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:

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?

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.

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

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.

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.

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

“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.

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.”

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.

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:

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:

Then the doctor, acting the part of errand-boy, delivers Card 2 and also Card 3 to his druggist. Here is Card 3:

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.”

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:

“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.”

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.

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.”

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.

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.

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.

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.”

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.”

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.

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.

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 -------+--------------+--------------+--------------

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:

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.”

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.

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.