27, 58, 59, 115, 123

  FRANCO-AMERICAN FERMENT COMPANY, 120

  FRASER TABLET COMPANY, 232

  FRAUD, GREAT AMERICAN, AND PHARMACEUTICAL MANUFACTURERS, 474

  FREDERICK, PURDUE, COMPANY, 100

  Friedmann’s Vaccine (Standard Distributing Co.), Reports Council
    Pharm. & Chem., 1914, p. 136.

  Fringe Tree, Reports Council Pharm. & Chem., 1912, p. 42.

  FROMM’S DIABETIC BREADS AND CHOCOLATE, 450

  Frosst’s Blaud Capsules and Frosst’s Blaud, Arsenic and Strychnine
    Capsules (C. E. Frosst & Co.), Reports Council Pharm. & Chem.,
    1915, p. 164.


  G. G. Phenoleum Disinfectant (G. G. Chemical Co., Inc.), The
    Journal, Jan. 30, 1915, p. 456; Reports Council Pharm. & Chem.,
    1915, p. 131.

  Galactagogue (Eli Lilly & Co.), Reports Council Pharm. & Chem.,
    1912, p. 43.

  GAMBLE, D. E., 119

  GARDNER, R. W., 310

  GARDNER-BARADA CHEMICAL COMPANY, 256

  GARDNER’S SYRUP OF HYDRIODIC ACID, 97

  GASTROGEN TABLETS, 87

  Gelsemine Hydrochlorid and Gelseminine, Reports Council Pharm. &
    Chem., 1911, p. 57.

  GENERAL DRUG COMPANY, 328

  Genitone (Wm. S. Merrell Chemical Co.), Reports Council Pharm. &
    Chem., 1912, p. 44.

  GEOLINE, LIQUID, 161

  GERMAN COUNCIL ON PHARMACY AND CHEMISTRY, 459

  GERMAN PROPAGANDA FOR REFORM, 458

  GERMILETUM, 139, 143

  GERO, LOUIS, LTD., 74

  GETWELL TABLETS, 476

  Ginseng, Reports Council Pharm. & Chem., 1912, p. 42;
    The Journal, Oct. 24, 1914, p. 1486.

  Ginseng Compound, Elixir (H. K. Mulford Co.), and Ginseng Compound
    (Special), Elixir (Parke, Davis & Co.), Reports Council Pharm. &
    Chem., 1912, p. 42.

  GLASGOW MEDICAL JOURNAL, ADVERTISING IN, 279

  GLIDINE, 449

  Glidine (Menley & James), The Journal, June 28, 1913, p. 2037.

  Globeol (Geo. J. Wallau, Inc.), The Journal, Sept. 18, 1915,
    p. 1046; Reports Council Pharm. & Chem., 1915, p. 157.

  GLUTEN PRODUCTS, VARIOUS, FOR DIABETIC USE, 450

  Glutol-Schleich (Schering & Glatz), Reports Council Pharm. & Chem.,
    1915, p. 170.

  GLYCERIN, MINERAL, 161

  Glycerine Tonic Comp., Gray’s (Purdue Frederick Co.), The Journal,
    July 10, 1915, p. 189; Reports Council Pharm. & Chem., 1915,
    p. 56.

  Glycero-Lecithin, Pill (Westerfield Pharmacal Co.), Reports Council
    Pharm. & Chem., 1915, p. 170.

  Glycerole of Lecithin (Fairchild Bros. & Foster), Reports Council
    Pharm. & Chem., 1915, p. 123.

  GLYCO, 161

  GLYCO-HEROIN, SMITH, 88

  GLYCOLINE, 161

  GLYCO-THYMOLINE, 92

  GLYCOZONE, 95

  GLYMOL, 161

  Goat’s Rue, Reports Council Pharm. & Chem., 1912, p. 42.

  GOMENOL, 304

  Gonococcide (Cox Chem. Co.), The Journal, Aug. 24, 1907, p. 708.

  GORDON, 18

  GOSSYPIN, 84

  GRAND PRIX AND GOLD MEDALS FOR SALE, 462

  Gray’s Glycerine Tonic Comp. (Purdue Frederick Co.), The Journal,
    July 10, 1915, p. 189; Reports Council Pharm. & Chem., 1915,
    p. 56.

  GRISARD, A. F., B. A., DR. JOHN P. AND DR. JOHN W., 18

  Guaialin (Organic Chemical Mfg. Co.), The Journal, Sept. 5, 1908,
    p. 818; May 8, 1909, p. 1511; Reports Council Pharm. & Chem.,
    1905-8, p. 166; Reports Council Pharm. & Chem., 1909, p. 76.

  Guarana and Celery, various Elixirs of (Hance Bros. & White, Parke,
    Davis & Co., and Ray Chemical Co.), Reports Council Pharm. &
    Chem., 1912, p. 40.

  GUBB, ALFRED S., 436

  GUDE’S PEPTO-MANGAN, 159

  GUM GLUTEN BREAKFAST FOOD, 450


  H-M-C; see Hyoscin-Morphin Cactin.

  HAGEE’S CORDIAL OF COD-LIVER-OIL, 51, 289, 443

  Hair Cap Moss, Reports Council Pharm. & Chem., 1912, p. 43.

  HAMMOND, G. H., COMPANY, 472

  HANCE BROS, AND WHITE, 175

  HANSON, EDWARD F., 476

  HAYDEN’S VIBURNUM COMPOUND, 218, 409

  HAYDEN, W. R., 218

  HEADACHE “CURES”, 305

  HEADACHE POWDERS, KOEHLER’S, 10

  “HEALTH FOOD” DIABETIC PREPARATION, 450

  HECTINE, 308

  HELONIAS DIOICA, 84

  Helonias, elixirs and fluidextracts of, various (Hance Bros. &
    White, H. K. Mulford Co., Parke, Davis & Co., Ray Chemical Co.
    and Smith, Kline & French Co.), Reports Council Pharm. & Chem.,
    1912, pp. 41, 46.

  Helonin Comp., Mist. (Schlotterbeck & Foss), The Journal, Dec. 18,
    1915, p. 2186.

  HEMO, 319, 322

  HEMORRHOIDAL SUPPOSITORIES, ANUSOL, 227, 280

  HENRY PHARMACAL COMPANY, 198

  HERBINE, 205

  HERRICK’S PILLS, 43, 205

  Hexa-co-sal-in (Hexa-Co-Sal-In Company), The Journal, Oct. 2, 1915,
    p. 1203; Reports Council Pharm. & Chem., 1915, p. 159.

  Hex-a-lith (Smith-Dorsey Company), The Journal, Feb. 14, 1914,
    p. 555.

  HILLE, H., 284

  HOFFMANN-LA ROCHE CHEMICAL WORKS, 68, 252

  HOGE, W. M., 328

  HORD SANITARIUM, 456

  Horse Nettle, Reports Council Pharm. & Chem., 1912, p. 43.

  HOSPITAL BULLETIN OF THE UNIVERSITY OF MARYLAND, ADVERTISING IN, 35

  HOWELL, H. B. & CO., LTD., 326

  HUNTLEY AND PALMER’S AKOLL BISCUIT, 449

  HURLEY, H. O., 351

  Hydragogin (C. Bischoff & Co.), The Journal, Jan. 27, 1906, p. 288;
    The Journal, Sept. 4, 1915, p. 894;
    Reports Council Pharm. & Chem., 1915, p. 154.

  Hydrangea and Lithia, Elixir (Hance Bros. & White), Reports Council
    Pharm. & Chem., 1912, p. 45.

  Hydrangea, Lithiated (Lambert Pharmacal Co.), Reports Council Pharm.
    & Chem., 1912, p. 42.

  HYDRASTIS AND CRAMP BARK COMPOUND, HYDRASTIS AND VIBURNUM COMPOUND,
    ELIXIR OF, 410

  HYDRIODIC ACID, GARDNER’S SYRUP OF, 97

  HYDROCYANATE OF IRON, TILDEN, 235

  Hydroleine (Charles N. Crittenton Company), Reports Council Pharm. &
    Chem., 1915, p. 171.

  Hydron (Wm. S. Merrell Chemical Co.), Reports Council Pharm. &
    Chem., 1912, p. 44.

  HYDRONAPHTHOL, 308

  Hydropsin (Ernst Bischoff Co.), The Journal, Jan. 8, 1916, p. 135;
    Reports Council Pharm. & Chem., 1915, p. 94.

  HYDROZONE, 96, 309

  HYMOSA, 238, 323

  Hyoscin-Morphin Cactin (now Hyoscin-Morphin-Cactoid) (Abbott
    Laboratories), The Journal, Dec. 21, 1907, p. 2103.

  HYPEROL, 100

  HYPOPHOSPHITE FALLACY, 464

  HYPOPHOSPHITES, FELLOWS’ SYRUP OF, 436

  HYPOQUINIDOL, 310


  Ichthynate (Mallinckrodt Chemical Works), Reports Chem. Lab., 1912,
    p. 110.

  INDIANAPOLIS MEDICAL JOURNAL, ADVERTISING IN, 31, 35, 300

  INDIGO, WILD, 209

  INGLUVIN, 101

  INGRAHAM, C. W., 285

  Interol (Van Horn & Sawtell), The Journal, July 10, 1915, p. 175.

  INTERNATIONAL JOURNAL OF SURGERY, ADVERTISING IN, 31, 49, 342, 429

  INTERSTATE MEDICAL JOURNAL, ADVERTISING IN, 49

  INTESTINAL ANTISEPTIC W-A., 103

  Intravenin P-H (Intravenin Products Co.), Reports Council Pharm. &
    Chem., 1915, p. 120.

  INTRAVENOUS PRODUCTS COMPANY, 212, 214

  INTRAVENOUS SOLUTION, BANNERMAN’S, 105

  IODALIA, 106

  IODEX, 107

  IODIA, 108

  Iodin Petrogen (John Wyeth & Bro.), The Journal, Nov. 30, 1912,
    p. 1992.

  _Iodine, Burnham’s Soluble and Burnham’s Soluble Iodine
    Tablets_, 110, 233

  Iodival (Knoll & Co.), The Journal, March 4, 1911, p. 685.

  Iodo-Bromide of Calcium Comp. “Without Mercury” and “With Mercury,”
    Elixir of (Tilden Co.), The Journal, Nov. 6, 1915, p. 1662;
    Reports Council Pharm. & Chem., 1915, p. 160.

  Iodomuth (Organic Chemical Mfg. Co.), The Journal, Sept. 5, 1908,
    p. 818; May 8, 1909, p. 1511; Reports Council Pharm. & Chem.,
    1905-8, p. 166; Reports Council Pharm. & Chem., 1909, p. 75.

  IODONUCLEOID, 310

  IODOTONE, 113

  IODOVASOGEN, 408

  Iodum-Miller and Iod-Izd-Oil, Miller’s (Iodum-Miller Co.), The
    Journal, Oct. 2, 1915, p. 1202; Reports Council Pharm. & Chem.,
    1915, p. 76.

  IOSALINE, 113

  IOSALINE COMPANY, 114

  IOWA MEDICAL JOURNAL, ADVERTISING IN, 35, 300

  IRIDIUM (MEDICINAL), 312

  IRON, HYDROCYANATE OF, TILDEN, 235

  Iron Solution for Intravenous Therapy--Perkins and Ross (Perkins
    and Ross), The Journal, Nov. 14, 1914, p. 1778; Reports Council
    Pharm. & Chem., 1914, p. 125.

  IRON TROPON, 313

  Isopral (Farbenfabriken of Elberfeld Co.), The Journal, Aug. 8,
    1908, p. 487; Reports Council Pharm. & Chem., 1905-8, p. 119.


  Jaroma (Jaroma Company), The Journal, Sept. 2, 1911, p. 835;
    Reports Chem. Lab., 1913, p. 103.

  JAROS, A. L., 225

  Jireh Diabetic (Diatetic) Biscuit, Flour and other foods (Jireh
    Diabetic Food Company), The Journal, March 22, 1913, p. 922;
    Dec. 14, 1912, p. 2174.

  JIREH DIABETIC (DIATETIC) FOOD PRODUCTS, 449, 450

  JIREH DIABETIC FOOD COMPANY, 451

  JOHNS, L. D., COMPANY AND DR. JOHN’S TABLETS, 154

  JOHNSON AND JOHNSON, 287

  JOURNAL OF NERVOUS AND MENTAL DISEASES, ADVERTISING IN, 35

  JOURNAL TROPICAL MEDICINE AND HYGIENE, ADVERTISING IN, 279

  Jubol (Geo. J. Wallau, Inc.), The Journal, Aug. 14, 1915, p. 639;
    Reports Council Pharm. & Chem., 1915, p. 152.

  Juglandin, The Journal, Nov. 13, 1909, p. 1655;
    Reports Council Pharm. & Chem., 1909, p. 135.


  KAISER, MAX, 462

  KALARI BATONS, 449, 450

  KALARI BISCUIT, 449

  KANSAS CITY MEDICAL RECORD, ADVERTISING IN, 296

  KATHARMON CHEMICAL COMPANY, 51

  KEELER, CLAUDE C., 436

  Kefilac (Kefilac Co.), The Journal, Jan. 30, 1909, pp. 372, 397.

  KELLAM [CANCER] HOSPITAL, 426

  KELLOGG’S DIABETIC PRODUCTS, 449, 450

  KENNEDY’S PINUS CANADENSIS, LIGHT AND DARK, 47

  KENNER, ROBERT C., 300

  Keratin, Reports Council Pharm. & Chem., 1911, p. 58.

  Kinazyme (G. W. Carnrick Co.), The Journal, Nov. 1, 1913, p. 1649.

  KLIPSTEIN, A., & CO., 178

  KNOLL & CO., 252

  KNOWLTON DANDERINE COMPANY, 474

  KOECHL, VICTOR, & CO., 135, 328

  KOEHLER’S HEADACHE POWDERS, 10

  Kola Compound, Elixirs (H. K. Mulford Co., Parke, Davis & Co. and
    Ray Chemical Co.), Reports Council Pharm. & Chem., 1912, p. 40.

  Kolynos (Kolynos Co.), The Journal, Nov. 15, 1913, p. 1812.

  KOMMANDANTAN APOTHEKE, 334

  Koyol (Koyol Co.), Reports Council Pharm. & Chem., 1915, p. 172.

  KRESS AND OWEN COMPANY, 92

  KUTNOW BROTHERS, LTD., AND S. KUTNOW, 316

  KUTNOW’S POWDER, 314

  Kutnow’s Powder (Kutnow Bros.), The Journal, Nov. 9, 1907, p. 1619.


  LABORDINE, 115

  LABORDINE PHARMACAL COMPANY, 116, 119

  LACTOBACILLINE, 120

  Lactone (Parke, Davis & Co.), The Journal, Jan. 30, 1909,
    pp. 372, 397.

  LACTOPEPTINE, 121

  Lactopeptine and Elixir Lactopeptine (New York Pharmacal
    Association), The Journal, Oct. 23, 1915, p. 1477; Reports Council
    Pharm. & Chem., 1915, p. 79.

  LACTUCARIUM, AUBERGIER’S SYRUP OF, 399

  LAINE CHEMICAL COMPANY, 196

  LANCET, ADVERTISING IN, 279

  LANCET-CLINIC, ADVERTISING IN, 31, 342

  LARYNGOSCOPE, ADVERTISING IN, 35

  LAXAPHEN, 344

  LAXINE, 344

  LAXOTHALEN TABLETS, 344

  Lecibrin (Fairchild Bros. & Foster), Reports Council Pharm. & Chem.,
    1915, p. 123.

  Lecithin, Reports Council Pharm. & Chem., 1915, p. 122.

  Lecithin Solution (Fairchild Bros. & Foster), Reports Council Pharm.
    & Chem., 1915, p. 123.

  Lecithol (Armour & Co.), Reports Council Pharm. & Chem., 1915,
    p. 123.

  LEHN AND FINK, 414, 415

  Lettuce Calmative (Nelson, Baker & Co.), Reports Council Pharm. &
    Chem., 1912, p. 43.

  Lettuce, Wild, Reports Council Pharm. & Chem., 1912, p. 43.

  LEWIS, ARTHUR G., 433

  LEWIS, HERBERT C., 434

  LIBBY, MCNEIL & LIBBY, 471

  LILLY, ELI, & CO., 133, 195, 410

  LIPPINCOTT’S MAGAZINE, ADVERTISING IN, 419

  LIQUID PEPTONES, 133

  LIQUID PETROLATUM, 161

  LIQUID TAKA-DIASTASE, 62

  LIQUOZONE, 413

  Lithia and Broom Corn Compound, Elixir (Parke, Davis & Co.), Reports
    Council Pharm. & Chem., 1912, p. 39.

  Lithia and Hydrangea, Elixirs (Parke, Davis & Co., Ray Chemical Co.
    and Smith, Kline & French Co.), Reports Council Pharm. & Chem.,
    1912, p. 45.

  Lithiated Sorghum Compound (Sharp & Dohme), Reports Council Pharm. &
    Chem., 1912, p. 39.

  LITHIA WATER, BUFFALO, 467

  LITTLETON, J. M. , 18

  Liver Leaf, Reports Council Pharm. & Chem., 1912, p. 43.

  LOEB’S IMPORTED GLUTEN FLOUR, 450

  LOUISVILLE MONTHLY JOURNAL OF MEDICINE AND SURGERY,
    ADVERTISING IN, 31, 35, 300

  LOUISVILLE PHARMACAL WORKS, 410

  LUYTIES’ HOMEOPATHIC PHARMACY COMPANY, 50, 240, 323

  LYMPH COMPOUND R-H, 317

  LYNCH, J. J. , 18

  Lysoform and Lysoform, Crude (Lysoform Gesellschaft), The Journal,
    Nov. 21, 1914, p. 1870; Reports Council Pharm. & Chem., 1914,
    p. 126.

  LYSOL, 318


  MAGISTRAL CHEMICAL COMPANY, 328

  MAIGNEN ANTISEPTIC POWDER AND MAIGNEN INSTITUTE FOR THE STUDY OF
    BACTERIAL DISEASES, 19

  MAIGNEN, P. J. A. , 20

  Maizavena (William S. Merrell Chemical Co.), Reports Council Pharm.
    & Chem., 1912, p. 44.

  MAIZININ COMPOUND, 249

  MAIZO-LITHIUM, 198, 203

  MALLINCKRODT CHEMICAL WORKS, 119, 252, 415

  Malt Extract with Pepsin and Pancreatin (Wm. S. Merrell Chemical
    Co., Parke, Davis & Co.), The Journal, Feb. 9, 1907, p. 533.

  Malt, Williams’ Syrup of (American Malt Extract Co.), The Journal,
    Sept. 4, 1915, p. 895; Reports Council Pharm. & Chem., 1915,
    p. 155.

  MALTBIE CHEMICAL COMPANY, 40

  MALTED BEEF-PEPTONE, 319

  MALTED MILK, 319

  Manaca and various manaca preparations (Hance Bros. & White,
    William S. Merrell Chemical Co., H. K. Mulford Co., Nelson, Baker
    & Co., Parke, Davis & Co., Pullen-Richardson Chemical Co., Ray
    Chemical Co., Sharp & Dohme, Smith, Kline & French Co., F. Stearns
    & Co. and Truax, Greene & Co.), Reports Council Pharm. & Chem.,
    1912, pp. 43, 44.

  MANOLA, 323

  MANOLA CHEMICAL COMPANY, 50, 240, 323

  MARCHAND, CHARLES, 95, 309

  MARCY COMPANY, 216, 344

  MARIANI & CO. AND MARIANI’S WINE, 221

  Marienbad Tablets (J. Sieke), The Journal, July 18, 1908, p. 237.

  MARMALADE, CASOID SUGARLESS, 449

  MARMOLA, 348

  MARYLAND MEDICAL JOURNAL, ADVERTISING IN, 31, 35

  MASSACHUSETTS MEDICAL JOURNAL, ADVERTISING IN, 35, 49, 300

  Matico Compound, Elixir (Parke, Davis & Co.), Reports Council Pharm.
    & Chem., 1912, p. 45.

  MAYFIELD MEDICINE MFG. COMPANY, 43

  MCKESSON AND ROBBINS, 281, 401

  MEAT EXTRACTS AND MEAT JUICES, 123, 470

  MEDICAL BRIEF, ADVERTISING IN, 31, 35, 49, 300

  MEDICAL CENTURY, ADVERTISING IN, 49, 342

  MEDICAL COUNCIL, ADVERTISING IN, 49

  MEDICAL FORTNIGHTLY, ADVERTISING IN, 31, 300

  MEDICAL HERALD, ADVERTISING IN, 31, 35, 300

  MEDICAL JOURNALS AND THE GREAT AMERICAN FRAUD, 426

  MEDICAL JOURNAL ADVERTISING, 422

  MEDICAL PRESS AND CIRCULAR, ADVERTISING IN, 279

  MEDICAL RECORD, ADVERTISING IN, 31, 303, 304, 342

  MEDICAL REVIEW, ADVERTISING IN, 35, 300

  MEDICAL REVIEW OF REVIEWS, ADVERTISING IN, 31, 35, 49, 300, 304

  MEDICAL SENTINEL, ADVERTISING IN, 31, 35, 49

  MEDICAL STANDARD, ADVERTISING IN, 31, 35, 49, 300, 342

  MEDICAL SUMMARY, ADVERTISING IN, 31, 300

  MEDICAL TIMES, ADVERTISING IN, 31, 35, 131, 300, 424, 426, 430, 438

  MEDICAL WORLD, ADVERTISING IN, 31, 35, 131

  MEDICINAL FOODS, 131

  Med-O-Lin (Waverly Oil Works Co.), Reports Council Pharm. & Chem.,
    1915, p. 172.

  MEISTER, LUCIUS & BRUNING, 135

  MEMPHIS MEDICAL MONTHLY, ADVERTISING IN, 35

  MENLEY AND JAMES, LTD., 107

  MERCK & CO., 252, 311, 415

  MERCK’S ARCHIVES, ADVERTISING IN, 35

  MERCOL, 326

  Mercury Sozoiodolate and Mercury Sozoiodolate Solution, The Journal,
    Feb. 13, 1909, p. 573.

  MERRELL, WM. S., CHEMICAL CO., 81, 83, 133, 231

  METCALF’S DIABETIC PRODUCTS, 450

  METHYL SALICYLATE OINTMENT, 267

  Methyl-Santal (H. K. Mulford Co.), Reports Council Pharm. & Chem.,
    1915, p. 173.

  METROPOLITAN PHARMACAL CO., 188

  METZ, HERMAN A., 328

  MEYER, DR. H. F. C., AND MEYER’S BLOOD PURIFIER, 80

  MICAJAH, & CO., 241, 243

  MICAJAH’S MEDICATED UTERINE WAFERS, 240

  MICROBE KILLER, RADAM’S, 413

  MIDOL, 327

  MIGRAININ, 135

  MILK, SUGAR-FREE, 449

  Miller’s Iod-Izd-Oil (Iodum Miller Co.), The Journal, Oct. 2, 1915,
    p. 1202; Reports Council Pharm. & Chem., 1915, p. 77.

  MILWAUKEE MEDICAL JOURNAL, ADVERTISING IN, 296

  MINERAL OIL, MINERAL GLYCERINE, 161

  Mist. Helonin Comp. (Schlotterbeck & Foss), The Journal, Dec. 18,
    1915, p. 2186.

  Mitchella Compound (Dr. J. H. Dye Medical Institute), Reports
    Council Pharm. & Chem., 1912, pp. 41, 46.

  MIZER, BLAKE V., AND MIZER SANATORIUM, 457

  MONTHLY CYCLOPEDIA AND MEDICAL BULLETIN, ADVERTISING IN, 35

  MORSE, WILLARD H., 436

  MOSQUERA-JULIA FOOD CO., 472

  MOTHER’S CORDIAL, 410

  Mother’s Cordial (Eli Lilly & Co., Ray Chemical Co.), Reports
    Council Pharm. & Chem., 1912, p. 46.

  Motherwort, Reports Council Pharm. & Chem., 1912, p. 44.

  MU-COL AND MU-COL CO. (INC.), 329

  MULFORD, H. K. CO., 193, 230, 267, 410

  MULLER’S TOMATOES FÜR DIABETIKER, 450

  Muthol (Demuth’s Laboratories), The Journal, July 10, 1915, p. 175.


  Narcophin (Merck and Co.), The Journal, Nov. 21, 1914, p. 1872.

  NARKINE, 329

  NASCHER, I. L., 479

  NASHVILLE JOURNAL OF MEDICINE AND SURGERY, ADVERTISING IN, 31, 35

  NASHVILLE SANITARIUM DIABETIC FOOD PRODUCTS, 449, 450

  NELSON BAKER & CO., 267, 410

  Nephritin (Reed & Carnrick Co.), The Journal, Oct. 5, 1907, p. 1198;
    Reports Council Pharm. & Chem., 1905-8, p. 79.

  Nephroson (William S. Merrell Chemical Co.), Reports Council Pharm.
    & Chem., 1912, pp. 39, 45.

  NERVE VITALIZER, WHEELER’S, 411

  NEURALGINE, 475

  NEURILLA, 136

  Neuro-Lecithin-Abbott (Abbott Laboratories), Reports Council Pharm.
    & Chem., 1915, p. 123.

  Neurocaine (Schieffelin & Co.), Reports Council Pharm. & Chem.,
    1915, p. 173.

  NEUROSINE, 139, 140

  NEUTRALOL, 161

  NEW ORLEANS MEDICAL AND SURGICAL JOURNAL, ADVERTISING IN, 31, 35

  NEW YORK HEALTH JOURNAL, 433

  NEW YORK INSTITUTE OF PHYSICIANS AND SURGEONS, 475

  NEW YORK MEDICAL JOURNAL, ADVERTISING IN, 31, 303, 304, 342

  NEW YORK PHARMACEUTICAL ASSOCIATION, 121

  NOITOL, 245

  NORWICH PHARMACAL CO., 254, 259

  Nose-Ions (Nose-Ions Company), The Journal, Dec. 4, 1915, p. 2026.

  NOURRY WINE, 115

  Nujol (Standard Oil Co. of New Jersey), The Journal, July 10, 1915,
    p. 175.

  NURITO, 327, 328

  NUTRIENT WINE OF BEEF PEPTONE, 133

  NUTRIOLA CO., 475

  NUTRITIVE LIQUID PEPTONE, 133

  NUT PRODUCTS, VARIOUS DIABETIC, 449, 450


  O-P-C SUSPENSORY, 436

  Oats, Reports Council Pharm. & Chem., 1912, p. 44.

  OD CHEMICAL CO., 182

  OLD DOMINION JOURNAL OF MEDICINE AND SURGERY, ADVERTISING IN, 131

  OLEUM GABIANUM, 161

  OLO, 161

  ORANGEINE, 10

  ORCHITIC FLUID TABLETS, 317

  Orsudan (Burroughs, Wellcome & Co.), The Journal, April 16, 1910,
    p. 1323.

  OXYCHLORINE AND OXYCHLORINE CHEMICAL CO., 147, 261

  Oxydendron Compound, Fluidextract (Nelson, Baker & Co.), Reports
    Council Pharm. & Chem., 1912, pp. 43, 45.

  OXYDONOR, 419

  Oxyntin (Fairchild Brothers & Foster), Reports Council Pharm. &
    Chem., 1915, p. 174.

  OXYTONIC, 413


  PACIFIC MEDICAL JOURNAL, ADVERTISING IN, 31, 279, 342

  Palmetto Compound (William S. Merrell Chem. Co.), Reports Council
    Pharm. & Chem., 1912, p. 44.

  PALPEBRINE, 139, 145

  PAM-ALA, 149

  PAM-ALA CO., 150

  PANCREATIN AND PEPSIN MIXTURES, 157, 229

  Pancreatin and pepsin preparations, various (Eli Lilly & Co., H. K.
    Mulford Co., Parke, Davis & Co., Sharp & Dohme, Smith, Kline &
    French Co., F. Stearns & Co. and William R. Warner & Co.), The
    Journal, Feb. 9, 1907, p. 533.

  Papain, The Journal, Feb. 9, 1907, p. 522.

  PAPAYANS BELL, 151, 282

  PAPINE, 330

  Para Coto and Paracotoin, Reports Council Pharm. & Chem., 1913,
    p. 39.

  PARAFFIN, LIQUID, PARAFFIN OIL, 161

  PARKE, DAVIS & CO., 62, 133, 231, 267, 311, 344, 396, 410, 474, 476

  PAROLINE, 161

  PASADYNE, 156, 332

  PAS-AVENA AND PAS-AVENA CO., 333

  PASSIFLORA, 156

  PATCH, E. L., MANUFACTURING CO., 476

  Pautauberge’s Solution (Geo. J. Wallau), The Journal, March 7, 1910,
    p. 1560.

  PAX CHEMICAL CO, 344

  PEACOCK CHEMICAL CO. AND PEACOCK’S BROMIDES, 28

  PEARSON & CO., 408

  PEDIATRICS, ADVERTISING IN, 131, 296, 342

  PEPSIN AND PANCREATIN MIXTURES, 157, 229

  Pepsin and pepsin and pancreatin preparations, various (Columbus
    Pharmacal Co., Eli Lilly & Co., H. K. Mulford Co., Parke, Davis &
    Co., Arthur Peters & Co., Sharp & Dohme, Smith, Kline & French
    Co., F. Stearns & Co. and William R. Warner & Co.), The Journal,
    Feb. 9, 1907, p. 533.

  Peptenzyme, Elixir and Powder (Reed & Carnrick Co.), The Journal,
    Feb. 9, 1907, p. 533; Oct. 5, 1907, p. 1198; Reports Council
    Pharm. & Chem., 1905-8, p. 79.

  PEPTO-MANGAN (GUDE), 159

  Peptone, Reports Council Pharm. & Chem., 1913, p. 41.

  PEPTONES, LIQUID, AND PEPTONIC ELIXIR, 133

  Perfection Liquid Food (Perfection Liquid Food Co.), Reports Council
   Pharm. & Chem., 1913., p. 44.

  PERTUSSIN, 334

  PETRALOL, PETRO, NAMES FOR LIQUID PETROLATUM, 161

  PETROLATUM, LIQUID, CLINICAL EXPERIENCES WITH, 167

  PETROLATUM LIQUIDUM, GRAVE, AND LEVE, DESCRIPTION OF, 166

  PETROLAX, PETROLIA, PETRONOL, PETROSIO,
    NAMES FOR LIQUID PETROLATUM, 161

  PETROLEUM EMULSION, ANGIER’S, 169

  PHARMACEUTICAL MANUFACTURERS AND THE GREAT AMERICAN FRAUD, 474

  PHECOLATES, PHECOLAX, PHECOTONES AND PHECOZYMES, 174

  PHENACETIN AND ACETPHENETIDIN, THEIR RELATIVE PURITY, 414

  PHENALEIN, 344

  PHENALGIN, 10, 335

  PHENO-BROMATE AND PHENO-BROMATE CO., 343

  PHENOL SODIQUE, 175

  PHENOLAX WAFERS, 344

  PHENOLPHTHALEIN, 343

  PHENOLPHTHALEIN LAXATIVE, 344

  PHILLIPS, I. G., 18

  PHOSPHATOMETER, DOWD’S, 476

  PHOSPHORUS, AMORPHOUS, 478

  PHOSPHORUS AMORPHOUS, PILL, S. & D., 482

  PHOSPHORUS TONIC, COMP., 476

  PHOSPHO-VANADIOL, 209

  PHYLACOGENS, 346

  PHYTIN, 178

  PIERCE’S FAVORITE PRESCRIPTION, 410

  PIERSON, ROMAINE, 428

  PINKERTON, E. D., 49

  PINUS CANADENSIS, KENNEDY’S, 47

  Piperazine Water (Lehn & Fink), The Journal, Feb. 29, 1908, p. 704.

  PISO’S CONSUMPTION CURE, 242

  PITMAN-MYERS CO., 267, 344

  PIX CRESOL AND PIX CRESOL CHEMICAL CO., 247

  Plasmon (Plasmon Milk Products Co.), Reports Chem. Lab., 1914,
    p. 88.

  PLATINUM CO. OF AMERICA, 312

  PLESSNER, PAUL, CO., 198

  Pluto Spring Water, Concentrated (French Lick Springs Hotel Co.),
    The Journal, March 29, 1913, p. 1013.

  POEHL’S SPERMIN, 395

  Ponca Compound (Mellier Drug Co.), The Journal, July 17, 1915,
    p. 269; Reports Council Pharm. & Chem., 1915, p. 60.

  Poslam (Emergency Laboratories), The Journal, May 22, 1909, p. 1678;
    Reports Chem., Lab., 1909, p. 25.

  Potassium Iodo-Resorcin Sulphonate, The Journal, Feb. 11, 1911,
    p. 441; Reports Chem. Lab., 1911, p. 21.

  POWERS-WEIGHTMAN-ROSENGARTEN CO., 252, 415

  PRACTICAL DRUGGIST, 428

  PRACTITIONER, ADVERTISING IN, 279

  PROBILIN, 344

  PROCTOLOGIST, ADVERTISING IN, 296

  PROTO PUFFS, HEALTH FOOD NOS. 1 AND 2, 450

  PROTONUCLEIN, 348

  Protonuclein and Protonuclein Beta (Reed & Carnrick), The Journal,
    Jan. 1, 1916, p. 48; Reports Council Pharm. & Chem., 1915, p. 90.

  PROTONUCLEIN SPECIAL, 349

  PROTOSE, KELLOGG’S, 449

  PROTOSOY DIABETIC FLOUR AND WAFERS, 450

  PRUNOIDS, 178, 344

  PSORA, 249

  Pulsatilla, Reports Council Pharm. & Chem., 1912, p. 44.

  PURDUE FREDERICK CO, 100

  PURGEN, 349

  PYO-ATOXIN, 350

  PYRAMIDON IN PATENT MEDICINES, 327


  Queen of the Meadow, Reports Council Pharm. & Chem., 1912, p. 45.

  Quina LaRoche (E. Fougera & Co.), The Journal, March 21, 1908,
    p. 978.

  Quinin Arsenate, The Journal, July 16, 1910, p. 235;
    Reports Council Pharm. & Chem., 1910, p. 73.

  Quinine Glycerophosphate, Reports Chem. Lab., 1912, p. 107.


  RADAM’S MICROBE KILLER, 413

  Radelium and the Radelium Generator (Radio-Active Water Company),
    Reports Pharm. & Chem., 1915, p. 128.

  RADEMANN’S DIABETIC PREPARATIONS, 449, 450

  Radium Solution for Intravenous Use, Standard (Radium Chemical Co.),
    The Journal, June 26, 1915, p. 2156; Reports Council Pharm. &
    Chem., 1915, p. 147.

  Rattlesnake-Venom, The Journal, March 15, 1913, p. 850;
    March 29, 1913, p. 1001; June 7, 1913, p. 1811.

  RECTOIDS, 249

  REIMANN, ARTHUR E., 477

  RENGO, 348

  RENNE’S PAIN KILLING OIL, 205

  RENOVA DISTRIBUTING CO., 434

  RESINOL, 352

  RESOR-BISNOL, 353

  Respirazone (Tilden Company), The Journal, June 14, 1913, p. 1899.

  REX BRAND BEEF EXTRACT, 471, 472

  Rheumalgine (Eli Lilly & Co.), The Journal, June 26, 1915, p. 2156;
    Reports Council Pharm. & Chem., 1915, p. 148.

  Rheumatic Bacterin (Mixed) No. 47, Swan’s (Swan-Myers Co.), The
    Journal, Nov. 6, 1915, p. 1662; Reports Council Pharm. & Chem.,
    1915, p. 160.

  RICHARDS, JOHN MORGAN, AND SONS, 121

  RICHARDSON CO., 476

  RICHARDSON’S LIFE-PRESERVING BITTERS, 43

  Ricinol-Grape Tape-Worm Remedy and Baby Taeniafuge-Grape (Grape
    Capsule Co.), Reports Council Pharm. & Chem., 1915, p. 174.

  RIGAUD & CHAPOTEAUT, 59

  RIO CHEMICAL COMPANY, 43, 49

  ROBINOL, 353, 354

  ROCK OIL, 161

  ROEMER, A. VON, 207

  ROYAL NEIGHBOR, CLEAN ADVERTISING IN, 418

  RUF, FRANK A., 276

  RUSKS, CALLARD’S CASOID, 450

  RUSSIAN MINERAL OIL, RUSSIAN PARAFFIN OIL, 161


  ST. PAUL MEDICAL JOURNAL, ADVERTISING IN, 35

  SALACETIN (BELL), 10, 152, 356

  SAL-CODEIA (BELL), 152, 357

  SAL HEPATICA, 87, 179

  Salesthyl and Sal-Hyl (New York Salesthyl Corporation), The Journal,
    Feb. 20, 1915, p. 684; Reports Council Pharm. & Chem., 1915,
    p. 134.

  SALIODIN AND SALIODIN CHEMICAL CO., 249

  Salit (Heyden Chemical Works), The Journal, June 5, 1909, p. 1852;
    Reports Council Pharm. & Chem., 1909, p. 106.

  SANATOGEN, 358, 378, 385

  SANATOGEN AND MEDICAL JOURNALS, 431

  Sanguinarine Nitrate, Reports Council Pharm. & Chem., 1911, p. 59.

  SANMETTO, 182

  SANOL ANTI-DIABETES AND SANOL MANUFACTURING CO., LTD. , 299

  SATYRIA, 202

  SAXOL, LIQUID SAXOLINE, 161

  SCHERING & GLATZ, 207, 227, 344

  Scopolamin-Morphin Mixtures, The Journal, Feb. 5, 1910, p. 446;
      Feb. 12, 1910, p. 516;
      June 7, 1913, p. 1814;
    Reports Council Pharm. & Chem., 1910, p. 11.

  SCROFONOL, 43

  Scullcap Compound, Fluidextract (Parke, Davis & Co.), Reports
    Council Pharm. & Chem., 1912, p. 43.

  SEABURY & JOHNSON, 308, 476

  SECRETOGEN ELIXIR AND TABLETS, 185

  Secretogen and Elixir Secretogen (G. W. Carnrick Co.), The Journal,
    Jan. 15, 1916, p. 178; Reports Council Pharm. & Chem., p. 99.

  Sedobrol “Roche” (Hoffman-LaRoche Chemical Works), The Journal,
    Jan. 2, 1915, p. 71; Reports Council Pharm. & Chem., 1914.

  Selenium compounds (in “Chemotherapy and Tumors”), The Journal,
    April 17, 1915, p. 1283; Reports Council Pharm. & Chem., 1915,
    p. 28.

  Semprolin (W. Browning & Co.), The Journal, July 10, 1915, p. 175.

  SENEKA OIL, 161

  Seng (Sultan Drug Co.), Reports Council Pharm. & Chem., 1915,
    p. 129.

  SEPTICIDE, 413

  Serum Vaccine, Bruschettini (R. G. Berlingieri), The Journal,
    Nov. 21, 1914, p. 1870; Reports Council Pharm. & Chem., 1914,
    p. 127.

  Seven-Bark, Reports Council Pharm. & Chem., 1912, p. 45.

  SEVETOL, 353, 355

  SHAC, 476

  SHARP & DOHME, 133, 231, 476

  SINKINA, 149, 150, 151, 188

  Sirolin (Sirolin Co.), The Journal, June 21, 1913, p. 1974.

  SMITH BILE BEANS CO. AND SMITH’S BILE BEANS, 43

  SMITH, CHARLES B., 155

  SMITH, KLINE AND FRENCH CO., 410

  SMITH, MARTIN H., CO., 82, 88

  SOCIETY OF CHEMICAL INDUSTRY, 178

  SOJA BEAN MEALS, 450

  SOMNALGESINE, 333

  SOMNOS, 193

  Sourwood and Sourwood Elixirs (Eli Lilly & Co. and Parke, Davis &
    Co.), Reports Council Pharm. & Chem., 1912, p. 45.

  SOUTH TEXAS MEDICAL RECORD, CREDITABLE ADVERTISING IN, 440

  SOUTHERN PRACTITIONER, ADVERTISING IN, 31, 35, 279

  SOUTHWEST JOURNAL OF MEDICINE AND SURGERY, ADVERTISING IN, 300

  SOY FLOURS, 450

  SPENCER’S ALMOND PASTE, 450

  SPERMINUM POEHL, 395

  Squaw Root, Reports Council Pharm. & Chem., 1912, p. 40.

  Squaw-vine and squaw-vine preparations (Eli Lilly & Co., Parke,
    Davis & Co.), Reports Council Pharm. & Chem., 1912, p. 45.

  SQUIBB, E. R., & SONS, 252, 415

  Standard Radium Solution for Intravenous Use (Radium Chemical Co.),
    The Journal, June 26, 1915, p. 2156; Reports Council Pharm. &
    Chem., 1915, p. 147.

  STEARNS, FREDERICK, & CO., 267, 410, 476

  Stearns’ Wine (Frederick Stearns & Co.), Reports Council Pharm. &
    Chem., 1915, p. 177.

  STERLING REMEDY CO., 475

  STEVENSON & JESTER CO., 133

  Stillingia preparations, various (Hance Bros. & White, H. K. Mulford
    Co., Parke, Davis & Co., Ray Chemical Co. and Smith, Kline &
    French Co.), Reports Council Pharm. & Chem., 1912, pp. 42, 47.

  Stone Root, Reports Council Pharm. & Chem., 1912, p. 46.

  STRONG, COBB & CO., 61, 81

  Strychnin Arsenate, The Journal, Sept. 24, 1910, p. 1128;
    Reports Council Pharm. & Chem., 1910, p. 74.

  SUCCUS ALTERANS, 195

  SUCCUS CINERARIA MARITIMA (WALKER), 50

  Sugar Cane, Chinese, Reports Council Pharm. & Chem., 1912, p. 39.

  SULPHO-LYTHIN, 196

  SULTAN DRUG COMPANY, 37, 178, 344

  SUSPENSORY, O-P-C, 436

  SWAIM’S PANACEA, 205

  SWAIN’S ALL-HEALING OINTMENT AND SWAIN’S LABORATORY, 43

  Swan’s Rheumatic Bacterin (Mixed) No. 47 (Swan-Myers Co.), The
    Journal, Nov. 6, 1915, p. 1662; Reports Council Pharm. & Chem.,
    1915, p. 160.

  SWIFT & CO., 471

  SYNERGIA, 231

  SYRUP OF COCILLANA COMPOUND, 396

  SYRUP OF HYDRIODIC ACID, GARDNER’S, 97

  SYRUP OF LACTUCARIUM, AUBERGIER’S, 399

  Syrup of Malt, Williams’ (American Malt Extract Co.), The Journal,
    Sept. 4, 1915, p. 895.

  SZENDEFFY, DR. R. DE, 74


  Tablogestin (F. H. Strong Co.), The Journal, Dec. 11, 1915, p. 2108.

  TAKA-DIASTASE AND LIQUID TAKA-DIASTASE, 62

  Tannyl (Charles Goslar), Reports Chem. Lab., 1912, p. 108.

  TARTARLITHINE AND TARTARLITHINE CO., 401

  TAUROCOL TABLETS AND COMPOUND TABLETS, 198

  TENNANT, GEORGE C., 155

  TERRALBOLIA, TERRALINE, NAMES FOR LIQUID PETROLATUM, 161

  TEXAS MEDICAL JOURNAL, ADVERTISING IN, 31, 35, 49

  TEXAS MEDICAL NEWS, ADVERTISING IN, 31, 35

  THALOSEN, 344

  THEOBROMIN SODIUM SALICYLATE VERSUS DIURETIN, 251

  THERAPEUTIC GAZETTE, ADVERTISING IN, 31, 35

  THERAPEUTIC RECORD, ADVERTISING IN, 279, 300

  THIALION, 205

  Thiocol and Syrup Thiocol-Roche (Hoffmann-La Roche Chemical Works),
    The Journal, June 21, 1913, p. 1974; Reports Council Pharm. &
    Chem., 1913, p. 16.

  Thioform (Otto Hann & Bro.), Reports Chem., Lab., 1909, p. 79.

  THOMPSON’S MALTED FOOD CO., 319

  THOXOS, 402

  THREE CHLORIDES (HENRY), 198, 201

  TILDEN CO., 235, 329

  TOLEDO MEDICAL AND SURGICAL REPORTER, ADVERTISING IN, 296

  Tonga and various tonga preparations (Hance Bros. & White, Eli Lilly
    & Co., William S. Merrell Chemical Co., Nelson, Baker & Co.,
    Parke, Davis & Co., Ray Chemical Co., Sharp & Dohme, F. Stearns &
    Co., William R. Warner & Co. and H. K. Wampole & Co.), The
    Journal, May 10, 1913, p. 1478; Reports Council Pharm. & Chem.,
    1912, p. 46.

  Tongaline and Tongaline Tablets (Mellier Drug Co.), The Journal,
    July 17, 1915, p. 269; Reports Council Pharm. & Chem., 1915,
    p. 58.

  TONIC BEEF, S. & D., 133

  Toxinol (Hughes Chemical Co.), Reports Council Pharm. & Chem., 1912,
    p. 39.

  TRI-IODIDES, 198, 199

  Trifolium preparations, various (Hance Bros. & White, Eli Lilly &
    Co., William S. Merrell Chemical Co., H. K. Mulford Co., Parke,
    Davis & Co., Ray Chemical Co. and F. Stearns & Co.), Reports
    Council Pharm. & Chem., 1912, pp. 39, 40.

  Trilene Tablets, Reports Council Pharm. & Chem., 1912, p. 39.

  Trophonine (Reed & Carnrick Co.), The Journal, Oct. 5, 1907,
    p. 1198; Reports Council Pharm. & Chem., 1905-8, p. 79.

  TRUAX, GREENE & CO., 231

  TRYPSOGEN, 403

  Tubercle Vaccine, Non-Virulent, Sherman’s (G. H. Sherman), The
    Journal, Nov. 21, 1914, p. 1870; Reports Council Pharm. & Chem.,
    1914, p. 128.

  Tuberculin Test Plate, Keller’s (A. H. Keller), The Journal,
    Dec. 19, 1914, p. 2250.

  Tuberculoids (Columbus Pharmacal Company), The Journal, Feb. 22,
    1908, p. 704.

  Tubo-Arg (Tubo Pharmacal Co.), Reports Council Pharm. & Chem., 1915,
    p. 175.

  Turkey Corn, Reports Council Pharm. & Chem., 1912, p. 47.

  TURNER, F. M., AND THE DR. TURNER CO., 211

  TYREE, J. S., 21, 405

  TYREE’S ANTISEPTIC POWDER, 21, 404

  TYREE’S ELIXIR BUCHU AND HYOSCYAMUS COMP., 407

  Tyree’s Elixir of Buchu and Hyoscyamus Compound (J. S. Tyree),
    Reports Council Pharm. & Chem., 1915, p. 167.


  Ulax Salt (F. H. Strong Co.), Reports Council Pharm. & Chem., 1915,
    p. 175.

  UNGUENTINE, 254

  UNGUENTUM SELENIO VANADIC (V. ROEMER), 207

  UNICORN ROOT, 208

  UNITED STATES HEALTH REPORTS, 433

  UPJOHN CO., 344

  Uranoblen (A. Grimme), Reports Council Pharm. & Chem., 1915, p. 176.

  Urasol (Organic Chemical Mfg. Co.), The Journal, Sept. 5, 1908,
    p. 818; May 8, 1909, p. 1511; Reports Council Pharm. & Chem.,
    1905-8, p. 166; 1909, p. 64.

  URIC ACID MONTHLY, 207

  URICEDIN, 256

  Uricsol (Uricsol Chemical Co.), The Journal, Aug. 14, 1915, p. 638;
    Reports Council Pharm. & Chem., 1915, p. 149.

  URISEPTIN, 256

  Urodonal (Geo. J. Wallau, Inc.), The Journal, Aug. 14, 1915, p. 639;
    Reports Council Pharm. & Chem., 1915, p. 153.

  Uron (Uron Chemical Company), The Journal, Nov. 3, 1906, p. 1500;
    Reports Council Pharm. & Chem., 1905-8, p. 26.

  USOLINE, 161

  UTERINE SEDATIVE ELIXIR, 410

  Uterine Sedative, Elixir (Eli Lilly & Co.), The Journal, Aug. 31,
    1912, p. 735; Reports Council Pharm. & Chem., 1912, p. 44.

  Uterine tonics, various (Abbott Alkaloidal Co., Girard Chemical Co.,
    Maltbie Chemical Co., H. K. Mulford Co., Nelson, Baker & Co.,
    Parke, Davis & Co. and F. Stearns & Co.), Reports Council Pharm. &
    Chem., 1912, pp. 41, 46.

  UTERINE WAFERS, MICAJAH’S MEDICATED, 240


  Vaccine, Curative, Bruschettini (A. Bruschettini), Reports Council
    Pharm. & Chem., 1915, p. 176.

  Vaccine, Friedmann’s (Standard Distributing Co.), Reports Council
    Pharm. & Chem., 1914, p. 136.

  VACCINE, MIXED, 346

  Vaccine, Non-Virulent Tubercle Bacillus (G. H. Sherman), The
    Journal, Sept. 20, 1913, p. 979.

  VALENTINE, M. J., 123

  VALENTINE’S MEAT JUICE, 123, 125, 129

  VALENTINE’S MEAT JUICE CO., 472

  Vanadic Acid, The Journal, May 9, 1908, p. 1548;
      July 24, 1909, p. 309.

  VANADIOL, VANADIOSEPTOL AND VANADIUM SOLUTION FOR INTRAVENOUS AND
    HYPODERMIC USE, 209

  Vanadium, The Journal, June 3, 1911, p. 1648.

  VANADIUM CHEMICAL CO., 201, 211

  VANADOFORME, 210

  VAPO-CRESOLENE, 408

  VASELINE, LIQUID, 161

  VASOGEN, 408

  VASS CHEMICAL CO., 205

  VENARSEN, 212

  VENODINE, 214

  VERACOLATE, 216, 344

  VERMONT MEDICAL MONTHLY, ADVERTISING IN, 35

  Veroform Germicide (Veroform Hygienic Co.), The Journal, Nov. 22,
    1913, p. 1920.

  VIAL, NEW YORK LABORATORIES OF, 59

  Viburn-Ovaro (Ray Chemical Co.), Reports Council Pharm. & Chem.,
    1912, p. 46.

  VIBURNUM COMPOUND, ELIXIR OF, 410

  VIBURNUM COMPOUND, HAYDEN’S, 218, 409

  Viburnum preparations, various (Fraser Tablet Co., Parke, Davis &
    Co. and Smith, Kline & French Co.), Reports Council Pharm. &
    Chem., 1912, p. 46.

  VIBURNUMAL, 410

  VIBUTERO, 410

  VIGORAL, 472

  VIN MARIANI, 221

  VINOL, 443

  Vinum Ext. Morrhuae, Stearns (Frederick Stearns & Co.), Reports
    Council Pharm. & Chem., 1915, p. 177.

  VIRGINIA MEDICAL SEMI-MONTHLY, ADVERTISING IN, 131

  VIROL AND VIROL, LTD., 225

  VITAOPATHY, 475


  WALKER PHARMACAL CO., 50, 238, 240

  WALKER, WILL E., 18

  WALLAU, GEORGE J., INC., 106

  WAMPOLE, HENRY K., & CO., INC., 26, 52

  WAMPOLE’S PERFECTED AND TASTELESS PREPARATION OF AN EXTRACT OF COD
    LIVER, 52, 443

  WARNER, W. R., & CO., 101

  Water Eryngo, Reports Council Pharm. & Chem., 1912, p. 47.

  WATERBURY CHEMICAL CO., 54, 57, 463

  WATERBURY’S COMPOUND, 54, 57, 291, 443

  WESTERN CANADA MEDICAL JOURNAL, ADVERTISING IN, 300

  WHEELER CHEMICAL WORKS, 245

  WHEELER’S NERVE VITALIZER, 411

  Whiteruss (Lubric Oil Co.), The Journal, July 10, 1915, p. 175.

  White Sulphur Salts (White Sulphur Springs, Inc.), The Journal,
    Nov. 21, 1914, p. 1870; Reports Council Pharm. & Chem., 1914.

  WHITING’S SUGAR-FREE MILK, 449

  WHITNEY, F. WALDO, 174

  WILD INDIGO, 209

  WILD YAM, 208

  Williams’ Syrup of Malt (American Malt Extract Co.), The Journal,
    Sept. 4, 1915, p. 895; Reports Council Pharm. & Chem., 1915,
    p. 155.

  WINE, CHAPOTEAUT’S, 60

  Wine of Cod Liver Ext. with Peptonate of Iron, Stearns’ (Frederick
    Stearns & Co.), Reports Council Pharm. & Chem., 1915, p. 177.

  WISCONSIN MEDICAL RECORDER, ADVERTISING IN, 31, 35

  WOMAN’S MEDICAL JOURNAL, ADVERTISING IN, 31, 49

  WYETH’S BEEF JUICE, 123, 125, 126

  WYETH, JOHN, & BROTHER, 123, 133, 259, 292, 354, 402, 472


  Xanol (Wm. S. Merrell Chemical Co.), Reports Council Pharm. & Chem.,
    1911, p. 64.


  YAM, WILD, 208

  Yogurt (Yogurt Co.), The Journal, Jan. 30, 1909, pp. 372, 397.


  ZEMACOL, 259

  ZYMOTOID, 412

  ZYME-OID, 261

  ZYMOLE TROKEYS, 476

  ZUMOTA, 436




Spelling inconsistencies:

  quinin/quinine
  soluble/solubile/soluable
  glucosid/glucoside
  peroxid/peroxide
  oxid/oxide
  Hydrastin/Hydrastine
  small-pox/smallpox
  protochlorid/protochloride
  narcotin/narcotine
  anilpyrine/anilipyrine
  vender/vendor
  chemic/chemical
  strychnin/strychnine
  pseudo-scientific/pseudoscientific
  semi-secret/semisecret
  beta-naphthol/betanaphthol
  to-day/today
  acetyl-salicylic/acetysalicylic
  indorse/endorse
  indorsement/endorsement
  gm./Gm.


Spelling corrections:

  folowing —> following
  wafer —> water
  Amedemin —> Anedemin
  Prepration —> Preparation
   he —> the
  decription —> description
  administation —> administration
  oven —> even
  test —> tests
  constitutent —> constituent
  iutensive —> intensive
  accurary —> accuracy
  Helionas —> Helonias
  Phamacopeia —> Pharmacopeia
  cancerns —> concerns
  repiration —> respiration
  commitee —> committee
  ampoules —> ampules
  fradulent —> fraudulent
  Thp —> The
  Diastate —> Diastase
  diminshed —> diminished
  acetphenentidin —> acetphenetidin
  1,169 —> 1,669 (in table)
  effciency —> efficiency
  that —> than
  thought —> bought
  Furthemore —> Furthermore
  bareley —> barley
  acetphentidin –> acetphenetidin
  prramidon —> pyramidon
  valuless —> valueless
  containg —> containing
  American —> America
  article —> articles
  nessary —> necessary
  out —> our
  strotium —> strontium
  sercretin —> secretin
  radicles —> radicals
  Speciment —> Specimen
  atained —> attained
  wo —> woe
  wounders —> wonders
  lives —> livers
  matiére —> matière
  Geseundhitslehrer —> Geseundheitslehrer
  readibly —> readily
  alkoloids —> alkaloids
  is —> it
  methol —> menthol
  amyolytic —> amylolytic